see all of these cases cccurring after the fifth month. In the way of treatment, I can offer but little advice, but it is apparent that more care of a lacerated cervix after labor, either at once or after the puerperium, is indicated. For the attack itself, mild sedatives, saline catharties in moderation, rest in bed, and the positive assurances of the physician to relieve the patient's distress. This latter is most important.

GENU VALGUM AND GENU VARUS OPERATED.

BY W. J. LITTLE, M.D., MACON.

The subject of knock-knees and bow-legs prepared for this meeting is presented not for the purpose of discussing the causes which enter into the production of these deformities, but to call attention to some procedures, which if thoroughly antiseptic would enable the surgeon, by a simple operation, to relieve and literally set straight upon his feet many a little sufferer to become, when grown up, capable of good serviceable labor, who otherwise would be more or less hampered throughout his life. The negro in the South, from his poverty and ignorance of the raising and caring for his "young," is the subject of rickets and its consequent deformities. So common is the deformity of knock-knee and bow-legs in the negro race that I doubt not that every physician who does a country practice that is in this assembly now, knows of one or more such cases within his immediate field of work. His poverty holds from him the chance of mechanical devices necessary for the gradual restoration of the distorted limbs. The doctor is frequently able to give one of these little sufferers the time requisite. to the treatment of a fracture of the leg, and not be put to much loss of time or expense. It is to you who see these deformities in the country and small towns without hospital facilities that I have prepared this paper, and make this appeal. These remarks apply, of course, to those cases of such marked degree as require surgical interference. Knock-knee, if not one of the most frequent of the deformities met in the negro, is one of the most painful and dis

abling malformations of his walking apparatus. The malposition of the tibia caused by the elongation of the inner condyle of the femur give to the leg a bent angular appearance at the knee, which is increased on standing. The feet are separated and the knees come in contact or override one another. The outward inclination of the legs produces a strain on the inner side of the feet which induces in marked cases flat-foot. The gait shows an awkward, shambling, wobbling movement. The knees tending to interlock must be assisted in passing one another, so the body is swayed from side to side while the legs are thrown alternately outward in their effort to pass one another. In bowlegs the conditions are entirely dissimilar from those of knock-knee, where the site of trouble is at the knee. Here we have a more or less gradual curvature of the bones of the leg tending to describe an arc, with the height of curvature most marked at the knee. An examination will sometimes show a deviation from the normal line at the middle of the shaft of the femur at the tibial diaphysis or at the lower third of the leg. It may, therefore, be necessary in these deformities to make several osteotomies to effec tually overcome the deformity.

Case 1.-A negro boy, age five and a half year was seen in April, 1898, at the Macon Hospital. He was undersized for his age. The long bones in the arms, the ribs and legs, showed marked signs of rickets. The knees were knocked and the right foot was abducted at a right angle to the median line. The left leg was more deformed than the right and the foot rotated outward from its normal angle. Both feet showed marked flat-foot. The leg being shortened by their curvatures gave the body a disproportionate length, which, with his awkward shambling movements in walking made him somewhat resemble in appearance a penguin. The legs were treated on the day prior to the operation with green soap and water and bichloride of mercury 1 to 1000,

and dressed with sterilized gauze. At the time of the operation this treatment was repeated with the addition of an application of ether, thoroughly rubbed over the site selected for the incision. At a point on the outer side of the thigh two inches above the condyle, a sharp pointed knife was directed inward to the femur in a line with the shaft of the bone, and a wound just large enough to admit a onehalf inch chisel was inserted by the knife used as a director. When the bone is reached the knife is withdrawn and the chisel is turned at a right angle to the incision, care being exercised not to use much pressure upon the bone for fear of injuring the periosteum. With a mallet the upper and lower portion of the bone are severed. The operator is aware of the canal when reached by the less resistance felt against the chisel. A few taps are made then on the opposite side of the bone, when the chisel is removed and the bone is easily broken. The hemorrhage in this case was slight, not over one or two drachms of blood flowed from the wound. Compressors were applied, the hemorrhage easily stopped and the wound was closed with a catgut stitch. The legs were then overcorrected and plaster of paris spicas from the toes to the waist were applied. This patient was under treatment for three months with two applications of plaster dressings, when he was discharged. Five years afterwards shows his present appearance in the photograph furnished.

Case 2.-A negro boy, three and a half to four years old was referred to me by Dr. W. R. Winchester, of this city, in April, 1903. He was at the time well nourished. He had a mixed deformity. The right leg was knock-kneed, while the left was bowed. He could not walk except with great difficu!ty, and his body leaned to the left, which gave him on standing, the appearance of the letter "S." The preparation for the operation here was the same as in the other case. The right leg was operated on similar lines. The left leg showed

its greater curvature to be at the upper third of the tibia, so an incision was made at this point. The bone was chiseled through and the fibula easily fractured. No hemorrhage of any moment occurred. After the compressors were removed and the blood stopped a catgut stitch was introduced. The deformities were corrected and double spicas were applied. In this class of work I have not found it necessary to make large openings for the chisel. It has not been necessary yet to remove a wedged shape piece of bone to correct the deformity. I do not drain. The wound is closed and sealed. The cases are treated on the lines of compound fracture. The temperature and pulse and general condition of the patient with evidence of hemorrhages, etc., would direct me as to the necessity of making an early opening in the caste, or otherwise the dressing remains. The photographs show this case as I first saw him, his dressings, and the results of five months following the operation.

I desire to thank Dr. Max Jackson and Dr. Olin H. Weaver for their assistance in these cases.