Excerpt from The Edinburgh Medical and Surgical Journal, Vol. 21: Exhibiting a Concise View of the Latest and Most Important Discoveries in Medicine, Surgery, and Pharmacy; 1824

Application of the Stethoscope to the Diagnosis of Fractures. Arch. Gen. De M éd. Aout 1825, ii. - M. Lisfranc, the well known lecturer on operative surgery at Paris, has completely succeeded in realizing a conjecture started some time ago by Laennec, with regard to the applicability of his stethoscope to the diagnosis of fractures. With the aid of this instrument, he avers that no surgeon can ever remain in doubt as to the existence of a fracture in any part cf the body, except the head. The tume faction around the injury can never be so considerable as to obscure the crepitation entirely; and the slightest possible movements are sufficient to produce the requisite sound. The following general rules have been established by frequent observation, both on the dead and on the living body. 1. The instrument may be applied over the seat of fracture with or without the end-piece; but the farther it is removed from the seat of injury, the sound is the more distinct when the end-piece is removed. 2. When the bone is near the surface, the sound is always most distinct; the slightest motion elicits it; and it is most sensible just over the fracture. Hence we may thus discover the precise seat of the injury. 3. The crepitation diminishes as the instru ment recedes from the fracture, yet may be felt at a very great distance. 4. When the bone rides, the sound is less obvious; but it becomes more distinct after extension and counter-extension. 5. The crepitation of compact bones gives a sharp, strong crackling, even sometimes so loud as to grate Upon the ear. 6. That of spongy bones resembles the action of a file on such a substance as pumice, interrupted, however, by occasional sharp crackling. 7. Oblique fractures crepitate more distinctly than those that are transverse. 8. If liquids are effused round the broken ends, a sound is superadded, like that of the foot when thrust into an old shoe soaked with water. _9. When the fracture is complicated with splinters, the crepitation is united With'a crackling asof several cornered bodies rubbing each other. 10. When it is com plicated with laceration of the soft parts, the crepitation is united with a sound like that of a person breathing forcibly with the mouth wide open. 1 1. Dislocations give a very obscure dead sound, almost confined to the seat of the displacement. 12. The sliding of the tendons in their sheaths causes a full, dead sort of shock, quite different from crepitation.

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