200 THE POPULAR SCIENCE MONTHLY. 



until full compensation for the defect had been reached ; and that, 

 with the growth of strength there had been corresponding enlarge- 

 ment, which, instead of being a morbid condition, however, is in this 

 instance really conservative and favorable. 



While stethoscopy possesses an interest amounting to fascination, 

 from its vital importance, from the numerous difficulties which can be 

 overcome by reasonable diligence, and from the great degree of exac- 

 titude on the whole attainable, it still has its difficulties intrinsic and 

 its difficulties of circumstance. In its practice observations must be 

 made principally through the single sense of hearing ; for, practically, 

 the organs which are within the range of a whisper are to the other 

 senses as distant as the antipodes. 



There are difficulties from within the chest, from overpowering 

 abnormal sounds, as in the asthmatic subject, where the noisy "rales" 

 entirely predominate, rendering auscultation of the heart temporarily 

 impracticable. 



Obscurities and difficulties arise in a negative way from lack of 

 expression ; occasionally, all sounds are distant and confused, re- 

 sponses are slow and ambiguous, and the observer is made to feel the 

 need of a perfected microphone which shall amplify, localize, meas- 

 ure, and, in fine, characterize all obscure indications. 



Difficulties from circumstances arise from disturbing voices or foot- 

 steps, or the roar and rattle of busy streets, and innumerable other 

 sounds which may in part preoccupy the ear with their clangor. There 

 are difficulties from disinclination on the part of the individual exam- 

 ined to offer the requisite time and facilities. There is too often in- 

 competence on the part of the examiner ; his sense of hearing as an 

 auscultator may be defective, though not appreciable by any other 

 test. He may never have acquired the requisite degree of skill gained 

 only by persevering practice, commencing with the normal conditions 

 in healthy persons, thence through every class and grade of morbid 

 states, untn he has become the trustworthy adept, if not the technical 

 expert. 



Difficulties exist to prevent the full popular benefit from stetho- 

 scopy, arising from the want of a better general knowledge of its claims 

 and capabilities. Formerly, when the circulation of the blood and the 

 functions of respiration were unknown and the arteries were supposed 

 to be air-vessels, the materia medica was a wonderful list with which 

 the physician made his round of experiments. In those days, in case 

 of a mysterious death, the verdict of the coroner's court would be, 

 " Died by the hand of God," and was considered as duly explicit. 



Sufficient advancement has now been made not only to demonstrate 

 the physiology of the lungs, heart, and arteries, but to comprehend 

 every shade of their diseased conditions and to show that the larger 

 part of the remedies once in use were entirely inapplicable ; and the 

 coroner, with no irreverent intent, but under the fear of the charge of 



