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thus designating its seat, and giving it name. Many speak of vesicular and respiratory murmurs as inter- changeable terms. The late Dr. Hyde Salter placed the seat of the periactin price respiratory or vesicular murmur in the convective sys- tem, and mostly in the sub-pleural, minute bronchioles {Brit- ish and Foreign Med.- Chi7\ Bev., July, 1861). Dr. Waters, of Liverpool, whose prize essay on the minute anatomy of cyproheptadine 4 mg tlie human lung has done so much to increase our knowledge EESPIRATOEY MXJEMUES. 491 on tins subject, describes the mode of connection of the bron- chioli with the air-sacs. The opening sometimes is, as it were, a hole punclied out, clean and periactin uk ronnd, and the air, buy periactin uk passing in and ont, mnst make a sound much in the same way as is done in a toy tin whistle. The late Dr. Cammann, of this city, believed the cause of the murmur to be the passage of air into the air- sacs and out again. Dr. AVilliams, after speaking of portions of the chest where blowing sounds are heard, goes on to say : " Then there is tlie vesicular respiration, which is heard in most other parts of the chest ; it is a diffused murmur caused by the air penetrating through the minutest tubes, and into their numerous periactin 4 mg vesicles or cells." Dr. Gerhard, of Philadel- phia (" Lectures on the Diagnosis, Pathology, and Treatment of Diseases of the Chest "), says : " The sound of air entering the vesicles is different from that caused by its passage through the order periactin tubes, and tlie former is, therefore, known as the vesicular sound, the latter as the tubal or blowing sound. The vesicu- lar sound is often called a murmur, from its softness and diffu- sion over a large space, and cannot be produced unless the vesicles are healthy or nearly so." And again he says the cause of difference " seems to be the different manner in which the air impinges upon the vesicles and tubes. But the vesicular sound is in part owing to the vibration of the air, and in part to the noise produced by the dilating of the vesi- cles themselves." order cyproheptadine Dr. Walshe represents the natural respiratory murmurs as caused by inspiration and expiration, for which there is usu- ally purchase periactin a healthy type, "commonly termed — a, pulmonary or ve- sicular ; 5, bronchial ; c, tracheal ; d, laryngeal ; e, pharyngeal, according to the part of the respiratory apparatus fi'om which the sounds audible externally are transmitted." Dr. Com- gan divides the sounds heard in auscultation into " simple sounds or murmurs, and compound sounds or rattles. . . . All the sounds heard in the chest belong to one or the other of tliose two kinds; and, if, when you hear a sound, the exact nature of which you may be in doubt, you will first refer it to its class, your labor in deterjnining what it is will be very much diminished." The American editor of " Stokes on the Chest " describes vesicular murmur as that " of a soft and 492 RESPIRATOEY MUEIVIUES. gentle, or, as it lias been otherwise described, a mellow, con- tinuous, gradually-developed, breezy murmur, unattended witli a sensation eitber of dryness or humidity ; and we are properly cautioned by M. Fournet and his reviewer not to expect a character of sound which conveys the notion of a successive dilatation of separate vesicles, or, as it is sometimes called, pure and vesicular." Dr. Hyde Salter says : " There is another reason, to which I have not buy periactin referred, which makes me think that the respiratorj'^ murmur must have a tubular or quasi tubular seat, and cannot be formed in the air-cells ; it is, buy cheap periactin that fine crepitation, such as that of pneumonia, supplants it ; it does not merely drown it, it supplants it, the two do not coexist ; " and farther on buy cyproheptadine : " If, then, pneumonic crepitation is a veritable tube-sound, and its seat the microscopical tubes immediately subtending the air-cells, the supplanting and destruction of the respiratory murmur by it would show that this latter has an identical seat, and is therefore a tube-sound." This ex- plains Dr. Salter's views as to tlie seat and cause of the mur- mur. He believes it to be caused by the passage of air through these microscopic air-tubes, just before they reach the vesi- cles ; and, as he is one of the latest and most brilliant writers on this subject, perhaps he represents the periactin buy online more advanced views of the profession. He does not deny that sounds formed anywhere in the convective system, from the mouth or nose to the smaller bronchise, mingle with and enter into the com- buy cheap cyproheptadine position of the ijespiratory murmur, but he denies that the air- vesicles or alveoli have any thing to do in forming the sound. He believes the sound is formed in the bronchioles, immedi- ately subtending the pulmonary pleura. Carefully examining the opinions of diiferent writers, it is evident that some consider the respiratory murmur as having a single seat and cause, while others order periactin online recognize its composite character. Yet, I am not aware that any one has ever at- tempted to analyze the murmur, and study its constituents separately as w^ell as together. They speak of the vesicular character, the pulmonary periactin online quality of the respiration, but they attempt no analysis. To show that this may, and ought to be done, in order to attain unto a higher grade of excellence in diagnosis, cyproheptadine hydrochloride is the main object of this paper. A clear under- EESPIKATOEY MUEMUES. 493 standing of this wliole matter will make it necessary, as pre- liminary, to look at tlie buy cyproheptadine online minute anatomy of the tissue of the lungs, and of the bronchial system ; secondly, the circulation of the lungs cyproheptadine 4mg and of the bronchial system ; and, thirdly, the char- acteristics and constitution of the residual air, its object and office. The bronchial system may be, and is frequently, cheap periactin called the convective or the broncho-respiratory system, and the pulmonary is called the true respiratory system. The}^ differ

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