207 



the inconvenience of moving the head, or the ordinary stetho- 

 scope, from place to place, the extent of the respiratory sounds 

 in different parts, so that a very minute difference, an excess in one 

 part or a deficiency in another, may with certainty be discovered. 

 Differences in quality, such as softness or roughness, are readily 

 recognized. The increased length and loudness in one part is accu- 

 rately contrasted with the healthy conditions of another part. In 

 cases where the Aspiration has been very full in one place, in order 

 to compensate for deficiency in another place, and where the expira- 

 tion was long and coarse in the deficient part, I have heard the in- 

 spiratory sound only in one ear, and the expiratory sound in the 

 other ear. The sounds were respectively restricted to the two parts, 

 and they alternated in a very marked manner. One part has re- 

 mained silent while the other has been heard to sound, and this has 

 been silenced when the other has awoke the ear. 



The diagram represents the sounds occurring alternately in two 

 sides of the chest in a consumptive patient. The dark spots repre- 

 sent the sounds. 



Healthy. Unhealthy. 



Right side of chest. Left side of chest. 



The influence which the acts of respiration exert in heightening 

 and lowering the murmurs in veins, say of the neck, in persons 

 affected with a thin and watery condition of blood, is well exhibited 

 by placing one arm of the stethophone on the chest and the other 

 upon the veins. 



When the respiration in two parts is alike in character, but de- 

 cidedly louder in one part than in another, the sound in the weak side 

 is lost. While this loss proves, in a very emphatic manner, the im- 

 portant fact of deficiency, it of course for the time deprives us of the 

 opportunity of judging of the quality of the deficient inspiration ; but 

 this is readily obviated by removing the cup of the instrument from 

 the full respiring part, and then the deficient respiration is immediately 



VOL. IX. Q 



