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in the course of the disease. In case of long generic provera standing, in which there is a large kyphos, ankylosis, and abscess, it is a dangerous procedure. I think we should go slow, and that this Section ought to discourage the general em- ployment of the method. For the present it should be confined to experts in orthopedic surgery. Within a few years we will know more about it. Dr. Gibney: I think we all agree with what has been said. We should discourage the wholesale performance of an operation of this kind. Lovett has recently dis- cussed the subject fully in a paper in the Boston Medical and Surgical Journal, Mr. Jones of Liverpool has also reported fifty or sixty cases in which he has performed the operation. I appreciate all the dangers connected with it, and I merely presented these cases this buy cheap medroxyprogesterone evening to show that it could be performed without reaction, and not for the purpose of advocating its general employment. The case referred to by Dr. Townsend is an exceptional one. Most of the cases we see offer no special contraindication to the operation. In regard to what Dr. Myers has said about waiting for a cure by other means, if anybody waits longer for a cure than the orthopedic surgeon, I provera online would like to know who he is. We treat our patients and kept them in braces for years, and I do not see why they should wear apparatus for these long periods if forcible reduction can cure them within a shorter time. There is much difference of opinion in regard provera mg to the details buy provera online of the operation. Mr. Jones and his colleagues in Liverpool criticise the French surgeons for putting their patients up in cotton. They also advocate the steel ap- paratus rather than the plaster-jacket. All of us know that there are great differences in plaster-jackets. We also know that if buy provera too much cotton is used, we do not get a good fit, for the parts recede and the jacket is then much too loose. If purchase provera the plaster is properly applied and fitted over the hard parts, it will give no trouble. Lovett claims in his article that a certain proportion of patients with hip-joint disease treated by forcible reduc- tion have died of tuberculous meningitis. I, for one, do not put much faith in this statement. I do not know how the reports of other operators read, but I do know that for years I have been forcibly correcting deformities of the hip, and order provera online that it is the rarest thing in the world to cause dissemination of the bacilli. I do not find that patients with a deformity of buy medroxyprogesterone online the spine are willing to go through life with it. They are morose, and feel that Nature has treated them harshly, and it is very necessary to do something for them. I know that if I had a child with such a deformity I would welcome anything which promised relief. I think there is a way of treating these patients by studying them and making a proper selection of treatment and provera cost not trying to do too much all at once. I do not believe it is necessary to buy cheap provera fix the head and shoulders. If we bring the plaster well up, we will not have any recurrence. Just what Nature will do in these cases remains to be seen. MALIGNANT DISEASE OF THE SPINE. Dr. H. L. Taylor: This man is forty-seven years of age, a waiter by occupation. purchase medroxyprogesterone He tells me that a num- ber of years ago he was kicked in the chest by a cheap provera horse. The injury resulted in the formation of a tumor which was excised six weeks ago at Mt. Sinai Hospital. The exact nature of the tumor is not known, but the man tells me that it was the size of his head. About eight months ago he began to have very severe buy medroxyprogesterone pain in the lower part of the back. Cough and expectoration also began provera price at this time. Examination of the back shows it to be round, and on the left side of the median line there is a projection which appears to be an enlargement of a spinous process at about purchase provera online the first lumbar vertebra. There is marked stiffness and limitation of motion. In addition to this there is an area of sweating on the right side which points Digitized by Google April 30, 1898] REVIEWS. 575 to the existence of a carcinomatous tumor. This is a pathognomonic sign of carcinoma, as proved by antopsy in cases in which the diagnosis was not made during life. This symptom is probably due to involvement of some of the sympathetic ganglia of the lumbar region, and is never seen in tuberculous disease of the spine. APPARATUS FOR FORCIBLE EXTENSION. Dr. Elliott : I have here an instrument which I have devised for forcible extention. It is especially in- tended for provera tablets use in reduction of the congenitally dislocated hip. It can also be order provera used for forcible reduction of the spinal column in cases of the angular curvature of caries. It can be adjusted to any table or bed, and the force em- ployed can be regulated at will, and, if desired, measured in pounds. It is light and inexpensive and was made for me by John Reynders & order medroxyprogesterone Co. REVIEWS. A Text-book of Materia Medica for Nurses. By Lavinia L. Dock, Graduate of Bellevue Hospital

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