He had to learn to walk the second time and remembers picking things up with his left hand and then taking them in his right hand, being unable to pick them up with his right.

This residual paralysis gradually improved until the hand recovered completely and the leg to such a degree that he learned to skate. At the age of thirteen it was discovered that the heel of the right foot was slightly elevated. This was corrected by adding an extra list to the heel of that shoe, and soon another was added, and then another, until the heel of the shoe was several inches high. At the age of seventeen a plaster cast of the foot was made which shows the tendo Achillis drawn tense, the plantar fascia contracted, and the toes doubled up and their flexor tendons tense and rigid. All which shows great progress in the deformity.

At the age of twenty a photograph of the foot was taken. Just before the operation, the foot was photographed, and when examined closely will be found most interesting.

The distal end of the metatarsal bones are in a direct line with the axis of the long bones of the leg, and rigidly fixed in that position, walking was painful, and for years Mr. J. suffered with every step he took. In fact the suffering was so great that he contemplated having the foot amputated and substituting an artificial foot.

To bring this foot into the normal position it was necessary to remove the astragalus, divide the tendo Achillis, which was done by subcutaneous section, and sever the plantar fascia.

The foot was then brought into the normal position, the wound covered with protective, and gauze well padded with cotton, and put up in plaster.

The plaster remained on two weeks; it was then removed, the foot examined, found to be doing well, and put up in plaster again. This time the plaster was left

on three weeks, when it was removed and starch substituted.

The wounds healed satisfactorily. In a few weeks the patient began to walk, at first with a crutch, then with a cane, and can now walk several miles at a good rapid gait.

Mr. J., impresses me now as being one of the most cheerful of men. Formerly his facial expression was one of pain with every step he took. The ankle joint is quite flexible, and keeps improving.

It is now two years and a half since the operation was performed, and I believe most of you gentlemen will ap preciate the opportunity to examine the foot and judge the result of the operation for yourselves, as it is not often we have the opportunity to see the result of an operation of this kind, performed on a man at the age of forty-three.

REPORT OF A CASE OF COXA VARA.

PHILIP D. BUNCE, M.D.,

HARTFORD.

Like many other pathological conditions in medicine and surgery, coxa vara has always existed, but until fairly recently it has been classed under the general heading "hip-disease."

Now we can put it in a class by itself, give a reasonable theory of causation, and, best of all, can either absolutely cure the condition or else greatly improve it.

Bow-legs and knock-knees are familiar to us all and coxa vara is an allied condition with the seat of the trou ble in the neck of the femur. The former are seen in infancy and childhood while the latter althought sometimes seen in childhood is regularly a condition of puberty, or about that age.

In

While congenital hip-dislocation is more frequent in girls, coxa vara is much more common among boys. a moderate number of the cases there is a history of rickets but there are more where there are no evidences thereof.

The ordinary anatomical change in coxa vara is a bending of the neck of the femur, which causes a shortening of the leg on that side. It may be in one or both hips, but usually only in one. Microscopical examination of sections of bone from the affected area shows no pathological changes.

The following case is reported because the results of treatment in such conditions are so favorable, while without proper treatment the patient may be a helpless cripple so far as his leg or legs are concerned.

J. G., seventeen years old, born in Russia, farmer,

family history good, previous personal history excellent. For three years he has not been able to walk well and the trouble has been increasing. Two years ago he fell off a load of hay and might possibly have been somewhat injured, but was not laid up in bed then. When farm work was light he did fairly well, but when work was heavy, he got about with great difficulty. Finally he was brought to the Hartford Hospital.

He appears unusually large and muscular for his age. Above his pelvis his body is normal in every way. He can stand erect, but any movement in the hip-joints causes him pain and he has practically no motion therein. The right leg is three quarters of an inch shorter than the left. The right great trochanter is about half an inch above Nelaton's line; the left great trochanter is about on this line. Both legs are much everted and adducted so that the feet can easily be made to be on their outer sides when he is lying in bed.

The rigidity in the hips, was very much like an acute tubercular hip.

To clear up the diagnosis he was etherized and both hip-joints moved freely although somewhat limited in abduction and internal rotation. Muscular spasm evidently caused the pain when the joints were moved. After several weeks rest in bed his condition remained the same. No motion in the hip-joints. An X-ray photograph of the pelvis was a failure as he was large and muscular.

A linear osteotomy below the right lesser trochanter was done and the leg put up in a plaster spica in marked abduction correcting at the same time the eversion of the foot.

January Third, 1903, the cast was removed and he went home two weeks later using a cane. The long rest in bed had caused the muscular spasm in both hips to disappear and he could easily move both joints.

March Fifteenth, 1904. Patient seen again for the

first time since he left the hospital. He has remained well. Can do the ordinary farm work and has had no more trouble with his hip-joints. He still limps some, but he considers the leg which was operated on his best leg.

He still has a moderate condition of coxa vara in his left hip, but it will not be necessary to do an osteotomy on that side unless he has acute symptoms.