Medical History · 1967 · 15 citations · 5 references
WITH every tap a peculiar itching or tickling sensation may be perceived in the tendon'. So was the feeling described, ninety years ago, in the first account of the hammer as applied to the patellar tendon.' For the well equipped physician had been carrying in his bag some variant of our red rubber triangle mounted on a stainless steel handle quite some time before the words just quoted appeared in Westphal's Archiv far Psychiatrie und Nervenkrankheiten. Their author was Wilhelm Erb, who wrote in 1875 Slightly flexed at the hip and knee, the leg is held fast while all its muscles are relaxed and, with a finger or percussion hammer, a very light and elastic tap is delivered (exactly as in very light and elastic percussion of the chest or in testing for fluid in the abdomen) to the region of the ligamentum patellae. Each tap is followed by a contraction of the quadriceps, immediate like lightning, unmistacable, visible, palpable, and apparently reflex: manifestly and often quite strongly is the shank set in motion. It is extraordinarily difficult to suppress this reflex by a voluntary effort ... The reflex was a novelty in the 1870s. But the instrumental hammer was surprisingly old in the diagnosis of disease. Even more surprisingly, its use was older in a disease of the brain than in one of the abdomen or chest, and in cattle rather than man. This remains true even if we believe Josef koda,* the great Viennese diagnostician and therapeutic nihilist: 'The abdomen has always been percussed for suspicion of too much gas in the intestine', he wrote in 1839.' Percussion of the chest, though, goes no farther back than Auenbrugger. Only then, in the middle of the eighteenth century, doctors seriously began to lay hands on their patients, not just for treatment, but for diagnosis. Auenbrugger's sonorous first axiom was 'The thorax of a healthy person sounds, when struck'.3 What inspired the friendly doctor to his discovery, we are told, was the customary checking, in his native Styria, for the fluid level of wine in the cask." Chest percussion, when it gave sounds either deeper or duller than the normal, spelt disease: cavities, effusions, and so on. A sensitive and musical man, in a musical country at its most musical period, Dr. Leopold Auenbrugger, Edler von Auenbrugg, had also written the libretto-to a comic opera for the court of Empress Maria Theresa," and a treatise On the Silent Rage or the Drive to Selfdestruction. He applied physics to medicine in the day of amateur physicists. Obviously also, he was steeped in the new vogue, morbid anatomy, or the aggressive search for the seat of disease.
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