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Monday, March 23, 2015

400 B.C.: Diagnosing lung diseases with succussion

One of the first techniques ever devised to help physicians diagnose lung disease was succussion.  This is a technique where the physician would grab the patient by the shoulders, shaking the patient so any fluid that may have accumulated within his body -- particularly the lungs -- could be heard.

While this technique was probably used earlier, it didn't become a common procedure until it was described by Hippocrates at around 400 B.C.  Calvin Newton and Marshall Calkins, in their 1854 book, said:
"The term signifies a shaking; and the act consists in suddenly agitating a patient with the view of detecting the existence of fluid in some one of the cavities of the body, -- particularly, one of the pleural sacs (lungs). Seizing, by the shoulders, an individual, as he is ordinarily seated, strongly jolt or shock his whole frame. In this way, the sound of a contained fluid may sometimes be heard, like that of a liquid in a cask or bottle that is forcibly agitated. This has been called the metallic splash. Sometimes, the patient in bed is able to shake himself as to give the splashing sound of the water, in the thorax. The art was known to Hippocrates and has, hence, sometimes termed Hippocratic succussion."
Newton, however, explains that there was little reason to use this method because there were better techniques available to detect fluid inside the body, such as percussion and auscultation with a stethoscope, both of which had been well established by 1854.

In his book "On the Different Parts of Man," that disease is a result of an imbalance of the humors.  Respiratory diseases, particularly phthisis, pleurisy and pneumonia, was caused when an abundance of phlegm resulted in the fluxation, or flowing, of excessive phlegm to the lungs.  (2, page 239)

When the humours flowed to only one lung, this usually resulted in pleurisy and phthisis, which was in infection that resulted an infection, or pus, forming in the pleural cavity, or the space between the protective covering of the lungs and the lungs.  Hippocrates said "on shaking the body, we can perceive a fluctuation, and hear a sound. (2, page 239)

He said:
We known an empyema (pus in a cavity of the body, particularly the pleural cavity) by these indications.  A patient at first feels a pain in the side, pus collects, and the pain continues with cough and expectoration of pus, and difficult respiration. If, however, the pus has not yet found an exit, concussion (succussion) of the body renders it perceptible in its fluctuation, by a similar sound to that of fluid shaken in a bottle.  (2, page 239)
Succussion is no longer used by physicians for the same reason Newton described in his book.  Could you imagine a doctor shaking you like that?

  1. Newton, Calvin, Marshall Calkins, "Thoracic diseases: their patterns, diagnosis and treatment" Worcester, published by D. and M. Calkins, page 89
  2. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846,, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston
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