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depressed piece of bone, a dislocation, a foreign body, an abscess, or a tumor, there is good reason to believe that removal of this pressure will Purchase Artane favor the restoration of the normal offices of the cord and help the patient to get well. The bony cavity in which the spinal cord rests is not difficult of access, nor is the mere opening of it bv surgical means more serious than opening the cranial cavity. Dogs and cats tolerate exposure of the spinal dura mater through a wound in the posterior segment of the vertebra with almost trilling inconvenience, and on them the sur- geon Buy Artane can learn more of the handicraft of removal of the spinous processes and vertebral laminae in a few hours than can be learned by months of patient study of the literature of laminectomy or laminotomy. There are characteristic Order Artane Online difiFerences between the cervical, dorsal, and lumbar regions which cause corresponding dif- ferences in the methods of doing these operations ; and it is an addition to the operation Buy Trihexyphenidyl Online to open the dura mater of the cord and explore its vascular and serous membranes. The danger Order Trihexyphenidyl to Buy Trihexyphenidyl life is greatly increased. The most delicate manipulations must be familiar to the surgeon who would do this, lie can not be permitted to tear round with his fingers and instruments as if he were removing an ovary or Artane Online peeling out a uterus. The godless and indiscriminating surgeon will never " cut for record " in spinal cases. One thing will always discourage and deter him — the patients are always sick, except in the rare cases of railway spine. The vertebral Artane Tablets canal may lie opened so that the lateral and posterior aspects of the spinal cord can be ejisily Generic Artane ex- amined by first making an incision through the integument and superficial fascia, four inches long, over the spinous processes nearest to the diseased area of the spinal cord. Then the muscles and tendons must be cut away from their attachments to the spinous processes and the laminie. For this purpose it is well to use a strong knife and [leriosteal elevator, so that the periosteum may be turned back with the tendons and muscles, as it subsequently becomes useful in tilling in flie boneless Artane Price area. A pair of strong retractors with teeth are commonly needed to Purchase Trihexyphenidyl Online hold back the soft parts, so that the lamina- can be divideil with a chisel and bone forceps. After the lamina' Order Trihexyphenidyl Online on each side of the spi- nous process have been cut llirough, the latter is catight with a strong forcejis and lifted from it-s bod, oxposiug the Buy Cheap Artane vertebral cavity and the dura mater. .\ considerable Hpacc normally exists between the dura mater anil its in- vcHling wall of bone. Tliroiigli an opening made by lifting out the spinous process and lamina of one vertebra, the cord can generally be examineil a distance of an inch above and below the opening. It is not often necessary to re- move mole than the posterior MOgiiient of one vertobra. If the chinel and bone forceps are u.sed cautiously, and no more bone Im removed thnii is n«'ci's.Hary to overcome the patliological conditions on which Purchase Trihexyphenidyl the o|icratioii restjt, there will lie no need of nplint Order Artane or other apparnlus to Artane 1 Mg support the Hpine during tlir healing of llio wound. 436 WEISSINOER: STRANGULATED FEMORAL HERNIA. [N. Y. Mkd. Jour., I dress the wound carefuilv with gauze and cotton and change the dressing as often as it becomes soiled. It is not a good plan to turn the patient during the dressing of the wound. It is better to have three or four strong at- tendants, who can lift him three times a day from his bed and support him in a horizontal position while the dress- ings are being applied. In closing the wound, I take pains to close the perios- teum and muscles over the boneless area Purchase Artane Online with silk sutures. Drainage by means of tube or gauzes is rarely needed, because gravity is competent to do the work. The internal treatment is generally limited to tonics and special attention to diet. The impairment of bowels and bladder incident to para- plegia makes the after treatment and care of laminectomy cases particularly Artane 2 Mg important. Bedsores are sure to come if the patient is not lifted from his bed several times every twenty-four hours. I have tried many devices for moving the patient to facilitate keeping him clean, but have suc- ceeded best when I have summoned a sufficient number of nurses to lift him bodily as often as required. The drib- bling urine is apt to get into the bedding and infect the wound if it is not carefully conducted away. I have had no trouble from using a sterilized catheter, lubricated with freslily sterilized oil, three times a day, and in the intervals a rubber or glass urinal has been constantly in service. A diet containing well-cooked Indian meal helps to keep the bowels in a proper state Buy Artane Online of solvency. A CASE OF

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