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off than when equipped so that he can rise from his bed after a painless sleep and pass the imitrex generic form day up and dressed, and with his schoolmates and play-fellows, his appetite and respiration stimulated by happy hours passed in the fresh air and sunshine ? With suitable mechanical equip- ment the patient should not, and will not if left to him- self, pass an hour of his waking time in the invalid's bed. Second, the arrest of motion in the joint may be am- ply secured by the traction exerted by the hip-splint in those stages in which it is required by the painful condi- tion of the joint and the apprehension which the very thought of articular disturbance excites in the mind oi the patient. Absolute immobilization is out of the ques- tion from the mechanism of the hip-joint, but fixation, or a reasonable degree of immobilization, is easily pro- duced, and conveniently maintained. Third, the patient equipped with the hip-splint, when standing and walking, is prevented from putting his weight on the joint. The heel cannot reach the ground. The patient sits on the perineal strap of the apparatus, which is essentially a crutch-head applied to the ischiatic instead of the axillary region. With this arrangement he wears a high sole on the well foot to make up for the factitious imitrex cost per pill length which is given by the splint to the af- fected side. It is not entirely fanciful to say that the patient is sitting while walking, because he alternately stands on the well foot and sits on the perineal strap. An adult patient tells me that when tired he rests, while still erect, by leaning against some support and sitting on the buy imitrex nasal spray online hip-s]jlint. It was thought at one time that it was impossible for a patient to go for any time touching the ground with only one foot. With the hip-splint, however, children run about for years, putting their weight on the well limb alone, the affected leg being thus converted into a pendent member, like the arm. Fourth, the patient while wearing the hip-splint may be induced by instruction and drill to give up the " false time " of his footsteps, which is the chief cause of the de- formity and limp of hip disease, and to return to the nat- ural rhythm of human locomotion, in which equal time is given to the two feet. The result of walking habitually in this way is at once the abolition of a great deal of the appearance of lameness and in time the correction of de- formity, because the adducted limb will pass, without conscious effort on the part of the patient, from adduc- tion to abduction (with, at the same time, and for the same reason, a decrease in flexion) in order to place itself in that position in which it can best do its half of the work of progression, thrown upon it by the adoption, or rather the resumption, of natural rhythm or " correct time " in walking. A few words are in place price imitrex describing the apparatus and buy cheap imitrex online its application. Its frame is made of steel. In use it does not require to be bent, as so many pieces of ortho- pedic apparatus do, therefore it may be well, but not too sharply, tempered. It consists of upright and pelvic band, as shown in Fig. 10. The upright, price imitrex nasal spray shown in imitrex cost canada Fig. 1 1 , extends from the ground to a point about midway between the iliac crest and the trochanter. It is flat, with its width imitrex available generic form laterally disposed, and its thickness antero- posteriorly, an arrangement by which the strength of the metal is in the direction of the strain when the patient's weight is borne by the instrument. It is composed of a bar and a box, the former being propelled in the latter by a rack and pinion, and held at the point of election by suitable mechanism. The box is attached above to the pelvic band, and the bar ends below in the foot-piece, which is shod with leather and carries two leather straps. A high sole for the well side is conveniently carved from a block of light wood and fastened to the sole of the shoe in the manner shown in Fig. 12. Properly shaped and stained it is quite as presentable as the more expensive cork sole. A knee piece is adjustable on the upright, and, being of soft steel, is easily adapted to the size of 548 MEDICAL RECORD. [October 28, 1893 the lower part of the thigh. If the patient is tall and re- quires a longer upright, this piece is carried on price imitrex without insurance the bar, instead of, as in Figs, ro and 11, on the box, thus do- ing away with the necessity of increasing the length of the latter with the increased length of the upright. A piece of webbing is buckled around the upright and the limb at the lower part of the thigh, and a leather strap around the upright and the lower part of the leg. The pelvic band, shown in Figs. 10 and 13, is a nearly semi- circular piece of bar steel, covered with leather, or better, with hard rubber, the angle of its attachment to the up- right being adjustable and firmly fixed by a bolt and nut. It carries the perineal strap of webbing, padded with blanketing and covered with canton flannel. A strip of adhesive plaster from one and one quarter to three inches wide, and ending below in a buckle, extends on each side of the limb from the middle of the thigh to the lower part of the how much does imitrex cost leg. The plaster is protected by a legging made of twilled muslin provid- ed with eyelets for lac- ing. To apply traction to the limb the leather straps attached to the foot-piece are buckled to the adhesive plaster strips attached to the limb, the perineal strap is buttoned over the ends of the pelvic band, and the rack is pro- pelled in the direction of the foot by the pin- ion or key. In prac- tice, if the patient is more than a" mere child, he uses the key at will, and may be de- pended on, if the joint is in a painful or ten- der condition, to keep up steady traction as long as there is any indication for its use. It was thought at first that traction thus ap- plied relieved pressure on painful articular surfaces, but there is excellent reason to be- lieve that its good effect is due to the fact that it assists the patient in his conscious and un- conscious (voluntary and reflex) efforts to keep the joint from motion, in other words, that it produces fixation, or a reasonable degree of immobilization. The knee-piece is useful in the same way. Worn at the lower part of the shaft of the femur, it hinders motion at buy imitrex online uk the knee, and, pari passu, at the hip. There is probably no more distressing sight than that of a patient in the acute stage of hip dis- ease, and no resort of surgery is more simple in modus operandi and more certain to give relief than the applica- tion of traction in this way. In this stage the apparatus should be applied although abscesses and great deformity are present, as in the exceptionally difficult cases related above. The end of the pelvic band may extend obliquely over the abdomen on account of the adduction of the limb. It may even be necessary at the beginning to attach the perineal strap by buckles instead of loops, to gain for it a suitable length, and in some cases to apply it to the perineum on the sound side. But with care and gentleness the ap- paratus can be arranged in some way so that a slight and increasing amount of traction is effected. Immediate re- lief from pain is followed soon by reduction of the de- formity, so that in a few days the restored symmetry of the patient's figure will enable him to wear the splint properly adjusted and comfortably. The pelvic band may then be brought down to its proper place on a level mid- way between the anterior superior spine of the ilium and the pubic bone. It ma)- thereafter be kept at that level if the perineal strap is of the right length and suspended by loops instead of buckles. A bed-ridden patient treated in this way soon recovers strength from the return of sound sleep, and before long seeks to leave his bed and try walking without crutch support except that afforded by the perineal strap. A high sole is attached to the shoe of the well foot, and a shoulder-strap, shown in Fig. 13, transfers retail price imitrex the weight of the splint to the opposite shoulder, and he is instructed in the necessity of acquir- ing, as soon as it can be done by daily effort, the habit of moving his feet in correct time. He then ceases to be seen at his home or in the hospital ward, and becomes an " office patient " or an " out-patient." The splint as thus far described is to be worn day and night. It makes traction on the limb and protects the joint from the traumatisms of walking. The latter is necessary in all stages of the disease, but there are long periods when traction is not necessary, when all that the patient requires is a perineal or i.schiatic support to keep the affected limb t"rom reaching the best price imitrex ground. The adhe- sive plasters and the rack and pinion and other machinery for maintaining traction may therefore be dispensed with during a large part of the treatment. The simple up- right, shown in Fig. 13, may then be used instead of the upright show^n in Figs. 10 and 11. Alteration in the length of this upright and adjustment of the knee-piece are provided for in a simple manner. The adhesive plas- ters are removed from the limb and the leather straps from the foot-piece, but in all other respects the appa- ratus is applied and worn as if it were a traction splmt. Thus is there a generic form of imitrex simplified, however, it is essentially an ischiatic crutch, and, like any other crutcli, it is to be laid aside at night. In closing it may be said that the apparatus, thus ar- imitrex cost us ranged as a crutch, may be useful in many other affec- tions besides hip disease. If its simplicity and conven- ience were generally recognized it might facilitate the treatment of any disease or injury of the lower extremity in which it is desirable to let the patient take exercise without usmg the affected limb. Treatment of Herpes Zoster. — Brocq recommends the following ointment : IJ . Boric imitrex generic no prescription acid i part. Oxide of zinc. Starch fia 2 parts. Vaseline buy imitrex online canada 6 parts. I.anoline 9 parts. The vesicles are carefully opened by means of a imitrex generic release date needle sterilized in the flame of an alcohol lamp, and are then washed with a boric acid solution containing a small pro- portion of alcohol. After this they are covered evenly with the above paste, and powdered with starch, and over all is placed a thick layer of wadding. If the pain is very buy imitrex injection online severe, a little chlorohydrate of morphine or cocaine is incorporated with the ointment. The Microbes of Bank-notes. — Two bacteriologists of Havana, .\costa and drande-Rossi, have been studying the microbes of bank-notes. They have proved that the weight of these notes increases in the course of circula- tion by reason of foreign matter. Then microbes ap- pear, their number exceeding nineteen thousand in one

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