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STETHOSCOPE WITH ELASTIC ENDS.
509
mected, and are chiefly
taken from other those of stricture of the rectum
are
thus
over:—" The appearance of stric-
vorks. The Author, however, passed I have in my possession the greater part ture in the rectum has been so faithfully oithe gullet of a young woman, who swal. described by Dr. Gregory, (see p. 16 of lowed a quantity of the sulphuric acid. this volume) as to supersede the necesThe gullet was discharged in a black gansity of further description."—362. The grenous state, fourteen days after the poison description referred to is no more than had been swallowed."-Page 327. In the rectum, a remarkable stricIt is not a little extraordinary, that the this,-" externally, like the contracted scar of a patient should have lived so longunder such ture, wound ; internally, afoul gangrenous ulcer; circumstances, and it is to be regretted that coats thick and hard." And this in a work no further details of the case have been expressly devoted to morbid anatomy ! given. The remainder of the book, on the other The account of that most important disdiseases of the mucous membrane and on ease, inflammatiou of the alimentary mucous those of the submucous tissue and the perimembrane, especially of the morbid ap. toneum, it is hardly necessary to notice parpearances, is very meagre and imperfect. on In the enumeration of the symptoms, one ticularly ; some of the sections, that better for rather are instance, of the most constant and most certain-ten- dysentery no oriderness on pressure, is not even mentioned, than the others, but there is little or and we find throughout information, ginal and the opinions of Broussais are disposed the same careless style, the same confusion, of in ten lines. The extract will states :
following
the same deficiencies, which we have comshow the looseness of the author’s of in the chapter on hernia. Thus, reasoning, and the carelessness with which plained the only case mentioned under the head of he draws conclusions :tumours of the mucous coat of the fatty ’ There exists, in some constitutions, a stomach, &c., is one of a large tumour which great predisposition to inflammation of the to " the anterior part of the stomucous membranes, and it is excited by very adhered alight causes, as variations in the tempera- mach" and to the ovary, had probably oriture of the weather. This predisposition is ginated from the latter viscus, and had no Lereditary, descending from father to son, connexion whatever with the mucous memand even to the grandson. I have been con- brane. Again; in the account of the consulted by the different members of a family, of chronic inflammation of the sequences in whom such a predisposition existed in a most striking manner. The father had long peritoneum, one of the most common of been liable to obstinate cough ; several of them, the granular roughness of that memthe children had croup in early life in a very brane, is not even mentioned. These are a severe form, and, at more advanced periods, very small part of the faults and omissions the females suffered much from leucorrboea, to which we have alluded, but they are and the males from repeated and very obstito show the character of the work, of enough nate attacks of gonorrhœa."-p. 323. Under the head of of the mu- which we have already sufficiently expressed serve to
thickening
membrane, a very remarkable case is related, in which, after the abdomen had
cous
been very
tense
opinion.
and tumid for several
months, an abscess formed and burst at the umbilicus, and from the opening, faeces, or ratlier chyme, was constantly discharged duriap the rest of the patient’s life. On exami-
tstim,
our
STETHOSCOPE WITH ELASTIC ENDS.
By DR. FRANCIS Fox, Derby.
small hole was found in the duodeDuRixG the last five years, I have made tum,about an inch below the pylorus, " and very frequent use of the stethoscope; my a
the remainder of the intestinal canal, not an inch of which could be traced below the opening, was converted into a hard fatt,y substance."-p. 3:)3. The symptoms of stricture are pretty well described, but comparatively little is said of the appearances of the affected part ;
residence in the Derbyshire General Infirmary for the above period, enabled me to pursue my examinations in a very satisfactory manner. I have been gratified to see that this simple instrumentis used more and more; it is generally condemned by those only who are incompetent judges of its utility, inasmuch as they have not given it
510 a fair trial. The stethoscope was laughed at, in the first instance, by the English ; and it is but due to the present indefatigable Professor Duncan, of Edinburgh, to state, that he was one of the first of our profession in this country who favoured the introduction and application of this invention of the
recommend
one
of
a
still
more
simple cor,.
flute joint in the middle to render it portable, and a hole of the usual size through each half, no funnel-shaped end or plug being required; it is well to have two small beads at one end, one to sustain the elastic collar projectingfull half an inch beyond the wood, for the examination of respiration ; and another bead further down, to secure a very slight projection of the col. lar, for the purposes of examining the heart, and to determine the existence and precise situation of pectoriloquism. I have also found, that a similar project. ing collar, attached to the other end of the
struction, having
a
celebrated Laennec, of Paris. The exami.. nations which have been so frequently made in this Infirmary, have convinced many persons of the importance of the instrument; and I am certain this assurance will extend, in proportion as the principle is submitted to careful investigation. The more precise our ideas are of the nature of disease, the more likely we are to pursue a rational mode stethoscope, secures that adaptation to the of treatment; it is the duty of every medi- ear of the examiner which is essential to cal practitioner to collect all the evidence success, but which I believe is not sufficientwhich may throw the least light on the cha- ly attended to ; I do not require the addi. racter of disease; we are not to neglect tion for myself, but I believe some persona symptoms because we have the aid of the do, where the external ear is so formed M stethoscope ; and by attentive examinations to prevent complete contact. The sounds we may increase the security of our patient, conveyed by the Indian rubber, are similar at the same time that we are promoting the and equal to these observed with the usual gradual improvement of our art, by adding wooden stethoscope ; and what may be con. tothe general stock of facts. In my exami- sidered an additional recommendation, is, nations, I have been in the habit of using a that much less watchfulness is required in simple stethoscope, which I obtained myself holding the instrument, as the elastic gum from Laennec’s iustrument-maker, in Paris, accommodates itself to any slight alteration at the time when I attended La and the in the direction of the hospital where the laborious investigations hence it may be expeditiously applied to of Laennec were made, and where I had several portions of the chest in quick sue. ample opportunity of learning the manner cession, without removing the ear from the in which the instrument should be used, at instrument. the same time that I witnessed the suferI have seen various complicaings of the unfortunate patients, occasioned tions of the stethoscope,unnecessary but think sinipliedy of by the continual application and pressure is the most to be admired, if the requisite ob. the hard end of the stethoscope ; the annoybe thoroughly obtained. I have seen ance was occasionally so great as to cause jects " Flexible Stethoscope," having a joint in persons to object to further examinations the middle but hard at the end, recommend, made. being ed, to render the application more easy to Having frequently found much difficulty the patient, as well as to the operator; it in applying the instrument where patients has also been suggested to complicate the are extremely emaciated, because adapta- instrument still further, by having it so COD’ tion could not be effected, and also on ac- structed as to be applied to both ears at count of the pain produced by the necessary once.* pressure, it occurred to me to apply a collar If these practical observations should in of Indian rubber to the end of the stethosway facilitate and promote patholobieal any I cope ; cut the neck, and opposite portion, studies, I shall not regret having again oc. ofr a small Indian rubber bottle, so as to a small space in your iuvaluable leave the middle part in the’form of a collar,cupied about one inch broad ; this being stretched,journal. applies itself round the end of the stethoscope, and when pushed on but a little way, forms the wide mouth for the examination * These modifications remind me of the of respiration ; when forced still further oa, observations of a late distinguished lecturer, so as to project in a slight degree beyond who said, when speaking of some compin the end, it protects the skin from the edgesobstetric instruments, that although they of the plug, and in both cases secures adap-were ingenious, they were perextremely tation, and prevents any pain being given to useless. the patient,---the elastic gum being soft and
stethoscope ;
Charite,
>
fectly
yielding. the Indian rubber collar is apthe stethoscope in general use, I
Although
plicable
to
mected, and are chiefly
taken from other those of stricture of the rectum
are
thus
over:—" The appearance of stric-
vorks. The Author, however, passed I have in my possession the greater part ture in the rectum has been so faithfully oithe gullet of a young woman, who swal. described by Dr. Gregory, (see p. 16 of lowed a quantity of the sulphuric acid. this volume) as to supersede the necesThe gullet was discharged in a black gansity of further description."—362. The grenous state, fourteen days after the poison description referred to is no more than had been swallowed."-Page 327. In the rectum, a remarkable stricIt is not a little extraordinary, that the this,-" externally, like the contracted scar of a patient should have lived so longunder such ture, wound ; internally, afoul gangrenous ulcer; circumstances, and it is to be regretted that coats thick and hard." And this in a work no further details of the case have been expressly devoted to morbid anatomy ! given. The remainder of the book, on the other The account of that most important disdiseases of the mucous membrane and on ease, inflammatiou of the alimentary mucous those of the submucous tissue and the perimembrane, especially of the morbid ap. toneum, it is hardly necessary to notice parpearances, is very meagre and imperfect. on In the enumeration of the symptoms, one ticularly ; some of the sections, that better for rather are instance, of the most constant and most certain-ten- dysentery no oriderness on pressure, is not even mentioned, than the others, but there is little or and we find throughout information, ginal and the opinions of Broussais are disposed the same careless style, the same confusion, of in ten lines. The extract will states :
following
the same deficiencies, which we have comshow the looseness of the author’s of in the chapter on hernia. Thus, reasoning, and the carelessness with which plained the only case mentioned under the head of he draws conclusions :tumours of the mucous coat of the fatty ’ There exists, in some constitutions, a stomach, &c., is one of a large tumour which great predisposition to inflammation of the to " the anterior part of the stomucous membranes, and it is excited by very adhered alight causes, as variations in the tempera- mach" and to the ovary, had probably oriture of the weather. This predisposition is ginated from the latter viscus, and had no Lereditary, descending from father to son, connexion whatever with the mucous memand even to the grandson. I have been con- brane. Again; in the account of the consulted by the different members of a family, of chronic inflammation of the sequences in whom such a predisposition existed in a most striking manner. The father had long peritoneum, one of the most common of been liable to obstinate cough ; several of them, the granular roughness of that memthe children had croup in early life in a very brane, is not even mentioned. These are a severe form, and, at more advanced periods, very small part of the faults and omissions the females suffered much from leucorrboea, to which we have alluded, but they are and the males from repeated and very obstito show the character of the work, of enough nate attacks of gonorrhœa."-p. 323. Under the head of of the mu- which we have already sufficiently expressed serve to
thickening
membrane, a very remarkable case is related, in which, after the abdomen had
cous
been very
tense
opinion.
and tumid for several
months, an abscess formed and burst at the umbilicus, and from the opening, faeces, or ratlier chyme, was constantly discharged duriap the rest of the patient’s life. On exami-
tstim,
our
STETHOSCOPE WITH ELASTIC ENDS.
By DR. FRANCIS Fox, Derby.
small hole was found in the duodeDuRixG the last five years, I have made tum,about an inch below the pylorus, " and very frequent use of the stethoscope; my a
the remainder of the intestinal canal, not an inch of which could be traced below the opening, was converted into a hard fatt,y substance."-p. 3:)3. The symptoms of stricture are pretty well described, but comparatively little is said of the appearances of the affected part ;
residence in the Derbyshire General Infirmary for the above period, enabled me to pursue my examinations in a very satisfactory manner. I have been gratified to see that this simple instrumentis used more and more; it is generally condemned by those only who are incompetent judges of its utility, inasmuch as they have not given it
510 a fair trial. The stethoscope was laughed at, in the first instance, by the English ; and it is but due to the present indefatigable Professor Duncan, of Edinburgh, to state, that he was one of the first of our profession in this country who favoured the introduction and application of this invention of the
recommend
one
of
a
still
more
simple cor,.
flute joint in the middle to render it portable, and a hole of the usual size through each half, no funnel-shaped end or plug being required; it is well to have two small beads at one end, one to sustain the elastic collar projectingfull half an inch beyond the wood, for the examination of respiration ; and another bead further down, to secure a very slight projection of the col. lar, for the purposes of examining the heart, and to determine the existence and precise situation of pectoriloquism. I have also found, that a similar project. ing collar, attached to the other end of the
struction, having
a
celebrated Laennec, of Paris. The exami.. nations which have been so frequently made in this Infirmary, have convinced many persons of the importance of the instrument; and I am certain this assurance will extend, in proportion as the principle is submitted to careful investigation. The more precise our ideas are of the nature of disease, the more likely we are to pursue a rational mode stethoscope, secures that adaptation to the of treatment; it is the duty of every medi- ear of the examiner which is essential to cal practitioner to collect all the evidence success, but which I believe is not sufficientwhich may throw the least light on the cha- ly attended to ; I do not require the addi. racter of disease; we are not to neglect tion for myself, but I believe some persona symptoms because we have the aid of the do, where the external ear is so formed M stethoscope ; and by attentive examinations to prevent complete contact. The sounds we may increase the security of our patient, conveyed by the Indian rubber, are similar at the same time that we are promoting the and equal to these observed with the usual gradual improvement of our art, by adding wooden stethoscope ; and what may be con. tothe general stock of facts. In my exami- sidered an additional recommendation, is, nations, I have been in the habit of using a that much less watchfulness is required in simple stethoscope, which I obtained myself holding the instrument, as the elastic gum from Laennec’s iustrument-maker, in Paris, accommodates itself to any slight alteration at the time when I attended La and the in the direction of the hospital where the laborious investigations hence it may be expeditiously applied to of Laennec were made, and where I had several portions of the chest in quick sue. ample opportunity of learning the manner cession, without removing the ear from the in which the instrument should be used, at instrument. the same time that I witnessed the suferI have seen various complicaings of the unfortunate patients, occasioned tions of the stethoscope,unnecessary but think sinipliedy of by the continual application and pressure is the most to be admired, if the requisite ob. the hard end of the stethoscope ; the annoybe thoroughly obtained. I have seen ance was occasionally so great as to cause jects " Flexible Stethoscope," having a joint in persons to object to further examinations the middle but hard at the end, recommend, made. being ed, to render the application more easy to Having frequently found much difficulty the patient, as well as to the operator; it in applying the instrument where patients has also been suggested to complicate the are extremely emaciated, because adapta- instrument still further, by having it so COD’ tion could not be effected, and also on ac- structed as to be applied to both ears at count of the pain produced by the necessary once.* pressure, it occurred to me to apply a collar If these practical observations should in of Indian rubber to the end of the stethosway facilitate and promote patholobieal any I cope ; cut the neck, and opposite portion, studies, I shall not regret having again oc. ofr a small Indian rubber bottle, so as to a small space in your iuvaluable leave the middle part in the’form of a collar,cupied about one inch broad ; this being stretched,journal. applies itself round the end of the stethoscope, and when pushed on but a little way, forms the wide mouth for the examination * These modifications remind me of the of respiration ; when forced still further oa, observations of a late distinguished lecturer, so as to project in a slight degree beyond who said, when speaking of some compin the end, it protects the skin from the edgesobstetric instruments, that although they of the plug, and in both cases secures adap-were ingenious, they were perextremely tation, and prevents any pain being given to useless. the patient,---the elastic gum being soft and
stethoscope ;
Charite,
>
fectly
yielding. the Indian rubber collar is apthe stethoscope in general use, I
Although
plicable
to