This appliance has been in practical use for the past three months. I first used it on March last, on a little fellow two years of age. I operated on this child when it was nine months old for an aggravated case of talipes equino varus in both feet. After dividing subcutaneously all the contracted tendons and fascia, I had the pleasure of placing his feet in their normal position, and holding them there by means of adhesive plasters, bandages, etc. I congratulated myself on what I considered a complete success, which it proved to be, so far as the operation was concerned. I had restored the feet and retained them in a proper position so long as I used the adhesive straps, but the moment these were dispensed with both feet became inverted, so much so, that they assumed a position at right angles with the normal. A few weeks later when the little fellow attempted to walk, he could place the soles of his feet on the ground, but the above-mentioned diversion was persistent. I applied this instrument and was more than pleased with the result. The feet could be everted at any desired angle without the least discomfort to the child. With it he can walk, run, sit down, or, in fact, get into any conceivable position with the utmost ease.

You will perceive that this steel spiral spring is light and very flexible and elastic, resembling in its latter quality muscular action. It holds the foot and limb in a normal position, but not rigidly. With it the patient can exercise his willpower, and rotate the foot outwards or inwards at pleasure, thereby allowing all the muscles their proper amount of exercise. It, however, constantly acts as a watchful monitor, guarding with zealous care the wants of the weakened or paralyzed muscles. It has no joints, but is flexible in any and every part of its entire length. It acts equally well with the patient sitting or standing.

It seems to be overlooked by many surgeons, that in a great majority of cases of inverted feet the entire limb is inverted, rotation taking place in the acetabulum. This is a result of partial paralysis of the abductor muscles. Many have wasted their time in trying to effect eversion with appliances wholly below the knee, and have had as much success as the man who tried to lift himself by his boot-straps.

The uses to which the spiral spring may be put are numerous. In cases of wry neck or torticollis great benefit, espe

cially in the young, may be derived from it. Fig. 2 fully illustrates it.

4. Spiral steel spring. B. Strap around the head. C. Set screw by which tension to the right or left can be regulated. D. Joints which allow an anteroposterior motion of the head. E. Back plate to which lower end of the joints is firmly fastened.

In fracture of the neck of the femur, rotation inward may be steadily and constantly maintained by the use of this instru

ment.

In the different stages of hip-disease good results will follow a proper application of the spiral spring rotation power.

No doubt a further and more extended use of this instrument will develop a larger sphere of usefulness for it.

A METHOD OF TREATING SPINAL DISEASE.

BY E. H. COOVER, M.D.,

PENNSYLVANIA.

THE inception of spinal disease and curvature seldom attracts our attention until some reflex action has taken place demanding aid. Recently the subject has attracted notice through the energy and skill of Drs. J. K. Mitchell, Benjamin Lee, of Philadelphia, and Drs. Jacob A. Wood, Taylor, and L. A. Sayre, of New York, all of these making effort toward suspension by some means between the ilii and occipito-vertebral articulation, and to secure some mechanical support or splint to retain the proper position. The various kinds of injury and disease, including malformation, to which the spine is liable, form a subject of the greatest practical importance, not only on account of the frequency of their occurrence, but the influence they exercise upon the functions of the body, particularly the nervous system.

The study, therefore, of these maladies, with the agencies employed to remedy them, is one of great interest to the general practitioner.

It is with this view that my mite is added to the store of knowledge upon this subject, inviting your attention to a description of the construction and advantage of a new mechanical appliance with corset facilities for their treatment.

The spinal column, as the seat of disease, is repeatedly overlooked because the symptoms arising from it are of a nature slow and insidious, leading one to suspect organic derangement when the real place of trouble is in the vertebra. Weeks, months, and even years pass away before they become known. One may fall, striking some hard body, or jump from a height alighting on his feet or nates, leaving no apparent injury beyond a feeling of having been well shaken up. After a time a failure. of nervous power ensues, and at a later period more definite symptoms develop.

The details of the causes, symptoms, or injuries, and their dis cussion are unnecessary here, nor should any attempt be made to detract from the several modes used and recommended by recognized authorities.

In my opinion rest, absolute rest, is essential to any probability of recovery from an injury or disease affecting the spine, and that rest can be properly secured only by means of a mechanical appliance which will give uniform support to the anatomical structures.

It is not claimed that the use of silicate of soda is original, for it has been used for years as a fixed dressing, but the application of it to the manufacture of a spinal jacket, with some peculiar mechanical contrivance, seems of the utmost importance when the bony system is contemplated and the point of support considered. The process employed by me enables one to easily adapt it to particular cases because it is an open corset.

It is as follows: from unbleached muslin are cut four pieces shaped like the front and back of a coat or bodice, and long enough to reach below the pubes and hip-joint. The patient being clothed in a skin-fitting, seamless garment, and seated upon a stool somewhat higher than an ordinary chair, the front pieces are laid on and wetted with a solution of silicate of soda, specific gravity 1.2755 in summer, and a little higher in winter. The back pieces are next put in place, the top and bottom edges are laid carefully together, the intervening edges being cut purposely to show an eliptical opening. This is done for the reason that, when the pieces are pressed to place, the edges will meet without overlapping, thus making the jacket conform to the natural curve of the back; after which a bandage, three or four inches wide, is passed around the body, from a point immediately under the axilla to the hip-joint, or below that point if you wish to extend the support lower down; this may be required in some forms of lateral curvature. This fixes the body pieces, and secures a firmer structure upon which to build the more substantial part of the apparatus, besides obliging the jacket to conform more strictly to the natural curve of the body of the individual. Each turn of the bandage should lap one-third, and be wetted with the solution of silicated soda, with a brush in the hands of an assistant. Care should be taken to avoid wrinkes or folds left in the bandage; it is better to cut the muslin. (Fig. 1.)