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Ir cannot be necessary at the present day to insist upon the advantages of auscultation and percussion to the practical physician. The remarkably rapid improvement which has recently taken place in the diagnosis of diseases of the chest, which, not more than thirty years ago, were the most obscure, but which may be now considered as among the most easily recognized affections to which the human frame is liable,


is almost entirely attributable to their employment. Their importance may be fairly supposed now to be generally, if not universally, conceded. It is, however, as I conceive, a duty incumbent upon all who venture to write, however briefly, upon these modes of investigating disease, to endeavour to impress upon the mind of the student, what has been frequently and in various ways forced upon my own mind; viz. that it is, to say the least, highly desirable, if not absolutely essential to his future success in combating disease, that he should become practically familiar with auscultation and percussion while at the Hospitals. They require much time-much practice-much training; in other words, a prolonged education is necessary to their advantageous employment. When, indeed, facility has been previously attained, and confidence already acquired by repeated trials, and by frequent reference to the dead body, in confirmation of opinions formed during life, they may be used with benefit to the patient and satisfaction to the attendant, in private practice. But I believe that skill and aptitude in their use are rarely acquired in private, and that, from the comparatively limited opportunities of studying morbid anatomy at the homes of patients, dexterity and confidence are not often attained except in public institutions. I would therefore earnestly recommend every medical pupil at the Hospitals to become acquainted with the

practice of auscultation, and familiar with the products of disease now, while he is able to do so; as I feel assured that he will never regret the time expended in the attainment of these objects. If, on the contrary, the present opportunity be allowed to pass unimproved, it is not impossible that he may never enjoy another, and it is highly probable that he never will have so wide a field, or so suitable a time, for the study of that which he will find of vast service to him in his future course.

1. Cautions as to the conduct and demeanor of the examiner.

Some care is occasionally necessary lest persons of an excitable and irritable temperament, whose chests are about to be explored, should be alarmed by the anticipation of the examination, the nature of which they do not understand, and the trouble and fatigue of which they consequently exaggerate. It is therefore in such cases desirable, that, if it have been previously made known that an examination of the chest is to be made, the process should be represented to be, as it really is, free from pain and attended with little inconvenience, though, if thoroughly effected, necessarily occupying considerable time. With the same view of not exciting alarm in the mind of such nervous individuals, all unnecessary display of stethoscope and

pleximeter, and parade of every kind, should be avoided; otherwise some undefined notion of an operation may be produced, and the patient may become unwilling, or unable, to submit to the ordeal. If everything be quietly done, and all treated as a matter of course, and managed with delicacy and gentleness, I believe very few persons, unless exhausted by disease, will be either unwilling without hesitation to submit to, or unable without injury to bear, a tolerably minute exploration of the chest.

The examiner should also endeavour at the commencement to wear a cheerful aspect, and be careful not to allow the results of his investigation to escape him in the hearing of the patient, or even to permit them in any way to affect the expression of his countenance, each shade of which is sometimes watched by patients with the most intense anxiety, and even slight changes in which occasionally have a very depressing effect upon susceptible individuals.

In all examinations the benefit of the person examined should be the primary consideration. -To this the mere gratification of the curiosity or interest of the examiner should be ever made to yield. The determination of a nice point of diagnosis should never be allowed to interfere with the real good of the invalid. When, therefore, patients are likely to become seriously exhausted by

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