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over the bent back. .A.ny difl^erence in contour is thus easily detected, the prominence on one side be ing distinctly outlined. There is some rigidity o' the spinal muscle, but not tlie spasm of muscle April 22, I9II-] OGll.rV: CHRONIC BACKACHE. 775 which is present in spinal disease, with which it must not be confounded. The backache of rotary lateral curvature is usu- ally referred to the lumbar region. It is mostly complained of at the end of the day or after a long- period of standing or sitting without the back be- ing supported. Backache is not a constant symptom of scoliosis ; a tired, dragging feeling may be the only discomfort complained of. Diagnosis: The deformity in scoliosis is so ap- parent, even in the milder cases, that, after an ex- amination has been made, its nonrecognition would be unpardonable. The diagnosis is rendered more easy when it is remembered that scoliosis is a con- dition and not a disease, and that the inflammation preceding Brand Viagra Online Prescription and accompanying disease never occurs in scoliosis and the history is always negative in this regard. Backache in scoliosis is always relieved by treat- ment. There are two forms of treatment, viz., ex- ercises, developmental and corrective, and spinal support. Both should be employed. Exercises alone are not sufficient, except in a very few se- lected cases. On the other hand, a spinal brace should not be applied unless at the same time we utilize to the best advantage the patient's corrected spinal muscle force, without which it is impossible to obtain the best results. III. Sacroiliac joint strain. During the past few years we have learned much more about the sacro- iliac joint than we previously had knowledge of. The sacroiliac joint had previously been considered a fixed joint without motion and was so described in anatomical textbooks. We now know it to be a movable joint lined with synovial membrane and partaking of regular joint functions. The joint capsule is firm and dense, but is liable to strain, and when such occurs the sacrum assumes a more vertical position than is normal. With these Brand Viagra Online Prescription changes there is an accompanying backache with a point of tenderness over the sacroiliac articulation. Two other symptoms usually present arc' a uni- lateral curvature of the spine toward the Brand Viagra Online Prescription side af- fected and a tenderness referred directly to the joint posteriorly when with the patient lying upon the back the thigh is forcibly flexed with the leg ex- tended. •Etiology. Sacroiliac strain may be caused by lifting a heavy weight; by slipping forward and suddenly jarring the joint in an effort to save one- self from falling. It also occurs during pregnancy. Many of the backaches complained of after labor are due to sacroiliac joint strain. It is also fre- quently the cause of postoperative backache. After lying for some time upon a hard, flat table without a posterior pelvic support, as is frequently the case, the leg structures holding the sacrum Brand Viagra Online Prescription are strained and subsequently pain is complained of. Another of the causes of this condition is one leg being shorter than the other. The difference in the length of the legs results in a tilting of the pelvis, which results in an uneven distribution of the body weight upon the sacrum, which again results in a sacroiliac joint strain. Treatment: The treatment of sacroiliac strain is to reduce the displacement of the sacrum if any, and to hold the joint firmly together. This is ac- complished Brand Viagra Online Prescription by properly adju.sted fixation Brand Viagra Online Prescription appliances: I. Adhesion plaster and bandage dressing; 2. nar- row pelvic belt with perineal straps ; 3, wide pelvic belt with abdominal support; 4, corset Brand Viagra Online Prescription firmly fix- ing pelvis. IV. Flat Feet. That flat feet or weak feet are a frequent cause of backache is too often forgotten by general practitioners. One reason of this is that the feet are not or may Brand Viagra Online Prescription not be complained of, and the only symptom referred to is the Brand Viagra Online Prescription backache. This type of case is exemplified as follows : M. M., aged :ii years ; bartender ; weight, 1.S4 pounds. History : For the past two years a dull aching pain in the back, lower lumbar region, worse toward the end of the day. No other symptoms. When asked about his feet re- plied that they were "perfectly all right." Examination showed a rather accentuated lumbar lordosis without any definite points of tenderness. The feet were markedly everted and the longitudinal arch was not properly sup- porting the body weight. He stood and walked with an out turning of the feet. His symptoms were entirely re- lieved after having had proper shoes orescribcd Brand Viagra Online Prescription and flat foot plates made. .Always examine the flat foot with the patient standing ; there is nn exception to this rule. The diagnosis should be made before the long arch of 776 FRIXK: PSVCHOGENETIC CONVULSIONS. the foot has been flattened or decreased. Look for