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Fig. 7. (vide Figs. 2 and 3). The observation which first led me Eskalith Cr to con- sider a change from the old one necessary was that the weight of the head, when suspended Buy Lithium Carbonate from the free extremity of the cephalic shaft, constantly tended to press the instrument, together with the upper posterior margin of the jacket, against the spine, causing abrasions of the skin. This pressure was noticed to be most per- nicious when the instrument was used in Lithium Carbonate Online cases of Buy Eskalith spondylitis involv- ing the medio-superior dorsal junction, and accompanied by a marked boss. The jurymast, in its modified form, differs mainly from its antecedent in that the arms, whicli are incorporated between the layers of the jacket, are curved forward under the axillae. This disposition of the trunkal shafts secures for the instrument, when sustaining the weight of the head and neck, a state of stable equi- librium, the center of gravity of the whole falling Purchase Lithium Carbonate within the base, and being located inferiorly to the lowest point of the shafts. Undue pressure against the spine is impossible, and the head is sustained without mechanical strain. It is unnecessary for me, in this con- PRINCIPLES OF TREATING POTT'S DISEASE. 347 nection, to make more than a passing allusion to the mechanical advantage thus gained. Another point gained in the modified form of the instrument is that of securing the maximum amount of strength with the mini- mum weight of metal. This is accomplished by making the ce- phalic shaft of a light strip of steel bent upon its edge, instead of flatwise, and widest at the point of greatest curvature, a feature not well shown in Fig. 7. Though the Eskalith Cr 450 altered head-rest, with elastic straps attached (Fig. Eskalith Er 7), probably fulfills the more important mechanical indications for treatment, it is, nevertheless, on some accounts, very objectionable. It, like all supports that pass over the head, is unsightly in appear- ance, and never fails to fix the eyes of the curious on the already over-sensitive patient whenever he chances to appear in public highways. Mothers, too, usually find fault with it because of attracting so much attention. For these reasons, among others, I set about devising an instrument which, while not extending over the head, would exert continuous elastic traction upon the diseased vertebrae, and permit of voluntary articular motion. After con- siderable experimentation, I have to oifer the head-rest shown in Fig. 8, which was made for me by G. Tiemann & Co. It permits of all the normal Buy Lithium Carbonate Online movements of the head being made at the pleasure of the patient, or controlled and directed by the surgeon. Fig. 8. Fig. 9. The lower part of the instrument, like that of the jurymast, is held between the layers of the gypsum bandage, the shafts being curved forward under the arms, so as to bring its base beneath the part supported. Fig. 9, when compared with Fig. 3, illustrates the 348 ROBERTS: NON-UNIFORMITY IN THE comparative inconspicuousness of tlie apparatus when the patient is dressed. Still more recent experiments have resulted in a mechanical device for the treatment of cervical caries which yields all the bene- fits derived from the above-described instrument, without neces- sitating the use of the plaster jacket to support it, and form a basis for counter-pressure. The disadviintage of restricting the move- ments, and consequently retarding the growth of healthy vertebrae, is thus avoided. The instrument is also exceedingly light, weighing from six to twelve ounces, Eskalith 450 Mg according to the size of the patient. To conclude the history of this case, I have only to arid that the abscess, after discharging about two months, closed. At the expi- ration of eight months' treatment, the patient was dismissed cured, and has Lithium Eskalith since remained in perfect Lithium Carbonate Buy health. I wish to have it borne in mind that this is not one Order Lithium Carbonate Online of the cured patients that still wear an apparatus " as a means of protection " against relapses or Generic Lithium Carbonate injury, but that he has for months dispensed with all mechanical props. Without any artificial support whatever, he holds his head as erect

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