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Monday, April 29, 2013

Stethoscopes and the Civil War

By Dr. A. Jay Bollet

The evidence that army physicians during the Civil War knew how to use a stethoscope can be found in numerous reports in the Medical and Surgical History of the War of the Rebellion. They are brief summaries, but with enough detail to know that physicians were skilled at physical examination.
 

Some examples:
"Case 4, Regimental Register, 28th Mass. April 11, 1863...dullness over left nipple; crepitant râles distinct...14th: rubbing sound heard over upper part of left thorax, râles below and dulness overall...17th...no rubbing sound, dullness less marked...26th...Sent to general hospital to-day."
"Case 9, from Third Division Hospital, Alexandria, VA: "Diminished resonance over right side anteriorly with subcrepitant ronchus [sic] below...""Case 10, Ladies' Home Hospital, New York City:...dullness posterior over the upper portion of the lower lobe of the left lung with feeble respiratory murmur and moist bronchial râles..
 
The stethoscope is needed to hear rales and rhonchi, and to detect a 'feeble respiratory murmur'. Notably, the findings were used to determine the specific location of the pathology in the lung and it is described in many of these case reports. In fatal cases the findings on physical examination were verified by the autopsy findings. Today physicians would rarely try to define the anatomic location of lung pathology without first seeing a chest x-ray. In other cases, the description of the examination of the heart mentions murmurs and friction rubs, which are heard only with the stethoscope. Note also in the cases listed above that the use of the stethoscope and other techniques of the physical examination which originated in Europe was widespread among the military units; it is documented in regimental and divisional field hospitals, as well as general hospitals.
 
The regimental surgeons in the field thus were skilled in the use of the stethoscope, not only specialists in the cities. Ladies' Home Hospital was a general hospital of 263 beds (according to the Surgeon General's annual report of 1862) and would be expected to have specialists in New York City functioning as contract physicians. It was on Lexington Avenue at the corner of 51st Street; initially all soldiers from the NYC area who needed trusses were sent there. This hospital was sometimes called the "Soldier's Home."The use of percussion, another component of the technique of physical examination, is documented by the descriptions of dullness and diminished resonance in these case reports. A statement attributed to General Robert E. Lee when he had the first of several illnesses during the war, describes what it felt like to be examined by percussion. His physicians, he said, were "tapping me all over like an old steam-boiler before condemning it." 

Excerpted from: The Society of Civil War Surgeons

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