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lower, and twists the spine and trunk into a mild form of deformity, the mechanism of which was so ably demon- strated by Dr. A. B. Judson ^ at the meeting of the American Orthopedic Association, in September, 1890. This deformity passes off when a normal standing or sit- ting position is assumed ; but when such temporary de- formity occurs not only daily, but several times a day, and for protracted periods, it gradually increases and later becomes permanent and fixed, and produces the actual bony and ligamentous changes which are met with in cases of long standing. The faulty sitting position is more frequent than the standing, as children as a rule spend about five hours Coreg Generic Name in the twenty- four, sitting in school. I will therefore call your attention to the school habits of children, while sitting, and their shifting of positions to relieve the tiring of the strained Coreg Er 'groups of muscles. Dr. A. Baginsky- in his admirable paper read before the " German Society for the Care of Public Health " at Berlin, in March, 18S8, says : '• More and more are sur- geons convinced through their anatomical and physiologi- cal investigations and from their practical observations, that scolioses, the most important of all deformities of the spine, in a very large majority of cases owe their origin to the influence of school life upon the organism-of the child." This writer further shows that if we observe a class of children during the early portion of school hours, more particularly if the subject of the lesson be interesting and the weather cool, they will all sit quite erect, with their heads well poised, their chests brought forward, their feet evenly placed upon the floor (if the lower Coreg 2.125 Mg extremities are not too short to reach it), and the frontal plane Coreg 20 Mg of their bodies parallel to the edges of the desks in front of them. Later on, one by one, the children will permit the shoulders to drop and fall forward, the chins to ap- proximate their chests, thereby changing the entire con- tours of their spines. There is a tendency to turn the trunk to the right or left, in order to relieve one buttock of the weight of the superimposed body. Some are apt to cross the thighs, thereby producing the same effect. The frontal planes of the bodies of the children are then no longer found to be parallel to the edges of their desks. Dr. Baginsky shows even worse positions which are assumed by children during their writing lessons, when the frontal planes of their bodies are placed at right an- gles to their desks. Any change of position, no matter how slight, changes the centre of gravity, and those muscles which hold the ' The Rotarv Element in Lateral Curvature of the .'^pine. A. B. Judson, M.D.,' N. Y. Trans-American Orthopedic Association. Vol. iii. . 1890. - Ueber RUckgrads-verkrummingen der Schulkinder, Deutsche Medical Zeitung, Berlin, 1888, ix.. pp. 529-541. 776 MEDICAL RECORD. [December i6, 1893 body upright are strained as soon as the position recedes from the erect one. When one set of muscles is thor- oughly tired, the child changes position to relieve the strained set of Coreg Cr 80 Mg muscles, and brings those muscles which have not been taxed into play. When children become habituated to faulty positions in sitting, they are apt to, and do, assume analogous faulty positions while standing, and when these faulty positions have Coreg Cr 10 Mg been maintained for Coreg Cr Generic a while, decided scoliotic attitudes are seen, and, as I have stated before, even though they be temporary, they become habitual, and lay the foundation for well marked deformities. Is Coreg A Beta Blocker Before taking up the treatment of scoliosis, I do not think it amiss to call general attention to the pernicious effect of long and continued school hours, without inter- mission for play or calisthenics, and also the improper furnishing of school houses with benches, chairs, and desks of a regulation size, witliout regard to the varying sizes of the pupils, and consequently without any regard for their comfort and well being. Sitting at best is tire- some, not only to children, but to everyone. Treatment. — In every case of rotary-lateral curvature, from the mildest case to the one which appears beyond redemption, the first efforts should be directed to the prompt removal of the causes, apparent or real, of the deformity. Any shortcoming of the extremities from pa- ralyses, inequalities, or deformities, as well as disturbances of vision, should be corrected. The child should at once be prohibited from attending school, thereby elim- inating the most persistent and potent cause. The gen- eral condition of health should be carefully attended to, by the correction of any disturbances of digestion or as- similation, by frequent baths to improve the condition of the skin, by the administration of tonics, if found neces- sary, to improve the nervous and muscular systems, and by sufficient open air exercise. The patient should have a properly constructed chair to sit upon ; the seat of the chair should incline downward from before backward, the inclination forming an angle of about eight degrees with a line parallel to the floor upon which the chair rests. The back of the chair should be Cheap Coreg properly shaped to receive the back of the patient, and it should extend at a right angle to the seat, up to the shoulders of the patient ; the seat of the chair should lie Coreg 40 Mg at such a height that the patient can rest the feet comfortably upon the floor. In a chair of this description, the patient assumes a slightly reclining position, thereby relieving all muscu- lar strain. The patient should be instructed to rest frequently for from five to fifteen minutes at a time by lying supine upon the floor, the lower extremities fully extended, and the upper extremities also fully extended above the head. Self suspension by means of a Sayre apparatus twice a day should be advised, and the patient should be in- structed in exercises while suspended from an horizontal bar or from rings. I shall now consider the various degrees of scoliosis, with reference to the treatment of each degree. 1. Habitual scolioses which can be obliterated by the voluntary muscular efforts of the patients. 2. Scolioses which are not affected by muscular efforts, but which can be reduced or obliterated by suspension of the patients. 3. Scolioses which are not affected by muscular efforts, or by suspension, the deformities being fixed. In Generic Coreg Cr all three forms of scoliosis nothing is of greater importance than proper, thorough, and regular gymnas- tic exercises, which will equally develop the entire mus- cular system. Various kinds of exercises have been ad- vocated by different writers and excellent results have been claimed by them. I wish especiallv to call your attention to that excel- lent paper of Dr. Reginald Sayre, ^ in which he minutely describes the gymnastic exercises which patients should be taught. These exercises, with slight variations, ac- cording to the requirements of individual cases, are ' New Yorl: Medical Journal, 1888. vol. xlviii. , pp. 533-338. the ones I use in cases which come to me for treat- ment. 1. Habitual Scolioses which can be Obliterated by the Voluntary Muscular Efforts of the Patients. — In these cases I place my entire Coreg Cr 40 dependence for good results upon the general directions before described, and syste- matic and Coreg Cr 20 regular gymnastic exercises. I neither con- sider it necessary nor wise to give support to the patient by means of any apparatus or even a corset, but I prefer to leave the muscles which are being developed and strengthened by exercises, entirely unrestrained and free. 2. Scolioses which are not Affected by Voluntary Muscular Efforts, but which can be Reduced or Oblit- erated by Suspension of the Patients. — In this clase of cases I adopt the same course and plan of treatment as in the first class of cases, but in addition I find it neces- sary and beneficial to apply well-fitting, light, and well cemented plaster of Paris corsets, while the patients Order Coreg are suspended in a Sayre apparatus, and to permit the pa- tients to wear them, if the deformities are obliterated when the first corsets are applied, until they have im- proved sufficiently to enable them to correct their de- formities through their own muscular efforts. They are then treated as patients of the first class. In those cases in which the deformities are only reduced but not oblit- erated by suspension, as the patients improve under treat- ment new corsets are applied from time to time, until at last the deformities can be entirely obliterated by sus- pension. These also become patients of the first class. 3. Scolioses which are not Affected by Voluntary Muscular Efforts, or by Suspension, the Deformities being Fixed. — The treatment of this class is the same as that in the foregoing class, but other means must be re- sorted to to reduce the fixed deformities of the ribs and spine. I have found Coreg 18.75 Mg the forcible daily twisting of the spine and compression of the ribs, of considerable value in reducing the fixed deformities, and I have within the past two weeks begun the use of an apparatus used by Dr. Albert Hoffa, of Wurzburg. This apparatus is de- scribed in the Zeitschrift fiir Ortlioptediiclur Chirurgie, 1891. Although I am not in a position to claim any re- sults or benefit from the use of the apparatus, I judge from Coreg Cr 40 Mg appearances and froin the combined effect Coreg Cr 20 Mg of sus- pension, fixation of the pelvis, twisting of the spine, and pressure upon the scoliotic eminence, that it will prove to be a powerful adjunct to the more successful treatment of old cases of fixed scolioses. It will give me great pleasure to report the results of cases treated in this manner, whether successful or other- wise. 134 East Sixty-first Street. The Use of Cocaine. — i. Coreg 80 Mg Amount of cocaine used must be in proportion to extent of surface it is desired to an- aesthetize. In no case should the quantity exceed one grain and three cjuarters. 2. Cocaine should never be used in cases of heart disease, pulmonary disease, or in persons of highly nervous temperament. 3. In inject- ing cocaine, the intradermic method is preferable to hy- podermic. By injecting into, not under, mucous mem brane or skin, the risk of entering a blood-vessel is avoided. 4. During injection the patient should always be in a recumbent position ; in operations upon the nose and throat the head should not be raised until anres- thesia is complete. 5. It is of great importance that cocaine should be pure, since its combinations with cer- tain other alkaloids result in poisonous compounds. — Brooklyn Medical Journal. To ftuench Thirst After Abdominal Operations. — Water alone will Coreg 10 Mg do it, but if given by the mouth it is often vomited, or else excites intestinal activity, which, for some hours at least, must be carefully avoided. Hence we may inject i)er rectum half a pint of warm water every two hours during wakefulness. This will generally permanently relieve the thirst in twelve hours. —Dr. C. W. Cathcart. December i6, 1893] MEDICAL RECORD. in

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