With the stethoscope, we first distinguish the action of the ventricles, which occurs at the same moment with the beat of the pulse at the wrist. It is accompanied by a rather dull, but distinct sound. Immediately after, and without any interval, the contraction of the auricles takes place, attended with a noise which M. Laennec compares to that of the lapping of a dog. The duration of this sound, and consequently the period of the contraction of the auricles, is less than that of the ventricles. Next, there is a very short, yet well-marked, interval of repose.
The regularity of this order will be variously disturbed, by the sympathy which the heart observes towards other organs, as I have already explained; but much more materially by changes taking place in its own structure.
The sounds occasioned by the action of the heart, or of the large arteries, when disordered, are remarkably characteristic in their nature, and, if well understood, assist in a very satisfactory manner, our diagnosis, pathology, and treatment.
The Treatise of M. Laennec, and the late original publication by Dr. Forbes, furnish us with much valuable information for the diagnostic use of the stethoscope in diseases of the heart. A new volume which is about to issue from the press, to be presented to us by the Master of this art, M. Laennec, will contain the important results of his later experience.
As, in a diseased condition of the lungs, when the symptoms are more serious in appearance than reality, we can obtain the comfort to the patient and ourselves, of giving a favourable prognosis by means of the stethoscope; so, in the disordered action of the heart, it may often be in our power to gain that clear perception of the case, which may arm us with confidence as to its true nature, and its freedom from danger, and thus enable us to dismiss much of the apprehension, with which the nervous mind of the patient is sure to be distressed.
Having thus brought in view an outline of the general merits of the stethoscope[3], and of the improved method of exploring the diseases of the chest, I proceed to the remainder of my subject; it being my purpose to discuss, in a brief manner, some leading points of theory and practice suggested to my consideration by the cases and facts which came under my notice at the hospitals in Paris; and also to offer a few observations on the most important new medicines which may be considered of French origin.
GENERAL OBSERVATIONS.
Hospitals, and hospices, are numerous in Paris. The latter establishments are for the reception of the aged and infirm, or foundlings. Some of the hospitals are general in their principle of administration; while others are appropriated to particular age, or sex, or disease.
A board of general administration is held daily for the purpose of examining the patients who apply for admission. By means of this arrangement, the physician of any hospital whose attention is directed to a particular disease, or class of diseases, may send a patient to the hospital to which he is attached. The attention of the medical officers of the different hospitals is highly laudable, and worthy of imitation. They make their visits of regular attendance in the wards daily, and usually at the early hour of seven, and deliver clinical lectures on the most interesting cases at nine. I was present at these lectures, both at the Hotel Dieu and at La Charité, and was much gratified with the ability displayed by M. Dupuytren at the former, and by M. Laennec at the latter hospital.