The Wheeling daily intelligencer. [volume] (Wheeling, W. Va.) 1865-1903, 1869-06-05

concentrstion of thought, is requisite
to every practitioner of Rational
Medicine. With all the facilities
now possessed for the acquisition
of medical knowledge, long study
and the cultivation of habits OF
close and accurate observation are in
disnensable. That student of his pro-
fassion only will attain proficiency and
| reach the eminence to which he is in
vited. who never ceases to be a student,
In the older medical schools of the
country seven different professorships
representing an equal number of dis
tinct branches, though integral parts
of one science, have been considered
adequate to the complete instruction OF
their pupils. In many of those more
recently organized, 1t seems to have
been considered necessary for ample
instruction that their corps of teachers
be increased 10 nearly double this num-
Der, Now, whether this extensive sub.
division is necessary to successful
teaching or not, it Is q fact worthy to
| be borne in mind that to the investi-
CATION OF each OF these departments
whole lives have been devoted,
and vet in none has the field been
each lie facts destined in their applica-
ton for the relief OF human suffering
and the promotion ofhuman happiness,
but awaiting, as yet, the approach OF
the explorer after scientific truth for
their development. II, therefore, we
have taste or inclination for original
research. we have abundant scope tor
| its exercise. If. however, we have no
desires In this direction; ifthe extent OF
our aspirations is simply to know what
| IL known In our profession land he who
| aspires to anything short OF this is not
worthy the name of doctor,) we have
but little time for outside business.
nf IA
microscope andthe oppthalmoscope, the
facts brought to light by researches in
physiological chemistry and many 9TH
err departments OF the science. as an
| illustration OF the progress made In
medicine, and as an example among
the many means and appliances fur.
nished us by the workers of the profess
sion, rendering the diagnosis of disease
more easy and certain, yet requiring
tjmeland study for their availability, let
us direct our attention for few mo-
ments TO the subject of physical dag
nosis.
Ina Treatise upon tho Practice of
Medicine published, but little more
than quarter OF a century since, the au-
thor OF which (Dr. Eberle) was, in his
day, one of the most eminent and popu-
lar teachers of Practical Medicine and
Therapeutics of which our country
could boast, under the head of "Dis.
ing language: 1.-THE diagnosis of dis
eases OF the heart is attended with much
difficulty. The symptoms OF diseases
of this organ are particularly liable to
be con1ounded with simple hydro
| thorax, MISREPRESENTATION, neuralgia
angina pectoris, and even with ''asth-
ma" Then proceeding to enumerate
in detail the many symptoms OF car
diac disease, such as 'dyspnae, Odema
of the feettpanXious expression OF ooun.
tenance, livid hue Of the prolabia,"
ETC.. etc. when these are present."
he remarked. 1--WE have strong
reasons for presuming thai there
exists some disease OF the heart" With.
out abiding in any part OF the entire
chapter devoted to the subject, 10 any
one of the many physical signs now
revealed by ausculatiou and percussion,
leading US to ditterential diagnosis
between the various forms OF cardiac
disease and the different LESSONS of
other organs Stimulating them, by
way OF reference simply, TO the tnves-
tigations;of Laennec in physical dag
nOsis, he admits the value of Mediate
AuscuLtn!l0n,' in recognizing the pres.
sence of organic heart disease, quail
flying the admission, however, with
this remark: "But the tact for prOfting
by this diagnostic test can only be ac-
uuired after u long course of careful
experience" Thus leaving the student
to rely solely upon symptoms which
he con fesses to be very imperfect in
dices to the discovery OF any one OF the
diseases in q uestion.
What a contrast to this does science
in our day present? Now. any prac-
titioner who has attained to even ordi-
nary proficiency in physical diagnosis
Ia III but little danger of confounding
with each other any OF the diseases al
luded to in this connection.
Inhhe examination of his patient, il
he find Oh applying his stethosGope to
the praecUrdial region a pericardial frlc.
ton sound, accompanied perhaps by
increased intensity OF the heart sound,
these heart sounds, however, becom'
ing more feeble and distant to the ear
as the, case progresses, and the hearts
impulse also, in the meantime, gradual
ly receding from its normal positionln
an upward directlOn,-and, II concur
renlly with these latter signs he finds,
upon percussion, dullness or natness
extending in a vertical direction be-
youd its normal area-the superficial
cardiac space-reaching ultimately, 1t
may be the summit of the sternum and
bounded, laterally by the limits OF
tiistended pericardial sac, he is as sure
that he has q case OF hydropericardttls
as he can be sure OF anything in
diagnosis.
II, on the contrary, he find the apex
beat Of the heart, instead of having
risen above, has fallen below its nor
NAL situation, and the area OF dizziness
instead OF rising, in vertical direction,
extends downward and to the left
these, in connection with other charac-
teristic signs, lead conclusively to the
diagnosis of hyperLrophy of the heart.
With equal certainty, by means OF ply
steal signs, the various LESSONS occur
ring within the organ may be ascer'
tanned, By the study of endocardial
sound - normal and abnormal the
character of the respective murmurs,
noting the region in which they are
perceived and their relations in point
of time to the systolic and diastoiic
movements of the heart, any one who
is at all an expert in the science may
be able to decide with comparative GER
tainty as to the nature and location of
auv lesion to which the interior struc
lures of the heart are liable.
Recurring to our author we find on
the MANY pages of his work devoted to
consideration of the diseases OF the
respiratory organs but little allusion to
auscultation and percussion as aids in
diagnosis. Ia the sections devoted to
acute and chronic bronchitis and
phthisis pulmonalis no notice OF them
whatever Is given. In those sections
treating of pleuritis and pneumonia
few extracts only from the writings of
Audral, Roux and Laennec relat-
ing to physical diagnosis are quoted,
the author still insisting that the sub.
iect is too intricate to be made availa-
BILE in the hands of any but the few
who by long study aud experience have
practitioner in our day, whose opinion
is reliable, would venture to diagnos-
ticate any one of these diseases without
invoking the aid OF auscultation and