port is effectually procured and maintained. This instrument 1 have applied as early as six weeks after the birth of the child.

During the process of eversion and its maintenance, and until the child is old enough to attempt to walk, nothing more is needed except careful manipulations of the foot, to favor freedom of flexion and extension; and it is the firm belief of your essayist that if these plans were carried out properly, no other treatment would be found necessary in very many cases of congenital varus; for, if proper watchfulness were observed, every step that a child takes, or attempts, after the foot has been fully everted and time has been allowed for the completion of the consequent absorption and remodeling of osseous and ligamentous tissue, tends to reduce the foot to its natural position, and secure the normal exercise of its functions. But this degree of caution is too great to be expected of even the anxious solicitude of the most faithful mother in many conditions of social life; and we are therefore compelled to resort to mechanical means other than the human hand, though aided by parental authority, in order to control the effects of childish indiscretion, and secure the proper freedom of flexion and extension, while preserving that amount of eversion which is the sine qua non of permanent success. To fulfil these necessities we know of no better resource than that which is furnished by the splint and shoe with stationary heel and moveable sole, introduced by D. W. Kolbe, of Philadelphia, which is undoubtedly superior to any other contrivance that has fallen under my observation. It consists of two side splints of steel well moulded to the external and internal portions of the lower extremity, from the middle of the thigh to the foot, and having moveable joints at the knee and ankle. These splints are conjoined by arched bands to fit the posterior position of the limb, and by a cross-bar to which a shoe of ingenious construction is attached. In this instrument the motion of the moveable sole effectually maintains the eversion of the foot, while this movement and that designed for the flexion of the

ankle being entirely distinct, and under control of separate mechanisms, is yet capable of combination under any necessity.

The apparatus with its ingenious bearings and counter bearings permits the child to take its initiative in walking with ease and perfect safety. [See Fig. 5.] So far as I am acquainted with Orthopaedic contrivances, I may truly aver that it is far superior for the purposes for which it is designed to any now in use, but it does not accomplish all that is claimed for it in making a good foot, unless the most perfect eversion is first effected. This last purpose, as I have before said, is a sine qua non. haste slowly" is an excellent motto for one who would succeed in the treatment of congenital varus; and I am free to testify that I have seen better cures of this deformity, without the use of the knife, than I have ever witnessed when it has been employed, even by the most skillful operators.

"To make

I presume that the unfortunate appeals to the last resort of surgeons in varus have been, in a great degree, the results of too great haste, or too little patience. If we would succeed by the purely mechanical method of treatment, the patient must be kept under the eye of the practitioner until the whole of the osseous tissue of the foot is perfectly formed and developed, or at least until the carthy portions of bone are present in sufficient quantity to give each tarsal and metatarsal bone a local habitation and a name. Even after the foot has been brought into a good position, and the child has reached an age that permits it to walk freely with perfect ease to itself, proper caution requires the use of another apparatus. This instrument is like the one just described, except that it is without the mechanisins for the forcible eversion • and flexion of the foot, and the shoe, which is open in front with eyelets for lacing from above the ankle to the toe, has a stiff sole which is fastened to the bottom cross-bar of the instrument, with the toe well everted, and provided with a steel arch bearing against the great toe joint, and a padded strap fastened to the sole of the shoe on the outer side, pressing against the cuboid, middle

and external cunieform, and heads of the third, fourth and fifth metatarsal bones, and fastened to the internal splint opposite the os calcis. [See Figure 6.] The principal object of this apparatus is to keep secure the foot in a proper state of eversion, without embarassing the motions of flexion and extension, as the child exercises the function of the limb in walking. Its action constantly impresses on the wearer the necessity of keeping the toes well turned outward if he would apply the leg and foot to this natural use. It may appear somewhat pedantic to enter into much detail in the consideration of this well known application; but when we call to mind the frequency of its occurrence in all parts of the country, and the extreme anxiety of parents concerning even the slightest defect of structure in their new-born infants, I trust I shall be pardoned for my fault, and the undue occupation of your time, if any such I may have committed; for who is the obstetrical practitioner that has not heard the fear-prompted cry of the mother almost in the last agonized wail of parturition, "Is the child all right?" Who has not felt a pang at witnessing the poignant grief of expectant parents, when after long months of ardent hope they are stricken down by the intelligence or perception of a deformity like this? If then this essay should, in any way, suggest to a single member of the profession a plainer path, or a more reliable method for the relief of a malformation so annoying to the friends and parents, and so serious in its consequences to the little sufferer itself, he who has trespassed for these few minutes on your kind attention will feel happy in the assurance that though he may not have accomplished all that the Society might have reasonably expected of him, he has done his best in his own humble way, to advance what he considers A TRUTH IN SURGERY: "THE INUTILITY OF TENOTOMY IN CONGENITAL VARUS."

In closing, your essayist begs leave to support the position he has assumed, by the assurance that during a professional experience of twenty-eight years as student and practitioner, he has treated or assisted in the treatment of some scores of cases of varus, and