196 THE POPULAR SCIENCE MONTHLY. 



the absence of those sounds and changes which are sufficiently distinct 

 and characteristic — a condition to be expected in all earlier stages of 

 pectoral troubles. 



A life-insurance agent brings to his company's medical examiner 

 an individual whom he considers an exceptionally " good risk." He 

 has the facial appearance, the physique, and record of perfect health. 

 The examiner, in making up the rigid descriptive list for his company, 

 must assure them, as " parties of the first part," that in this case the 

 sounds of the heart are perfectly natural ; that its movements are en- 

 tirely correct as regards their rhythm, strength, and frequency ; that 

 the pulse does not intermit, etc. ; and that there is no disease or mor- 

 bid condition, or tendency thereto. Tested by the spirometer, the ap- 

 plicant is found to breathe easily the amount of air known to be the 

 average for persons of his size (more strictly, height). By the usual 

 tests of auscultation nothing is found wrong. On a more scrutinizing 

 review of the case, as becomes the faithful officer who is to be the im- 

 partial judge on the trial, a small area is found near the upper portion 

 of one lung where, by percussion, the normal resonance has given 

 place to a degree of dullness — a sound which signifies the half-way 

 limit between the resonance of perfect health and the " flatness " of 

 advanced change. 



This quality of sound would pass unobserved, except for easy com- 

 parison with the adjacent portion of the same lung, and with the cor- 

 responding part of the opposite one. The dullness is found to be 

 better shown by light percussion than by more forcible strokes — an 

 indication of the superficial situation of the changed tissue. 



On again applying the stethoscope over the region, the natural 

 vesicular quality of the inspiratory murmur is found to be changed to 

 the broncho- vesicular murmur — indicating partial solidification of 

 lung, which, if more complete, would give the bronchial or tubular 

 sound. The pitch of its tone is raised, and it is "rough" or "harsh." 

 A sound of expiration is also heard distincthj, while normally it is 

 barely audible. 



There are now three facts which tend to becloud the otherwise 

 good record of the case. 



A further test may be made by auscultation of the applicant's voice. 

 On applying the stethoscope upon the place mentioned, the subject is 

 required to speak or count in his ordinary tone of voice. There will 

 be heard sounds apparently near the ear, approaching in distinctness 

 to words — not articulate, as would be heard in complete solidification, 

 but easily distinguished from the distant jarring sound of a healthy 

 lung, called vocal fremitus. 



The applicant has now through his own honest voice given ad- 

 verse testimony. Try next whether he shall whisper a confirmation 

 of the same unfavorable story. The whispering voice heard through 

 solidified lung-tissue is increased in intensity and raised in pitch. 



