administered so rapidly that in two minutes the patient is ready for operation. The bending or breaking of the bone in the osteoclast rarely takes more than six or eight seconds. The deformity is over corrected by hand and held while a plaster bandage is applied. Seldom more than five minutes is consumed in the application and setting of the plaster bandage, and eight minutes suffice for the anesthetic and operation, and the patient is removed from the table. The brevity of the anesthesia necessitates the administration of but a small quantity of ether, permitting the patient to escape nausea and vomiting, and the rapidity of the operation is necessary to preserve the soft parts from bruising.

In bow leg with three contributing curves, the apex of the most prominent is usually selected for the operative point and over correction is made not only sufficient to correct the curve attacked, but continued sufficiently to neutralize the two minor deformity

curves.

Fig. V. represents a severe case of bow leg. The only operation was an over correction of the tibia just above the middle, in the apex of the deformity. The skiagram of this case, Fig. VI, shows that the two minor curves and the over correction curve, though pronounced, have neutralized each other. The over correction has lengthened the legs about six centimeters and, as will be seen in Fig. VII, has assimilated into the general contour of the legs, producing a perfectly symmetrical appearance.

To illustrate knock knee correction to the best advantage I have selected a bilateral case, as will be seen in Fig. VIII, the only deformity being in the left tibia about three centimeters below the head. In this case the only operation was an osteoclasis at the apex of the deformity in the tibia, with slight over correction. The result will be seen to be perfect, both in the skiagram, Fig. IX, and the photograph taken six weeks after the operation, Fig. X. By comparison of the two legs in the skiagram it will be seen that there is practically no difference in the condyles.

Rapid unions are the invariable rule following osteoclasis, and in six weeks after the operation the patient is walking on straight legs, without braces of any kind. A record of five hundred cases without a single abrasion or delayed union, or other unsatisfactory result, would seem to prove that rapid osteoclasis is a safe and certain operation for the correction of genu varum and genu valgum, and that it is free from complications.

In conclusion, skiagraphic observation seems to prove that the

FIG. IX.

FIG. X.

rig. VIII. A case of bilateral genu valgum with the central deformity just below the head of the left tibia.

Fig. IX. Skiagram, with right and left reversed, after correction at the apex of the deformity in the tibia at letter
A, showing the condyles of both legs to be practically normal.

FIG. VIII.

deformity of knock knee and bow leg is seldom, if ever, central in either the condyles or the joint.

I feel constrained to say that epiphysiolysis is hardly worthy of serious consideration, when compared with either osteotomy or osteoclasis. That osteotomy has some slight dangers from which osteoclasis is free, and the comparatively prolonged time taken for bone union and recovery should condemn it when osteoclasis is available.

BIBLIOGRAPHY.

1. Lorenz. Med. Rec., N. Y., Dec. 27, 1902.

2. Reiner. Zeitschrift fur Orthopadische Chirurgie, XI. Band.

34 WASHINGTON STREET.

CONTINUOUS INTRA-UTERINE IRRIGATION IN GRAVE PUERPERAL SEPSIS WITH REPORT OF CASE.

BY EDSON B. FOWLER, M. D., CHICAGO.

This treatment seems to be of value more especially in those severe cases of puerperal infection in which other more or less heroic therapy has failed and where by some hysterectomy has been considered the only recourse.

In 1862 Veit and Hirsch used antiseptic washings as did somewhat later Winkel, Bischoff, Fritsch and Thiele. Beginning with Veit's report in 1879 some details are obtainable. He reports the

Kob re

results of 950 irrigations (number of cases not given) with ten deaths. Breisky gives details of fifteen cases with two deaths. One of these came under treatment complicated with pulmonary tuberculosis and pneumonia, and the other with gangrene of the lung and pleurisy. Lalesque had two cases which recovered and Rendu one. ports fifty-two treated in the Königsberg clinic with three deaths. Talbot Jones had three successful cases. Dunsmore reports one which died at the beginning of the irrigation from possible embolus. Pinard and Varnier report two cases, one of which died with pyemia and the other with general peritonitis. Their irrigations were brief and they conclude that continuous irrigation would have been more beneficial and was "the only rational treatment." Kurz cites eight cases which recovered and compares them with six parallel cases not irrigated, which died. Manseau reports four cases with recovery. He employed sterile water. Steinhall, in a translation of Sneugeriff,

states that he used the treatment in fifty cases with "most favorable results." Haynes has collected thirteen cases of irrigation for puerperal fever which came more or less under his notice. He refers to two deaths, one of Chastrain's from passage of the irrigating fluid into the tubes, and one from rupture of a diphtheritic uterus. Langenbach and Schede each mention two cases with recovery. Richter reports twenty cases with two deaths. This gives a record of 129 cases with 12 deaths besides 52 cases of Sneugeriff who does not state the number of deaths, and Veit, who had 10 fatalities, the exact number of cases not being given.

Antiseptics were used in 125 of the 129 cases with a mortality of about 10 per cent. The other four cases were successfully treated with sterile water only.

The case which I report was thirty-three years old, multipara, history negative. At the 9th month of pregnancy moderate albuminuria developed which diminished under treatment. The child died in utero about term. Induction of labor had been advised but refused by patient. Labor began some ten days later. A midwife attempted to deliver the child before the writer arrived. The placenta was delivered in a broken condition. In 24 hours patient had a chill and temperature of 101. In another 24 hours temperature was 103.5 and the other signs and symptoms of sepsis were present.

Treatment Before Irrigation was Used.-She was given a very little chloroform and the uterus thoroughly explored with the hand, but no pieces of placenta were found. The uterus was douched with two quarts of 1 to 1,000 lysol solution. The temperature dropped to 99.5 for a few hours and then rose to 103.8, pulse 126. An effort was made to control the fever with quinine, douches and cold sponge baths. The baths were given almost continuously for 24 hours, but the fever remained at 103.8, pulse 126.

On the following day, in spite of almost continuous baths, quinine, strychnia and spiritus frumenti, the temperature was 104.6, pulse 136. An intra-uterine douche of 2 quarts of 1 to 500 lysol solution was given. The temperature fell to 102.8 and pulse 116. The sponging and medical treatment (quinine 144 grs., strychnine 1/10 gr. and spiritus frumenti 12 oz., in 24 hours) was continued, but the temperature rose to 104.2, pulse 122. Skin dry, thirst, scanty urine, trace of albumen, tympanitis, pulse thready, restlessness and later a deep mental stupor from which the patient was aroused with difficulty. The uterine douches had been but of temporary value, while the other treatment was clearly not controlling, or even keeping pace with the infection. In addition to the treatment as given we decided to use continued intra-uterine irrigation. To avoid extensive destruction of tissue by antiseptics and poisoning from the same source, boiled water only was used for irrigation.