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By T. Fraser. Idaho State University. 2018.

The undulating countryside obtained by “Pugh’s traction” in early cases quality 0.5 mg avodart medicine 003. In provided ideal conditions for the open-air treat- the early 1920s cheap avodart 0.5 mg online symptoms 4 weeks, the first tip-up hip carriage was ment of skeletal tuberculosis so popular at that produced and this was essentially the fracture time. In addition, enforced rest, adequate diet and board on wheels, elevated to 30 degrees from the conservative surgery, which included the aspira- horizontal. When there was clinical and radi- “There had never yet been devised a jacket or ological evidence of healing, many children were splint... Pugh argued that hyperextension opened side, thus elevating each kidney in turn to up a gap between the vertebral bodies, which improve urinary drainage. The lesion would high fluid intake, restriction of dietary oxalate and then heal with fibrous tissue, which allowed oral administration of potassium citrate, solved recurrence of the deformity on assumption of the the problem. In 1933 Pugh introduced a second upright posture, despite the support of a jacket or hip carriage in which the spinal frame was brace. He was also against posterior spinal bone mounted on rollers on a backward inclined slope grafting as a method of shortening the duration of to produce traction by suspension. He regarded the procedure as per- spinal carriage, a rotary device was incorporated. The operation was often done while the to lie in the more comfortable horizontal disease was still active in an endeavor to reduce position. Pugh commonest single cause of crippling in children argued that the center of gravity for the body was in the London area,9 and in 1924 the London well in front of the spinal column and that if County Council designated 50 beds at Queen recumbency was discontinued before healing was Mary’s Hospital for the treatment of this condi- well advanced, collapse of the vertebral bodies tion in the second stage, that is, from the loss could occur anteriorly. Furthermore, the graft pre- of muscle tenderness until the disease became vented telescoping of the vertebrae and main- stationary. Pugh did not believe in outpatient tained the space between them with a persistent treatment, as was commonly practiced then, and abscess and further sinus formation. Pugh attempted to neutralize the defor- ered that heat, massage and electrical stimulation mity after arrest of activity by encouraging the were beneficial, although he was fully aware of compensatory curvature in the healthy region of the dangers of fatigue. An outdoor his children, spinal caries developed before the heated swimming pool was constructed for the age of 6 years, when the shape of the spine was use of these patients in 1927. Constructed of suspension” remains of considerable value for gas piping, the frame was shaped individually for the treatment of children with transient synovitis each child to produce the appropriate compensa- of the hip, Legg–Calvé–Perthes’ disease, coxa tory spinal curvatures. The child was secured to vara,11 and fractures of the femoral shaft, and pro- 282 Who’s Who in Orthopedics vides a memento of “Pugh of Carshalton,” who foreign editor of The Journal of Bone and Joint devoted his life to the care of crippled children. The Cathedral of San Pietro e San Paolo, built in part from the References Roman remains, was erected in the fourth century. D’Arcy Power, Le Fanu (1953) legends attribute the founding of the famous Uni- 2. Wastson-Jones (1952) student population has decreased, but the medical school of the university is still outstanding. The Istituto Ortopedico Rizzoli is situated on a hill on the outskirts of this fascinating old city and occupies the picturesque buildings of a Benedic- tine monastery known as San Michele in Bosco. The early years of this institute for crippled children were not noteworthy, until Alessandro Codivilla, modest and skillful master, became its director and surgeon-in-chief. This great general surgeon, after excelling in the surgery of the gastrointestinal tract and the brain, devoted his talents to orthopedic surgery, and the “Istituto” became world-famous. Codivilla made original and important contributions to the surgery of frac- tures and the methods of tendon transplantation, and to the development and standing of the specialty. At his death in 1912, Codivilla was succeeded by Vittorio Putti, the son of a well-known surgeon who was for many years professor of surgery in the University of Bologna. Putti had first become identified with the Istituto Ortopedico Rizzoli in 1903, when Codivilla had appointed him as an Vittorio PUTTI assistant. Following 2 years of study in European 1880–1940 clinics, he returned to the institution in 1909 as vice director, and in 1914 became director and Vittorio Putti was professor in the University surgeon-in-chief of the Istituto. He was also of Bologna, surgeon-in-chief of the Istituto professor of orthopedic surgery at the University Ortopedico Rizzoli, a founder of the Société of Bologna. Internationale de Chirurgie Orthopédique et In 1922 he opened the country branch, which de Traumatologie and president of its 1936 provided for the care of 100 cases of surgical Congress, Honorary Member of the British tuberculosis, and as director of this hospital (Isti- Orthopedic Association, the American Orthope- tuto dio terapico Codivilla di Corona d’Ampezzo) dic Association, Corresponding Member of the in the Dolomites, he found frequent escape from American Academy of Orthopedic Surgeons, and his very strenuous city life. He was a bib- A brilliant student, a wide reader, an able liographer, medical historian, orthopedic investi- administrator, a resourceful and skillful surgeon gator, and teacher of surgeons. He had been a with a mechanical bent, he enhanced the 283 Who’s Who in Orthopedics reputation of the Istituto Rizzoli, and like Surgeons held in Boston in 1934 and in Chicago Codivilla, made lasting contributions to the in 1937.

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From early life he a disinfectant in dealing with sewage at Carlisle avodart 0.5mg otc symptoms multiple sclerosis, had been accustomed to the scientific attitude he decided to give this chemical a trial on wound towards phenomena around him and he had been treatment cheap 0.5mg avodart mastercard symptoms wheat allergy. After investigation with the pure acid, fortunate in the masters who trained him. When he finally adopted a 1 in 20 watery solution, and he arrived in Glasgow, he was already mature as this strength of carbolic acid became a permanent a scientific investigator; indeed among surgeons feature of his technique. With this solution he there was scarcely anyone so well equipped; he cleansed his hands, his instruments, the patient’s belonged to the Hunterian tradition. Lint soaked in car- Of his many papers embodying the results of bolized oil was first used as a dressing but after researches, two in particular were of great signi- many experiments was abandoned in favor of a ficance, indicating the trend of his thinking and putty made of carbonate of lime and a solution of the preparation leading to the accomplishment of 1 in 6 carbolic acid in linseed oil. The study of coagulation of the The result of this treatment upon abscesses and blood attracted his attention for many years. Suppuration physiological phenomenon in the healing of disappeared; wounds became healthy; patients wounds formed the subject of his Croonian were comfortable; the number of amputations Lecture before the Royal Society in 1863. In con- diminished rapidly; and Lister was able to say: sidering the pathology of the open wound, he was “But since the antiseptic treatment has been led to the study of the genesis of inflammation. Lister, with his microscope, respects under precisely the same circumstances observing the capillaries of the frog’s web and the as before, have completely changed their charac- bat’s wing when they were subject to irritants of ter; so that during the last nine months not a all kinds, accurately described for the first time single instance of pyaemia, hospital gangrene, or 199 Who’s Who in Orthopedics erysipelas has occurred in them. As there pied in Edinburgh was far superior to the one appears to be no doubt regarding the cause of this offered him in London, but he was attracted by change, the importance of the fact can hardly be the great city itself and the opportunity it gave exaggerated. He therefore migrated south, 1867, entitled “On a New Method of Treating back to the city of his youth, where he had many Compound Fracture, Abscess, etc. The introduction of subcutaneous to gain acceptance of the antiseptic principle as tenotomy had been hailed as a great advance in fundamental in the practice of surgery. The road the treatment of deformities, but it had strict lim- he had to travel in gaining his objective was more itations. For some years there dawned a new era of immense possibilities his teaching was misunderstood and he had to for the treatment of injuries, diseases, and defor- meet violent criticism. Indeed the successful management of the medical schools were indifferent, or accorded the compound fracture by Lister stands at the very doctrine a chilly reception. On the other hand, beginning of the introduction of the antiseptic well-known surgeons in France and Germany method. He pointed out that blood clot, protected were not slow to see the merits of the antiseptic by an antiseptic, would be organized by the principle and he was encouraged by the enthusi- ingrowth of cells and vessels from its vicinity; in asm of some industrial surgeons at home. He also explored the best missionaries of the new surgical learning badly united fracture, reset the fragments and were Lister’s house surgeons and pupils. He was the first to explore simple had been witnesses of the principle in practice and transverse fractures of the patella and olecranon with conviction they went out to preach the new and to bind them with wire until union occurred. The rest of Lister’s time at Glasgow was In 1880, William Macewen of Glasgow, a pupil occupied in the observation and recording of of Lister, operated upon a boy whose shaft of the various diseases and injuries dealt with by the humerus had been destroyed by osteomyelitis. He also introduced carbolized sewed tibial grafts along the former track of the catgut for the ligature of arteries after testing it in bone and a new shaft was reproduced. He internal semilinar cartilage completely separated became fully occupied with the duties of the from its anterior attachment to the tibia. The Chair and of his large private practice, but in the cartilage was stitched back in its proper place, the laboratory in his own home he carried out end- man recovered perfect movement of the joint and less experiments with the object of improving returned to his work. For many years before methods of carrying out the antiseptic principle Esmarch introduced his elastic bandage, Lister and rendering its use in everyday practice more had operated upon bloodless limbs. This provided a bloodless field for 200 Who’s Who in Orthopedics operation. He proved experimentally that blood left the limb not by gravity alone but also by reflex constriction of the arteries induced by stim- ulation of the vasomotor nerves. This is still a valuable procedure, particularly when it is inad- visable to use an Esmarch bandage. Lister retired from practice in 1896 but contin- ued his scientific work. Many other academic honors and foreign orders had been showered upon him. His appearance at sci- entific meetings in foreign countries had been greeted with triumphal acclaim. He was made a baronet in 1883, a peer in 1897, and was one of the original 12 members of the Order of Merit instituted in 1902. The universal and abiding value of Lister’s work for the physical ills of mankind has made him one of the outstanding benefactors of humanity.

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Use any special effects judiciously and be consistent in applying them cheap 0.5mg avodart otc symptoms when quitting smoking, for instance using a particular style to indicate all the main headings discount avodart 0.5mg without prescription symptoms genital herpes. Always PRESENTING YOUR WORK 261 check your publisher’s house style rules, which may give specific instruc­ tions on adding style to text. Some stipulate that certain characteristics are omitted, for example using bold. It is not your job to arrange and design the manuscript as if it were the final printed version. Your role is to prepare and present your work in a form that the editor can deal with quickly and efficiently. Spelling Computers help us by providing tools that check spelling and grammar in a document. For example, a computer will not correct mistakes such as ‘The children took their dog fore a walk’ or ‘The children took there dog for a walk’. Make sure you have manually checked the spelling and grammar of your final draft. This is especially im­ portant if somebody else has typed or word-processed your manuscript. There are certain spelling conventions to which you will need to ad­ here. Always check your publisher’s house style rules on the following: ° Variant spellings. For instance, the use of ‘z’ is applicable if selling to the North American market. Words are always spelt out in full, unless you want an abbreviation to appear in the final text. In that case, write out the word in full followed by the abbreviation the first time it appears in the text, for example, electronic mail (e-mail). Check whether your publisher accepts the use of common abbreviations in your manuscript, such as e. Write these out in full the first time they appear in the text, followed by the acronym in brackets. Use a capital letter at the beginning of a proper noun (that is, where a name is specific to a person, place, organisation or object). For example, the trade name for a drug would be written with a capital letter, but the generic name of the same drug would start with a lower-case letter. Check the house style rules on how to deal with accent marks, digraphs and Greek letters. Numbers Numerals It is common practice to write numbers one to ten in words and those above in figures. Alternatively you can use the rule that any number requir­ ing more than two words should be written in figures (Winkler and McCuen 1999). Percentages and amounts of money Treat these in a similar way to numbers. The most important thing is to be consistent in the format that you choose, and that it is acceptable to the publisher. Common units of measurement These can usually be abbreviated, for example 39°C. Footnotes and endnotes Most publishers prefer that footnotes and endnotes are kept to a minimum, so try to include as much information as possible within the main text. Collate them at the end of each chapter or at the end of the manuscript. Remember to indicate their intended position in the text by using an appropriate symbol like an aster­ isk, number or letter. Tables, figures and illustrations You may want to use some form of visual material to support your text, for example graphs, figures, drawings and photographs.

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Nonetheless order 0.5mg avodart otc treatment 5ths disease, working-age persons who do not qualify for Medicare or Medicaid are often out of luck best 0.5 mg avodart symptoms appendicitis, even if they are employed. Over half of uninsured people who have any disability work (Meyer and Zeller 1999, 11). Some employers avoid hiring disabled workers, fear- ing higher health insurance premiums (Batavia 2000). The ADA does not address employment-based health insurance explicitly, although it does prohibit employers from discriminating in “terms or conditions of em- ployment” against an employee. The ADA’s legislative history suggests that em- ployers and health insurers can continue offering health plans with restricted coverage “as long as exclusions or limitations in the plan are based on sound actuarial principles” (Feldblum 1991, 102). But only 76 percent of those with minor and moderate mobility problems have health insurance, while 83 percent of younger Who Will Pay? Health Insurance Coverage among Working-Age People Mobility Health Difficulty Insurance (%) Medicare Any Medicare Medicaid and Medicaid None 80 1 4 1 Minor 76 9 20 3 Moderate 77 16 27 5 Major 83 28 35 10 persons with major mobility difficulties are insured, primarily through Medicare and Medicaid (Table 17). More unemployed than employed working-age people with major mobility problems have insurance (86 versus 79 percent), because of these public programs. Even persons with health care insurance “are rarely covered for (and have access to) adequate pre- ventive care and long-term medical care, rehabilitation, and assistive tech- nologies. These factors demonstrably contribute to the incidence, preva- lence, and severity of primary and secondary disabling conditions and, tragically, avoidable disability” (Pope and Tarlov 1991, 280). Health insur- ers typically decide what to reimburse in two stages: organizationwide de- cisions about what services are “covered” by a particular plan; and case-by- case decisions about the “medical necessity” of covered services for individual persons (Singer and Bergthold 2001). A third-order decision, potentially critical for persons with mobility problems, is the setting of care: can patients receive services at home? For mobility-related services, two major concerns generally underlie coverage decisions for private and public health insurers: • How long will the person need the service? Neither issue is especially propitious for persons with progressive chronic conditions, who, by definition, generally need services long-term and are unlikely to improve. Private health insurance appeared about seventy years ago, partly to help acute- care hospitals make their increasingly costly services affordable to “the pa- tient of moderate means” (Law 1974, 6). To ensure their financial survival during the Great Depression, hospitals organized prepaid health insurance or Blue Cross plans, writing contracts with employers to insure their work- ers. Over ensuing decades, as new hospital-based technologies offered “medical miracles” to combat acute threats to life and limb, costly but time-limited hospital interventions became the cornerstone of most health insurance plans. Therefore, early and subsequent commercial plans primarily covered short-term, acute hospitalizations and physician services. Given today’s competitive pressures, private health insurers offer numerous plans to meet diverse demands. Private health plans typically cover acute medical and sur- gical hospitalizations and primary and specialty physician visits but differ widely in coverage for other services. Medicare and Medicaid, enacted in 1965, reflect decades of political ma- neuvering and compromises (Marmor 2000; Fox 1989, 1993). As with pri- vate health insurance, Medicare’s roots reach back to the Great Depression. Although President Roosevelt wanted to add health insurance to his 1935 Social Security bill, he did not, concerned that opponents (such as orga- nized medicine) could derail his entire Social Security plan. Decades later, Johnson administration officials underscored Medicare’s focus on acute care in short-stay hospitals to gain congressional support. Policymakers feared that adding chronic care would exacerbate concerns about uncon- trollable costs and derail political approval (Fox 1993, 75). The structure of the benefits themselves, providing acute hospital care and intermittent physician treatment, was not tightly linked to the special circumstances of the elderly as a group. Left out were provi- sions that addressed the particular problems of the chronically sick elderly: medical conditions that would not dramatically improve and the need to maintain independent function rather than triumph over discrete illness and injury. What looks like a half-empty glass when benefits are being designed may be a bottomless pit once the payments begin to flow” (Vladeck et al. Medicare beneficiaries themselves pay for uncovered services or items, filling in two broad gaps: covered services for which Medicare pays only a portion of the expense; and services not covered at all (such as outpatient prescription drugs in traditional Medicare, sometimes covered by Medicare managed-care organizations). So if you’re in the hospital for, say, two days, can you imagine what 80 percent of that bill would be? Daigle kept working solely for private health insurance to supplement Fred’s Medicare. About three quarters of Medicare beneficiaries purchase these private “Medigap” policies, roughly one-third through employers (Rice 1999, 112).

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