Voice-sounds 2OI 



well as pneumonia. In collapse of the lung, however, the sound is 

 heard only at the back, whereas in consolidation it is found also at 

 the front of the chest, for solid lung is an excellent conductor. It is so 

 clear in the healthy child that when it is somewhat exaggerated in the 

 adult it is called ' puerile.' 



When the lining of the small air-tubes is swollen, and the air does 

 not enter the vesicles freely, the vesicular murmur becomes ' harsh,' 

 and it is entirely lost when the lung is collapsed on account of the 

 pleura being full of air, serum, blood, or pus ; the space over which it 

 is heard is diminished in partial collapse of the lung, and when a 

 large tumour or a hypertrophied heart trespasses on the pulmonary 

 area. 



When pneumonic exudation has made the walls of the vesicles 

 sticky, the air enters them with a fine crepitation, like that which is 

 heard when a small bunch of hair near the ear is rolled backwards and 

 forwards between the tips of the ringer and thumb. 



When the lining membrane of the bronchi is inflamed, as in bron- 

 chitis, viscid or watery mucus is poured into the tube, and the air 

 passes through it in large bubbles, rhonchi (poyxs, snoring) or 

 in smaller bubbles rales. 



The larger the tubes, the coarser the rales; and as death approaches, 

 and the patient has not the strength to clear his larynx, trachea, and 

 bronchi of the collecting mucus, the coarse bubbling of the air through 

 the fluid is popularly known as the * death-rattle.' 



Prolonged expiration is due to obstruction in the bronchial tubes, 

 as from inflammation of the mucous membrane ; in the apex it is an 

 early sign of catarrh, and if also pus be spat it is a grave sign of phthisis. 



Amphoric (amphora, a flagon) breathing is that heard when the air 

 enters a bronchiectatic or pulmonary cavity ; it is something like the 

 sound produced by blowing into an empty bottle. 



Metallic tinkling is the sound produced by fluid vibrating in an 

 air-cavity which contains some fluid ; thus it is heard in large bronchi- 

 ectatic and pulmonary vomicae ; it is a kind of splash. It is probably 

 due to the echo in the cavity of the bursting of an air-bubble. ' It 

 nearly resembles the sound caused by shaking a pin in a decanter.' 

 (Hughes.) A metallic splash is also heard when a pleura containing 

 air and liquid (pyo-pneumothorax) is sharply shaken from beneath 

 (succussion}. The sound produced by air bubbling through the fluid 

 in a pulmonary cavity is termed cavernous. 



The voice-sounds. If the stethoscope be placed over the larynx 

 or trachea the voice is heard with extraordinary distinctness. This 

 sound is called, when it is heard over other regions of the chest than 

 that of the large air-tube, pectoriloquy (pectus, pectoris, breast ; loqtii, 

 speak). It means that the voice comes so straight to the ear that it 

 seems to be spoken in the chest itself, and not in the larynx ; and, as 

 healthy lung-tissue is a muffler of sound, pectoriloquism suggests 



