An Essay on Intestinal Auscultation. By Charles Hooker,
M. D. Professor of Anatomy and Physiology in Yale Medical
College.
This is a well written pamphlet of about ten pages, read at the
annual meeting of the Connecticut Medical Socie'ty in April,
1847, and reprinted from the Boston Medical and Surgical Jour-
nal. In it is explained the applicati )n of auscultation to the sounds
produced in the intestinal canal by the movements of its contents.
“ These sounds,” says the author, “ are varied by many causes, such
as the quickness, regularity, and other variations of the peristaltic
action, the degree of fulness of the intestines, the proportions of the
gaseous and other contents, the fluidity of the liquid contents, &c.
The sounds thus varying with the causes of their production, afford
indication of these several causes ; and they thus become signs of
actions and conditions of the intestines, a knowledge of which is of the
utmost importance in investigating the diseases of these viscera. In
most diseases of the intestinal canal the sounds do not afford definite
diagnostic signs to characterize the different diseases, like the diagnos-
tic signs disclosed by auscultation in thoracic diseases. They are
chiefly signs of particular conditions or actions, which may occur in
various intestinal diseases, rather than diagnostic signs to distinguish
different diseases. In some diseases, however, signs are thus obtained,
which perhaps may be considered as truly diagnostic of the diseases in
which they occur.
In the Asiatic Cholera, which prevailed in New Haven in 1832,
this application of auscultation was attended with interesting results,
which were noticed in an account of the cases which came under my
observation, published in the Boston Medical and Surgical Journal for
July 1833. Writers generally noticed the loud borborygmi, audible
at a distance from the patient, which occurred in that disease ; and to
the ear applied over the abdomen the sounds were so peculiar—at
least so different from what I have observed in other diseases—that
they seemed distinctly characteristic of that disease. These sounds
manifested a rapid commotion of the whole intestinal canal, and might
be compared to those produced by shaking together several flasks of
various sizes partly filled with water. Frequently the sounds appear-
ed to indicate that the rapid peristaltic motions were suddenly arrested
and reversed by an anti-peristaltic action, which occurrence immedi-
ately preceded a paroxysm of vomiting. The large quantity of serum
effused into the intestines, causing an extreme fluidity of their contents
with the rapid and irregular peristaltic and anti-peristaltic motions,
would sufficiently account for this unusual variety of sounds.
The effects of various remedies upon the intestinal action, as indi-
cated by the sounds, were carefully observed. Practitioners were
generally disappointed, in that disease, to find the frequent vomiting
and purging not checked by the administration of stimulants and
astringents; and the sounds manifestly indicated that the common
effect of these remedies was decidedly to increase the intestinal commo-
tion. Such was the manifest effect of opium, unless given in doses so
large as to produce alarming prostration. On the contrary, frequent
small doses of camphor, with a free administration of ice, appeared to
have a soothing operation in moderating the rapid and irregular intes-
tinal action. The comparative effects of large and small doses of calo-
mel were strikingly interesting. Frequent small doses did not seem
to diminish, but, at least temporarily, to increase the disordered peris-
taltic and anti-peristaltic motions: while a single drachm dose almost
invariably caused a total suspension of these motions. Calomel, in
very large doses, thus seemed to be the appropriate remedy for the
disease. It appeared to overpower the diseased intestinal action, ar-
rested the vomiting and purging, and caused a total suspension of all
intestinal motion, during which no sound was audible. An interval of
perfect intestinal si'.ence and repose now continued, ordinarily from
eight to twelve hours, after which a natural peristaltic murmur indi-
cated a gradual return of healthy action, which was in time succeeded
by the grass-green evacuations, commonly regarded as evidence of a
favorable crisis of the disease. Thus the large doses of calomel, in-
stead of exhausting the system by an excessive cathartic operation,
actually obviated exhaustion by arresting the profuse serous evacua-
tions attenoing the disease.
Ordinarily the danger was considered as overcome, when the disor-
dered intestinal action was suspended, and the stage of repose pro-
duced ; and in this town few cases terminated fatally, when the
practice was adopted of effecting this result by the large doses of
calomel, before the system had been extremely exhausted by evacua-
tions.”
The application of auscultation to the diagnosis of other
intestinal affections is exceedingly interesting, and worthy the
study of practitioners ; for instance, the author states, that in
ordinary colic there is an incipient, forming, or latent stage, in
which, although no acute pain be present, there are symptoms
such as precede the cold stage of an intermittent fever ; languor,
lassitude, &c. The abdominal sensations, although not often noticed
at the time, are often described as a cold, heavy, numb feeling
between the region of the stomach and umbilicus.
In this stage a perfect stillness is discovered within the abdo-
minal cavity. Occasionally there is a slight rumbling in the
course of the large intestine, but no indication of movement in the
small bowel. This stage is deserving of particular attention,
because in it, the peristaltic action is readily restored and the vio-
lent symptoms averted by slight friction, a hot draught, or some
aromatic, or antispasmodic, as a few grains of camphor.
If the patient be examined, however, during the violent symp-
toms, the ear will discover no evidence of peristaltic motion ; and
this the author asserts to be a chief “ essential character of colic”
occasionally, however, slight accidental movements take place
from abdominal pressure ; or, anti-peristaltic motions occur pro-
ducing either nausea or vomiting, these are only occasional, how-
ever, and transient. As the cessation of peristaltic action is an
essential character of colic, so is the return of this movement,
extending throughout the intestinal tube, indicative of a favorable
crisis; “ when this description of sounds is beard,” says our author,
“ the patient may be considered as safe, even if the pain continues
severe.” A subsidence of pain, without the return of peristaltic
action, affords no favorable indication, indeed is significative of
great danger, if the strength be exausted by extreme suffering.
Usually, the return of movement is accompanied by a cessation
of pain ; but in protracted cases, where inflammation has super-
vened, peristaltic action may be accompanied by pain. This is
similar to what is often observed during the resolution of pneu-
monia, when a return of respiration to the inflamed lung, previously
impermeable, produces the keenest pain. “ In such cases, auscul-
tation informs us that all is well, even when the sensations of the
patient would indicate an aggravation of the disease. The signs,
above mentioned, in colic, will often indicate that further medication
is unnecessary, even before the general symptoms show any sign of
mitigation, and frequently enable the practitioner, under the same
circumstances, to give a cheering prognosis.
The author also explains how in lead colic, by the same means,
much valuable information may be gained as to its progress and
duration. So again in dysentery.
In the management of cathartic medicines much discretion is often
needed, as to their administration or withdrawal. By the applica-
tion of the ear, it may be discovered that spontaneous evacuations
are about to occur. Or when cathartics have been administered,
knowledge of their speedy operation is obtained, and the ill effects
of over dosing obviated.
In diarrhoea, too, this method of exploration is valuable, says
the author, as affording an estimate of the severity and obstinacy
of the disease, or an immediate assurance from the cessation of
abdominal sounds that there is no danger.
We wish that space were allowed us to give a full analysis of
this excellent paper. Enough, however, we trust, has been given
to prove its usefulness, and to stimulate others to the employment
of this valuable diagnostic means, as well as to show the wide
range of its applicability.