. Physical diagnosis . stethoscopewith a bell-shaped chest piece, arises in case the chest piece is notheld perfectly in apposition with the skin. If, for example, thestethoscope is slightly tilted to one side so that the bell is liftedfrom the skin at some point, or if one endeavors to listen over avery uneven part of the chest on which the bell of the stethoscopecannot be made to rest closely, a roar of external noises reaches the 148 PHYSICAL DIAGNOSIS. ear through the chink left between the chest piece and the a little practice one learns instantly to detect this conditionof th
. Physical diagnosis . stethoscopewith a bell-shaped chest piece, arises in case the chest piece is notheld perfectly in apposition with the skin. If, for example, thestethoscope is slightly tilted to one side so that the bell is liftedfrom the skin at some point, or if one endeavors to listen over avery uneven part of the chest on which the bell of the stethoscopecannot be made to rest closely, a roar of external noises reaches the 148 PHYSICAL DIAGNOSIS. ear through the chink left between the chest piece and the a little practice one learns instantly to detect this conditionof things and so to shift the position of the chest piece that exter-nal noises are totally excluded ; but by the beginner, the peculiarbabel of external noises which is heard whenever the stethoscopefails to fit closely agamst the chest is not easily recognized, andhence he tends to attribute some of these external sounds to diseasedconditions within the chest. Again, it is not until we have had considerable practice that. Fig. 91.—Stethoscope Held Right side Up. Fig. 92.—Stethoscope Held Wrong Side Up. our sense of hearing comes instantly to tell us when something iswrong about the stethoscope itself ; when, for example, one of thetubes is blocked, kinked, or disconnected, or when we are hold-ing the stethoscope upside down, so that the ear pieces pointdownward instead of upward (see Figs. 91 and 92). It is onlywhen we have learned through long practice about how much weought to hear at a given point in the normal chest that we recognizeat once the fact that we are not hearing as much as we should, incase some one of the above accidents has happened. Many begin-ners do not listen long enough in any one place, but move the chestpiece of the stethoscope about rapidly from point to point, as theyhave seen experienced auscultators do ; but it is remarkable howmuch more one can hear at a given point by simply persevering and AUSCULTATION. 149 listening to beat after beat, or breath
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