Last September, while I was examining a patient with chronic advanced pulmonary tuberculosis with a fair-sized cavity, the stethoscope was placed over the cavity when the patient swallowed. I was startled at the loudness as well as the character of the sounds elicited. A series of coarse crackles was heard that seemed directly beneath the bell of the stethoscope.
It frequently happens that in the course of routine examinations of the phthisical chest when the patient is instructed to breathe out, cough and breathe in, he will at the end of inspiration unconsciously and involuntarily swallow, so that the normal reflex of deglutition is heard and familiarized. It sometimes happens that the normal sounds produced in the chest by swallowing follow so closely the fine posttussic crepitations characteristic of tuberculous involvement that the two seem blended, misleading an inexperienced auscultator unless he has noticed the patient's swallowing.
After the abnormal