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AUSCULTATION IN LIFE ASSURANCE EXAMINATIONS.
1021 or cog-wheel breath sounds heard constantly at and at a distance from the heart, so that a apex cardiac systolic origin of the cogging can be excluded, are very suggestive of early tuberculous deposit and must lead to careful search for other physical signs. In connexion with the breath sounds, the occurrence of muscular sounds heard in shivering or in emphysema was also referred to as requiring care in some cases. Various spurious rrties, creaks, and clicks due to fascial movements, to deglutition of saliva, and to movements of the head were described, and also the atelectatic rAtes heard in the infra-axillary regions of many normal persons. Probably most practitioners, both in ordinary practice and in insurance work, have been faced with problems such as those referred to, but their collection in the paper to which we have referred served a useful purpose and should be of value, especially to the occasional examiner for insurance purposes.
true
Annotations. "
No quid nimis."
ASSURANCE EXAMINATIONS. IN a paper read before the Life Assurance Medical Officers’ Association, entitled " Some Auscultatory Problems in
AUSCULTATION IN
LIFE
jerky
one
Insurance Examinations," Dr. R. A. Young reviewed recently the difficulties of interpretation of auscultatory physical signs encountered by the medical officer during the course of the routine medical examination prescribed by most insurance companies. He pointed out that the newer methods of diagnosis applicable in ordinary medical practice are for the most part not available for the use of the insurance examiner owing to the expense and delay involved, and that the history given by many proposers is scanty ..and often misleading. The examiner is, therefore, left to THE EASTER EGG. establish the absence of disease armed chiefly with a tapeIT does not require any shrewd guess to account for the measure, a weighing-machine, a stethoscope, a few testing reassociation of Eastertide with the egg. In the days when agents, and his otherwise unaided senses, unless he is assiduous old customs and well equipped, when a microscope may be pressed into were, relatively speaking, young, neither nor service occasionally. The stethoscope is, therefore, of great physiology chemistry had revealed much as regards the inner secrets of the egg, but instinct taught that it must from importance, and the information it yields requires careful the nature of its function be a strong aid towards very consideration, since it is not sufficiently emphasised that the waste of the human body, and it is interdepartures from the generally accepted normal standards replacing to find that of auscultatory sounds are not uncommon and are yet esting eggs were regarded by the Church On Easter Eve and as a blessed food after a fast. "compatible with perfect health. The differentiation of these all the heads of the families sent great conditions from those which are the index of commencing Easter Day full hard to the Church for a blessing. of disease or the stigma of past attacks is obviously of great chargers eggs virtue of sanctifying the entrails importance from an insurance standpoint. In connexion "These blest eggs have the the and are first fat or fleshy nourishment to be the with auscultation of the heart Dr. Young discussed the of body the of Lent." It is interesting to abstinence significance of variations in the rate, rhythm, intensity, and they take after quality of the heart sounds and the differentiation of mur- compare this statement with the modern physiological view of the food value of the egg. The absorption of eggs in the murs indicative of serious organic derangement of the valves intestinal tract is known to be very complete, for it has been or muscle of the heart from those of functional or exocardial character. In connexion with the rhythm of the heart found that even when 21 hard boiled eggs are taken daily sounds, the question of irregularity or arrhythmia was dis- they are absorbed as completely as meat, only 5 per cent. cussed at some length. The general conclusions arrived at of the dried substance being lost. The direction of the Church was therefore in complete harmony with modern were that a single irregularity in a young subject in associaThe introduction of varied colours tion with respiration is of no serious importance, even though scientific views. no there may be a history of occasional slight syncopal attacks followed, doubt, the custom of colouring eggs red to blood denote the of the Christ. There is, however, some and even if an exocardial murmur be present. Cases with in show evidence to that varied colours were used in pretea irregularities due to smoking and to over-indulgence and Christian that red was the c)lour adopted when and coffee may be accepted after postponement on times, the was taken in and custom over by the Church. trial. Extra systoles middle-aged people young in not of serious character the absence are necessarily of arterio-sclerotic changes and of signs of cardiac INTERMITTENT HERNIA OF THE LEFT LUNG enlargement, but should be regarded with suspicion and AFTER CRUSHING OF THE CHEST. probably declined. Irregularities due to heart-block, to weakened muscular power, and those associated with valvular AT a meeting of the Societe Medicale des Hopitaux of Paris or myocardial lesions cannot be considered as insurable on on Feb. 10th M. Galliard and M. Baufle showed a carman, any terms. In connexion with organic murmurs, the diffi- aged 21 years, who was caught between a wall and a cart There was no culties met with in some cases of mitral stenosis and of and had his chest crushed on Nov. 6th, 1908. aortic regurgitation were discussed, and the importance of wound, but the sternal region immediately became swollen. auscultating in both the erect and recumbent positions was He was taken to a hospital more dead than alive,"where he emphasised. The various functional and exocardial or remained until Jan. 20th, 1909. He coughed up a little spurious murmurs were categorically considered and the blood. He resumed his occupation. In January, 1911, he features by which they could be recognised were outlined. was admitted to the Lariboisiere Hospital under the care of ’The problems afforded by auscultation of the respiratory M. Galliard for a slight attack of influenza. It was found system were described as no less difficult than those in con- that the left side of the chest in front was slightly depressed nexion with the circulatory mechanism. The physiological and that the pectoralis major was atrophied. The normal differences in breath sounds and in voice sounds occurring at prominence formed by the fourth rib was replaced by a the right apex and over the right upper lobe were carefully depression, at the bottom of which the heart could be seen worked out, and the distinction from the signs of early tuber- to beat. This depression admitted three fingers. It resulted culous disease was discussed. The nature of cog-wheel from the separation of the two fragments of the fourth rib, breathing and of the cardio-respiratory murmur so commonly which was broken at the time of the accident. The external heard in normal chests was considered, and it was stated that fragment projected above the nipple. The internal fragment
true
Annotations. "
No quid nimis."
ASSURANCE EXAMINATIONS. IN a paper read before the Life Assurance Medical Officers’ Association, entitled " Some Auscultatory Problems in
AUSCULTATION IN
LIFE
jerky
one
Insurance Examinations," Dr. R. A. Young reviewed recently the difficulties of interpretation of auscultatory physical signs encountered by the medical officer during the course of the routine medical examination prescribed by most insurance companies. He pointed out that the newer methods of diagnosis applicable in ordinary medical practice are for the most part not available for the use of the insurance examiner owing to the expense and delay involved, and that the history given by many proposers is scanty ..and often misleading. The examiner is, therefore, left to THE EASTER EGG. establish the absence of disease armed chiefly with a tapeIT does not require any shrewd guess to account for the measure, a weighing-machine, a stethoscope, a few testing reassociation of Eastertide with the egg. In the days when agents, and his otherwise unaided senses, unless he is assiduous old customs and well equipped, when a microscope may be pressed into were, relatively speaking, young, neither nor service occasionally. The stethoscope is, therefore, of great physiology chemistry had revealed much as regards the inner secrets of the egg, but instinct taught that it must from importance, and the information it yields requires careful the nature of its function be a strong aid towards very consideration, since it is not sufficiently emphasised that the waste of the human body, and it is interdepartures from the generally accepted normal standards replacing to find that of auscultatory sounds are not uncommon and are yet esting eggs were regarded by the Church On Easter Eve and as a blessed food after a fast. "compatible with perfect health. The differentiation of these all the heads of the families sent great conditions from those which are the index of commencing Easter Day full hard to the Church for a blessing. of disease or the stigma of past attacks is obviously of great chargers eggs virtue of sanctifying the entrails importance from an insurance standpoint. In connexion "These blest eggs have the the and are first fat or fleshy nourishment to be the with auscultation of the heart Dr. Young discussed the of body the of Lent." It is interesting to abstinence significance of variations in the rate, rhythm, intensity, and they take after quality of the heart sounds and the differentiation of mur- compare this statement with the modern physiological view of the food value of the egg. The absorption of eggs in the murs indicative of serious organic derangement of the valves intestinal tract is known to be very complete, for it has been or muscle of the heart from those of functional or exocardial character. In connexion with the rhythm of the heart found that even when 21 hard boiled eggs are taken daily sounds, the question of irregularity or arrhythmia was dis- they are absorbed as completely as meat, only 5 per cent. cussed at some length. The general conclusions arrived at of the dried substance being lost. The direction of the Church was therefore in complete harmony with modern were that a single irregularity in a young subject in associaThe introduction of varied colours tion with respiration is of no serious importance, even though scientific views. no there may be a history of occasional slight syncopal attacks followed, doubt, the custom of colouring eggs red to blood denote the of the Christ. There is, however, some and even if an exocardial murmur be present. Cases with in show evidence to that varied colours were used in pretea irregularities due to smoking and to over-indulgence and Christian that red was the c)lour adopted when and coffee may be accepted after postponement on times, the was taken in and custom over by the Church. trial. Extra systoles middle-aged people young in not of serious character the absence are necessarily of arterio-sclerotic changes and of signs of cardiac INTERMITTENT HERNIA OF THE LEFT LUNG enlargement, but should be regarded with suspicion and AFTER CRUSHING OF THE CHEST. probably declined. Irregularities due to heart-block, to weakened muscular power, and those associated with valvular AT a meeting of the Societe Medicale des Hopitaux of Paris or myocardial lesions cannot be considered as insurable on on Feb. 10th M. Galliard and M. Baufle showed a carman, any terms. In connexion with organic murmurs, the diffi- aged 21 years, who was caught between a wall and a cart There was no culties met with in some cases of mitral stenosis and of and had his chest crushed on Nov. 6th, 1908. aortic regurgitation were discussed, and the importance of wound, but the sternal region immediately became swollen. auscultating in both the erect and recumbent positions was He was taken to a hospital more dead than alive,"where he emphasised. The various functional and exocardial or remained until Jan. 20th, 1909. He coughed up a little spurious murmurs were categorically considered and the blood. He resumed his occupation. In January, 1911, he features by which they could be recognised were outlined. was admitted to the Lariboisiere Hospital under the care of ’The problems afforded by auscultation of the respiratory M. Galliard for a slight attack of influenza. It was found system were described as no less difficult than those in con- that the left side of the chest in front was slightly depressed nexion with the circulatory mechanism. The physiological and that the pectoralis major was atrophied. The normal differences in breath sounds and in voice sounds occurring at prominence formed by the fourth rib was replaced by a the right apex and over the right upper lobe were carefully depression, at the bottom of which the heart could be seen worked out, and the distinction from the signs of early tuber- to beat. This depression admitted three fingers. It resulted culous disease was discussed. The nature of cog-wheel from the separation of the two fragments of the fourth rib, breathing and of the cardio-respiratory murmur so commonly which was broken at the time of the accident. The external heard in normal chests was considered, and it was stated that fragment projected above the nipple. The internal fragment