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stage. Frequent change of position is desirable so as to prevent pressure sores. Keeping the patients out of doors is very beneficial. Treatment of the deformities : After the tender- ness is gone, active treatment should be begun viagra online mastercard accepted — the sooner the better. The resistance of the patient should be built up with general tonics, fresh air, and good food. Massage, electricity, and muscle training .should be given until the period of spon- taneous repair has passed. This period is an in- definite one, and by most authorities is to last where can you buy viagra between one and two years. The massage should be given daily for fifteen minute periods; it may be given either with an electrical vibrator or manually, preferably the lat- ter. The mothers are taught how to massage the affected parts at home, so that no time is lost. The benefits derived from massage are: (1) The im- provement of local and general circulation. (2) The prevention of muscular deterioation. In regard to the electrical treatment, there are a great many authorities who claim that little bene- fit is derived from its use; many others, however, lav much stress on its use. In our clinic at the Lebanon Hospital, we have found it of some value; but cer- tainly not the specific benefit claimed by some ortho- pedic surgeons. Static electricity is best, because. it improves the life of the muscles and nerves, without overstimulation. Should overstimulation take place, much serious damage can be done. Hence it is best to give these treatments for short periods of time, about five to ten minute seances three times a week, alternating them with massage; the current used should be the weakest viagra online mastercard accepted that will produce a contraction. Where static electricity cannot be had the galvanic current is next best. The faradic current is useless and can only do harm by overstimulating the muscles and nerves. Hydrotherapy is of some benefit, as it increases the circulation and stimulates the growth of the limb. The affected part should be immersed in water 95-100' F. every night for fifteen to twenty minute periods. Muscle training is the most useful. It is based on the fact that all the motor centers in the cord have not been destroyed, unless the destruction in the cord has been a very extensive one. Hence new connections and new paths for sending a motor impulse from the brain to the muscle are produced. Passive movement is the first one done. It should be done slowly and to the fullest range of motion possible, pausing at each extreme and returning the part to the normal position when the motion is fin- ished. The same movement is then performed against slight resistance offered by the patient, the resistance being gradually increased. The patient then performs the movement himself while the phy- viagra online mastercard accepted sician guides it along the proper plane. The guid- ance is gradually diminished and as the patient becomes more proficient the guidance is removed entirely; finally the movement is done against the resistance of the physician; the resistance may be varied according to the degree of paralysis present. In addition viagra online mastercard accepted to this muscle training, a good means at our disposal is to get the patient on his feet as soon as possible after the painful stage and in that way have him use his muscles by his viagra online mastercard accepted own efforts, to walk and balance. The sitting posture is most adaptable for training the muscles of the spine and trunk. If there is fixed deformity, by which is meant if the functions of a joint are limited and there is restriction of its arc, this deformity must be over- come where can you buy viagra before any treatment can be satisfactory. The deformities usually met are footdrop or pes equinus, flexion deformity at the knee, flexion and abduction deformity' at the hip. In the spine the most troublesome deformity is lateral curvature. At times if the paralysis of the posterior group of muscles is extreme, kyphosis may be induced. In the shoulder the deformities are usually slight, be- cause the part is not subjected to the strain of weight bearing and because the force of gravity is opposed to muscular contraction. The best way to overcome these contractures or fixed deformities, is by gradual forcible stretching and the subse- quent application of plaster of Paris bandages, splints or braces. One jnust always viagra online mastercard accepted bear in mind the possibility of injuring nerves and blood ves- sels when stretching a limb. If the contracture deformity is too powerful to be controlled by these means, tendon lengthening by either the open or subcutaneous method, myotomy with the subse- quent application of plaster of Paris bandages should be resorted to. These preliminary steps where can you buy viagra September 11, 1915] MEDICAL RECORD. 441 should subsequently be followed by mechanical or operative measures. A few words about lateral curvature of the spine. This deformity should be looked for in every ease and where present, es- pecially low down in the spine, forcible correction, and retention by a Kleinberg brace, or an Abbot jacket, perferably the former, should be done. The brace or jacket must be applied early and worn persistingly because the cause of the deformity which is the unilateral paralysis is always present to aggravate the condition. If after about one or two years of conservative treatment cases do not respond satisfactorily they are then ready for radi- cal operation.