DISEASES OF ADULT LIFE. 335 
SOUNDING THE CHEST. 
To understand the different sounds of the chest the first 
thing is to get the healthy sounds well in the mind. Geta 
person in good health to practise upon. Let him be 
stripped to the waist: look at the chest—is it barrel-shaped 
Or pigeon-breasted? This condition is found in asthmatical 
people Look if both sides of the chest expand with the 
inspiration ; put a tape round in a line with the paps when 
the chest is empty take the measure when expanded with 
the deepest inspiration again measure—the average difference 
being 14 inches—if 2 inches 1! is good, if only one the lungs 
are weak: if much less some trouble may be expected. This 
part of examination 1s called inspection, the next is palpation, 
feeling Not much can be learned by it in chest complaints. 
SnlJ. if both palms are put on the chest, and the patient or 
person be asked to count J, 2, 3, you wil] findthesound conveyed 
to the hand. this is called voca) fremitus In congestion of 
the Jungs and pneumonia the sound wil] be very distinct, or 
as 1L1s termed exaggerated The next proceeding 1s ausculta- 
tion The earor stethescope ts placed on the chest between the 
ribs, and the healthy sound on the right side wil] be a breezy 
one, as if you were blowing gently into a handful of fine 
wire, on the left you wil] hear the heart’s beat, which you will 
perceive is double, a sound somewhat similar to one produced 
by striking the hee! cf your hand first, then the point of the 
middle finger onthe table The lower half of left side of chest 
is occupied in front by the heart, the upper part by lung 
sssues, In bronchitis there wil] be a wheezing. whistling 
sound on inspiration, and a blowing cne on expiration ; this, 
accompanied with the cough, will generally determine it to a 
practised ear In pleunsy, tf unaccompanied with any other 
disease, there will be the friction or dry rubbing sound, with 
feeble breathing sounds, from the inflamed condition of the 
pleura, and diminished motion of the chest.¢ If adhesion of 
the pleura takes place, which it frequently does, these sounds 
will not be heard. Jn pneumonia, when advanced, the ling 
becomes like the liver, almcst solid, so that little or no sounds 
