A MULTIPLE STETHOSCOPE FOR THE USE OF TEACHERS OF PHYSICAL DIAGNOSIS.

BY THOMAS E. ROBERTS, M.D., CHICAGO, Ill.

1

ANY aid to the medical student, by which he is enabled to better understand and recognize the results of auscultation, should be warmly welcomed by every teacher of physical diagnosis. My student days are not so far in the distant past that I cannot remember the impressions of my first attempts at physical examination of the chest, especially my attempts at auscultation. As I tried to classify the different sounds which came rushing through the stethoscope to my ears, immense interrogation points arose before me, which would not be dispelled even after patient explanation on the part of my instructors.

Remembering my own experiences, and listening to the questions. asked by students during clinical instruction, the thought came that finally resulted in the multiple stethoscope.

By means of this instrument, either one, two, three or four persons, can listen to the same sounds at the same time. The instructor, being one of the number, can designate, define, and differentiate the sounds, while the instrument is perfectly adjusted to the patient's chest and to the listening ears. This stethoscope has been tested both at the clinics of the Chicago Homœopathic Medical College and in the wards of Cook County Hospital, and has been found to convey sounds with as great clearness as any single stethoscope.

Before devising the multiple, I designed a double stethoscope. This was very satisfactorily used by me and my students for several weeks during the latter part of the college year.

While, with the double stethoscope only one person besides the instructor can listen at once, with the multiple three besides the teacher can auscultate at the same time, thus greatly enhancing the value of class instruction.

Briefly, the advantages of the stethoscope are: 1. Simplicity of construction.

2. Adaptability to number desiring to listen-one, two, three, or four, equally well accommodated.

3. Saving of time for both professor and student, enabling each student of a class of three to get three times as much instruction as he would otherwise receive.

4. Increased positiveness and better understanding on the part of the student.

5. Increased accuracy in the differential diagnosis, and in the description of detail on the part of the professor.

6. Fewer mistakes, and more reliable diagnoses and prognoses on the part of newly graduated doctors.

7. It would be of great value to the student while he is associated with his preceptor.

8. It will enable consultants to listen at the same time; absolutely getting the same sounds.

I desire also to say, that I can see how this instrument can be changed in detail of construction to materially increase its serviceability. I especially invite those who are particularly interested in the diseases of the heart and lungs to test this stethoscope, assuring them that I will welcome any suggestion or criticism which will result in the production of a more serviceable instrument.

[NOTE.-The above paper was discussed by Drs. A. R. Crawford and J. S. Mitchell. Their remarks have not been received.]

GALL-STONES.

BY W. J. MARTIN, M.D., PITTSBURGH, Pa.

TWENTY years ago, the late Dr. Thayer, of Boston, declared upon the floor of this Institute that China off. will cure gall-stone colic. This was before my time, medically speaking, and it was before the time, medically speaking, of the majority of those who are now engaged in the active practice of medicine.

The experience I have had in treating this painful ailment leads me to repeat the declaration of twenty years ago that China will cure gall-stone colic, or I would rather say, cure the cause of gall-stone colic. I present this subject for the reason also, that there may be some who have never tried the remedy for this purpose or perhaps had not known that the claim is made that the remedy is capable of accomplishing such results.

In the works on materia medica which I have at my command it is mentioned by some and by some not. In the Materia Medica Pura of Hahnemann, the only symptoms of China that would direct one's attention to it for this trouble are, "Several attacks of intermittent aching in the hepatic region when standing, which go off on bending the body forwards; on touching, the region is painful as if gathering." "Obstruction of the liver."

In Allen's Encyclopædia we find the same, with an asterisk. The same in italics, occurs under China in Allen's Handbook and in addition in a clinical note is the following: "Gall-stone colic (Dr. Thayer declares that China will permanently cure a tendency to gall-stone colic with all the attendant symptoms)." Lippe's Materia Medica makes no mention of gall-stone colic; neither does that child of the American Institute of Homœopathy, the Cyclopædia of Drug Pathogenesy; indeed, if the few vague symptoms given under China in this work were the only uses to which it were applicable, it would be scarcely worth keeping in our prescribing case.

A work on drug provings would not be expected to say anything

about gall-stone colic; no drug in its proving ever has or ever will produce gall-stone colic. It is a matter of great importance, however, that the medical student and practitioner should know the treatment promising the greatest success in the care of a subject of gall-stone colic. This he cannot get from a work of pure drug pathogenesy or of drug provings. What he is seeking and what he needs is clinical information, which is as important and valuable, and in some conditions and under some circumstances more so, than any and all other knowledge. Hence the wisdom of incorporating the best authenticated of clinical experience in our works on materia medica, as Allen has done in his Handbook, as is done in Hering's Condensed and Guiding Symptoms, and in Farrington's Materia Medica, where we read, p. 179, "The remedy to permanently cure biliary calculi is Cinchona, highly recommended by Dr. Thayer, of Boston." "Unless some symptom or symptoms," says Farrington, "call your attention specifically to another drug, put your patient on a course of China and have him continue it for months."

Hughes in his Pharmacodynamics, while himself neither condemning nor endorsing this claim for China on the part of Dr. Thayer, gives his readers the following information: "Dr. Thayer, of Boston, an old and experienced practitioner, esteems China very highly in gall-stones."

"Since 1854," he says (writing in 1874), "he has not failed in a single instance to cure permanently and radically every patient with gall-stone colic who has taken the remedy in his manner; and he has treated many from all parts of the United States. He gives the 6th dilution, at increasing intervals till only one dose a month is taken; sometimes he says the first effect seems to be an increase in the frequency of the attacks till, as he supposes, the gall bladder is emptied; but then they subside and cease.'

I am not prepared to claim that China will cure every case of gall-stones, though it has cured every case for me in which I have had the case long enough. True, I have not had many cases,—not more than half a dozen in a general practice of over seventeen years; but while the Old School are discussing the respective merits of cholecystotomy and cholecystectomy for the relief of chronic cholelithiasis, I will pin my faith to China. If the 6th potency does not help, I try the 3d or 1st and if I can hold my patient I believe I can cure him. Perhaps I should state more distinctly and explicitly

that the China treatment, as I view it, is to cure the cause producing the attack of colic-not the paroxysm of colic; this, I hold, should be treated by morphine hypodermatically. One injection over the seat of the pain is often sufficient; when not, it should be repeated as necessary. I have tried to cure the paroxysms with our remedies time after time, with no satisfactory result. The morphine injections on the contrary, are satisfactory every time, to both patient and physician.

A few illustrative cases and I will close. In 1878 I was called one night to see a slender wiry old lady over sixty years of age.

She told me she was suffering an attack of gall-stone colic to which she had been subject for a number of years at irregular intervals; I prescribed Belladonna, the attack passed over during the next day and was followed by the usual jaundice, dark urine, and light colored stools. I proposed to her to take treatment for the prevention of future attacks; she readily consented-the treatment was China 6th four times a day for six months, and she never had another attack. In the winter of 1891 I was called to a large strong woman of about fifty, suffering a most terrific attack of gall-stone colic which she for some years had been subject to; I tried to relieve her suffering with Calc. carb., which I had read in one of our journals had never failed in the hands of some one. In my case it did no good and I resorted to Morphine hypodermatically; this relieved her. She was subsequently put on China which she took for a number of weeks and quit because she "could see no use taking medicine when there was nothing the matter with her." In the spring of 1892 she had another violent attack, the worst she ever had; it lasted over twenty-four hours; I gave her at intervals of six or eight hours three injections of twenty drops each of Magendie's solution (Morphine 16 grains, water 1 ounce). She now was willing to take medicine as long as I wanted her if she could obtain immunity from future attacks; she took China 3d for about a year and has had no more gall-stone colic. This woman's attacks of colic seemed to be precipitated by a violent fit of anger, for every time she had an attack it was after she had been angry, though she did not get an attack every time she got angry.

In the winter of 1892, Mr. H. R., an elderly gentleman of good health and habits, was taken with his first attack of gall-stone colic. He was under Old School treatment and received no attention after