Abdominal Physical Signs and Medical Eponyms: Part II. Percussion and Auscultation, 1924-1980.

BACKGROUND: Percussion and auscultation are derived from the Latin words to touch and hear, respectively. Covered are abdominal percussion signs and ausculatory signs discovered from 1924 to 1980. Signs ascribed as medical eponyms pay homage to these physicians who provided new and unique insights into disease. DATA SOURCES: PubMed, Medline, online Internet word searches, textbooks, and references from other source text. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. CONCLUSION: Many of these signs have been discarded because of modern imaging and diagnostic techniques. When combined with a high clinical suspicion, positive results using percussion combined with palpation is a useful bedside technique in detecting splenic enlargement. Thus, some of these maneuvers remain important bedside techniques that skilled practitioners should master, and along with a meaningful history, provide relevant information to diagnosis. It is through learning about these signs that we gain a sense of humility on the difficulty physicians faced prior to the advent of techniques that now allow us an easier way to visualize and diagnose the underlying disease processes.

Venothromboembolic signs and medical eponyms: Part II.

Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and important questions have been raised regarding their appropriateness. Although there have been instances where eponyms were abandoned, the remainder are largely embedded within the established literature making their disappearance unlikely. Physicians used a variety of techniques to describe signs of medical eponyms as a method for diagnosing deep venous thrombosis (DVT), pulmonary embolism (PE) or venothromboembolism (VTE). These methods (observation, palpation, pressure, or maneuvers), were detected during the physical examination and using bedside sphygmomanometer or radiographic imaging. Reviewed are both common and less frequently encountered VTE eponyms identified during the physical examination and radiologic imaging. Most of these signs have not been further studied and, therefore, there is a lack of information regarding their accuracy and reliability in clinical practice.

Tapping on the chest of history. Lost and found memories of Leopold Auenbrugger, inventor of percussion, in Austria and beyond

Leopold Auenbrugger (1722-1809), the inventor of percussion, joins René Laennec as the father of modern physical examination. On the occasion of the bicentennial of the invention of the stethoscope (1816), I went in search of the material footprints left by Auenbrugger in his homeland, Austria. This attempt led me to construct a rather fragmented picture, with some disillusionment (e.g. about his tomb) and some pleasant surprise (e.g. a new interpretation of the extant iconography). Apparently, posterity has not been sufficiently mindful of or grateful towards this great innovator of medical science. All the more reason for knowing and protecting what is left of him: buildings, monuments, portraits… Anyway, Leopold Auenbrugger is honored and implicitly remembered today, as he was in the past, every time a doctor practices the percussion on the chest of a patient (i.e. billions of times each year).

Music, Mechanism, and the "Sonic Turn" in Physical Diagnosis.

The sonic diagnostic techniques of percussion and mediate auscultation advocated by Leopold von Auenbrugger and R. T. H. Laennec developed within larger musical contexts of practice, notation, and epistemology. Earlier, François-Nicolas Marquet proposed a musical notation of pulse that connected felt pulsation with heard music. Though contemporary vitalists rejected Marquet's work, mechanists such as Albrecht von Haller included it into the larger discourse about the physiological manifestations of bodily fluids and fibers. Educated in that mechanistic physiology, Auenbrugger used musical vocabulary to present his work on thoracic percussion; Laennec's musical experience shaped his exploration of the new timbres involved in mediate auscultation.

["... my friend Leopold was percussing her through her bodice...". Leopold von Auenbrugger in Sigmund Freud's dream of Irma's injection]. / "... Freund Leopold perkutiert sie über dem Leibchen...". Leopold von Auenbrugger in Sigmund Freuds Traum von Irmas Injektion.

This paper provides a psychoanalytic interpretation of an element in the Irma dream that Freud had ignored in his own interpretation. The allusion to Leopold von Auenbrugger, the originator of percussion as a method of clinical investigation, which appears in the manifest dream reflects Freud's hopes and fears about how his Interpretation of Dreams and the new human science established there would be received by his medical colleagues.

Weir Mitchell's 1859 demonstration of "a peculiar contraction" produced by a percussion hammer.

BACKGROUND: The 1875 publications of Erb and Westphal brought widespread attention to the percussion of muscle stretch reflexes. Although the maneuver may have been observed before 1875, there is little concrete evidence of this. OBJECTIVES: To bring to light an early report of percussion eliciting the muscle stretch response. METHODS: While studying the Weir Mitchell papers (Philadelphia College of Physicians), the author came across an early report of the maneuver. RESULTS: The 531-word 1859 report, published in the Proceedings of the Academy of Natural Sciences of Philadelphia, was written by a pro tem reporter who observed Mitchell's demonstration of the phenomenon. The other attendees, including Dr. William Hammond, were so well aware of the phenomena that Dr. Mitchell "did not consider it necessary to describe them more fully." Mitchell viewed the response as muscular in nature and the relationship between this response and disease was not explored in the report. CONCLUSIONS: This 1859 report preceded the Erb and Westphal publications by nearly two decades. It is perhaps the first concrete proof that neurologists were observing this phenomenon as early as the mid-1800s. Mitchell viewed the phenomenon as a local muscle response. While the concepts that later allowed Erb to correctly interpret the phenomenon as a reflex arc were already in place, Mitchell did not synthesize these concepts.

Cranial percussion.

Percussion of the skull dates from a time when there were virtually no radiological methods for examining the skull and brain. Three apparently independent contributions appeared within the years 1893-1895. The sound elicited, tenderness, and auscultatory percussion have each been employed for diagnostic purposes, but have long been superseded.

Leopold Auenbrugger: camphor-induced epilepsy - remedy for manic psychosis.

Leopold Auenbrugger invented the art of diagnostic percussion. This paper recalls his use of camphor to induce epileptic fits, which were considered a remedy for psychosis. The initiation of the art of percussion by Auenbrugger is outlined, with a brief biographical sketch.

[The bicentenary of Josef Skoda's birth (1805-1881). An innovator in the field of the physical examination]. / 200 Jahre Josef Skoda (1805-1881): Neuerer der physikalischen Untersuchung.

The bicentenary of Josef Skoda's birth (December 10(th) 2005) was seen as an excellent opportunity to review his accomplishments for internal medicine. He extended the physical examination, namely percussion and auscultation, and established the scientific basis for these techniques. While Skoda's predecessors interpreted sounds and murmurs by natural philosophy and phenomenologically, Skoda established diagnoses based on empirical and experimental investigations. He compared diagnostic findings with post mortem results at Rokitansky's morgue. Thus, Skoda's work led to the modern capabilities of the physical examination.