the solid lung, and the “bronchial breathing,” the sound caused by the air passing along the bronchial tubes, comes to be audible. This sound is characteristic, has been described, but, like the other, will not bear description, and must be heard to be recognised. We may take one other example by way of roughly illustrating the teachings of auscultation. It happens sometimes that fluid of a certain nature is poured out into the vesicles of the lung or into the air-tubes, and it is easy to understand how the passage of air through this fluid will cause a sound very different from that accompanying its passage along comparatively dry tubes, and into a comparatively dry receptacle.
There are, of course, very many modifications of these sounds, healthy and morbid, as regards their distinctness, their intensity, and various other of their properties, not only in different patients, but over different portions of the same chest. Nor is it necessary to say that the sounds we have briefly glanced at as examples, represent but a small fraction of those existing, and without difficulty recognisable. We need simply mention that auscultation, like percussion, serves for the detection, in a way equally interesting and accurate, of many unhealthy conditions of the heart, besides other affections of the human frame. But, in one instance as in all, the sounds which it distinguishes, and from which it derives its knowledge, depend on physical causes as simple and obvious as in the cases we have considered. There is nothing abstruse or mysterious about the stethoscope, nothing in its use at variance with common sense, and nothing more vain than its employment without the guidance of common sense. The stethoscope has had its specialists; maybe has some now; men who, trusting wholly to its indications, and perhaps straining them to meet their views, overlook accompanying signs and symptoms, and in their too blind trust to a single set of observations, lose their power or their care to take account of the whole bearings of a case, and so go needlessly astray.
Nevertheless, too much confidence can hardly be placed in the stethoscope, or rather, in its principle; and too much gratitude can hardly be bestowed on the memory of Laennec. On many an obscure case it has thrown light; many a year of life and comparative ease its timely warnings have gained to the victims of consumption; while to many it has been the means of complete reassurance against the dread of this enemy’s approach.
Curiously and sadly enough, of this very disease, towards elucidating and combating which he had done so much, Laennec died.
GUSTAVE DORÉ.
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