and sweet milk passes down through the stomach in an undigested state, and instead of undergoing lactic acid fermentation undergoes butyric acid fermentation, and we know how susceptible all people are to butyric acid fermentation. The masses of curd from sweet milk not properly digested pass down into the intestine, forming an excellent pabulum for the development and growth of the bacilli, and constantly increase the toxalbumens. Buttermilk, on the other hand, has already undergone lactic acid fermentation, the curds are already broken up into fine particles, it is much more digestible, and affords less pabulum for bacterial growth in the intestine itself. Lime water and Vichy I often use along the lines already indicated. The more you dilute milk the more digestible it is. While milk alone offers all the food necessary for the growth and development of the infant, it does not contain all the food properties necessary for the adult.

If I understood Dr. Irwin correctly, he stated that while typhoid fever was a systemic disease, yet he laid special stress upon the fact that it is a local disease. You may have typhoid fever without a single ulceration of Peyer's patches, without even an inflammatory condition being shown in Peyer's patches or in the ileum. Numbers of post-mortem examinations have proven that the patients died absolutely of typhoid fever without any of the gross appearance of the disease being found in the intestinal tract. The disease is one of systemic character, the ulcerations in the intestines being only a symptom, and no more dangerous symptom than the rapid wasting, rapid degeneration of the heartmuscles, visceral degeneration, involvement of the mesenteric glands. All these symptoms are of just as much importance and just as much necessary to typhoid fever as ulceration of the intestines.

JOHN R. WATHEN, M. D., Secretary.

NEW YORK ACADEMY OF MEDICINE SECTION ON

ORTHOPEDIC SURGERY.

Meeting of December 20, 1901. George R. Elliott, M. D., Chairman.

Dr. Royal Whitman presented a child twenty-one months old suffering from a condition which had at first been mistaken and treated as tuberculous disease of the knee-joint. The particular interest lay in the fact that it was rheumatoid arthritis. The mistake was not uncommon when the larger joints alone were affected, as the signs were similar in the early stage. At present both knees are involved; also a wrist, ankle, and the fingers. The case was presented, first, because rheumatoid arthritis was rare in young children, and to call attention to a common error in diagnosis.

Torticollis. Dr. Whitman presented a patient showing the ordinary treatment of confirmed torticollis. The permanency of the cure was the especial point to be noted. The treatment was by the open method of complete division of all the contracted tissues, over-correction of the deformity, and fixation for several weeks in plaster of Paris. The advantage of a thorough operation was the ability to dispense with apparatus, while after the subcutaneous method apparatus was often necessary because not always possible to completely overcome all deformity. The case showed, to a moderate degree, hemi-atrophy of the face, which is very marked in some instances.

Radical Treatment of Club Foot. Dr. Whitman also showed the result of radical treatment of club foot in a child eight years of age. One foot had been cured by the ordinary means in early life; the other foot was operated upon in July last. The foot that recovered first was much larger than the other, an illustration of the effect of deformity in retarding development. He considered the Phelps open operation the best of the more radical operations for the ordinary club foot of childhood and adolescence, the advantage being that the inner border of the foot was lengthened instead of the outer side being shortened, as was the case in certain operations on the bones. This patient was not confined to bed for more than one week; after that it was allowed to walk about on the plaster of Paris bandage.

Dr. V. P. Gibney asked Dr. Whitman if the occurrence of rheumatoid arthritis in young children was frequent in the literature?

Dr. Whitman replied that he had not investigated the statistics on the subject, but that he had seen several cases in his practice and would judge that it was not exceedingly uncommon in early life.

Dr. W. R. Townsend said, in referring to the case of torticollis operated upon by Dr. Whitman, that he could not agree with Dr. Whitman as to the disappearance of the scar. He had seen many of these scars which looked well shortly after operetion, yet had a tendency to grow more unsightly; he had even known keloid to develop. He thought that at all events patients should be warned of the possibility of a scar remaining.

Dr. Homer Gibney stated that he had seen a number of cases treated by both methods, open and subcutaneous. He had seen several scars disappear in young children. He considered the subcutaneous method the safest except in very severe cases.

Dr. T. Halsted Myers said a transverse incision would give the same exposure of the operative field, and would enable the deformity of the scar to be better concealed.

Dr. Whitman had had no experience with keloid developing late in the scars; if such appeared it was usually within a few months after operation, he thought. He stated it as his experience that the scars practically disappeared.

Extreme Deformity of Rickets. Dr. V. P. Gibney presented two cases showing extreme deformity of rickets. The upper arms, back, and legs were involved in one case, giving the typical deformity of the disease. The second patient showed the lateral spinal curvature, the typical deformity of the thorax, beaded ribs, also deformity of the legs and arms. Both were being treated in the Bradford frame, made convex, in conjunction with general constitutional treatment.

Club Foot Shoe. Dr. Gibney also presented a patient wearing a club foot brace, seen in Hartford and used by Dr. Cook as a modification of Taylor's club foot shoe. In private practice he had been able with this apparatus to control some of the most obstinate cases. In the patient presented, treatment was begun when the patient was six weeks old. Several forms of apparatus had been used from time to time, but relapse had occurred. At present, after wearing the modified shoe, the child holds her foot in perfect position and walks without deformity. The apparatus is a good retentive one, though it does not take the place of operation.

Talipes Equino-Varus. Another case, a child twenty-one months old, was also shown by Dr. Gibney with talipes equino-varus. The deformity was extreme and was corrected under an anesthetic, and various methods had been employed. The last time it was seen it presented the typical "reel-foot." It was thought that if the head of the astragalus could be removed, the fascia divided, and the foot replaced, a cure could be effected. A relapse occurred after six or eight months. Under anesthesia the foot was forcibly put in calcaneo valgus; later a club foot spring with pelvic band was put on and served fairly well, except that two sets of apparatus had to be kept on hand. Finally the modified braces were used successfully.

Case for Diagnosis. Dr. Gibney also presented a boy eleven years old for diagnosis. He came to the hospital some months ago with the history of an injury four weeks previous, having fallen, striking his hip. He got up and limped about, but the next night could not sleep; he had fever, with delirium. On admission to hospital he walked with thigh flexed on pelvis, had little fever, and complained of pain in the hip extending to the knee. He was thought to have hip disease, and was treated with pulley in bed. After three weeks the angle of extension was 110 degrees, flexion normal, practically no pain on pressure. There was no apparent abscess, and the spinal column was not involved. The diagnosis became doubtful. In October fluctuation was thought to be detected under the vastus externus. Incision was negative. The original diagnosis was finally abandoned and the case was considered one of periarthritis.

Dr. Myers asked Dr. Gibney what would be his prognosis in the case of the spinal curvature in the rickety patient?

Dr. Whitman stated in reference to the case of rickets, that when the patient entered the hospital the spinal deformity was thought to be the most serious of the distortions, and that for that reason the patient was placed on the frame.

Dr. Gibney said that Dr. Whitman had partly answered the question of prognosis. He thought the child should be kept in overextension for a while longer, and that afterward a brace would keep the spine in place, and that as the child developed the deformity would be in a measure outgrown. He considered the cases easy to manage so long as they could be kept under observation in a hospital; outside the prognosis was not so good. No manual force had been applied to these cases yet.

Dr. A. B. Judson suggested that while the children were being kept on the frame would be a good time to give mechanical treatment to the lower limbs.

Dr. Gibney considered the suggestion a good one, and would adopt it.

Dr. S. A. Twinch asked what dietetic treatment was adopted.

Dr. Gibney stated that no scientific feeding was followed. Milk and cod-liver oil were given; sometimes iron. The object had been simply to keep the children well nourished.

Dr. Judson said that the club-foot shoe that was shown seemed more like a modified Taylor brace. It was evidently an effective apparatus. He noticed the absence of an ankle-joint, which was very properly omitted, as better leverage was thus obtained, and there was no good reason for the fear that want of motion in the brace would impair ultimate motion in the ankle.

Dr. Myers asked Dr. Gibney his opinion of tuberculin injection for diagnosis.

Dr. Gibney stated that he had not made use of these injection-tests recently. He cited a case at St. Luke's Hospital (the first case treated there) where several lesions developed after the injections, which some years have been required to relieve.

Dr. Townsend said that at a symposium on tuberculosis recently held under the auspices of the New York County Medical Association Dr. DeSchweinitz and others discussed the tuberculin test at length. The consensus of opinion, as expressed by the men presen, was that as a test for tuberculosis its value was doubtful, but that the injections were inocuous.

Incipient Hip-Disease: Recovery. Dr. A. B. Judson presented a girl eight years old, who had been before the Section on November 16, 1900. At that time the history of left hip-disease, covering twelve weeks, had included inconstant lameness, knee-pain and reflex, night cries, muscular atrophy, and limitation of motion. A steel crutch and high shoe had been worn from November, 1900, to November, 1901. Recovery had been so complete that the only traces were three eighths of an inch shortening and one fourth inch muscular atrophy. The case illustrated the importance of early diagnosis. Traction and immobilization had not been sought. Recovery visited the limb, freed from the weight of the body by being made pendant. In this artificial environ