Excerpt from Auscultation and Percussion

The primary object of the physical examination of the chest is the attainment of 'a knowledge of the physical condi tion of the important organs contained within it. Not until this knowledge has been obtained are we in a position to de termine with all possible accuracy the cause or causes which have led to, or which underlie, those deviations from the normal physical condition revealed to us by the methods about to be described. Essentially the same physical con dition may be encountered in widely difierent diseases - z'. E., as the result of quite difierent causes - to discriminate be tween which the family and previous history of the patient; the influences to which he has been exposed; the symptoms which he presents, with their mode of onset, progress, and sequence; a careful examination of the patient as a whole, of his other organs or systems of organs; and, finally, a thorough knowledge of the natural history of general and local morbid processes; must all likewise be duly noted and weighed. In a word, percussion and auscultation - the two chief modes of thoracic physical exploration - lead directly to the detection of diseased conditions, only indirectly to that of diseases.

Health precedes disease; it is, therefore, incumbent on us to master healthy conditions first. Perfect familiarity with the anatomy of the healthy chest and its contents, with the structure of each separately and the mutual relations of all is of vital importance. Furthermore, the variations of size and relation within the limits of health which may occur in the same person at difierent periods of life or under difier ent conditions - as in activity and repose - as well as the limits of normal variation in difierent persons. Must beknown. Finally, the physiology of respiration and circula tion must be thoroughly understood. The possession of most of this knowledge is 'here presupposed, inasmuch as this series of Manuals is intended rather for physicians than for younger students. We may, consequently, now go on to consider the special methods of physical exploration and the results which they may be made to yield in health and dis ease. At the same time the accompanying plates, after Weil, may serve to refresh the memory as to the space occupied by the thoracic viscera and their mutual relations.

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