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for rickets. There was a shortening of three-fourths of an inch in the affected limb, and now I doubt if any of you can tell which it was. I consider this a perfect re- sult. DISCUSSION. Dr. R. H. Sayre: This is the first case I have ever seen in which a perfect cure has resulted. Dr. T. Halstead Myers: Last summer I saw a case in which a perfect cure was obtained. There was one-eighth of dapoxetine india an inch of shortening, but the child could run, jump, and do anything that dapoxetine purchase other children could do. Dr. A. cheap priligy M. Phelps : This seems to be a case of dislo- cation occurring at birth in a child in whom the acetabu- lum was normal. I have treated thirty-one patients with congenital dislocation of the hip, and in only one have I found a normal acetabulum. There is a perfect reduc- tion in this case, but it should not be placed before us as a standard ; for in most cases there is no acetab- ulum in which to put the head of the bone. I do not believe that bloodless forcible reduction is a good method ; for shortening will follow because there is usually no acetabulum in which the head of the bone can rest. The only way to treat these patients is to make an acetabulum with the chisel. Of course, I am in favor of making an attempt at reduction, especially if the X-ray shows the presence of an acetabulum. Dr. George R. Elliott : In regard to the non-cut- ing operation for congenital dislocation of the hip, I wish to emphasize the fact that there is considerable acetabu- lum in young children when the joint is dislocated, say in children under four years of age, and this is readily ap- preciated by the operator at the time of reduction. The head of the femur can generic priligy be distinctly felt as it is forced over the posterior border of the socket. It is felt to be retained, and can be easily dislocated again. Now, if the limb is purchase priligy fixed at the proper degree of abduction, there is no possibility of its getting out of position, being held by the ligamentous and muscular priligy price structures of the joint. If it is not felt to be in something at least partially perform- priligy cost ing the functions of a socket, I believe the probability of its being retained, and thus leading to more perfect acetab- ular development, is greater than dapoxetine online after the cutting buy priligy online opera- tion in which the ligamentous and muscular structures have been divided. The field for the operation is in young subjects. Dr. Whitman : This case is one of a dapoxetine in india series of six- teen in which I have employed the bloodless method of reduction. I think the head of the bone is capable of making an acetabulum. A rudimentary acetabulum ex- ists in nearly all cases. I know this because when I push the head of the bone in place it stays there. When the dislocation is anterior, which is not usually the case, I twist the bone around. pott's disease. Dr. R. W. Townsend : This little child is three years of age, and was brought to the Hospital for Ruptured and Crippled last week because of a swelling of the neck. The question of dapoxetine hydrochloride the causation of this tumor was investi- gated, and it was found that the order priligy child had Pott's disease of the upper cervical vertebrae. This condition had not been suspected, although the child had been seen by a number of physicians. It is rather unusual to see a Pott's abscess in this location ; under these circumstances it is much more apt to be retropharyngeal. She was put on this temporary frame, and as yet nothing much in order priligy online the way of treatment has been done for her. priligy tablets discussion. Dr. Phelps: When these abscesses occur in the cer- vical region they should be at once operated upon from without on account of their liability to rupture internally. I have seen cases in which purchase priligy online such an abscess appeared and pushed the pharynx forward. If they rupture internally the child will die of pulmonary tuberculosis. Therefore, they online priligy should be incised from without. ENLARGEMENT OF THE TIBIA; OPERATION. Dr. B. Farquhar Curtis: You will remember that Dr. Ketch showed this little girl at one of the meetings last fall. She is twelve years old, and had an anterior bowing of the right tibia and some eversion of the foot. The right tibia was three inches longer than that of the sound leg and greatly thickened, the circumference of the affected leg being one and a half inches greater than that of the other. The child's general health was also poor, probably as a result of pain. A skiagram showed a thick- ened tibia with some irregularities in the enlargement, and an almost complete disappearance of the epiphyseal line, which was due to pressure. When the child was shown there was some discussion as to the exact nature of the affection. There was no ascertainable history of syphilis, but in order to give the patient the benefit of the doubt, she was given iodid of potassium. She was op- erated upon on January 6th, after a month of medical treatment and rest in bed. During this buy priligy time the tender- ness disappeared and her general condition improved. The tibia was then exposed and a wedge-shaped piece of the bone removed. This wedge, however, was not sharp at one end, and was sufficient to shorten the leg about an inch. The bones went into position very well, but the soft parts were so voluminous that the skin could not be made to dapoxetine buy cover the wound, and consequently it burst open. Later, it was necessary to do a plastic operation. Two long incisions were made on either side of the wound, the skin dissected up and drawn together over the wound. Thiersch grafting was performed on February 22d. She now has a fairly good leg. The bone is the same length as that of the sound leg, and there is absolutely no tender- ness. As yet, she does not walk very well, because she has been out of bed only a week. The bone was found to be roughened on the surface, and the central canal bad entirely disappeared. It was much more solid than usual, although not as hard as cortical bone. My recollection is that the wedge meas- ured over an inch at the narrowest part, which was buy cheap priligy pos- teriorily, and as much as two inches on the anterior sur- Digitized by

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