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inflammation, so often dreaded as a complication, rarely comes on as a result of early movement. We must, however, know just what damage has been done before we begin to move a joint, or we may make matters worse. For example, in making passive motion in a sprain of the buy viagra seychelles ankle, where the external lateral ligament is so often torn, it would be bad practice to adduct the foot. If, after cautious and well-regulated movements, the joint swells and becomes tender, it is buy viagra seychelles well to wait at least a week or more before resuming movement. The second indication order viagra 25mg in treatment, i.e., to promote the absorption, is to be met to a great extent by band- aging and rest. After two or three days, soaking the joint in hot water, or, better still, a strong solution of vinegar and salt applied just as hot as can be borne for ten or order viagra 25mg fifteen minutes, three times a day, does much to soften and absorb the coagulated effusions. These baths should be followed by frictions with some good stimulating liniment, the rubbing being done firmly but gently in the direction of the return current of the lymphatics. It is a most excellent practice to begin these frictions above the seat of the injury in order to empty the absorbents, so that they may the better ac- commodate the lymph from the injured tissues. This lymph is probably more viscid than that found circu- lating in normal vessels. If after ten days the thick- ening about the joint has not disappeared and there still remain tender spots in moving the articulation and on making pressure, counter-irritation by iodine, or, often better still, by buy viagra seychelles a fly blister, is indicated. In two weeks' time, with the treatment outlined, we will nearly always find the joint which has been quite se- verelv sprained in good condition and ready for work. At this period sometimes, however, owing either to the severity of the injury or to some constitutional peculi- arity, it remains painful and insecure, and even the slightest movement may cause acute suffering buy viagra seychelles with swelling. The joint structures are in a condition of subacute congestion. What is now needed is absolute rest, and rest must be had or there buy viagra seychelles will be a long his- tory of disability, which may become permanent. A plaster-of-Paris splint will nearly always give the re- quired rest. Put order viagra 25mg on properly, it will last at least a month, when, as a rule, it should be taken off and the joint examined. It may be necessary to reapply this splint one or more times, though usually four to six weeks of this treatment is enough. We are now in great danger of carrying our rest too far, and it often requires the nicest discrimination to tell when to begin forcible movements. Forcible movements are move- ments made with some force, let us understand, and when we are of order viagra 25mg opinion that they are necessary to break up any adherent bands and to restore motion to the joint. they should be carried out in a thorough manner. Half-hearted, inefficient attempts order viagra 25mg do more harm than good, and, by producing pain and swelling without getting motion, often doom the joint to still further rest, when rest does positive harm. The trouble at this time is to a great extent in the muscles, which really are the true ligaments of the order viagra 25mg joint. Frictions with stimulating buy viagra seychelles applications, together with the use of electricity, are extremely useful in restoring their tone and strength. The faradic current in these conditions is probably more generally useful than the continuous current, especially if there be simply muscular wast- ing and stiffness without much pain. When there is marked tenderness accompanying atrophy, the galvanic or constant current meets the indications better, not only improving the nutrition of the muscle, but removing the pain as well. Thus does the joint, which is other- June 13, 1S96] MEDICAL RECORD. 837 wise perfectly normal, often remain weak and uncertain simply because of this lack of muscular tone. Our attention cannot be too strongly called to this state of the muscles, which it seems is so frequently oxer- looked. The various elastic appliances which are so frequently worn after sprains, have much to do very often with keeping them weak and uncertain. They are of unquestionable value at times, but their indis- criminate use without the proper medical supervision does much harm. Constitutional treatment, as has been intimated, is often necessary: rheumatic and gouty patients often require colchicum and the iodides and the salicylates. Where there is a peculiar buy viagra seychelles feeble- ness of the power of repair without any special dia- thesis, iron and strychnine are of great value. In looking over the accident records of a large industrial establishment, the-Pennsylvania Steel Com- pany, with which I am connected, I buy viagra seychelles find in thirty- eight hundred cases of accidents, two hundred and sixty-one sprains of all kinds, or an average of one sprain in about every fifteen accidents. These are by no order viagra 25mg means all that have occurred during this time, this record having been made up only from those which were considered order viagra 25mg worth recording. The least time for treatment was three days; the longest time eight months. The general average was a trifle over nine days. Sprains of the wrist, the ankle, the back, and the knee were the most common; there being forty wrist-joint sprains, which were under treatment about six d lys. Knee sprains, while common, are not so nu- merous as those of the ankle, there being twenty-six cases in this record, which were under treatment on an average of about twenty-three clays; of ankle-joint sprains there were seventy-two < ases. which got well on an average of about thirteen days. Sprains of the back were most numerous, there being eighty, with an average of eight days for treatment. These back injuries were with few exceptions marked cured on the record, though as a matter of fact there are, it seems, few bad sprains of the back which are ever really cured permanently. Time will not permit my taking up the treatment of these back injuries. In the total of eighty eases there was not one in which the spinal cord was seriously involved. The muscles or their tendinous attachments, or order viagra 25mg the invest- order viagra 25mg ing membrane of the fascia, were almost invariably