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examination, and of distinguishing the more common physical signs. With terms they may be sufficiently familiar; the theory of morbid sounds may be not unknown to them; but how they are to elicit some of these sounds, and how they are to distinguish others, they know not. They cannot, in fact, practise auscultation and percussion; and they are unacquainted with the mode of setting about it. How, then, is this knowledge to be attained?

Clearly by clinical

instruction, most efficiently; by the precepts delivered and the illustrations offered at the bedside. But it unfortunately happens, that comparatively few students attend to these instructions, whether of precept or example, and that numbers find out their deficiencies only when it is too late for them to devote their attention to this infinitely most desirable mode of supplying them.

It has, then, appeared to myself as well as to others, that a work was wanted, in which should be simply explained to the student of auscultation, not merely the origin, character, and diagnostic value of certain physical signs, but also the manner in which he should proceed to elicit them; and which should direct him how to

percuss, as well as state the indications afforded by percussion.

It may, indeed, be asserted that all this, and much more than this, has been already done by several preceding writers. It may be so. Still the tyro in auscultation is at a loss. Preceding writers do not appear to have afforded the required information in an available form. The present attempt may be equally unsuccessful. But though I have certainly perused nearly all, and I believe, with one or two exceptions, all the works which have been recently published on diseases of the chest in the English language, and many that have not been translated, I know of no writing which approximately answers the purpose I desire. to effect; unless it be the articles "Thorax, exploration of," and "Auscultation," by Dr. Forbes, in the Cyclopædia of Practical Medicine. Had these articles been published in a separate form, and been somewhat extended, it is possible that the present attempt would not have been made, and this work would have never appeared; though from my recollection of those articles, perused a long time ago, I trust some useful additions may be found herein.

I cannot forbear here to recommend, and to

express the delight I derived from the perusal of, the admirable little book of Barthe and Roger. It contains a great amount of information, conveyed in a very agreeable way; but it treats of auscultation alone, and is in some other important particulars unsuited for the object I have in hand.

That object is not to attempt to teach the practice of auscultation and percussion ;—that I feel assured can be attained only at the bed-side of the patient-but it is to point out to the student the way in which he may learn it by himself. It is not to treat of the diagnosis of thoracic diseases; upon that I profess not here to enter; but it is to point out the physical signs of those diseases, and, as far as I am able, simply and intelligibly to explain the causes of those signs; it is to instruct the beginner in the mode, by which he is to obtain a knowledge of them, as well as to direct him how to interpret them.

Consistently with this object, I have desired that my statements should be plain, my directions distinct, and my explanations simple, and devoid of anything approaching to erudite mystery. Consistently with this object, also, I have thought it desirable to avoid all quotations, as well as any

statements of the different opinions which are, or have been, entertained upon various disputed points; which I have thought might probably tend to perplex, rather than instruct. Upon such questions I have considered it preferable, in a work purely practical and elementary, simply to express the opinions which I myself entertain, and which, though they may have been often expressed before, or have been originally derived from others, it is but fair to state, have been adopted by myself only after lengthened consideration and prolonged experience.

I have already acknowledged that I have read most of the works which have been separately published in these realms on diseases of the chest. From each author I hope and believe I have derived considerable information, and to each, therefore, I have to express my obligation. I am willing to resign every novelty to each writer who may lay claim to its paternity, and to concede originality to all who may esteem it theirs. I make no pretension to novelty, and of originality (excepting in regard to my errors) I make no profession. But I trust that, without egotism, I may claim the privilege of an independent observer, and of an unbiassed expression of opinions, de

rived from an experience of more than fifteen years, especially devoted to the practical study of diseases of the chest; during the whole of which I have neglected scarcely a single opportunity of examining the signs of disease in the living, or the products of disease in the dead subject; and during nearly the whole of which I have possessed the advantages afforded by one of the largest hospitals in the British dominions.

With the exception of the article by Dr. Forbes, referred to in the body of the work, I have not made a single extract from any author; to that article I have referred simply for the purpose of examining, and partially copying, the author's regional divisions of the chest. Though, therefore, the statements herein contained may have been repeatedly made, and the opinions herein delivered may have been again and again expressed by others; and though I may have seen them recorded by one or a dozen writers; yet, unless it be so acknowledged in reference to any particular fact or opinion, I believe I may with confidence assert, that I have given no directions, of which I have not by long practice proved the utility, and that I have made no statements, which, from whomsoever they

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