ize ventolin proventil the dangers of the operation. The difficulty will be
to select the cases in which it may be safely performed-
Dr. H. L. Taylor: I quite agree with Dr. Town-
send that proventil price we ought not to let the impression go out that
we advocate the method until we have had more experi-
ence with it. The operation has been much modified
since it was first suggested. In his first article, Calot
said that " the spine should be forced into place." In his
next article he said that if any difficulty was experienced
in forcing the spine straight, he took out a wedge-shaped
piece of the bone. Chapeaux (7) considers it essential to
wire the spinal processes. All these modifications of the
operation have been adopted. The French surgeons also
consider it important to encase the head and shoulders
in a plaster-of- Paris jacket. It has further been suggested,
and very sensibly, that the proventil hfa coupon reduction should not be done
at one sitting, but at several. The tendency is to make
the operation very much less radical. Many surgeons
say that it is wrong to use much force. Calot says he
uses all his strength — "toutema force" — while traction
is made upon both upper and lower extremities. The
operation has been so much modified that it remains to
be seen how much of the original procedure will be left
after it has been well studied. While it is in the hands
of experts, we are safe ; but it is not well to let experi-
mentation extend into non-expert hands.
Dr. Sayre: "An ounce of prevention is worth a
pound of cure." In Pott's disease the diagnosis should
be made before the kyphos forms, and there will then be proventil coupons
no necessity for correcting it. I would like to call atten-
tion to the fact that proventil cost as far back as coupon for proventil 1830, or thereabouts,
this same procedure was employed, except that instead
of the hands, they used a large windlass arrangement and
a long lever with which to proventil inhalers force the spine into position.
This apparently met with disfavor, for it passed out of
use. It seems to me that in a great many instances
forcible reduction would be followed by very serious re-
sults. If we could only determine in advance the cases
in which the spine could be safely straightened we would be
able to proceed intelligently. Inasmuch as we cannot do
this, it is difficult to buy proventil online know what to do. In some cases
the bone is so diseased that any attempt to forcibly
straighten the spine will result in producing gaps between
the vertebrae ; in other cases a psoas abscess will result.
When my father first applied plaster-of- Paris jackets,
he stretched the patient as much as he could and still not
cause discomfort. One of the celebrated German sur-
geons, probably on the ground that if a little of a good
thing is good, more is better, stretched his patients by
means of weights applied to their heels. Two or three
of them promptly died, and the autopsies showed that in
each an abscess had been ruptured. How much the re-
lationship between perpendicular position and the anes-
thetic had to do with the deaths, I do not know. I be-
lieve there is proventil mdi now a surgeon who suspends his patients by
the heels when he applies a jacket.
Forcible reduction has been employed in quite a num-
NEW YORK ACADEMY order proventil OF MEDICINE.
ber of cases, and the death-rate, I believe, is so far only
one per cent. It is extremely doubtful, however, proventil inhaler whether
we should employ this method. The cases should be
most carefully selected. There should be no elevation of
temperature and no active pathologic process. I recall a
case almost exactly like the one referred to by Dr.
Townsend, in which the child died within two hours.
Autopsy showed a large saddle-shaped abscess at the
junction of the trachea.
Dr. Elliott : In a recent number of the British
Medical Journal Murray reports two cases in which proventil nebulizer forci-
ble reduction was followed by death. One patient died of
acute tuberculous pneumonia and the other of acute
Dr. Phelps : As I said before, I confess that I un-
dertook the operation in fear and trembling and against
my convictions. After examining pathologic specimens
and noting the bone proventil albuterol changes which take place in Pott's
disease and in analogous affections, it seemed a danger-
ous thing to do. I have studied the literature of the
operation, and find that it proventil hfa inhaler is a very old one, although
there is no question but that Chipault is the modern
originator of the method. Calot followed him in the
work. The latter presents deductions which seem to
show that the bone is reproduced in cases in which there
is wide separation after reduction. Regnault also reports
reproduction of bone. Lorenz and others have had re-
lapses and have reported them. Menard had a case In
which he reduced the kyphos and ruptured an abscess.
In another case fracture of the vertebrae was produced.
Calot reports 204 cases with no accidents and no deaths
on the operating-table. Menod criticises him and says
his results are too buy proventil good and should not carry weight.
Chipault says there are too many relapses, and contends
that all cases will relapse unless the spine is wired.
Lorenz reports paralysis and relapse following the opera-
tion. Jonnesco has reported three deaths in thirteen
operations. Lorenz and Menard are the chief critics and proair proventil
they denounce the operation. Chipault is conservative
and cautious. M£nard is judicial and skeptic, proventil inhaler coupon and the
majority are enthusiastic, says Lovett.
The patients presented here to-night are not the first
to be operated upon by this method in this country.
Rid Ion of Chicago has performed the operation a number
of times with excellent results. proventil 90 mcg I believe there is a legiti-
mate proventil coupon field for this method. The time to employ it is early
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