Dr's Casebook: Wine casks to medicine

Dr Keith Souter writes: I told him that the technique is called percussion and it is done to get an idea of the state of the inner organs. He found it amusing when I told him that he had actually been correct when he likened his chest to a barrel, because it was from tapping wine casks that the technique was devised.

When anatomy and physiology started to give doctors an idea of what really happened in the body, there was a need to be able to work out the state of the internal organs. Towards the end of the 18th century an Austrian physician, Dr Leopold von Auenbrugger, made the breakthrough when he invented the simple technique of percussion. This is the technique that doctors still use during their examination of the chest and the abdomen.

Leopold’s father owned a hotel. It is thought that the method he used to check the level of wine in casks, by tapping on them to determine where the level of wine was, was something that he had seen in his father’s cellar throughout his childhood. His genius was in adapting it to the human body.

The technique involves laying one hand flat on the part of the body to be examined, usually the chest or the abdomen. The middle finger of one hand then taps the middle finger of the flattened hand in order to produce a noise. Four types of noise can thus be elicited, allowing the examiner to determine the state of certain organs. Essentially, the amount of dullness or hollowness can give a lot of information, and it can help in determining whether or not fluid is present.

Leopold spent ten years examining thousands of patients, and his book, Inventum Novum, translated into English as ‘A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest,’ is now considered one of the most important classics of medicine.

And it all started with those wine casks in his father’s cellar.