was a combination of the typhoid and malarial poison which produced the continued fever. With the more modern methods of diagnosis and advanced knowledge of the nature of both typhoid and malarial fevers, we now know that no such conditions exist; these cases are either typhoid or malarial. The term typho-malarial is incorrect, misleading, gives rise to confusion, and should not be used, for there is no such disease.

Pursuant to the writing of this paper, I sent out letters to a number of physicians in different parts of the State, making inquiry as to the number of malarial and typhoid fever cases they had had during the past five years. Out of over eighteen hundred cases reported, there were scarcely more than one hundred cases of typhoid fever, the remainder being malarial and typho-malarial. As these cases were reported from outside of the larger cities, I think I am safe in saying that the vast majority of them were of malarial origin. That typhoid fever exists in epidermic form in the larger cities no one can question, but in the rural districts and smaller towns I believe typhoid fever to be a rare disease unless transmitted from an infected area by an infected individual. Cases arising spontaneously in the country, where there is pure water and a case has never existed before, I believe to be almost an impossibility. However, in these cases an examination of the blood will settle the question. Where the parasite is seen inside the red corpuscles the patient has intermittent fever. Where the crescents and elongated masses are found, they have some form of remittent fever.

Having determined as to the form of fever, the treatment will suggest itself. In the malarial types we have a specific in quinine. The time and manner in which it is given is very important. The drug may be given (1) by the mouth, (2) hypodermically, (3) intravenously, (4) by unction, (5) by the rectum.

The quinine should be in solution in the blood at the time of the setting free of the fresh parasites, both before and after the paroxysm. Various drugs have been tried, but none are so efficacious as quinine. Complications and sequelæ call for treatment according to the conditions present. In the severe remittent types of malaria it is best to give the quinine either hypodermically or intravenously, as the severity of the case is frequently such that immediate effect is desired. For this purpose the bimuriate of quinine is the best; the solution can be made. so that 15 m. represents 71⁄2 grs. of quinine. The bisulphate may be used; it is soluble in ten parts of water. Intravenous administration

of quinine is the only treatment in the severe pernicious cases. When the bimuriate of quinine is used the solution should be perfectly clear and warm. Apply tourniquet to forearm'; use strict aseptic precautions in the preparation of the arm and instrument; then with a Pravaz needle inject from below upward into the vein-always select a small one in order to avoid hemorrhage afterward; after withdrawing the needle close wound with collodion. The rectal administration of quinine is unsatisfactory and should not be used, as in this way the amount of quinine absorbed is not sufficient to have any marked effect. The one object to bear in mind is to have the quinine in the blood when the parasite is fresh in the blood as a segmenting body.

PARIS, KY.

Reports of Societies.

NEW YORK ACADEMY OF MEDICINE.

Meeting of October 15, 1897. Section in Orthopedic Surgery.

Congenital Absence of the Radius. Abstract of a paper read by Dr. H. L. Taylor. The absence or imperfect development of the radius in the newborn causes the appearance of club-hand from dislocation of the carpus to the radial side. Case 1: Girl, five weeks old. Absence of the radii. Hand at right angles with forearm. Genuvarum. Mechanical treatment. The figure shows the absence of the radius and the ulna shortened, thickened and bent, also the improved position of the hand at fifteen months. Case 2: Girl, two weeks old. Absence of the right radius and both thumbs with their metacarpal bones. The deformity of the right hand was extreme. The patient. lived but a few months. Case 3: Boy, five weeks old. Slight double radial club-hand with the radii abnormally small. The hands were kept in good position by leather splints. Case 4: Girl, two and onehalf years old. Absent ulna and fourth and fifth digits with their metacarpal bones. Radius thickened, and bent toward the ulnar side. The hand usually turns toward the ulnar side but is sometimes held straight. The elbow has abnormal lateral mobility and hyperextension, as might be expected from absence of the ulna. Children with deficiencies of this kind are usually premature or still-born. If alive,

they seldom live many weeks. There are about two hundred recorded cases of absent fibula and one hundred of absent radius; but the deficiency shown in Case 4, absence of the ulna, is believed to be very rare. The dimples, furrows, and scar-like marks, vestiges perhaps of separated adhesions, support the theory that these defects are caused by the pressure of a contracted amnion. As rotation of the fetal limbs. is said to begin about the fifth week, if the amnion exerts pressure from the fifth to the eighth week the radius and fibula may be blighted. If, on the other hand, the contraction takes place before the fifth week and before the rotation of the limbs, the ulna and tibia will suffer.

Operations, if performed, should be preceded by mechanical treatment. Contracted structures may be divided. Osteotomy may be followed by overcorrection and the ulna may in various ways be attached to the carpus in an improved position.

Dr. R. H. Sayre said that he had treated a patient affected with double congenital absence of the radius by manipulation, stretching, and retention in plaster of Paris. The hands had been brought into a fairly normal position, but the child died of cholera infantum when ten months old. In another case the ulna was so small that it hardly seemed feasible to split it for the reception of the carpus, as has been done in a reported case. He therefore fixed the ulna in a gap in the carpus.

Dr. A. H. Phelps said we could hardly use the term club-hand in speaking of congenital absence of the radius.

Dr. A. B. Judson said that there seemed to be no affection of the hand corresponding to congenital club-foot. So-called club-hand was caused by deficiencies of the skeleton, by injuries and diseases of the bones, by cicatricial contraction or by paralytic affections. There were also cases of club-foot originating in all these ways, but what we know as congenital club-foot is caused by factors which are apparently not operative in the upper extremity.

A Case of Traumatic Club-Hand. Dr. Taylor exhibited a girl, eight years old, a portion of whose radius had been resected for necrosis. The radius was, in consequence, much shorter than the ulna, and the result was that the hand was thrown toward the radial side and had the appearance of a club-hand.

Dr. Phelps said that, in a case of club-hand thus acquired, he would shorten the bone instead of cutting the tendons. Tendons when divided in their sheaths are apt to become adherent, while resection of the longer bone would in suitable cases bring the hand to a normal position.

Traumatic Club-Foot. Dr. Judson was reminded of a patient whose tibia had been shortened for disease of the bone. As the boy grew the fibula projected to such a degree that the patient could not walk. In such cases another operation was necessary to shorten the unaffected bone.

Dr. R. Whitman was reminded of a man whose tibia had been shortened by an operation when he was thirteen years old. The result was that when recently seen the leg was five inches short, and the foot had been forced into extreme varus by the relative overgrowth of the fibula. Bone reproduced to fill an interval left after resection did not grow. Final results after such operations, performed in childhood, were usually unsatisfactory.

Dr. R. H. Sayre cited a case which shows that reproduced bone did not cease to grow. The patient had been exhibited to this Section by Dr. L. A. Sayce. Four inches of the neck and head of the femur had been removed, and when the boy was twelve years old there was only about one fourth of an inch of shortening. In some of Dr. J. R. Wood's resections of the jaw the lower maxilla had been reproduced and had grown with the rest of the body.

Dr. Whitman said he referred to parallel bones of the extremities. Deformity was almost inevitable when a portion of one bone only is removed.

Dr. Phelps said that new bone had feeble circulation, grew less rapidly than normal bone, and becomes very hard, as was shown when one of two parallel long bones was reproduced.

Dr. R. H. Sayre said that the vicinity of a nutrient artery would probably influence the growth of new bone.

A Case of Helpless Club-Foot, from Deficiency of the Skeleton. Dr. R. H. Sayre described a case in which double club-foot was associated with congenital deficiency of both of the bones of the leg in a girl twelve years old. There was a bent and rudimentary fibula and a tibia, only an inch or so long, which stuck out like a little sprout under the skin. The foot was very much twisted and hung with a helpless flailjoint against the leg. Amputation at the knce was done.

Club-Foot Caused by Absence of the Fibula.

Dr. Whitman exhibited a child, eight months old, in whoin congenital absence of the fibula had caused talipes equino-valgus and anterior bowing of the tibia. The equinus had been extreme, but division of the tendo Achillis and the application of a brace had brought the foot to a right angle.

Dr. Taylor had seen eight or ten patients affected with congenital absence of the fibula. He said that in such a case it was very difficult to remove the lateral deformity by an operation. As there was no malleolus to support the foot it would return to its former position. Another interesting point was that the shortening found in infancy, in congenital absence of the fibula, would greatly increase with the growth of the child. In an adult, whose measurements he had taken for some years, there is a shortening of five or six inches. In a boy of twelve years the shortening was the same, and increasing. This progressive shortening took place in the forearm as it did in the leg.

THE LOUISville meDICO-CHIRURGICAL SOCIETY.*

Stated Meeting, October 22, 1897, the President, Frank C. Wilson, M. D., in the chair.

1. Trephining for Partial Imbecility. Dr. A. M. Vance: This boy is seventeen years of age. His history was given in full at our meeting four weeks ago; but I will now give a brief resume of it. Two years ago, the patient being then comparatively speaking a normal boy, not brilliant or extraordinary, was struck by a bowlder on the right side. of the head a little above and posterior to the ear. From that time he

Stenographically reported for this journal by C. C. Mapes, Louisville, Ky.