The Rise and Fall of Physical Examination in the Diagnosis of Diseases of the Chest

The use of physical signs in the diagnosis of diseases of the chest developed rapidly after the discovery of the stethoscope, and reached its acme at the end of the nineteenth century. It has since tended to decline as a result of the greater emphasis on etiological and functional, rather than on purely anatomical aspects of disease and the introduction of more sensitive and reliable endoscopic, radiologic and laboratory methods. Despite the gross fallibility of physical examination, however, neglect of its teaching and application is deplored. The eye, ears, and touch remain the quickest, simplest and most readily available means of detecting pathologic alterations. Suspicion aroused by physical findings is often the necessary precursor to the application of the instrumental, radiologic and laboratory measures which are required to establish the diagnosis. Omission of the more delicate and precise objective methods through excessive confidence in the less trustworthy physical signs can only lead to disaster.