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wild, weird chant of the dusky maid in darkest Africa, to the singing of Patti and Melba. The development of the voice in infancy and child- hood fluticasone nose spray follows the law of evolution observed in the lower animals, and as that comes under our observation we can learn much that is needful in our everyday routine. Indeed, before we are aware of it we acquire a wonder- ful comprehension of this apparently complex subject. Fortunately, we learn all the characteristics of human voices as we personally learn to speak the language of our parents, through the sense of hearing ; and when we begin to apply our flovent mg knowledge, unconsciously acquired in buy cheap flovent childhood, to our scientific work in the profession of medicine, we have only to review and arrange the facts according to the process of natural evolution. II. The Voice as an Aid in Diagnosis.— The voice and its modifications indicate the flovent online conditions of body and mind more clearly than any other factor in the long list of phj'sical signs and symptoms presented to the physician for his guidance in the great science and art of diagnosis, and, strange to say, very little attention is given to the subject by writers and teachers of medicine and surgery, so far as I know. I am bound to say in justice to others that my opinion on this part of my fluticasone propionate nasal subject is based upon the fact that a rather extensive reading of the literature of diseases of women discloses a notable silence regarding the voice. If, however, I am unjust to others whose labors may have escaped my notice, I trust you will correct my sins of omission. As this communication. is intended to generic flovent be suggestive, rather than elaborate and comprehensive, it may, I trust, not savor of pedagogic nutocraoy to stale, by way of recalling familiar fncts, that there are three factors of interest in the f)roduction of tlie voice: First, the flovent cost larynx, or vocal organ ; second, cheap flovent the motor power, or resjjiratory system; and third, the directing, controlling agency, innervation. Necessarily there must be back of all these a psychological mainspring, the nature and relationship of which may be determined according to the way of purchase flovent thinking of my hearers individually and collectively. Recalling these facts and the infinite variety of bodies and minds concerned in the production of voices, leads up to the different types of natural voices with which one must become familiar before undertaking the study of changes produced by disease. The subject is rather complex, yet none the less interesting, because of the vast variety of modulations and intonations employed in speech, to fully express all the ideas, thoughts, and emotions of the mind. If human beings spoke in mono- tone one could soon learn to distinguish the different types of normal voices, and as easily learn the changes and modifications of character, intensity, pitch, volume, and sustaining power. The voice used in quiet narra- tive or description, in logical argumentation, and in ex- pressing the stronger emotions, such as fear, anger, joy, and sorrow, must first become familiar to the diag- nostician before he can avail himself of these charac- teristics as evidence of disease. When one recognizes the fact that there are as many kinds of voices as there are of faces in this world, he may despair of ever being able to familiarize himself with the natural voices as heard in everyday life; but a little careful observation and thoughtful study soon reveals the fact that there are a few types which are readily recognized, and that all others are simply modifications of the leading dis- tinctive ones. First, there is the immature child voice, which is untrue; that is, it is characterized by being a fraction of a tone above or below the normal key. This is the natural voice of childhood, and when once under- stood becomes familiar and easily remembered. Some adults retain the child voice, the significance flovent price of which will be referred to later on. Then there is the soft voice of the timid, bashful person, a variety of which is found in the cautious, cunning one, who often drops into a whisper in conversation, although alone with his auditor. The quiet, nasal spray fluticasone clear, musical voice of the educated person who speaks correctly is the highest type, and is in marked contrast with the loud, strong voice of the self- confident, aggressive one, whose head is usually small and round, while the stomach is large and powerful in proportion to its size. The low-pitched voice of the uncultivated who talk in monotone; the high-pitched voice of those of the nervous temperament who talk rapidly and in staccato. The voice that may be of any pitch, but is used in a hesitating, drawling sort of way, if musical and agreeable, belongs to the thoughtful; but if in the minor key and acutely accented, betokens a vinegarish element, citlior of peevishness, dissatisfaction, or sarcasm. These are a few of the order flovent types which require to be familiarized by observation, not only as a prcjinra- tion to the study of voice changes as indicative of dis- ease or derangement in given cases, but also as a valu- June 10, 1899. SKENE: THE VOICE IN DIAGNOSIS. Sll able indication to assist the practitioner purchase flovent online in determining the mental, and to some extent the physical, make-up or personality of each of the many who come under his care. All this may appear to be a most complex and obscure subject, difficult to master and not easy to put in practice; but it is no more so than to take into ac- count constitutional peculiarities and idios}'ncrasies. To one possessing an acute sense of buy flovent online hearing the subject order flovent online is so interesting that knowledge is acquired regarding it with a facility that gives pleasure instead of by pain- ful, laborious work; indeed, to one with good hearing much of the required knowledge comes unconsciously through contact with those about him in daily life fluticasone spray and before taking up the study of medicine. buy flovent In order to follow the subject in something like sys- tematic or natural evolutionary order, the voice fluticasone nasal modifi- cations which indicate the condition of the mind at the time of examination fluticasone salmeterol should be considered. This natu- rally follows after acquiring a knowledge of the various

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