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strated by buy singulair online Williams, montelukast price by the silence which ensues if, while generic singulair listening through it, the rubber tubes are plugged * buy cheap singulair D. M. Cammann. An Historical Sketch of the Stethoscope. New York Medical Journal, 1 880, p. 4fio. t London MedicaJ. Gazelle, 1842; 'Ci/clopwdia of Practical Medicine, 1859, article Stethoscope' I A fault common to the ordinary binaural stethoscope is the imper- fect manner in which the head pieces often tit the ears, for it is neces- sary in this instrument not only that the ear tips tightly plug the audi- tory meatus singulair online on each side, but that their perforations open freely into the auditory canal. I have derived great satisfaction from a stethoscope modified by cutting in two the metal head pieces, just above the attach- ment of the spring, and then reuniting the divided parts by a closely fitting swivel montelukast tablets joint. The angle between the two head pieces can thus he made to vary within wide limits, and the ear tips may be perfectly fitted into the auditory canal in any position of the head. I am not aware that this modification has hitherto been employed. Dec. 4. J 897.1 SEWALL: STETHOSCOl'IC PRESSURE IN HEART EXAMINATION. 759 or clamped. But it cheap singulair is extraordinary how readily vibra- tions can be transmitted from tlie solid parts of the instrument to the air columns, or the reverse, for exam- ple, when the orifices of either the chest or head piece of the stethoscope are plugged, the ticking of a watch against which the bell is placed is still distinctly audible through the instrument. It may be proved that, on the one hand, vibrations of the solid bell are somewhat transmitted to the inclosed air, and, on the other, vibra- tions of the air columns of the flexible tubes are, to a slight degree, taken up by the solid head pieces of the instrument. The physical difference between the two chief forms of stethoscopes can be illustrated by simple experiments. Let a ticking watch be suspended in singulair mg a cardboard or wooden box (such as an empty cigar box), so that the watch may touch that side of the box nearest the ob- server. If this surface be now explored with a flexible binaural stethoscope, the bell passing lightly over it, the ticking of the watch will be loudly heard over the whole singulair tablets of the area traversed. When, however, the bell of the stethoscope is applied to the surface levocetirizine montelukast with increasing pressure, the sound of the watch gradually dies out and usually totally fails except at those points which are opposite the place of contact with the timepiece. "When the bell touches the surface opposite the watch no amount of pressure annuls the sound, though its quality is somewhat changed. In this way the area in contact with the unseen watch may be accurately mapped out. In the wooden box the sound is conducted with greater intensity from the point of origin along the grain of the wood, but in the cardboard receptacle conduction is equal in all singulair price directions. The same results are obtained when the mouth of the stethoscope bell is tightly cov- ered by a sheet of rubber. When, however, the straiglit wooden stethoscope is used instead of the binaural instrument, it is found that the sound of the watch is heard indifferently over the surface of buy singulair the box singulair cost whatever degree of pressure is used; the sound, in this case, is rather intensified by in- crease of montelukast sodium tablets pressure. An instructive modification of montelukast tablet the order singulair experiment consists in applying the bell of the flexible stethoscope to the sounding board of a stringed instru- ment, such as the " autoharp " or zither. When a string- is plucked the complex note is finely transmitted by the stethoscope when this is lightly applied; but when firm pressure is used the overtones are, for the most part, abolished, and the note becomes poorer in quality and apparently lower in pitch, because of the diminished intensity of the overtones. "UHien the same experiment is tried with the wooden stethoscope, pressure does not cause diminution of the sound, but rather intensifies certain high overtones, and order singulair online thus apparently raises the pitch of the note. Any thin board placed in contact with a tightly stretched wire takes up the vibrations ac- cording to its own properties purchase singulair online of resonance; stethoscopic pressure with the flexible instrument applied to boards of difl'erent size, made to vibrate in this way, purchase singulair annuls now one, now another set of partial tones. It is evident that the physical effect of firm -pressure of the stethoscope bell is to dampen the vibrations of the surface included in the border of the bell, and, as it is this vibration which is the chief source of sound that is transmitted by the flexible binaural instrument, in- crease of pressure must greatly decrease the intensity of the note. And, also, it can hardly be doubted that it is the vibrations due to sympathetic resonance which are thus dampened, and not those depending on direct sound conduction. On the other hand, as in the ex-

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