. Physical diagnosis . mostany hat, but it is not necessary todo so. The ear pieces of the ordi-nary stethoscope are often too smalland rarely too large. In case ofdoubt, therefore, it is better to errupon the side of getting a stetho-scope with too large rather thantoo small ends. (2) The binaural stethoscope,which is now almost exclusivelyused in this country, maintains itsposition in the ears of the auscul-tator either through the pressureof a rubber strap stretched around the metal tubesleading to the ears, or by means of a steel spring-connecting the tubes. Either variety is usuallysatisf
. Physical diagnosis . mostany hat, but it is not necessary todo so. The ear pieces of the ordi-nary stethoscope are often too smalland rarely too large. In case ofdoubt, therefore, it is better to errupon the side of getting a stetho-scope with too large rather thantoo small ends. (2) The binaural stethoscope,which is now almost exclusivelyused in this country, maintains itsposition in the ears of the auscul-tator either through the pressureof a rubber strap stretched around the metal tubesleading to the ears, or by means of a steel spring-connecting the tubes. Either variety is usuallysatisfactory, but I prefer a stethoscope made witha steel spring (see Fig. 105) because such a spring-is far less likely to break or lose its elasticity thana rubber strap. A rubber strap can always beadded if this is desirable. It is important to pickout an instrument possessing a spring not strongenough to cause pain in the external meatus of the ear and yetstrong enough to hold the ear pieces firmly in place. Persons with. Fig. 106.—Cam-man StethoscopeWith Stiff Tubingand Rubber Strap. Fig. 105.—Stetho-scope Fitted withLong FlexibleTubes, EspeciallyUseful When Ex-amining Children. AUSCULTATION 139 narrow heads need a much more powerful spring or strap thanwould be convenient for persons with wide heads. (3) The rubber tubing used to join the metallic tubes to thechest piece of the instrument should be as flexible as possible (seeFig. 105). Stiff tubing (see Fig. 106) makes it necessary for the aus- cultator to move his head and body from place to place as the examination of the chest progresses, while if flexible tubing is used the head need seldom be moved and a great deal of time and fatigue is thus saved. Stiff stetho-scopes are especially incon-venient when examining the axilla. (4) Jointed stethoscopes which fold up or take apart should be scrupulously avoid-ed. They are a delusion and a snare, apt to come apart at critical moments, and to snap and creak at the joints whe
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