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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- Digitized by Google 574 NEW YORK ACADEMY order proventil OF MEDICINE. [Medical News 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 tuberculous meningitis. 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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