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types of voices and becoming acquainted with the normal voice in those who come under the practitioner's atten- tion. Bearing in mind always that the function of the lar3'nx is dominated by the brain and nervous system, the voice itself, to a great extent, expresses the state or attitude of the mind more truly than the words spoken. 'I'he tongue may lie, but the larynx tells the truth. The words spoken may purposely conceal the thoughts, and thereby deceive by conveying wrong impressions; while the character of the voice betrays the true feeling at the time of the articulate speech, whatever it may be. The modulations, intonations, pitch, degree of resonance, and other modifications of the voice change the meaning of words; so that one sentence spoken in different ways conveys to the hearers very different ideas. It is be- cause of this that a remark like the following is so often heard : Purchase Floxin Online " It was not what he said, but the way in which he said it, that offended me — pleased me — or made me suspect him." Another good illu.«trntion of the misleading character of words used and tlic truth- fulness of the voice that speaks them may be observed in women who, desiring to conceal their sorrows, talk cheerfully, l)Ut have tears in their voices. (The latter phrase Is borrowed from the language of the artist.) This shows that the voice has a natural Floxin Otic Drops history of its own, wiiich plays an important part in making up the natural a.s well as the clinical history of every Iniinan bortant part in the development of the clinical hiHtory of nearly all known diseases. The voice as an evidence or index of certain states of the mind which are normal under certain circumstances is illustrated in the following: In a perunn who is in ill-huuKir lem- |«>rarily the voice is confined imually to the middle rcgis- tiT and he »i)onkii in rather hIow time. Thin is popularly known as jjr"*''njj. The voicv in atronf; nnper, wrath, or rajjo is harsh in character, hi({h in pitch, somewhere in the upper register, in faster time, and punctuated with deep, rapid respirations. The consonants are em- phasized, and the voice, when lowered in resonance, gives the hissing voice of the stage villain. The harsliness of the voice is perhaps Floxin Antibiotics due to Order Floxin the extreme tension of the muscles of the neck and larj-nx. Contentment or pleas- ure Order Floxin Online is indicated by a rather low-toned voice, musical in character, and of middle register and pitch. In some cases the voice has an element approaching laughter. In joy or glee, the voice is higher pitched, more intense in character, and of good volume, generally interrupted. This is expressed by the laymen as shouting for joy, or screaming with delight. Dread, apprehension, and doubt are shown by the voice being slightly tremulous, imperfectly sustained, low-pitched, uncertain in reso- nance, and interrupted. The voice of fear or fright is high-pitched, staccato, or whispering, if the fear is in- tense. In women it is often thin in character, wanting in resonance, and screaming or screechy in tone and tempo. The voice of sorrow is low, soft, tremulous in character, not well sustained, but inclined to be con- tinuous, or approaching to the singing voice, and in the minor key. The chief interest for the physician is to know how to distinguish the voice of sorrow from an imitation. Many patients try to talk in Floxin Price a sorrowful way, but they simply grumble in a minor key, and the voice of the imitator is generally more harsh Floxin Otic Ear Drops and higher pitched than the genuine voice of the truly sorrowful. They fail to produce the quiver or tremolo. No one but a consummate artist can counterfeit the voice of sorrow, and then only in singing; rarely, if ever, is the imita- tion well made in speaking. These are only a few hints regarding certain ways in which the voice changes ex- press the physiological mental attitudes. With this meagre introductionary basis I may take up the subject in its relations to Floxin Ophthalmic diseases in Generic Floxin infancy and childhood. Infant patients being unable to express their aches, pains, and suffering in words, the physi- cian has to depend upon other signs in making a diag- nosis; consequently the voice should be carefully ob- served. Of necessity tliis needed attention has been given in paediatrics, I presume, more fully than in Aqua Floxin deal- ing with adults. Ordinarily students arc taught to recognize the piercing screech as diagnostic of cerebral meningitis, which, once heard and its meaning under- stood, is not forgotten. This voice sound, or a similar one, is occasionally uttered at the beginning of a con- vulsion. It is therefore an Floxin Otic Suspension unnatural voice, being only Buy Cheap Floxin heard in cerebral affections, and is in a marked degree diagnostic. Crying is the only Cipro Floxin way in wliicii an infant can express its wants, and it ntay be said that then^ is a natural cry in infancy which is not expn^ssive of any kind of suffering and has nothing of the nature Floxin Online of weep- ing in it. 1 have lieard that infants never cry unless they are sick or suffering. That mat/ (>f truf of rhililrfn, hut not of infitntf. Infants cry vigorously wlu*n they want food, though not painfully hungry. They often 812 SKENE: TEE VOICE IN DIAGNOSIS. [N. Y. Med. Jocb.^ awake from a sound sleep and, if not nursed, cry until they are fed. On the other hand, infants who seldom or never cry are often found to have serious organic disease — hydrops cerebri, for example. The cry which indicates some slight Floxin Ear Drops irritation of the mucous membrane of Purchase Floxin the alimentary canal, such as intestinal indigestion, or disturbance of the Floxin Eye Drops skin from heat, cold, or annoying clothing, is so near to the natural cry that it is not easily distinguished or described. From the ordinary cry, which may be called normal, it differs in several respects, according to the degree of discomfort suffered by the patient, and its temperament or personality. Some of the characteristics are that the Floxin Tablets cry is louder and more intense, and the screams follow each other in rapid succession ; or Buy Floxin Online the sound is begun in a high pitch and falls abruptly; or the sound ends in a higher pitch than that in which it began. In more pronounced indiges- tion or skin irritation the cry is more intense and pro- longed, or continuous, with only a pause of a moment or two now and then. There is occasionally an abrupt rise

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