. Physical diagnosis . ening over the apexof the lung for fine rales, , inincipient phthisis. (2) For listening for superficialsounds, such as a friction rub ora presystolic When Idesire to listen for fine rales at anapex, for a friction rub, or for apresystolic murmur, I separate thechest piece of the Bowles stetho-scope from the hard-rubber bellinto which it is inserted, therebyconverting the instrument into oneof the ordinary form. With anextra hard-rubber bell attached,the instrument is no more bulkythan an ordinary stethoscope, andfar more efficient. When used forlistening to
. Physical diagnosis . ening over the apexof the lung for fine rales, , inincipient phthisis. (2) For listening for superficialsounds, such as a friction rub ora presystolic When Idesire to listen for fine rales at anapex, for a friction rub, or for apresystolic murmur, I separate thechest piece of the Bowles stetho-scope from the hard-rubber bellinto which it is inserted, therebyconverting the instrument into oneof the ordinary form. With anextra hard-rubber bell attached,the instrument is no more bulkythan an ordinary stethoscope, andfar more efficient. When used forlistening to the respiration, theBowles instrument giyes us infor-mation similar in some respects to that obtained by the use of thefree ear—that is, we are through it enabled to ascertain by listeningat one spot the condition of a much larger area of the chest thancan in any other way be investigated. Owing to the fact that both cardiac and respiratory sounds aremagnified by the Bowles stethoscope, this instrument is especially. Fig. -Bowles Multiple Stethoscopefor Six Students. 1 It has frequently been observed, when listening with the ordinary stethoscope, thata presystolic murmur can be better heard if only the very lightest pressure is made withthe stethoscope. The fact that a thrill is communicated to the chest wall, and that thatthrill is connected with the audible murmur explains my calling this murmur a superficialone. 142 PHYSICAL DIAGNOSIS well adapted for use with some sort of an attachment whereby severalsets of ear pieces are so jointed by tubing to one chest piece thatseveral persons may listen at once. Bowles multiple stethoscope,fitted for six and for twelve observers, is seen in Figs. 110 and 111, andthe method of its use in Fig. 112. In the teaching of auscultation thisinstrument is of great value, saving as it does the time of the instruc-tor and of the students and the strength of the patient. The soundsconducted through any one of the twelve tubes used in this
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectdiagnos, bookyear1912
