THE EXAMINATION OF THE CHEST.
There are few organs of the body whose con dition can be so directly observed by a physi cian as the lungs, few in the examination of which the physician is so independent of the feelings of the patient. This is due to the adoption, in quite modern times, of methods of investigation by means of which a physician can, in very many cases, ascertain for himself the condition of a person's lungs without ask ing him a question. It may be well to note briefly how such an examination is made.
Inspection. -- Moth information may be gained by simply viewing the chest in a good light, the person sitting upright. Its shape is regarded first of all. In children the shape is circular, in grown-up people the distance from side to side is greater than from front to back. In disease the shape may be altered in various ways: it may bulge at one side, or be drawn in at one side. The "pigeon chest" shows a marked change in shape, the breast-bone being thrust forwards, and the sides flattened. It is the result of such disease as whooping-cough, occurring in childhood, when the bones are soft and readily yield to strain. In rickety children the shape is also greatly altered.
Again, by the simplest inspection one may frequently detect flattening in some part. This occurs specially just under the collar-bone, and indicates that, under that place, the lung does not sufficiently expand. Inspecting the chest in this way gives information also about the movements of breathing. Movement increased in one place and lessened in another indicates something unusual. In children particularly
an impediment to the free entrance of air into the air-cells is shown by a heaving motion of the belly, accompanied by a sucking in of the lower ribs.
Auscultation is another method. It has been mentioned that the ear applied closely to the chest walls hears sounds of the expanding lungs—a fine rustling noise. If part of a lung be blocked up, no sound will be heard over it. If matter be present in the bronchial tubes, as in bronchitis, the air, as it enters and leaves the lungs, will bubble through it, and give rise to bubbling or gurgling or crackling sounds; or if the tubes be narrowed by inflammation or spasm, whistling or piping sounds will be heard as the air rushes through the narrowed passages. Auscultation may be performed, as stated, by applying the ear directly to the chest, only a soft handkerchief being interposed between ear and skin. It is also performed by means of the stethoscope, a tube made of wood, or vulcan ite, or metal, having a widened portion at one end for placing on the chest, and a larger ex panded part at the other for fitting the ear. The sounds are conducted to the ear by this means. It may be observed that an untrained ear will very readily fail to catch the soft breath sounds of healthy lungs, which the accustomed ear can perceive at once, so that anyone unused to lis tening over the chest should not conclude that the breath sounds are abolished because he can not hear them. They are particularly loud in children.