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DR. BROWN'S REPORTS OF CASES
BOSTON ORTHOPEDIC INSTITUTION. 
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REPORTS OF CASES
BOSTON ORTHOPEDIC INSTITUTION,
HOSPITAL FOR THE CURE OF DEFORMITIES
OF THE HUMAN FRAME.
BY JOHN B. BROWN, M.D.
Re-published from the Boston Medical and Surgical Journal.


         ?Li:^Aiiy. *

        BOSTON:
  PRINTED  BY  D  CLAPP, JR.
          18 4 4. 
 
PREFACE.
  I herewith present to the public a few specimens of the Orthopedic art.
They are but few, but enough  to show  what may  be done by judicious
treatment in relieving deformities of the  human frame.   Notwithstanding
the light which has been thrown upon this subject within a few years, and
the prevalence of belief in the beneficial  effects of  proper treatment, few
practitioners, who have not given particular attention to the subject, are
aware that such distortions can be made, so nearly, to approximate sym-
metrical conformation.
  The art of orthopedy is not of recent origin.  It was practised a hundred
years ago—in the  eighteenth century—but  the  discovery (of recent date)
that tendons could be divided  with  impunity, gave new life to this most
useful,  but  which had become  obsolete,  art.   The word  Orthopedy, or
Orthopaedy,  (the  English  spell  it  with  a diphthong) is derived from the
Greek—orthos, straight; and jj««'.s,  child; straight child (or young person).
The term is  now extended to the art of curing  deformities in general.
Much of the success  that attends the practice of  orthopedy at the present
day, may be attributed to  the  increased  experience in mechanical treat-
ment—the scientific adaptation of  mechanical means to the cure of defor-
mities, upon anatomical and physiological principles.
   From time immemorial, no age has been exempt from pretenders  to cure
club-feet, spinal distortions, &,c. &c.  These pretenders have mostly con-
sisted of quacks  and machine-makers, who knew nothing of anatomy and
physiology.   Regular surgeons, finding the uncertainty, difficulty  and fre-
quent impossibility, of curing these deformities, had relinquished the prac-
tice of orthopedy to these  ignorant men, who applied such  means as their
cupidity and stupidity might suggest.  The practice of orthopedy is a dis-
tinct branch of surgery,  as much as  dentistry, or the profession of the oc-
ulist  or aurist, and should be practised  exclusively.   It certainly requires
all  of any one  man's mind to treat these deformities  judiciously.   It would
be  better for the profession and for the public at large, if the duties  of the
profession were more divided  and subdivided;  for the same reason that the
mechanic arts are carried to a  higher state of perfection in proportion as
their distinct branches are made the exclusive objects of attention by indi-
viduals.   It is reasonable to suppose, that an individual who gives his ex-
clusive attention to any one subject, will  make greater  progress in it than
one who devotes his attention promiscuously to a variety of subjects.
   Deformities of the human frame cannot be conveniently and judiciously
treated, except in  a Hospital or Institution expressly devoted to this object.
It is not for the interest of any general practitioner of medicine  and surge- 
IV
PREFACE.
ry, to be at the expense of furnishing himself with the variety of apparatus
(some of which is very  expensive) required in treating these deformities.
Then, again, ho might not always have at command suitable mechanics.   I
have been obliged to keep two or three first-rate mechanics constantly in
employ, for several years,  in making, altering and repairing apparatus.
   The Orthopedic Institution at  Paris, under the direction of  Dr. J. Gue-
rin, has nearly a hundred  thousand dollars invested  in  apparatus.   The
Boston Institution has a considerable amount, and is constantly increasing.
   Some have asked why this class of patients could not be treated at the
Massachusetts General Hospital.  The answer to this is, that there would
be an impropriety in patients of this description being mingled with the
patients who usually resort  to that useful  Institution, suffering under all
kinds of disease.  Then, again, they have  not the  accommodations,  as it
regards  room.  Should they put  themselves  in readiness  for a suitable
orthopedic establishment, they ought to erect two buildings, one for males
and one for  females, with  a gymnasium  attached  to each.  These ought
to be furnished with every variety of apparatus for correcting every variety
of physical deformity ;  and then  a skilful surgeon should be hired to  give
his whole attention to this  business,  with two or  three mechanics under
his direction.  As well  might they comprise  under their  wing, the  Eye
and Ear Infirmary, and set up the  business of dentistry.  These are no
more remote from the object for which the  Hospital  was founded, than
orthopedy.  It  requires a peculiar combination of talent to practise this
branch of business with success,  and he who possesses the most of the pre-
requisite qualifications, will meet with the greatest success and do the most
good in the community.
   Deformities of the spine and chest, and their deviations, variations and
improvements, are not so  easily  delineated  on paper as those of the limbs,
and would be attended with more expense.  I have not, therefore, given
any engravings of this description of patients.  My patients, however, with
curved spines and deformed chests, are  quite  as numerous as those with
deformed limbs ; and if I may be permitted  to express an opinion, I should
say the treatment has been quite  as successful.
   There is one fact, in connection with this subject, which I wish to state,
and which I am led to suppose is not generally known in the community,
viz.,  that physical deformities occur much more  frequently  among   the
poor  than the rich.   This  is more particularly the  case  in deformities of
the limbs.  From my experience, I should say seven tenths of this descrip-
tion of deformity happen among those unable to pay the expenses of being
cured.   How can a  given  sum of money do so much  good, in  any other
way,  as appropriated to the cure  of these deformities ?
JOHN  B.  BROWN,  M.D. 
                          CASE  OF

CLUB-FOOT  AND CURVATURE OF THE  SPINE,

           TREATED AT THE BOSTON ORTHOPEDIC INFIRMARY.
 December 9,  1840,  Miss A.  E., aetat. 25, daughter of a distinguished
 clergyman, now deceased, placed herself under my care.   She has varus
 congenitus of the left  foot, of the third degree.  The temperature of the
 limb  is lower,  and the foot  smaller than the other.   The  leg  is also
 smaller, and an inch and a half shorter than its fellow.  The tarsal bones
 are loose and easily moved on each other.  She is constitutionally slender
 and delicate, and has  not enjoyed  good health  from infancy.  The spine
 is badly curved, in consequence  of her irregular manner of walking; and
 the sternum hollowed  in posteriorly, so as to impede the free action of the
 lungs and heart.  She has frequent palpitations, and labors for breath, par-
 ticularly on going up an ascent,  or making a hurried effort of any kind.
   16th. Divided the  tendo-Achillis, and the tibialis  anticus, in the pre-
 sence  of Dr.  J.  Mason Warren, and  applied my  apparatus,  as  usual,
 on the same day.
   17th.  Has had no pain, and  rested well.
   26th. Removed the dressings for the second time.  Found the punc-
 ture made in dividing  the tendo-Achillis, somewhat  inflamed, and  had a
 festerino- appearance.  The ankle was slightly swollen.   Applied empl.
 plumbi, and bandaged the leg.
   27th. Found the appearance  of the puncture much as yesterday.  The
orifice was open, and not healed as usual by the first  intention.   In doing
this operation, 1 made  use of a knife, in breadth not more than the twelfth
of an inch,  but the integuments  were more divided than usual when I use
the tenotome.   Probably some  air was admitted.
   29th. On  removing the  dressings, found  the orifice not healed, and
discharging a thin, ichorous matter.   The skin was  inflamed around it,
and  the integuments  adhered  to the  tendon.  Applied court plaster,
                  2 
10
  bathed the limb with camphorated spirit, and bandaged the foot and leg.
  At night applied a poultice made of sol. acet. plunibi and bread.
    31st. Appears much better.   Inflammation has subsided, and the parts
  look more  healthy.
    Jan. 5th, 1811. There is  some (edematous swelling of the ankle, but
  the orifice has closed.  Continued bandages and spirituous solution.
    20th. Put on a boot.   She is to  wear this during the day, and apply
  the apparatus at night.
    May  23d.  It is now nearly five months since Miss A.  E.'s foot was
  operated upon.   She lias  walked very well,  and  occasionally in the
  streets, for the last two months ;  and for a  longer time about the house.
  The foot is nearly normal, and she begins to think about taking measures
  for correcting the curvatures in the spine.
    On minute examination. I find she  has four lateral curves.  The upper
 one extends quite up to the  os occipitis.   She inclines  her head to the
 right, and is in  the habit of resting  it  on  the right  fore-arm and  hand ;
 the elbow being supported on  a table, chair, or any convenient article that
 may be near her.   The greatest curvature is situated about the middle of
 the dorsal vertebrae, with its convexity towards the right side.  The  devia-
 tion here is  two inches from the mesial  line.   The  right shoulder is ele-
 vated.  The  right scapula projects, and there is very considerable excur-
 vation of the  ribs on  this side.  I  asked her if she was willing I should
 cut her  back.  She  unhesitatingly said yes.   Dr.  J. C.  Warren, my
 friend and  brother-in-law, was called in consultation.  He  advised to an
 operation.
   May 23th.  Divided this day  the longissimus  dorsi, the sacro-lumbalis,
 and trapezius, in the presence  of Dr. J. Mason Warren and Dr. J.  V. C.
 Smith.   There was very little  blood  lost in  the two  operations, and she
 bore them with that cheerfulness and  equanimity which so strongly mark
 her character.  While in the  act of dividing the muscles, she was asked
 if it hurt her.   She smiled, and said " a little—not much."   A  compress
 was applied and secured by a  bandage.
  26th. Slept little last night, owing  principally to the compress, which
 was rather thick, and  the tightness of the bandage.   Removed the ban-
 dage and compress, and applied a common poultice, moistened with tinct.
opii.  She suffers  no  inconvenience  from  the division of the trapezius.
Afternoon of this day, she is now quite comfortable ; has slept considera-
ble; still feels some dull  pain  in  her back.  Recommended, if it con-
tinued, 25 drops of tinct. opii  at night—also sol. sulph. magnesia.
  27th. Slept well.   Says she has no pain,  but a weary sensation in her 
11
back.   Laid four hours on  the extension plane this morning, without its
causing the least uneasiness.
   2Sth.  Slept well.   Suffers no pain or uneasy sensation in the back or
neck.   In  fact,  the  division  of the trapezius has occasioned no inconve-
nience whatever, from the first.  She has  moved her head with perfect
freedom.   There is a slight tenderness in  the back on pressure upon the
parts where the  muscles were divided.
   31st.  Has had no pain  since last date.  Has  spent most of the days on
the extension plane,  and a part of each night.   Back much improved.
   June 15th. The back continues to improve  daily, but she  complains
that in walking  her  foot  inclines on  the  outer side.  On examination, I
find that the foot has outgrown  the  shoe  of the boot, and consequently
the foot  is cramped and  twisted, which causes the weight of the  body
to rest too  much on  the outer marginal  surface.  I regret that I had not
known this circumstance before, as it  might easily have been prevented by
substituting a suitable boot.   She has now  been walking for some weeks
in this cramped  condition  of the foot.
   18th.  Think  it best to  re-divide  the tibialis  amicus, and the abductor
propius policis pedes, and re-apply the foot-apparatus, which 1 did.
   July 1st. Miss A. E. wore the foot apparatus nearly  a week, without
attempting to walk ;  after which she had a boot made adapted to the im-
proved state of the foot, and sufficiently long, since  which she has taken
her usual walks, with perfect ease to herself, and with the sole of the foot
resting naturally on the sole of  the boot.
   Sept. 6th. The foot is almost entirely restored.   It is  now  fourteen
weeks since the  operation  on  the back.  She has passed one week of the
time in the country.   With this exception, she  has  very steadily pursued
a course of orthopedic  means  to bring the spine into a normal shape.
The neatest deviation now is only one fourth of an  inch  from the mesial
line.   She has gained over an inch in height,  and  her health  has  very
much improved.  Notwithstanding the various operations  on her  foot and
back, and  the various mechanical  means  she has made  use of, she has
been regularly gaining flesh  and strength; and  her  health is in  every re-
spect much better than when she came to Boston.  She is still continuing
orthopedic  exercises.                              John B. Brown.
   Boston,  Sept. 13, IS 11. 
 
                         CASE  OF

PES  EQUINUS  ACQUISITUS OF  RIGHT FOOT,

          TREATED AT THE BOSTON ORTHOPEDIC INFIRMARY.
John Gates Trulan, of Andover, Mass., set. 14, was placed under my
care by his father, Hugh Trulan, Esq.
  June 15th, 1841.   The heel is elevated to the fullest extent, and can-
not be brought down by the hand, on account of resistance of the  tendo-
Achillis.  The knee is contracted to sixty degrees from a right angle with
the thigh.  The whole limb, and particularly the foot, is twisted inward.
There is a slight convexity of the tarsus externally.   The weight, as  he
walks, rests  upon the extreme end  of the metatarsal bone  and joint of
the little toe (see fig. 1).  For a further description, I refer to the history
of the case below, sent me by his father.
 
14
  Aug.  10th.  He  threw aside his crutch, and walked  anywhere  about
the  city.
  Au<r.  17th.  Eight weeks after the division  of the tendons, John's foot
had improved to the state represented in fig. 2.
  Aug.  31st. Returned home cured, the knee having been brought straight
by mechanical means and orthopedic exercises.
  The following letter has since been received from his  father.
                                        "Andover, Sept. 24, 1841.
  " Dr. Brown.   Dear Sir,—1 received yours of the 21st inst., in  which
you wish me to inform  you  how  my son's  deformity originated.  I an-
swer, he was as well  and  straight as any child until  he was about two
years old, when he was taken sick of a fever.   Soon after his recovery he
began to turn in his right foot a little.  We did not mind much about it,
and thought he would outgrow it,  but  it kept growing  worse and worse
until  1831, when 1 carried him to  a doctor in  a  neighboring town, who
tried to  cure him  by machinery.  Here he  stopped one month.  I will
give the doctor credit for his  honesty, for he  found he could not cure him
and told me so.  Then we let it rest until  1837,  when I heard of  a doc-
tor  in New Hampshire who was in  possession  of Goodrich &,  Co.'s pa-
tent apparatus for curing club-feet.  I carried him there, and he stopped
with him until we fancied he was better, and brought him home, but when
he  began to walk, he was  as lame as ever.  The tendons which had been
stretched went back again, and he kept growing worse and worse, and we
had given up all hopes of  his getting any help,  until we heard of you,
and 1 shall ever rejoice,  and so  will my son, that  I placed him under
your  care, where, I can say, with great pleasure, he was made from a
deformed  cripple to an upright lad, and there is  no  doubt  in  my mind,
that,  when he grows up to maturity, that foot and leg will be equal with
the other.   His health is good, and he is in good spirits.   He says  he will
never forget the kindness he received  from you.   When my son entered
the Orthopedic Infirmary  he had been obliged to  use  a crutch for  two  or
three years.   His foot was so much turned in, that when he put it down,
he  trod on the joint of the little toe, and the inside of the foot  turned up-
ward.  The cords of the heel and  ham were so much shortened, the
heel  was  seven inches  from the  ground, and the leg one and  a half inch
shorter  than the other.   Now he stands and  walks perpendicular,  the foot
being elevated to a level with the other by a cork sole, placed in his shoe.
Since he came home, all  who have seen  him, look with astonishment;
and this was done in the short space of ten  weeks.
                                                  Hugh Trulan." 
                       CASE  OF

DOUBLE  VARUS   CONGENITUS,

      TREATED AT THE  BOSTON ORTHOPEDIC  INFIRMARY.
Miss E.  A. Sawtell, aet.  10, entered the Orthopedic Infirmary in Bos-
ton, May  9th, 1840.   She has double varus congenitus of the third de-
gree ; left foot the worst; both feet are turned in to nearly a right angle
with the legs.  She rests  her weight, when she stands or walks, on the
outside  of the  feet  and the  external  ankle,  the sole looking  upward.
As she steps, one foot goes over the other.   (See figs. 2 and 4.)
Fig. 1.                      Fig. 2.
   May 14. Divided the tendo-Achillis in both feet, and the tibialis ami-
cus in the left foot, in the presence of Drs. J. Randall and E. W. Leach.
   July 30.  It  is now rather more  than  six weeks  since these feet were
operated upon.  They are both very much improved, and she walks very
well.   The right foot has improved  faster than the left.  There appears
to be  a thickening  of the sheath of the heel cord, which  prevents the
heel from being brought down.   Re-divided, this day, the tendo-Achillis,
together with its sheath.  She  returned  home in  about twelve weeks 
16
from the time she came to the Infirmary.   Her feet are as represented
in figures 1 and 3.
                   Fig. 3.                          F'°- 4
  After Miss Sawtell's return home, the following favorable notice of the
case appeared in  the Boston Medical and  Surgical Journal, communi-
cated by her physician, Dr. Wilder, of Groton, Mass.
  " Miss  Sawtell, of Groton, aet. 10, general health good, muscles well
developed, had what is  termed  double varus of the third degree, as  bad
as it could well be, as  the feet  were  nearly vertical.  The  point of sup-
port  was the outer ankle, nearly up to the end of the fibula, and  the
foot so  completely turned that the  sole looked  nearly upwards.  The
unnatural points  of support were  most of  the  time so much  inflamed
as to be very painful, and many times so much  so as  to  prevent sleep.
Walking, or rather hobbling, was  exceedingly difficult  and painful,  pre-
cluding  all expectation of her limbs  ever being  of much service to  her.
Upon being informed of the  improvements  in  surgery, and  of the  skill
and success  of Dr. J. B. Brown, of Boston, her friends determined to
place her under his care, which they did the 14th of  May  last, where
she remained until the 23d  of  August, when she  returned with her feet
entirely changed, so that she placed the sole of the foot perfectly upon
the floor, with the soles in the position they should be, in  relation to the
limb, neither in nor out too much.   When the  muscles  and tendons have
had time to become accustomed to their present  position, and  regain full
strength,  I think it will be a case of complete success, and that she will
not only walk with ease, but elegance.       A.  H. Wilder, M.D." 
                           CASE  OF

PES  EQUIMS  VARUS  CONGEMTUS  OF RIGHT FOOT,

            TREATED  AT THE BOSTON ORTHOPEDIC  INFIRMARY.
 July 22d,  IS 11, Mr.-------,  aged 55, of Ho ton, placed himself under
 my care with a deformed foot, which has afflicted him from birth.   When
 he stands the heel is elevated six inches from the floor.  The great toe is
 turned up, so as to render it impossible for him  to wear any kind of shoe.
 (See fig. 2.)  The ham-strings are shortened, so as to keep the knee  per-
 manently bent.   By  inquiring into the  history of this case,  I  find  that
 some of his  relations are affected in a manner not very dissimilar.   There
 seems to be a hereditary predisposition, in this  family, to a contraction of
 the  muscles, particularly  of  the  hands, feet  and back.   I have now  a
 niece of this gentleman under my care, who  has been troubled with eon-
 traction of the small toes, so as to produce much inconvenience and pain
 in walking.   1 have divided  the flexor tendons of some of them,  which
 enables her  to walk with  ease.   She also  has  a lateral curvature of liie
 spine, arising from  the unnatural  contraction of some of the  associated
 muscles of the back.  She has been at the Infirmary, pursuing orthopedic
 exercises, about six months, and  is very much improved ;  the deviation is
 now very slight.  Six  months more will entirely correct  the  deformity,
 and restore her to perfect symmetry.  This case is mentioned, as one of
 many others, where particular deformities run  in  particular families.   I
 have now under treatment a boy. who  has two club-feet of the worst
 kind.  His  father has two  of the same  kind.   His uncle, who is now
 dead, had  two, his grandfather one—seven in one family.   I have  also a
 lad under treatment, in whom the ham-strings of  the left  leg are shortened,
 the knee permanently bent to  a certain extent, and  the left foot so much
 distorted as hardly to be recognized as a human foot.   It may  be techni-
 cally called pesequinus varus.  M. J. Guerin, of Paris, would denominate
 it  l'equin varus—a combination of two distinct species of club-foot, united
 under one generic term.  But even this complex  technicality does not give
an idea of the extent of the deformity in this case.  The foot may be con-
sidered as an exaggerated and varied condition of two species of club-foot,
viz., pes  equinus and pes varus, combined.   This lad has a sister with one
                    4 
18
 foot somewhat similarly affected, and a cousin with both feet.  But enough
 of family idiosyncrasies.   I will  proceed with the report of my case.
   The gentleman of whom I was speaking cannot be said to have walked
 for the last ten years.   He has only been  able to hobble across the room,
 and into the adjoining house, by the aid of a crutch and cane, resting his
 weight partially on the outside  of the  metatarsal  bone and joint of the
 little toe. The foot is shorter than its fellow, and the entire limb  is shorter
 and very considerably smaller than  the healthy one.
   This day, July 22d, I divided the tendo-Achillis, and the extensor ten-
 don of the great toe, in the presence of Dr. J. W. Gorham.   The di-
 vided ends of  the tendo-Achillis separated two and  a half inches at once.
 My  usual apparatus was immediately applied—the foot-board having been
 first  perforated, so as to admit  a  strap for the  purpose of reducing, and
 confining the great toe in a natural position.
   Sept.  1st.—The heel is perfectly down,  and ho treads fairly on the sole
of his  foot.   The toe  was  immediately brought straight, and has  con-
tinued  so.  It  was necessary to confine it but a few  days.   (See  fig.  I.)
  Oct. 4th.—Put on a boot with a steel support on one side, and directed
him to walk as much as he could.
   The knee still inclines to bend forward, but he can bring it straight by
volition.   He  walks  rather imperfectly at present, but  this is not to be
wondered at, as the  leg has  been out  of  employ for many years.   It
will acquire strength by use, and there is  no doubt but he will walk well
in the course of a few months.   He has no reluctance in representing his
own case as it was, and as it now is: and  his  name may be known by
inquiring of me, 65 Belknap street.                   J.  B. Brown. 
i 
I 
CASE  OF  TORTICOLLIS,  OR WRY NECK,
TREATED AT THE BOSTON  ORTHOPEDIC INFIRMARY.
Miss H. S., aetat. 7.   The right sterno-cleido-mastoideus muscle strongly
contracted.  The face  is  turned over the left shoulder, and the  back of
the head over the right and almost in  contact  with  it.  She has the vis-
age of a wry-neck patient, but not so much so as  in cases where the de-
formity is congenital.   The angle of the mouth is depressed and drawn
down.   The left eyebrow  is  elevated  above the right.  The right side
of the head is so strongly  inclined to the right shoulder  as to give an ob-
liquity to all the features of the face.  This deformity was the sequel  of
scarlatina maligna; and so far as my experience  extends, non-congenital
deformities and contractions of muscles  are more  frequently the result of
this disease than any other.
   She has combined with the torticollis  a lateral  curvature of the spine.
The greatest deviation  is between the shoulder-blades, the  convexity  be-
ing towards the right, but there is an acute angular convexity of the  cer-
vical vertebra? towards  the left, produced  by the  strong and  permanent
contraction of  the sterno-cleido-mastoideus muscle, which draws the back
of the head over and nearly on  to the right shoulder.
   March 6th,  1840.   After a consultation with Dr. J. C. Warren, I di-
vided the sternal branch  of the  sterno-cleido-mastoideus,  in  presence  of
Drs. Thompson of Charlestown, Pratt  of the  House of Representatives
of Mass.,  J. M. Warren, and E. W. Leach.  Applied the paste-board
stock after the manner of Dieffenbach, which was used for some weeks,
but to very little effect.   This  day, April  18th, applied  an  apparatus
which  I  contrived for the purpose.   It  consisted  of a  brass belt resdng
on the hips, with crutches  coming  up  under  the  arms, the  anterior ex-
tremity of which, on the   left side, extended  to about  the height of  the
top of the head—and the posterior extremity on the right side extended
to about  the level  of the  ear.  The tops  of these were connected by a
steel wire in  the form of an arch, which went over the head for the purpose
                    5 
oo
of giving them support.   Each of these uprights  had a spring attached
at the top and running at right angles, an inch wide and six inches long;
the one on the left  side running  posteriorly, and  that on the right ante-
riorly.   A cap was  made for the head, of brown cambric, so as to fit, and a
strap attached on the right side and brought round posteriorly and buttoned
to the top spring on the  left side.   Another strap  of the same material
was attached  to the cap on the left  side, brought  round the chin, and
buttoned to the  right top spring.   These straps acting together, had the
effect of elevating the head, and bringing its posterior part from the right
shoulder, to which it inclined, towards the left, and  of bringing the  chin,
which  inclined towards the left shoulder, round to a front position.   This
operated very well, and much was gained towards bringing the head into
a normal position ;  but the divided branch of the sterno-cleido-mastoideus
united so quickly as not to give time to  correct the acute angle which its
contraction had produced in  the cervical vertebrae, and the cleidal  por-
tion of this muscle  also became a barrier to the restoration of the head to
a natural  position.  It was  thought best, after a consultation, to  divide
this branch,  and also to re-divide the sternal branch of the sterno-cleido
mastoideus, which  was done in the presence of Drs. J. M. Warren and
E. W. Leach.   The head  did not turn suddenly round,  and perform
all manner of evolutions, as  represented by some writers who have done
the same operation,  but  it  gradually  came round, and  as  much  as it
could  consistently  with the previous contracted cervical  and dorsal cur-
vatures.  When these curvatures are entirely  corrected,  I have no doubt
the head will assume its  normal position and be placed as it should be,
in  a mesial line between the shoulders.  In  fact,  it is  so much so  now,
that an acquaintance of the family, a  lady  who called  in, having heard
that one of  the children  had  a wry-neck,  asked  which  it was,  all be-
ing present.
    The application of the apparatus above  described  is represented in
the annexed  cuts.  A B,  fig. 1, are  the top springs, to which are attach-
 ed two straps.   The one running from  right to  left, back  of the head,
 is  buttoned to a knob at the end of spring A, which runs backward over
 the left shoulder.   The other, running from left to right under the chin,
 is  buttoned  to a  knob at the end of spring B, which runs forward over
 the right shoulder.   Both  acting together  have a tendency to bring the
 head  into an  upright and  central position.  C, the crutches which run
 from the brass belt up under the  arms.   D, a strap running front  of the
 body, which connects the two ends of the brass belt, and keeps it steady
 upon the hips. 
23
   Fig. 2 represents a wire stock which was made use of when the appa-
ratus above described was taken off.  This may be folded  in  a  necker-
chief  as  a stiffener and tied in front, or the wire may be covered with vel-
vet and a ribbon passed through the two ends, and tied back of the neck,
as is here done.
Fig. 1.
Fig. 2.
   It is a mistaken idea to expect to restore the head to its normal position
in torticollis by simply dividing muscles;  still, the division  of muscles is
a  necessary  prerequisite  step.   There  is always  in wry-neck of long-
standing a lateral curvature of the spine,  particularly of the cervical part
of it.  "subsequent treatment is necessary, and  the  same kind of means
ought to be adopted, as is made use of for correcting lateral  curvature. 
 
CASE   OF   PES   EQUINUS   VARUS,
TREATED  AT THE BOSTON ORTHOPEDIC INFIRMARY.
  The following communication from the Rev. Chauncey Eddy, of Sara-
toga, New York, was published in the Boston Medical and Surgical Jour-
nal, May  11, 1842.

                  TRIUMPHS OF TENOTOMY.
     To the  Editor of the Boston Medical and Surgical Journal.
gIRj__The  notices which have appeared in your Journal, of successful
operations performed  by Dr. John  B. Brown, for the cure of club-feet,
induced me  to place a little son, afflicted with this infirmity, under his
care.   I did it after much hesitation and deep anxiety, lest the lad might
be subjected to pain, and myself to expense, without a cure.  Testimony
from some responsible, disinterested person, such as I can now give, would
have been exceedingly valuable to me,  and I therefore suppose mine may
be to others who  are in the same state of doubt and anxiety in  relation
to what they ought to do for their afflicted children.
   Dr  Brown does not need my assistance or recommendation.  1 hough
under  much obligation to him for his kindness to my son, in many ways ex-
pressed, and for the  cure he has performed on very  reasonable terms  I do
not write  this  for his benefit,  but for those who are deformed or have deform-
ed children, and are ignorant or doubtful in relation to the fact that  they
can be easily  and  quickly cured.
   The case of my child did not differ materially from other cases  of club-
feet seen every day.  The whole limb, from the hip downward  was
 „ed inward so as  to bring the  knee-pan  (excuse my omrss.on  of  your
  natomical  nomenclature) and the toes of the foot tn the du-ecuon of the
  h    l"  By a  retractton of some of the tendons, and tco great lasness
     to! ,be foot was turned over, the heel drawn up as far as « ccadd
 b  so It  t had not the appearance of a heel ; all  the bones m the ms tep
 weCouTof  their proper position, and in the ankle there was none but a
                  6 
2fi
 side-way motion.  When he began to stand, the side  or outer ankle was
 upon the floor, and the sole was  nearly behind.  From  his birth 1 had
 his foot kept as much of the time  as was possible in its normal position,
 and when he began to walk  I had him furnished with a boot that not only
 turned the sole upon the floor, but forced the whole limb around into its
 proper direction, with the  knee-pan and toes  a  little  out.  By compel-
 ling him  to walk in  this  way, and  to  sleep in the boot as much of the
 time as he could endure it—for  it was quite painful—I hoped the cords,
 kept thus continually extended, would become sufficiently lax  to suffer
 the bones of the foot to  remain  in their places.   But after six years of
 effort and expense on the part of his  parents,  and much suffering on his
 part, there was not the least improvement.   As soon as the  constraining
 apparatus was taken off, we had nothing but a  deformed club-foot.
    Ib>  was about six years of age when 1 brought him  to Dr. Brown.
 Respecting the treatment of the case, I need  to say nothing,  except that
 the surgical operation occasioned no more pain  than the prick  of a pin or
 the opening of a vein with a lancet.  After the heel-cord had been sepa-
 rated for a few weeks, it was necessary to part two others on the instep,
 and after  a  time others;  but  after the first operation,  the  lad had  so
 little fear  or dread of another, that he requested  me  to  let  him see it
 done, and while the operation was performing he  looked on  as atten-
 tively as  the operator,  without wincing—not because he is insensible  to
 pain,  or   has   uncommon  fortitude, but  simply because the  tendons
 having no  sensibility the  cutting  of  them  did  not  hurt  him.  The
 cords being severed,  the foot  was placed in a  boot very ingeniously con-
 structed, so as to bring a slight  pressure upon  the protruding  points, and
 at the same time turn the  whole foot and limb  towards their proper posi-
 tion by such  slow  degrees as  to occasion  no suffering.   In  a  very few
 days the boy was walking, much  better than  he  had ever done before,
 and for the first"time without any pain ;  and  since  that  time he  has con-
 tinued to  improve slowly.   The  process of recovery  must  necessarily
 be slow.  Now, after about twenty months, there  is nothing   in   his  gait
 nor in  the  appearance of  his limb to indicate that he was ever deformed,
 except that it is much less in size  than the other.   But as  it is rapidly
developing, the  disparity  in  this respect will  soon disappear.   For  a
 thousand times the amount the cure  has cost, I would not  have  had him
grow up with the deformity, because  I have seen in other instances the
inconvenience and the suffering which it occasions.
  If this meets the eye of any person  who  is  afflicted in the  way my
son was, or the eye of parents who  have children  thus  deformed, my ob- 
27
ject will be accomplished if it induces them to go, without delay, fear or
doubt, to Dr. Brown for a cure.  It is cruelty, of  which no parent ought
to be guilty, to suffer  a  child to grow up with such a deformity, when a
cure can be obtained at so cheap a rate as it can now be; and it is almost
equal cruelty to effect a cure, as in  some instances has been done, by ma-
chinery alone, extending the cords by force, and crowding the bones into
their places against the action of the tendons.   By relieving the contract-
ed tendons, and then, with proper  apparatus, gently and slowly pressing
the protruding parts into their places, and inclining the limb or member to
its proper place and direction by degrees, a cure can  be effected with less
than an  hundredth part the  suffering that  will result from either of the
other courses.
   I mention the name of Dr.  Brown as the proper person to call upon,
because I have  seen the  patients  of  four surgeons of three different
cities, and  none of them except Dr. B.'s had apparatus at all suited to
the purpose.  Some were suffering severe  pain from theirs, some will de-
rive no benefit from the  operation, and I have seen but one that will pro-
bably be cured ;  and that because, being an infant, it has the hand of its
nurse for a boot to keep it in its place.   Any surgeon  can  separate the
cords well  enough;  but the cure depends  more upon the machinery that
is afterwards used, than all things else.  I  have reason to presume that
there  is none in  the country to be compared with  that invented and used
 by Dr. Brown.                               Yours> &c-
    Saratoga Springs, N. Y. April, 1812.        Chaincey Eddy.
                     PES EQUINUS VARUS.
  To the Editor of the Boston Medical and Surgical Journal.
Sir—I  noticed in No. 14 of your Journal, a  communication from the
Rev Chauncey Eddy, dated  Saratoga, N.. Y., giving a representation of
his  son's case  of  club-foot;  and happening to have in my possession
the casts of the foot referred to,  I take  the  liberty  of sending  you a
wood-cut of the same, to be inserted  in  the  Journal.  I will observe
that when Mr.  Eddy's son first came  under my care, there %vas no mo-
tion of the ankle-joint.  Such was the rigidity of the muscles, that the
tibia and fibula  did not move  on the  astragalus.  Now the motion is as
free as in the other foot.  Mr. Eddy  says, in his communication, «• INow
it is about twenty months," &c.  It is true, that from the  time  his son 
28
entered the Infirmary to the date of Mr. Eddy's communication, twenty
months had intervened;  but it may, perhaps, be well to observe, that the
lad had  spent three  fourths of that time  at  his father's residence in
Saratoga, N. Y.   It is unnecessary to occupy  your  pages by  giving a
minute detail of treatment.  Suffice it  to say, that  those  tendons'which
restrained and kept the foot fixed in its unnatural position, were  divided,
and some of them  more than once.
  In the above cut, fig. 2 represents the foot as it was before the lad w
brought to me for treatment;  fig.  1 shows it as it now is.
  Boston  May 23, 1842.                        j0HN. R  Brqwn> 
CASE   OF   PES  EQUINUS  VARUS,


        TREATED AT  THE BOSTON ORTHOPEDIC  INFIRMARY.
 The following case is remarkable only on account of the age of the pa-
 tient—being the oldest  ever  operated  upon  for  the  cure of club foot,
 either in this country or in Europe.  The case of a gentleman in Boston,
 set.  55, which I reported in the Boston  Medical and Surgical Journal
 about two years ago, was then, I believe, and still is, the oldest on record
 previous to the one I now shall concisely describe.
    Mrs.  Smitb, of Boston, aet. 73, was  attacked with hemiplegia, the left
 side being affected.   She partially recovered the use of  her arm  and leg.
 Certain  muscles, however, were  permanently contracted, and remained >o
 after a lapse of two  years.  These were  the flexors of the fingers, the
 gastrocnemii, and the tibialis  anticus.   The fingers were  so  much  con-
 tracted (and still remain so) as to keep the  hand nearly  closed; still she
 has the use of the arm.   By  the contraction of the gastrocnemii  and the
 tibialis anticus, the heel was elevated and the  foot turned in  towards the
 other, forming that species of club-foot called  pes equinus varus, of the
 second degree.  When she attempted to walk, which she  could only do
 by assistance, the weight of her body came  upon the outer  margin of the
 anterior portion of the metatarsal  bone of the little toe.  This became
 very sore.   She  had, besides, constant  pain  in  the  whole of the  foot,
 which had existed  for  two years.  She consulted Dr.  Gay, her physi-
 cian, Dr. Z.  B. Adams who had  attended her during Dr. Gay's absence
 in  Europe, and Dr. Bigelow.  They stated to her they thought  favora-
 bly of an operation,  and advised  her to consult me, which she did.   My
only doubts were whether, at  her advanced  age, and in her  feeble state
of health, the  tendons  would unite, if divided.   I,  however, made up
my mind that dividing the tendons would  relieve the pain, from  which
she had been  a constant sufferer  two  years ;  and again, that if the  ten-
dons never united, 1  would put on apparatus which would  enable her t^ 
30
walk much better than  she then did.   Accordingly  I divided the tendo-
Achillis and the tibialis  anticus, in  presence  of Dr. Gay and Buckminster
Brown.  I applied  my  usual  apparatus.  In  a few  days the pain in the
foot was relieved, and in the course of a fortnight entirely left her.   The
tendons are united, and she walks with ease.   Her  health has improved,
and she has gained flesh, as is remarked  by all her acquaintance.
Fig. 2 represents the foot as it was eight weeks ago.
Fig. 1  represents it as it now is.
   It will be perceived, in this drawing, that the leg makes an acute angle
with the foot.  This is done to show that the ankle-joint has its free and
natural motion.  Tt is  a  mistaken notion that  a  foot is  cured,  when
brought in a  parallel line with the leg,  laterally, even if it can be flexed
to a right angle with it.   It may appear  very well as the patient stands,
but very awkward when he  walks.   We  all  make  an acute angle be-
tween the foot  and leg every step we  take, and particularly in going up
an ascent.   A  person would make awkward work in going up Mt. Wash-
ington with feet which  could only be flexed to a  right angle with the
leg.   The fact is, a person who can merely flex his  feet, so  as  to  bring
them at  a right angle with the leg, must  turn them  in, or out, every step
he takes, in order to give  the  propelling power forward ; and it is most
natural to turn  them in.  Hence  it is  that feet which have been  cured
in this way (and many such have been reported)  will, after  being walked
upon a short time, revert to their pristine obliquity, or nearly so.   The
importance of the free use of the ankle-joint, and the necessity that the
foot should be capable of forming an acute angle with the leg, have not
been noticed by writers on  the cure of club-foot with sufficient emphasis;
and, in fact, I do not recollect any author who has mentioned it at  all. 
31
  January \2lh, 1844.—Since the above (and I state the case in illus-
tration of the position that no foot can  be  properly cured where there is
not a free use of the ankle-joint,  and also  of the  futility  in  most cases
of attempting to cure club-foot by mechanical means alone),  I have been
called upon to operate on a  lad  11  years old, who is  said to have been
cured about five years ago by mechanical  means, and by one Valentine
Brown, a mechanic in  VVoburn, Mass.   He  supposed the boy cured.
He had him under his  care over a year.   The parents also supposed the
boy cured, as the foot  was in front  of the leg, and straight.   On ques-
tioning them, however, they  said  the heel was not brought  down, and
the foot could not be brought up  to more than  a right angle with the leg,
if so much—consequently the lad  could not walk naturally ; for, as I have
previously stated, an acute angle  between the leg and  foot is  necessarily
formed every step we  take.   As he walked and propelled  himself for-
ward, the foot turned in; and the more he walked, the more  it turned in.
In  addition to this, the contracted tendons, which had been stretched, did
not elongate in proportion as the  leg grew, and  the  consequence was,
the foot resumed its  former mal-position—and so I found it.
   I was told of a young lady, belonging to the  same  town where this
lad resides, who had a club-foot,  and who  was factitiously cured in  the
same  way, about the  same  time, and by the same  individual.   She is
now, I understand, " in  statu quo ante bellum."
                                             J. B.  Brown, M.D. 
 
   PES   EQUINO-VARUS   ACQUISITUS

        AND  CONTRACTURE  OF THE  KNEE  JOINT,

Successfully treated  at the Boston Orthopedic Institution, or Hospital fox the Cure of
                     Deformities  of the  Human Frame.
Sept. 30,  1841.  John Kilby, Esq., of Dennysville, Maine,  placed his
son, a lad about 13 years old, at the Institution.  The following account
of the case and treatment is copied  from my Note  Book.  This lad has
not walked without a crutch for  many years.   The left knee is contract-
ed to an angle of 30 degrees, beyond which it cannot be extended.  The
foot on  the same side is  more deformed than any one I have met with.
If it was separated from  the leg,  and  the toes broken off, no one would
suspect what it was, or for what purpose it  was made.   When the ante-
rior part of the  foot is  placed  upon  the ground, the heel is elevated  four
inches.   The anterior part of the foot is twisted inwards, in a very unusu-
al manner.   The astragalus is very prominent, being subluxated upward
and outward.   There is no motion  in the ankle-joint.  The cuboidal ex-
tremity  of the metatarsal bone of the little toe projects outward to a very
unusual degree.   All the metatarsal  bones oblique inwards.  The sole of
the foot looks upwards, the foot  being  turned nearly upside down.   The
toes are turned  back, so as to  be nearly in contact wiih what ought to be
the top  of the foot.   The little toe  presses  back against the  metatarsal
bone of the toe next it.  There is  a  thickening of the  integuments on the
outside of the little toe and the upper side of  the metatarsal bones of the
toes next it, marking the point on which the body rests, when the foot was
placed on the floor.
   This  day, Sept. 30, divided the tendon of Achillis  and the flexor  lon-
gus policis  pedis.  There was not a drop of blood.   My son, Buckmin-
ster Brown, was present, and aided me in this, as  in  all the subsequent
operations on this foot and leg.
   It would be tedious, and is unnecessary, to go through with a loog, de-
tailed,' daily record of the treatment  of this  case.  Suffice ,t to say, that
                8 
34
the tendon  of Achillis was  divided  five times;  the  long flexors  in the
sole of the foot, three  times;  the abductor policis pedis, twice;  the plan-
tar  fascia, the biceps flexor cruris, the semitendinosus, and the semimem-
branosus, each once.
  The apparatus for leg and  foot, used at this Institution, were apphed to
this case.   It was not until  after  the fourth division  of the  tendon of
Achillis, that 1 was able to reduce the  subluxated astragalus.  I could
then with my thumbs press it into its  place, and  even make an indenta-
tion where the greatest prominence  had existed ; but this bone had been
so pinched and wedged in, that it was not sufficiently  developed to fill the
space nature designed for it.  It was difficult  to  retain  k in place.  By
perseverance, however, the foot and leg  were  brought to the state of per-
fection represented in fig. 2.
   Fig.  1 represents  the  foot and leg as they were when the lad came to
the Institution.
   Fig. 2 represents them as they were when he left. 
 
 
A  DEFORMED   CHILD
               SUCCESSFULLY TREATED AT


THE BOSTON ORTHOPEDIC  INSTITUTION.
The following account of this case is copied from my note-book.
   September  14, 1843.—Wm. Willis, Esq., with Mrs. Willis, child and
nurse, arrived  from Portland, Me.  The child is a boy about 5 months
old.   He exhibits the following singular deformities.  Both hands  are
permanently flexed and  pronated (see fig.  1).   The  wrists are partially
dislocated.  All the fingers, and the thumb  of each hand, are contracted.
The thumbs  are sub-luxated by  the  preternatural  contraction of their
abductor muscles.  The shoulders are  curled in towards each other, so
as to leave only the space of one inch and three fourths between them,
measuring across the breast, in front, from one to the other.
   The  left thigh is  permanently flexed, on the pelvis, to  an angle  of
45 degrees, and the left foot  is clubbed.   The right foot is also  club-
bed  (double  varus of the  3d degree). The right leg  is  completely
twisted round, so that the calf and heel are in front—the foot looking di-
rectly back.   The tibia  is on the outside, and the fibula is on the inside
of the leg.  The knee-pan is felt in the ham.  The  whole lower leg,
and all the apparatus  by  which it is naturally moved, are completely re-
versed.   The  knee can be but slightly bent.   The body and head of the
child are symmetrical, and the countenance intelligent.   The child is the
offspring of healthy parents.  No deformity can be traced on either  the
paternal  or maternal  side of the  family.   The grandfather, on the ma-
ternal side, is  the Chief Justice of the State of Maine,  Ezekiel Whit-
man, LL.D.;  and on  the paternal side, Benjamin Willis, Esq., of Boston.
The  father, Wm. Willis, Esq.* is a  prominent lawyer of Portland, Me.
There is no reason to  suppose that  the deformity of  this  child is in any
              9 
38
 way  hereditary.   The mother was  alarmed, previous to his birth, by the
 discovery of her own house being on fire, in the night, which burnt to the
 ground.  She imputes the mal-formation  of her infant to this cause, and
 perhaps not without reason.
    19th.—Divided the palmaris longus, in the right hand.   Also the ten-
 dons of the  long flexor muscles and the abductor  pollicis pedis in the
 right foot; and the tendons of the long flexors in the  left  foot;  and put
 on an extemporaneous apparatus upon both  legs.  This  consisted of a
 metallic belt, extending  round the  back and  resting on the  hips, with
 uprights on each side, extending to the  feet, with joints corresponding to
 the joints of the leg;  and so constructed as to turn out the left foot and
 leg, and turn in the  right foot and  leg.  This was  made  of malleable
 iron,  so that  it could  be  easily bent  to any necessary angle,  and still stiff
 enough to sustain the position in which it was  placed.
   Drs. J. C. Warren,  Hay ward,  Townsend,  Z. B. Adams,  Homans,
 Fisher, Perry, the lamented Wiley* Lane, J. Mason Warren, and Lewis,
 saw this patient before treatment commenced.   The case was evidently
 looked upon  as one which offered very little hope of relief.   Still, no dis-
 couragement was thrown  in the way of any  judicious efforts which might
 be made for  the restoration of the child.
   23d.—This is the  fourth day since treatment commenced.   The child
 w;h quietly asleep in half an hour after the  operation  on the 19th  inst.
 The  leg is nearly restored to  a natural position.  The knee-pan is  now
 in its place,  instead of being in the ham as it was four days a^o.
   October H.—Divided the  abductor pollicis, in the left hand, which
 very  much liberated the  thumb.
   December  4.—The child has now been at the Institution about eleven
 weeks.  It is plump and healthy.   It will return home to-morrow, about
 as straight  in its limbs as most children.   The only difficulty to be ap-
 prehended is the  one I stated to the parents, when 1 first saw  the child,
 viz., that there may  be a  deficiency of nervous influence ;  and  that the
 muscles, in consequence,  may not have their full  and  complete  action.
 It is to be hoped, however, that by perseverance in a judicious course of
treatment, the  nerves will be excited  to  a  healthy action, and  that the
muscles will perform their appropriate functions.
   It was a subject of regret to me,  that the medical gentlemen  who ex-
amined this child, when it was first  brought to  Boston, could  not have
seen  it again immediately before  it left; but circumstances prevented.
. Wiley has aince decerned, leaTing a character worthy of i; 
39
Dr. Window Lews was  the only one of them who saw it immediately
(and I believe on the day) before it was  taken  home. As the transforma-
tion was  so great as to be in danger of staggering the credulity of some,
1 have requested him to state the facts,  as  they appeared to him  on his
first, and  also upon his  second, examination.           J. B. Brown
  Boston, Feb., 1844.
Fig. I.
Fig. 2.
   Fig.  1 represents the child as it was when it came.
   Fig.  2 represents it as it was when it left.

   I  witnessed, with  the greatest interest, the happy termination  of the
above case, as I visited the little patient in his very deformed state, which
is accurately described by Dr. Brown; and although  aware of the great
success  of orthopedic  surgery,  I did not anticipate that so much could
have been  effected.   The cure is complete as regards the position of the
extremities, and eminently shows the judgment and skill of  the operator.
                                            Winslow Lewis, Jr. 
 
 
   BOSTON   ORTHOPEDIC   IS">STITUTiOSf,
                                     0 R

 Hospital   for   the   Treatment   of  Deformities   of  the

                           Human  Frame.



  This Institution has been in successful operation about seven years.  Very many can tes-
 tily to the benefits they have derived from it.  The treatment of club-feet, crooked limbs,
 wrv necks, (TKVATriiKs, and other affections  of  the bpine  and chest, comprise the
 principal objects for which it was founded.  A House, in a healthy situation on Mt. Vernon,
 in Boston, is especially devoted to the treatment of curvatures and other affections of the spine.
 This is furnished with every appropriate variety of apparatus for correcting these deformities,
 and restoring symmetry to the back and chest.
  An experienced matron superintends this Institution, and is always in attendance. Patients
 board any where in the city that  is most convenient and agreeable to themselves.  They attend
 at tin-  Institution forenoon and afternoon, and devote about the same number of hours each day
 that are usually appropriated lor  schools.
  The treatment adopted at this  Institution is in conformity with that which has been for some
 years, and is now, so successfully made use of in France, England and Germany.
                                           JOHN B.  BROWN, M.D., Surgeon,
                                                OlRce 65 Belknap Street.
  Consulting Surgeons.—John C. Warren, M.D., Professor of  Anatomy in Harvard Univer-
sity.  Geo. Hayward, M.D., Professor of the Principles of Surgery and Clinical Surgery in
 Harvard University.  J. Ma»on  Warren, M.D., S. D. Townsend, M.D., and Winslow Lewis
Jr., M.I).  These gentlemen render  their advice and aid gratuitously whenever it is desired.
 There  is a Library in the Institution, for the benefit of the patients, and from which they are
at liberty to take books free of charge.