from the indications afforded by the physical signs. To a neglect, or comparative disregard of the history and ordinary symptoms of disease, and a too implicit confidence in their important art, is it probable that some of the errors of even accomplished auscultators are to be attributed. There is, however, I repeat, no valid reason why the auscultator should not use with equal diligence, and be equally skilled in the employment of, all other modes of investigation, as the individuals who discard the stethoscope, and make no use of the ear in forming their diagnosis, and why he should not enjoy the advantage of his art in addition to all those possessed by others. Let, then, auscultation and percussion be regarded as ancillary only to other, or rather as two among many, modes of investigating disease; as two stout and strong additional strings to our bow; albeit the information they afford is in some cases equal, if not superior, to that derived from all other modes combined.

3. Position of the patient.

The object to be desired in reference to the position, is so to place the individual to be examined that the parietes of the chest may be put upon the stretch, without contraction of the superficial muscles, or any exertion on his part likely either to induce fatigue, or in any way to affect his perfect ease. For this purpose, when the fore part of the chest is to be ex

amined, if the patient be able to sit up, I have found sitting upon a chair with a high, rounded, and reclining back, against which the head and shoulders can be supported without any muscular effort, to be the most suitable position. He should be placed opposite to a good light, with the shoulders thrown back, and the arms hanging down by the side of the chair. If a chair with a high reclining back be not at hand, the patient may be seated on an ordinary chair, with his arms passed over its back, and his head and shoulders as far retracted as his ease will admit. When the side, or axillary space, is to be examined, the patient's hand should be placed upon the occiput or back of the neck, and the body inclined to the opposite side. To explore satisfactorily the posterior regions, a "good back" should be made by inclining the head and bending the body forwards, and folding the arms across the breast. At the same time the scapulæ must be firmly pressed down by the examiner, as, by their elevation, they otherwise remove the supra- and infra-spinal fossæ from those parts of the lung which they ordinarily overlie, the careful examination of which is particularly important, particularly in phthisis.

Exactly the same plan may be adopted in exploring the posterior and lateral parts of the chest, if the patient keep his bed, but is able to sit thereon. If he be incapable of enduring this fatigue, he must be turned, while lying, to either side, as far

as his strength and circumstances will admit. The examination of these parts, in such cases, must almost necessarily be any thing but satisfactory. In the exploration of the front of the chest, on the contrary, an arrangement can generally be easily made so as fairly to examine every part without materially interfering with the supine position of the patient. This may be advantageously effected, without much trouble, by placing two pillows below the shoulders, and one only below the head, so that the former may be higher than the latter, and the chest be thereby somewhat rounded. If the position of the body be favourable, and we have the benefit of a good light thrown directly upon the front of the chest, it is not necessary that the surrounding curtains and furniture be particularly regarded, as they have really very little or no effect in modifying the sounds proceeding from that cavity in the process of exploration. It is, however, desirable that as little noise as possible should be made in the chamber, or ward, in which the examination is being made, and it is especially important that no part of the patient's or the examiner's dress, or any thing in contact with either, should itself, by friction, give rise to a rubbing or rustling noise, which might interfere with the purity of, or be actually confounded with, those proceeding from the chest.

4. Division of the Chest into regions or compartments.

Opinions of the nature of diseases are materially influenced by their locality. The most important diagnostic signs are frequently elicited by a comparison of the indications afforded by one part of the chest with those derived from another. It is often important accurately to define the limits of disease affecting certain organs; to be able to mark their progress or their secession, or to be assured of their remaining stationary; to determine if the organs themselves are in their natural situation, or to ascertain to what extent they have diverged therefrom. It has consequently been found convenient to divide the chest, as well as the abdomen, into various regions or compartments. For this purpose vertical lines passing between certain fixed points, and transverse lines passing round the body on a level with other fixed points, and intersecting the vertical lines, have been employed.

The following divisions are those usually adopted, with the exception of some slight modification of the useful additions and alterations advocated by Dr. Forbes, in his valuable articles, "Abdomen," and "Chest, exploration of," in the "Cyclopædia of Practical Medicine." By three vertical lines, one passing on each side of the sternum, and the other running the whole length

of the dorsal and lumbar spine, the chest is first divided anteriorly into a central position, and a right and left side, and both the chest and abdomen are posteriorly divided into equilateral compartments. A vertical line is then drawn from the scapular extremity of the clavicle, on each side, to the spinous process of the pubis; another from the posterior boundary of each axilla perpendicularly to the crest of the ileum, and another along the inner margin of each scapula, between two transverse lines to be immediately mentioned. The transverse lines encircle the body-1st, on a level with the clavicles; 2dly, on a level with the junction of the cartilage of the fourth rib with the sternum; 3dly, on a level with the extremity of the xiphoid cartilage ; 4thly, on a level with the end of the last rib; and, 5thly, on a level with the spinous processes of the ossa ilii. All these points are well defined, can be almost always distinctly felt, are not liable to vary (excepting from disease), and may be, without difficulty, remembered. By these vertical and transverse lines the chest is divided into a superior, two central, and seven other regions upon each side. The superior, or acromial region, embraces all the space between the lower part of the neck and the level of the clavicles, but is superiorly bounded behind by the seventh cervical vertebra, and before gradually tapers off or merges into another region at the upper end of