Tenotomy should be avoided, both because it deranges the weakened muscles and because it is unnecessary.

Here I would like to append a brief description of a

case of

Pes equino-varus in a fatus of three and a half months. Three years ago the mother aborted in the fifth month of her first pregnancy. There was no apparent deformity of that foetus. October 13, 1870, she aborted in the fourth month of her second pregnancy. On the left side, as best seen in Figure 1, was a well-marked pes equino-varus. On the

same side the elbow was in abnormal flexion with a considerable foreshortening of the biceps humeri.

The foetus was at once referred to Prof. Jacobi and Dr. Guleke.

The adductor muscles of the left thigh and the Achillean muscle of the left leg were a trifle shorter than the corresponding ones of the other extremity, the left leg and left foot perceptibly thinner than the right-so the left

Fig. 1.

planta pedis appeared a little more hollow than the right. When the right thigh was flexed upon the abdomen, and the leg gently sustained flexed at a right

angle to the thigh, the foot made an obtuse angle with the leg and the toes pointed to the opposite chest. When the left thigh was flexed upon the abdomen and

the leg gently supported at a right angle with the thigh, the foot made an obtuse angle with the leg; but the angle opened backwards, and the limp toes pointed

towards the right flank. When the lower extremities were straightened out by light pressure on the knees, the right foot made an obtuse angle with the leg, and the toes pointed but slightly inward. But the left foot lies in quite the same plane with the leg, and the toes looked downward and inward. When the attempt was made to make the injured foot take the position normally assumed by the sound foot, a sense of resistance was felt from the planta fascia and the tendo Achillis. An attempt to make large and equal abduction of the two thighs, was met by a similar slight resistance on the part of the left adductors.

The right upper extremity lay nearly straight, with the palm looking forward; but the left upper extremity lay with the elbow flexed to an obtuse angle, with the palm looking forward and inward.

The right hand appears more muscular than the left. The left thenar and hypothenar eminences appear less full than the right, as if from hypotrophy.

CRANIOTABES.

BY A. JACOBI, M. D.,

Clinical Professor of Discases of Children in the College of Physicians and Surgeons, New York. (Read before the New York County Medical Society, Nov. 8, 1870.)

THE specimens I present* are designed to show different degrees of osseous development.

The first cranium presented here, is that of a fœtus

* The paper was accompanied with specimens and diagrams.

born at full term.

Both the bones and their sutures are normally developed, and within the cavity, unless there be disease of its contents, circulation, growth, and functions must necessarily become quite regular.

The second specimen is a cranium in which the same normal development of osseous tissue has taken place, but only to a limited degree. The peculiar sloping off of the margins, and the manner in which the sutural substance appears to overreach its normal outlinesfurther, the thinness and transparency of the bones, seem to show that but an insufficient amount of osseous material has been deposited. Thus, if we are to compare this specimen with the first, we have to speak of a minus of normal osseous development, and nothing else.

The third specimen here shown, is one which I claim as a plus of osseous development-not that there is any change in the condition of the osseous structure as such, but bone tissue has been developed in large quantities at an unusually early period.

While in the specimen just before shown the result must be a looseness, a flabbiness, of the cranial bones and integuments, and a relative instability of the contents, this last skull would exhibit a greater solidity, firmness, and stability of the bones and their coverings, and the effect upon the contents would be just the reverse of that we should have seen in the other.

The brain contained in a cranium which undergoes too early ossification will miss the necessary space for its development. It is not necessary here to recall the fact, that in the first year or two of life there is not a

single organ of the infantile system which develops with greater relative rapidity than just the brain. Thus it happens that when the cranium is ossified too early, the brain, although in itself normally developed, will be compressed; and, though the cranium be in other respects perfectly normal, this too early ossification alone may give rise to idiocy, to epilepsy, and so on. According to whether the early ossification has taken place uniformly throughout the cranial bones, or irregu larly, it will give rise to a number of different shapes, which, in the scientific nomenclature of modern systems of anatomy, have been designated by as many different names.

The fourth specimen I present is one in which there is not a plus or minus of normal osseous development, but a pathological condition. That I may make myself perfectly intelligible, I ask you to follow me through a few remarks.

The growth of osseous tissue takes place from two different sources, either from the junction between epiphysis and diaphysis, or from under the periosteum. In the normal bone the medullary canals progress in a uniform manner upwards to the epiphysis, in the direction of the cartilage, every medullary space remaining the centre of a territory of cartilage, in such wise that the medullary spaces appear to have the function of vessels; for the cartilage is at too great a distance from the blood-vessels of the bones to be fed by their circulation.

The deposit of lime in the soft connective tissue of the bone is the result of the slowness of circulation.