In exploring the state of the chest with the stethoscope, it is incumbent upon us to reason carefully upon every phenomenon which we discover, and not to consider this or that circumstance as merely curious. We should weigh well the importance of the pathological indications; and form our conclusions, in great measure, from our knowledge of the anatomical structure of the particular parts of the organ which we find to be affected; and, also, from the relative situation of one part to another. For example, we discover different kinds of rattle, accordingly as the bronchial tubes, or the air cells, may be respectively affected; and the effect produced on the action of the heart by a morbid condensation of the left lung, is very different from that occasioned by the same state of disease in the right. In cases of pulmonary consumption, it is important for us to ascertain whether or not ulceration has yet taken place. In this investigation, we use the stethoscope with its stopper, as serving better to bring the sound of the voice to a focus. If there be an open tubercle (in synonymous terms, ulceration, or excavation), the vibrations produced by the voice passing more readily to the ear of the auscultator, than when there is no breach of surface in the lung, it seems as if the patient were speaking up the tube, and hence the exact situation of the ulceration is indicated. This phenomenon is called by the expressive term, pectoriloquism. If the instrument be applied over the windpipe, when there is not disease, the voice produces in some measure the same effect; because at this part, the integuments are thin, and do not interpose much medium between the voice of the person speaking, and the ear of the auscultator. It is a consoling circumstance that M. Laennec does not view tubercular consumption as an incurable disease. He mentions having several patients under his care ill with chronic catarrh, affording distinctly the sign of pectoriloquism, although in all other respects then free from symptoms of consumption. He refers to the case of a lady, a patient of M. Bayle, in whom pectoriloquism was quite distinct. She had been decidedly affected with the symptoms of consumption eight years before: she had recovered beyond all expectation, and was then stout, not having any other symptom of pulmonary irritation than a slight cough. M. Laennec next relates[2] the morbid appearances in the lungs, found on dissection in five cases of patients who died from other diseases. In each instance, tubercular excavations were found cicatrized, and for the most part lined by a semi-cartilaginous membrane; adding testimony therefore to the opinion already stated, that nature does sometimes exert a curative process, in cases of consumption which were apparently hopeless.