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This paper reviews the literature regarding the use of applying conventional low-frequency vibration analysis as a possible diagnostic tool in the orthopaedic field. Although a considerable number of investigations have been carried out, including the effects of soft tissue, the technique has not been widely accepted clinically. The application of ultrasound appears to be a more realistic alternative.
Two Bostonians, Henry Ingersoll Bowditch (1808-1892) and Oliver Wendell Holmes (1809-1894), went to Paris for advanced medical training and came home ardent disciples of Pierre Charles Alexandre Louis, leader of the French school that derived its eminence from expert auscultation and careful correlation of bedside and autopsy findings. Both Bowditch and Holmes became leaders in 19th-century American medicine. Bowditch, a successful practitioner and prolific medical writer, wrote the first important American text on physical examination and became our first specialist in pulmonary disease. He pioneered in the public health movement, was a charter member and later president of the American Medical Association, and was an abolitionist and an advocate for equal rights for women in medicine. Holmes left practice to become a medical educator. As Dean of Harvard Medical School, he tried unsuccessfully to admit white women and free black men to the school. Although his greatest fame came as a man of letters, Holmes considered himself first a physician and medical educator, and was justifiably proud of his definitive study, "The Contagiousness of Puerperal Fever" (1843). Today, Bowditch and Holmes are little appreciated as pioneers and reformers, but we remain in debt to them both.
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The present study discusses the description of the tubercules of the lung which appeared in the 1826 edition of the treatise De l'auscultation mediate (1819) by Laennec, the author with Bayle of the first anatomo-clinical conceptualisation of pulmonary tuberculosis. Employing the analytical framework developed by Othmar Keel, the study investigates the interrelationships between two contemporaneous modes of interpreting the pathological evidence--the localist vision and the anatomo-pathological conception--in order to understand the influences of the surgical model upon the progress of anatomical, physiopathological, and tissue investigations by researchers such as Hunter and Bichat.
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In order to found the stethacoustic nomenclature on objective facts, we suggest to express lung sounds in a way taking first into account acoustical physics. Indeed the physicoacoustical definition of lung sounds has to take place before its psychoacoustical definition. Acoustical physics identifies only four kinds of vibrations: simple and complex periodical vibrations, transient and continuous non periodical vibrations. Lung sounds are bound to fall into one of those four categories. Phonopneumograms in time and frequency domain allow an objective classification of breath and adventitious lung sounds and introduce a simplification into the nomenclature which recognizes only four sorts of lung sounds, all of them included in these two categories: 1 degree breath sounds include normal and bronchial breath sounds, 2 degrees adventitious sounds include crackles (for every discontinuous sound) and wheezes (for every continuous sound). Objective parameters add their specific characteristics in terms of pitch, complexity, Hz-frequency, timing in the respiratory cycle and duration. The proposal of a new nomenclature is justified because it is supported by measurable physical phenomena. The solution of semantic problems should enable clinicians to progress toward a worldwide consensus.
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Percussional auscultation of the frontal sinuses is used for diagnosis of frontal sinusitides. Phonendoscope placed by the sinus walls auscultates sounds forming as a result of comparative percussion of the anterior sinus walls. Three main percussional tones are singled out. This method was employed for diagnosis in 48 patients with frontal sinusitis. The technique is easy to perform, safe and precise (90%). The trend in frontal sinusitides development can be followed up.
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