until full compensation for the defect had been reached; and that, with the growth of strength there had been corresponding enlargement, 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 exactitude 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 "râles" 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, responses are slow and ambiguous, and the observer is made to feel the need of a perfected microphone which shall amplify, localize, measure, and, in fine, characterize all obscure indications.
Difficulties from circumstances arise from disturbing voices or footsteps, 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 examined to offer the requisite time and facilities. There is too often incompetence 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, until he has become the trustworthy adept, if not the technical expert.
Difficulties exist to prevent the full popular benefit from stethoscopy, 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
