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the United States was in somewhat the same state of inertia as it seems to be in now in England, Dr. H. G. Davis, then of New York, demonstrated the value of traction in the treatment of chronic joint disease. Soon after, if not contemporaneously, several surgeons in New York, men of unquestioned ability, whose reputations to-day are world-wide, began to devote themselves Purchase Protonix to the treatment of chronic joint affections. These men, among whom may be mentioned Dr. Lewis A. Sayre and Dr. Charles Fayette Taylor, contributed largely to form a school of American orthopaedic surgery, Cheap Pantoprazole the distinctive feature of which was the portative traction idea of Davis, Although the pathology of joint Pantoprazole Online disease was not then fully understood, the relief afforded by traction apparatus properly applied and the benefit conferred by the almost unrestricted out-door life per- mitted by its use, was apparent to those who investigated the subject intelligently. And now, as the result of the efforts of the eminent men above named and of those Purchase Pantoprazole Online who have followed them, orthopasdic surgery is a fally recognized specialty in the United States, and there are many men Buy Pantoprazole of ability engaged in promoting its interests and in extending its usefulness. In several of the leading medical collegesof the country — the University of Pennsylvania, Bellevue Hospital Medical College, and the University of the City of New York, not to mention several others — there is a chair of orthopaedic surgery. The American Orthopaedic Association, composed of thirty active members living in different parts of the United States, has been duly admitted to membership in the Congress Order Pantoprazole Online of American Phy- sicians and Surgeons. In New York there are many ortho- paedic clinics, especially in two of its colleges and in the schools for practitioners ; two large orthopaedic hospitals where thou- sands of patients are treated annually ; one large general hos- pital with a distinct orthopaedic service; several hospitals which have orthopaedic consultants ; two large hospitals which have orthopaedic dispensaries; and an exceedingly active orthopaedic society. In Boston, Philadelphia, and Buy Cheap Pantoprazole other places also ortho- paedic surgery is recognized and appreciated. On the other hand, orthoptedic surgery in England has ap- parently made but jlittle progress during Generic Pantoprazole the period named. There are no college professorships of orthopaedic surgery ; there are no national or local associations devoted to this spe- cial branch of surgery ; and, while there are orthopaedic insti- tutions in London and elsewhere, under tlie care of eminent surgeons whose names are familiar to all students Protonix Mg of surgical literature, the mechanical treatment of joint disease is sadly neglected. The general surgeon still holds almost unopposed sway, and chronic joint disease is not considered worthy of special orthopaidic Purchase Pantoprazole care. When the general surgeon of England needs mechanical as- sistance in the conduct of a case of joint disease he is apt to call in an instrument-makei-, whose imperfect knowledge of the me- chanical needs of the patient is not always supplemented Order Pantoprazole by an extended experience Cheap Protonix on the part of the surgical adviser. Not only is this true, to a great extent, of general orthopaedic meas- ures, but the portative traction treatment is Buy Protonix not appreciated in England, and the skill, experience, and patience required to use the traction apparatus successfully have not been sufficiently cultivated by either the surgeon or the mechanician. The con- sequence is that English surgeons find themselves unequipped for the proper mechanical management of chronic joint disease, and as between the uneducated aid of the conventional instru- ment-maker, and their own unwillingness or inability to meet the indications from a mechanical standpoint, there is, at least, a tacit confession of failure. Under these circumstances, and while the surgeons of the English orthopaedic institutions, who had the opportunity of de- velopingthe mechanical therapeutics of chronic articular disease, allowed the opportunity to pass or preferred to follow the beaten paths of their predecessors, Mr. Thomas, of Liverpool, promul- gated a ijiechanical treatment of chronic joint disease which re- sembled very much that advocated by the late Dr. Hutchison, of Buy Protonix Online Brooklyn. Dr. Hutchison's method may be briefly described, and, as a matter of illustration, the hip apparatus will be selected for description. In order to protect the diseased hip joint, a patten three or four inches high is placed under the sound limb and is secured Buy Pantoprazole Online to the foot, tlie patient using axillary crutches for the purpose of locomotion. The diseased member thus be- comes a pendent limb — very like the arm. This simple expe- dient constituted the sole protection of the diseased joint. It seems almost useless to say that the method never became popu- lar with the orthopaedic surgeons of the United States. Mr. Thomas's apparatus consists of the same general ar- rangement, as above described, with the addition of a posterior splint (a bar of steel bent to fit the outline of the body and ex- tending from the thorax to the lower end of the thigh bone) on the diseased side. At its upper end this steel bar is attached to the thorax by bands and straps; at its lower end it is secured to the thigh by a strap. As in the Hutchison method, locomo- tion is performed by the aid of axillary crutches, a high patten being placed under the sound limb. Mr. Thomas contends «that his apparatus absolutely immo- bilizes the hip joint. It exerts no traction whatever ; on the contrary, as it is fitted only for " fixation," on the lever prin- ciple, it must be apparent that this posterior hip splint makes a fulcrum of the inflamed articular surfaces. Hence, if the at- tempt is made to " fix " the joint by this method, there must be an increase of the articular pressure, which is just the thing to be avoided in the treatment of chronic arthritis. But we have never Order Protonix seen, either in England or in this country, a Thomas splint for the hip that produced anything approximating true 400

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