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From the case of Thomas we learn that by the operation of incision, agreeably to the views of Millot and Aran, we should be careful not only how deep we make our incisions, and exactly where, even if the measure to relieve the constric- tion promises to be of value in certain cases. The mind is ever fertile in reasoning out and suggesting from experience, and in the medical profession it should be more so than in many other avocations, when it is for the relief of such unfortunate accidents as paxil discount the present one under paxil 12.5 mg consid- eration in the female. Besides the recently-revived method of Millot and Colum- bat, it has been proposed, though not yet carried out, by Tait, of London, and Dr. Thomas, to pass, according to Tait, a tenotomy-knife through the inverted fundus, purchase cheap paxil and then incise the neck of the peritoneal flask on both sides, and thus reduce the dislocation. Another suggestion of Dr. Thomas's and Tait's was, to per- paxil price in pakistan form the operation of opening the peritonceum, as for ovarioto- my, and then dilate paxil mg the cervix by cheap purchase online paxil dilating instruments. Dr. Thomas was the fii'st to essay this treatment, which proved, fortunately for the patient, successful under several adverse circumstances. RESPIRATORY MURMURS. 489 "With these various resources the gjnfficologist, in cases of in- version of the uterus, recent or paxil price chronic, it is evident (although the cases may be of long duration, and if adhesions have not formed with the surrounding structures, which paxil price india is rare, as it is seldom the intestines have been found in the uterine peritoneal cavity) that cheap order paxil one or the other devices are capable of effecting the desirable object of the replacement of the ute- rus. Under the conservative principle of action based on ex- perience of paxil prescription the great success attending the various methods, whether by paxil cr the usual or the combined rectal and vaginal taxis, or by the elastic pressure, or incisions of the neclj:, external or internal, or opening the peritonaaum. The idea of ablation ot the uterus should be deferred as the very paxil 25 mg last resource. Much as this operation has been lauded and adopted by some gynae- cologists, it has gradually been laid aside, and probably may pass into the " idea of a day." rx paxil The experience, in a clinical point of view, as to treatment, proves the great advance which has been made by careful and patient study, faithfully wi'ought out. Correct observation shows the conservative tendency to save that important organ fi'om mutilation for inversion, and not, paxil price without insurance as some authorities would advocate in this enlightened day, the maiming another organ, for a procidentia uteri, TVe should advance with the great advantages we possess through experience and observa- tion, and not rctrofirrade. Art. II. — Respiratory Murmurs^ By James R. Leamixg, M. D. Since the time of Laennec, those engaged in investigating physical conditions of the chest have ever united in looking to the breath-sounds for the elementary key. Able and distinguished men have given much of their lives to the consideration and practice of auscultation, but certainty in diagnosis in incipient disease is yet vainly de- sired. It must be that the method of study has been faulty, or that attention has been wrongly directed. Under these ' Read before tlie Academy of Medicine, January 4, 18V2. 490 EESPIRATOEY MUEMUES. circumstances, presumption may be jDardoned, even if it sliould fail in the attempt to show a better wa j. Laennec recognized both bronchial and pulmonary breath- sounds, and explained them as being caused by air-friction. In describing pulmonary respiration, he says: "On applying the cylinder, with its funnel-shaped cavity open, to the breast of a healthy person, we hear, during inspiration and expira- tion, a slight but extremely distinct murmur, answering to the entrance of the air into and expulsion from the air-cells of the lungs. This murmur may be compared to that produced by a pair of bellows whose valve makes no noise, or, still better, to that emitted by a person in a deep and placid sleep, who takes now and then a profound inspiration " (Forbes's Laennec, p. 29) ; paxil 10 mg and the translator adds in a foot-note : " It purchase paxil will be most easily and distinctly perceived by applying the naked ear to the chest of a child." Laennec's view is theoretical, not based on a careful study of all the facts. Indeed, at that time the mi- nute anatomy of the lung, and the constitution of the residual air, paxil buy were not known. Subsequent opinions have been in- fluenced more or less by Laennec's, especially in this, that all respiratory murmurs are considered to be air- and tube-friction sounds. Many differ from him as to the seat, but all agree with him as to the mechanism. M. Beau, of Paris, placed its seat in the pharynx ; Dr. paxil 30 mg Sanderson, of Edinburgh, in the rima glottidis. Skoda, of Vienna, considered vesicular mur- mur as occurring only in inspiration, and being caused by air- friction, and he likened it to the noise one makes in forcing the air through the nearly-closed lips. He denies that the re- generic paxil spiratory murmur has any thing to do with the vesicular breath- ing, which, he says, is a purely bronchial sound. Andral called it a sound of pulmonary expansion or vesicular respiration,

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