Archives of internal medicine . the superioi vena cava on the right of themediast inum. i- of fundamental importance in the apprehension of the physical signsof th \tissue vibration can in nun. when powerful enough, read on distanltissue and produce or increase vibrations in it. jusl a- a singing voicicalls forth a response from the wires and sounding board i ai n HEXRY SEWALL—8. B. CHILDS 47 piano. Tims a sound heard on auscultating any part of the chest isprimarily due to tissue conduction or air transmission of vibrationsarising in the larynx. The quality, pitch and intensity of the soundhe
Archives of internal medicine . the superioi vena cava on the right of themediast inum. i- of fundamental importance in the apprehension of the physical signsof th \tissue vibration can in nun. when powerful enough, read on distanltissue and produce or increase vibrations in it. jusl a- a singing voicicalls forth a response from the wires and sounding board i ai n HEXRY SEWALL—8. B. CHILDS 47 piano. Tims a sound heard on auscultating any part of the chest isprimarily due to tissue conduction or air transmission of vibrationsarising in the larynx. The quality, pitch and intensity of the soundheard with the stethoscope depend on the acoustic conductivity and sympa-thetic resonance of the tissues traversed, and especially on the resonatingand conducting properties of the tissues immediately under the bell ofthe stethoscope. Thus, the examiner can usually declare with confidencethe situation of a small superficial excavation anywhere in the lungs,. Fig. 2.—Same, supposedly normal, subject as Fig. 1. but the negative was takenin the phase of forced expiration, the effort being continued with nose and mouthclosed. Note the diffuse shadow covering both lungs due to crowding together ofpulmonary capillaries. Apparently distended bronchi are seen outside each larger blood-vessels are compressed and obscured. The sign of abnormalcongestion below the left clavicle still persists. The greater congestion of theright apex is of doubtful significance. presumably because the cavity forms a veritable resonator for the vibra-tions reaching it. Again, the modification of voice and whisper in alimited section of the lung gives evidence of a local intense congestion orconsolidation through which distant vibrations are more readily trans-mitted to the surface. The examiner who listens to the sounds in thechest inevitably tends to ascribe to the visceral conditions on which hismind is fixed all the auditory phenomena that are manifest.
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