Makers of Modern MedicineWalsh, James J. (James Joseph)
History
Makers of Modern Medicine
Walsh, James J. (James Joseph)
Medicine -- Biography
Auenbrugger's discovery consisted in recognizing that diseases of the
chest can be distinguished from one another and their varying
character differentiated by the sounds elicited when the chest is
tapped with the finger. To this tapping he gave the technical name,
since become classic in medicine, of percussion. Wherever there is air
in the chest, that is all over the healthy lungs, the sound elicited
by percussion resembles that given out by a drum over which a thick
woolen cloth has been placed. Over the heart, where there is no air,
the sound given out, when the chest is percussed, corresponds very
nearly to the sound produced when the thigh is tapped. The sound
elicited by percussion of the thigh Auenbrugger took as the standard
of dulness and applied to it the term Schenkel-ton, or thigh sound.
When the lungs become consolidated because of an inflammatory process
such as pneumonia or tuberculosis, then the percussion note over the
consolidated area resembles the sound over the leg or that found over
the heart. As a rule the heart is somewhat covered by the lungs, and
the sound produced by percussion over it is not quite as dull as that
over the solid muscular structures of the legs. Whenever fluid finds
its way into the thorax, as in pleurisy, then the sound produced on
percussion is very dull.
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Auenbrugger further showed that by means of the sound thus obtained he
could demonstrate the size of the heart under varying conditions, and
so determine whether it is larger than normal or not. This gave the
first inkling as to the discernment of hypertrophy and dilatation of
the heart, and was the first step in the modern differential diagnosis
of heart diseases. He showed, moreover, that he could, by percussion,
outline very exactly the extent to which a consolidation of the lung
has taken place, or the height to which an effusion into the pleural
cavity reaches. These conclusions and demonstrations require not only
the greatest care but the most deliberate confirmation of every detail
by comparison of the diagnosis during life with the condition found
after death in fatal cases.
Auenbrugger seems to have spared neither time nor labor in this work
of confirmation. He made a number of experiments upon dead bodies,
injecting fluid into the pleural cavity and then demonstrating by
percussion the line of demarcation that indicated the level of the
fluid within the chest, as well as the pulmonary conditions that
developed because of its presence. In the study of pneumonia and
tuberculosis particularly, Auenbrugger spent many hours of patient
investigation during his ten years of hospital service. He succeeded
not only in demonstrating the presence of consolidation, but also the
existence of cavities in the lungs and their size and general
character.
Public-domain text, read in full here on John Shaqi.
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