The percussing physician

 The percussing physician

All medical students remember being taught the basic clinical methods of inspection, palpation, percussion and auscultation when they step into hospital wards and this forms a part of their training. I remember trying to use my middle finger which was suddenly called the pleximeter and trying make out the differences in resonance and diagnosing fluid, cavities etc. In the chest and abdomen.

This technique of medical percussion was invented by Leopold Auenbrugger in 1761 while seeing his father use it on wine barrels in his tavern. Percussion involves listening with ears, fingers and skin. This is like a musician who detects tone while playing percussion instruments. Though he was inspired in this invention by his father, he was accused of plagiarising Hippocrates, who had already discovered somewhat similar techniques. As a reward for his invention of the technique, Auenbrugger was dismissed from military hospital service though his private practice thrived.

His technique was rediscovered and popularized by Corvisart, who was Napoleon’s physician and remains popular to this day.

Auenbrugger was also a composer and wrote an opera for an Austrian empress.This composition was called “The chimney Sweep” and was a libretto for a comic opera. Here is a part of the music that he composed.

https://www.youtube.com/watch?v=bTVLJJd0-OQ

Flute and stethoscope

 I spent the last few days racking my brains trying to find an association between the flute and the stethoscope. I will elaborate further in the following paragraphs.

The flute is a woodwind instrument that produces sound according to Bernoulli principle.

The stethoscope is the instrument used to listen to sounds from within the chest and is the most popular gadget commonly identified with doctors.

The stethoscope was invented by Rene Laennec in 1816. Laennec studied medicine at Paris. He was a surgeon/physician and trained under prominent physicians of that time. Laennec's mother had died of tuberculosis and with frequent interruptions because of his own ill-health, he studied and worked on chest disorders like Tuberculosis and emphysema.   

Laennec used to play the flute and being an excellent carpenter, used to carve his own flutes. The method used to listen to chest sounds was crude at the time and involved direct application of ear to the chest wall. Laennec once noticed some children playing with hollow sticks and using them to listen to pin scratches. This gave him an idea and coupled with his knowledge of acoustics led him to make a wooden cylinder about 25 cms long which revolutionized the method of auscultation of the chest and survives to this day.

Laennec ironically died due to tuberculosis and it is said that when he listened to his own chest sounds with his stethoscope, he was horrified. When we proudly flaunt our stethoscopes, we realize and appreciate  the work and genius of many persons who helped us reach here.

Keys and cuts; Brahms and Billroth

 

I was going through literature about surgeons who were musicians and came across this interesting information. In this write-up, I am going to discuss the association between Billroth, a surgeon and Brahms, a composer.

Billroth is known to surgeons as the pioneer and founding father of abdominal surgery. I know him from his association with gastrectomy. I did not know that he was also a proficient musician. He wanted to study music but was persuaded to take up medicine by his family. He played both the piano and violin. He never considered science and music to be in conflict with each other. He attempted to apply scientific principles to musicality and wrote research articles on this subject. He organized small concerts at his home.

Johannes Brahms was a noted composer in Vienna. Along with Bach and Beethoven , he was considered musical royalty (3’B’ s).Practically all of his compositions were played first in Billroth’s home.

Billroth and Brahms developed a close friendship. They met in Zurich and their association continued lifelong.  

Billroth believed that the study of music aided his surgical abilities. Although he was pessimistic regarding the future of music, thankfully he has been proved wrong.

There are several associations between physicians and artists. In Greek mythology, Phoebus- Apollo is considered to be the God of both medicine and music. Here is a piece of Billroth's music.

Foleys, Foleys and follies!

 I came across this term while browsing through an audio software and thought that I knew it from somewhere. That word, foley, turned out to be familiar terrotory.  

A Foley artist creates sounds for media to improve the quality of audio. Everyday sounds like footsteps, creaking doors etc are such examples. This was started by a person named Jack Foley and it became a specialty all by itself which survives to this day.

The more popular Foley (in my world) is the Foley catheter named after Dr Frederic Foley, an American urologist and this self retaining catheter has been and will be used by most healthcare personnel.     

Etymologically, the word foley is derived from Irish language and means plunderer!

About biceps- Two heads are better than one!

Let me be frank. I am a scary dude because I have two heads. I swear it’s not my fault as I was born like this. My second name is brachii. That makes me Biceps brachii.

Each of my heads arises from the scapula and gets inserted into the humerus. To get along well with my colleagues (tendons and bones), I have several coverings-bicipital aponeuosis, bicipitoradial bursa . I am forced to get along well with them to help in smooth functioning of my host. 

I rank higher than the two muscles lying below me, coracobrachialis and brachialis. I am run by musculocutaneous nerve and cervical nerves. I am fed by the brachial artery. I flex the elbow, flex and abduct the shoulder and also help in supinating the forearm. My chief antagonist is triceps muscle.

If you have read enough, let me go on to some interesting facts.  When I flex, I look like the back of a mouse. This made the humans (living in Rome) call all the muscles as muscles  because musculus means ‘ little mouse’ in Latin. You can’t call me bicep because it is considered incorrect.

Between 1505 and 1510, there was an artist named Leonardo Da Vinci who drew my portraits and explained my functions. He was not believed because he was not an anatomist. Two hundred years later, I was rediscovered by William Cheselden and Guillaume Duchenne.

Another interesting fact is that because of me, horses can rest and sleep while standing.

Fistula - A brief history

The barber and the surgeon

During 17^th century lived King Louis XIV. In the year 1685, he developed a swelling in his bum which became an abscess and finally a fistula.

The king was rumoured to have bathed only twice in his lifetime because water was supposed to cause infections! In desperation, the services of the barber- surgeon were sought.

Barber surgeons were barbers who performed minor operations. Charles- Francois Felix, who was the barber surgeon, prepared for 6 months and developed tools for his tryst with glory or despair.

He operated on the king in November 1686 and the operation was a success. The surgeon became famous and also prosperous. The courage of both the king and the barber gave a new respectability to surgeons and eventually led to the establishment of the royal academy of surgery.  

( An anal fistula is an abnormal communication between the anal canal and the skin. It occurs due to infection of anal glands.)

Jeep bottom!

Imagine that you were a driver in the World war. You drive a jeep, fight for your country and do all that is required of you and make yourself feel proud. You are tired at the end of the day and just want to take rest. Suddenly you find that fluid is leaking from the base of your spine and it is foul smelling. You think that it is just sweat, forget all about it and take rest.

In a few days, the fluid leak increases and then suddenly it becomes an abscess (pus filled). It is throbbing, painful and unbearable. You take some antibiotics and forget all about it.  It keeps coming back again and again and then you decide to do something about it. You don’t know which doctor to consult. You search the internet and think that it is ‘piles’.

I met a patient a few days ago in my clinic who did not know which doctor to approach for a pilonidal sinus. He knew the diagnosis because he had done a little bit of research on the internet. That made me dive headlong into the topic.

Pilus means hair and nidus means nest and pilonidal sinus means nest of hair. Pilonidal sinus disease was first described in 1833 and attained fame due to its presence in soldiers during World War II. During this time, it was known as “Jeep Disease”. Hair goes through the skin, forms a track and stays until it is removed.

There are several treatments for this condition. It can be excised and left to heal by itself or it can be closed primarily. Several types of flaps can be planned for the primary closure.

Since the disease happens in young individuals, cosmesis has to be considered. Time away from work or school also plays a role.