part of the external malleolus, extending from just below the knee to the last mentioned point.

After the application of this apparatus, the foot was drawn daily more and more toward the desired position, until, at the end of one week, it was brought into a direct line with the leg.

To fulfil the second indication-the flexion of the foot-the instrument represented in Fig. II, was applied. The apparatus was secured to the leg and foot, and bound firmly at the instep by means of the strap, (f.) The point of the sandal and the upper extremity of the splint at the knee, approximated daily by the aid of the two lateral straps connecting those points, until the twenty-first day after the second instrument was applied, when the foot was restored to its proper position.

After the first few days the patient was able to begin to walk, which accelerated the flexion.

The pain produced by these instruments throughout the whole operation was by no means worth regarding. The process of restoration was slow but constant, and the changes brought about so gradual, that not even an unpleasant sensation was experienced beyond an hour, at any one time during the treatment. Not the slightest inconvenience was felt in any of the tendons, not even in the tendo Achillis during the treatment, but the pain was confined to the outer side of the foot during the abduction, and to the instep, during the flexion.

An abrasion of the skin took place and continued for a few days, being caused by frictions which were employed in aid of the treatment, but no such result was produced by the apparatus.

September 28th. There is still considerable rigidity in the instep. The motions of the foot are limited, and in walking, the rotatory motion of the knee is apparent. It is expected that support for the knee and continued exercise of the foot, will in time overcome these difficulties.

The condition of the foot, thirty days after the application of the first instrument, is shown in Fig. VIII.

This patient was seen, at different stages of the treatment, by Professor George McClellan, Drs. E. W. Leach of Boston, Bald

win of Georgia, and Drs. R. Coates, Brewer, and West, of this city.

CASE IV. Greatly Distorted Foot, from exposure, which commenced in early life, restored in fifty-one days, by mechanical means alone. In the spring of 1840, my attention was called to Julia Dunmore, who was standing upon her crutches and on one foot, resting herself. The patient is now fourteen and a half years. old, healthy, and as active as could possibly be expected, with the deformity under which she labors. She was a remarkably healthy and unusually active child-walked readily when nine months old—but at the age of a year and a half, she entirely lost the use of her limbs from exposure in a damp cellar, was placed under medical treatment, and recovered the motion of her extremities except that of her right foot, so far as to be able to walk in six months, with the aid of one crutch. She retained this power for some time, when it was observed that the hip was enlarging, and the leg growing shorter. A second crutch was then obtained, and the patient began to place the foot to the ground. The ankle was still however weak, but she continued to rest upon this as well as on the opposite leg, in walking. The ankle continued giving way, until the foot was brought to the position seen in Fig. IX., and thus she remained when she came under my care.

The whole limb was at that period much emaciated, measuring only five inches in circumference, at the ankle, six and a half at the knee, and eight inches at the largest circumference of the thigh. The hip, and in fact the right side of the body, partook of the general emaciation.

She could stand, but she could not walk without her crutches, and she was so feeble in her limbs, that when she fell, she was compelled to crawl upon her knees, until she met with something by which she could raise herself up. The use of the limb produced great fatigue in it.

It would seem almost impossible that a greater deformity, or one more difficult of restoration, could exist, than is here shown. The foot was completely reversed. The patient rested the limb

on the instep, which had been so long accustomed to pressure, that an enormous cushion (see Fig. IX., a.) had been formed to protect the foot from the ill-directed pressure.

In the treatment of this case, the same principles were to be applied as in the foregoing. The foot was first to be brought to the same axis with the leg, after which, flexion was to be made.

Accordingly, on Saturday, the 22d of May, 1840, I applied the brass splint to the outer side of the leg, as described in the preceding case. By the aid of the strap around the foot, I drew it daily nearer the line with the leg, until the tenth day, when it was made to assume the position seen in Fig. X.

On Monday, June 15th, I commenced flexion, and succeeded at the end of fifty-one days, in bringing the foot to the position seen in Fig. XI.

The entire restitution of the natural position of this foot, was accomplished perhaps with less difficulty than would be presumed by observing it in its distorted state. This was owing to the relaxation of the ligaments, and the ease with which the bones moved upon each other.

In the restoration of the foot, the pain experienced was comparatively little. In both rotation and flexion of the foot, this sensation was principally confined to the osseous structure.

With some effort this patient could bring her heel to the floor on the 10th of July, and on the 13th she began walking for the first time, and on the 30th the foot exhibit

ed the apearance seen in Fig. XI.

a

Fig. XI.

That part of the foot on which it rested during the greatest degree of deformity, is now seen at a.

By reference to this figure it will be observed, that the leg is thrown slightly backward upon the foot, in consequence of a loss of proper action in the tarsus. This action the patient will again

recover.

This patient has been seen by Drs. R. Coates, West, and Brewer; Drs. E. W. Leach of Boston, and Baldwin of Georgia.

NOTE.-October 17th, 1840. This patient has gained the use of her foot at the instep, and the leg is thrown forward to the proper position. She can walk several squares without much fatigue, and the general appearance of the foot is much improved from that seen in Fig. XI. She was examined by my class on the 15th inst.

CASE V. Everted Deformed Foot; deformity commenced at two years of age, from paralysis; restored in ninety days by mechanical means. During the month of February, 1840, Professors George and Samuel McClellan referred to my care Mr. J. B., aged twenty-five years, who was laboring under an everted deformed foot, as seen in Fig. XII., the history of which as given by the gentleman himself and his parents is as follows:

He was a healthy, fat child, and walked readily at nine months old. At two years of age he was suddenly seized with paralysis of the lower extremities, and spasm of the muscles of the back of the neck: his head was drawn far backward, and remained immovable for several weeks. He could not walk or sit without support, and both legs became entirely useless. This state of things was followed by several months of severe illness, when the left limb gradually recovered. At three and a half years of age he could climb up by a chair. At eight years old he could walk a short distance by the aid of two crutches, and continued in this situation for eight or ten years. He then walked four or five years with a crutch and a cane, and afterwards with a cane only.

Neither of his ankles had entirely recovered from paralysis when he began to bear his weight upon his feet; and as his general health improved, enabling him to take more exercise, his ankles, particularly the right one, gradually gave way, and assumed the appearance represented in the figure referred to.

The internal malleolus was very prominent, the bones of the instep rigid, the foot attenuated, and the leg and thigh much smaller than those of the opposite side. The left foot was also slightly everted. He had no control over his toes. In walking, the foot was thrown outward, resting upon the inner edge, and the internal malleolus came nearly to the ground. He suffered much pain in the ankle and leg in walking.

By considerable effort the foot could be brought inward nearly on a line with the leg, and in order to retain it permanently, a firm gaiter-boot was fitted to the foot and ankle. Two plates of steel were provided, three quarters of an inch wide, two lines in thickness, and attached at their upper extremities by means of a semicircular plate, designed to pass behind the leg near the knee. These were long enough to extend from the knee along each side of the leg to the bottom of the boot, beneath which they were bent and united by their extremities. Attached to the inner plate at the internal malleolus was a circular piece of steel plate three inches in diameter, about two lines in thickness at the circumference, and one-fourth of an inch at the centre. The whole