the floor, doors, and windows were taken out and burned, and new ones substituted. A heavy fine was imposed on those who bought or sold clothing which was exposed.

This law was in full force up to the year 1848, for a period of sixty-six years, and yet during that time there appears no evidence to show its practical usefulness; but, on the other hand, Dr. Rienzi says "that the injury which it inflicted on the city of Naples is simply indescribable." Patients and their friends became objects of execration; houses in which a death occurred from the disease depreciated in value, and their owners became impoverished. A similar law existed in Portugal for many years, and was followed by like disastrous results.

In summing up the evidence which has been adduced in these pages, it appears from the first portion that nearly all the organic diseases of the human body are infectious, but that some, on account of the facility with which their germs multiply and diffuse through the atmosphere, are very readily communicated, while others, which possess these properties in a small degree only, are not readily communicated. The former we have called the contagious, and the latter the non-contagious diseases. Continuing this line of reasoning, we saw that pulmonary tuberculosis clearly belongs to the second or non-contagious class of diseases. In the second or clinical portion we found corroborative evidence of the first portion. Here the danger of exposure; the intimacy between husband and wife; the tubercle-bacilli, or the tubercular virus in the atmosphere; the distribution of the disease; the effects of quarantine; were all discussed in the light of contagion, and nothing was discovered to show the slightest danger of communicating this disease from one person to another under ordinary conditions.

In conclusion, we trust that altogether we have offered sufficient proof for believing that pulmonary tuberculosis is entirely due to influences other than those which are swayed by evil genii residing in the air; and hope that we have succeeded in allaying the morbid fear and the abomination with which consumptive people have recently come to be regarded by the medical profession, by their friends, and by all with whom they come in contact.

1716 CHESTNUT STREET.

CUNEIFORM OSTEOTOMY FOR ANTERIOR CURVATURE OF BOTH TIBIÆ

AND BOTH FIBULÆ:

ILLUSTRATING THE GREAT PRACTICAL VALUE OF THE ELECTRO-OSTEOTOME AS A BONECUTTING INSTRUMENT, AND THE SPHENOMETER AS AN INSTRUMENT OF PRECISION IN BONE SURGERY - SUTURING OF THE BONES WITH KANGAROO TENDONS-HYDRONAPHTHOLIZED SURGICAL DRESSINGSBRUCE'S BOW-LEG BRACE.*

G

BY MILTON JOSIAH ROBERTS, M.D.† ENTLEMEN: -The patient whom I present to you to-day is a colored boy 4 years of age. He has been brought to this clinic from Newburgh-on-the-Hudson, a distance of some sixty miles. He is the youngest of a family of seven children, five of whom are living. He has a rachitic history. He was two and a half years old before he began to walk, and he has such an aggravated deformity that he has never been able to walk with any degree of comfort.

As I have not previously had an opportunity of getting a photograph of this patient, I have brought with me my camera, together with some dry plates, that I may make a pictorial record of his deformity. (The patient was at once placed in a sitting posture on a small table covered with a white sheet. The nurse stood at the farther side of the table, and held up a white sheet, which served as a background. Prof. Roberts quickly placed his camera in position, focused the image of the patient on the ground glass, put a plateholder in position, and exposed one of the sensatized plates, occupying in all not more than a minute and a half of time. The negative was subsequently developed, and Fig. 1 was made from it. - REPORTER.)

I think it is of the greatest possible importance, in making records of examples of deformity, to have photographs which illustrate them. They give the best idea of the deformity in the shortest space of time, and as evidence of the existence and extent of a deformity will usually rank higher than almost any other form of record.

Now for the geometrical observations which

tions in bone surgery. The instrument which I will use on the present occasion is a new one, and has some improvements over the old one which I have been using for a number of months. As this is the first time I have had occasion to use it since it came from the shop, I hope you will make allowance for any delay that may arise in consequence.

The patient having now been anesthetized, and his lower extremities thoroughly cleansed, first by the use of soap and water, and subsequently by rinsing in a solution of corrosive sublimate (1 to 1000), a carbolized Esmarch's bandage is tightly applied, beginning at the toes and carrying it up the limb to the upper part of the thigh, where it is made fast. Re

at a and b are in pairs, while those at c, d, e, and fare single, and are provided with much longer blades, which are curved up so as to serve the same purpose as a pair of retractors with shorter curves. The single retractors are much more difficult of introduction on account of the increased length of curvature. These retractors are placed in position by passing them in around the bone, between it and the soft parts, so that when they are in position the bone lies directly upon them and the soft parts are behind them. In this way the soft parts are absolutely protected from all danger of being cut while using the circular saw of the electro-osteotome.

The bone being thus exposed, its exact diameter at the site of operation is readily de

a

b

C

moving the lower part of the bandage, we have a bloodless limb upon which to operate. The first step in the operation is to make a longitudinal incision down to the bone along the anterior aspect of the tibia over the site of the greatest deformity. Care should be taken in making this incision not to carry the knife through the periosteum, thus injuring it unnecessarily. Having made a clean-cut incision down to the bone, the soft parts on either side of the incision are picked up with a pair of dressing forceps, and the cellular tissue between them and the bone is divided with a scalpel, so as to admit, without the use of undue force, the end of the protecting retractor which is placed between the soft parts and the bone.

The forms of protecting retractors used for this purpose are illustrated in Fig. 4. Those

termined by means of a pair of calipers. The diameter of the right tibia we ascertain to be in the present instance twenty-four millimetres.

The next step is to determine the exact dimensions of the base of the wedge of bone to be removed in order to correct this deformity. For this special purpose I have invented a mathematical instrument* (Fig. 5), which, given the degree of deformity to be corrected and the diameter of the deformed bone, will automatically calculate the dimensions in millimetres of the base of the wedge of bone to be removed to exactly correct the deformity, thus saving a somewhat elaborate trigonometrical calculation. This instrument-the sphenometer-is used as follows: The lateral shafts, all four of which are of the same length, are set so as to enclose the angle of deformity. We have already determined in the present case that the angle of deformity is forty-five degrees, therefore we move the instrument so that the inner edge of the lateral shaft over which the graduated arc passes coincides with the line indicating forty-five degrees on the arc. (See Fig. 5.) Thus set, the lateral arms of the instrument enclose an angle equal to the degree of deformity. It

diameters of bone and corresponding increasing dimensions of base of wedge.) We have determined the diameter of the right tibia in the present instance to be twenty-four millimetres. Upon the central arm of the sphenometer, which is graduated in millimetres, a straight bar, also graduated in millimetres from its middle towards either end, is made to slide at right angles to it. This graduated bar, at right angles to the central shaft, is moved along until the diameter of the bone at the site of operation has been

900 70 50 40 30

will be understood, from an examination of the diagram (Fig. 6) that the sides of the wedge-shaped piece of bone to be removed to correct this deformity, indicated by dotted lines c, x, d, must be inclined to each other, so as to enclose an angle of equal extent to that of the deformity, d, o, b, to be corrected, viz., forty-five degrees. Having set the instrument so that its lateral shafts enclose the angle of aberration, it can readily be seen that the dimensions of the base of the wedge depend entirely upon the diameter of the bone at the site of the operation. (See Fig. 6, in which j, k, h, i, and f, g represent varying

measured off on the central arm of the sphenometer. (See Fig. 5.) Having done this, we can now read off from the graduated bar, which passes over the lateral limbs of the instrument, the dimensions in millimetres of the base of the wedge of bone necessary to be removed in order to correct the deformity. It will be seen by reference to Fig. 5 that the straight movable bar is graduated both ways from its middle, and therefore it is necessary, when reading off the dimensions of the base of the wedge, to count the graduations included between the lateral shafts of the instrument on both sides of the central shaft. The base of