STETHOSCOPY. 197 



which, discouraging symptoms being found in this case, may suffice 

 although further tests are available. 



There are now five witnesses, each of whose testimony is more 

 than " circumstantial " ; collectively they agree perfectly and are in- 

 variably truthful. 



The following decision must be rendered : The applicant is in pos- 

 session of health so good, and a record so favorable, that he has proba- 

 bly made his application for life-insurance in all fairness, but, subjected 

 to the company's exact tests, he is debarred. He must be rejected on 

 the ground of organic pulmonary lesion. A portion of one of his 

 lungs is by some morbid process changed from its delicate, spongy 

 structure to one which is more solid ; the air-vesicles have been en- 

 croached upon by material which not only has interfered with their 

 functions (though inappreciably to himself), but which may prove a 

 progressive and fatal invasion. 



This case is one of a numerous and highly important class — an in- 

 dividual in fair health, without symptoms of any disease, is, by the 

 stethoscopic ordeal, accounted a " bad risk," or is denied the advan- 

 tages of assurance, and informed that some hygienic or curative 

 course is essential for his safety. 



On the other hand it may be stated that, without multiplying illus- 

 trations, there are very numerous instances in which the subjective 

 indications (symptoms) of organic disease are so prominent and the 

 distress so urgent as to appear conclusive proof of imminent danger. 

 A test of a few moments' time will make the correct diagnosis and 

 furnish a comforting stethoscopic negative. 



Disorders of the heart, although of less frequent occurrence than 

 those of the lungs, are of equal importance and require the best skill 

 of the examiner. 



In searching for its disordered conditions it is necessary to keep 

 in mind the anatomical features of the organ. As a piece of mech- 

 anism it is a pump, constructed of pliant, fleshy walls ; it has four 

 chambers with numerous valves, and its columnse and chordoe. Pro- 

 tected from friction and abrasion by the constantly renewed fluid 

 within its strong membranous ineasement, it expends an incredible 

 amount of force in its incessant and exclusive work of propelling the 

 blood. But it must also be considered as a sensitive center with an 

 apparently independent vitality, in direct communication, through its 

 web-work of nerves of the sympathetic system, with every organ and 

 tissue of the body, according to whose demands, as well as to the 

 varying activities of the brain, it regulates its movements. 



The manner of this response is frequently so energetic and tumultu- 

 ous as to cause much mental disquietude, if not real physical distress, 

 and to furnish the well-known question, whether there be " functional 

 or organic disease." 



Its vigorous impulsion, its notable sounds, and its location near the 



