MODERN ORTHOPEDIC SURGERY. A Reply to Dr. Shaffer. BY A. M. PHELPS, M.D. REPRINT FROM American Medico-Surgical Bulletin, October I, 1895. TO CONTRIBUTORS. Contributions of Original Thought and Experiences, on Medical and Surgical Topics, are desired by the AMERICAN MEDICO-SURGICAL BULLETIN on the following conditions: 1. —Authors of Scientific Papers or Clinical Reports accepted by us will receive—according to their own preference expressed with each communication either: . , a:—A number of Reprints of their article in neat pamphlet form (pocket size); or, b:—Instead of the above, an Equivalent value therefor in Cash. 2. —All contributions are received only on the express understanding: a:—That they have not been printed anywhere, nor communicated to any other journal. b:—That, if they have been read anywhere to an'audience, this fact be stated in full detail by a note on the manuscript. 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Aim at Fact. it is not to be expected that every Medical or Surgical paper should be a mere array of statistical data, hospital records, tabulated figures, or graphic summaries; some room must be allowed to theory, or even conjecture, in its proper place; but the true aim of theory should never be left out of sight,—which is, to lead to fact; to a rule or result of practice.—And it should be likewise borne in mind that the Reader will attach little weight to mere generalizing statements (such as, that a certain rem- edy, procedure, or line of treatment has uniformly proved successful, etc.);—to be oonvinced, he wants to see positive evidences recorded in clinical detail of cases: con- ditions found, courses pursued, and results achieved* Do Not Fear, nowever, that a communication you may be inclined to make would be devoid ot value because you have but little time to spend on writing it! If your thought be a good one to yourself and for your patients’ benefit, it will be equally so to your colleagues and their practice, and will be worth communicating. It need not come in the garb of an elaborate Scientific treatise ; a simple “Letter to the Editor ” will often be just aa acceptable. Some Rules of Order we should bke to have our esteemed Contributors comply with Do not write on both sides of the sheet. Write as legibly as you conveniently can ( names especially so). Leave a liberal margin on the sheet, or space between the lines. ( Clost writing is not conducive to correct typography; and what you save in writing material has to be expended a thousand-fold by us in eyesight labor, and expense for printer’s corrections.) Address :—P O. Box, 2535 New York city. Editor American Medico-Surgical Bulletin. MODERN ORTHOPEDIC SURGERY. A Reply to Dr. Shaffer. BY A. M. PHELPS, M.D. REPRINT FROM American Medico-Surgical Bulletin, October i, 1895. MODERN ORTHOPEDIC SIRGERY. A Reply to Dr. Shatter. By A. M. PHELPS, M.D. THE highly classical and rhetori- effusion which Dr. Shaffer is pleased to call “A Reply to Dr. Phelps,” and which appears in the columns of the “A. M.-S. Bulletin” (July i, 1895, p. 777 et seq.) is before me. The methods of the distinguished orthopedist have so far taken him beyond the limits of any fair and gentlemanly discussion, that I shall refrain, as far as possible, from refer- ring to his personal attack upon me. The question at issue cannot be decided by any such methods, but must stand up to the main issue—the definition of orthopedic surgery. Every statement that I have made in my address Dr. Shaffer has clearly proved by his own pen. My address is before the medical pro- fession for their fair criticism, and it is for them to speak of its character. It was a defense of orthopedic surgery, and was specially aimed against a class of gentlemen who pretend to orthopedic surgery, but who are nothing more than simple blacksmiths, ignoring entirely every scientific discovery in the surgical and pathological world. Dr. Shaffer arrogated to himself the privi- lege of speaking for this class, and, if he belongs to that class who do not believe in surgical methods in a certain class of orthopedic cases, I suppose he has a right to speak—not for orthopedic surgery, but for orthopedy and himself. His report clearly proves, notwithstanding his personal disclaimer, and his attempt to convince the profession that he is an operating orthopedic surgeon, that he only performed twelve tenotomies in a series of 2440 cases ad- mitted to the “New York Orthopedic Dis- pensary and Hospital.” It will not do for Dr. Shaffer to pretend that he has been misrepresented in these figures. The eighty- three cases included in the “Hospital Re- port” for the year ending September 30, 1894, were, I suppose, included in this series of 2440 cases admitted to the “New York Orthopedic Dispensary and Hos- pital,” and seem to be included in the table of results. In this series of cases is arro- gantly printed, “No abscesses were opened during the year,” and twelve tenotomies for club-foot were performed. There is no evidence in this report—which was, no doubt, made by his faithful staff—of anv other operation having been performed. No deaths occurred in the hospital during the year, and no deaths are reported to have occurred in the dispensary work traceable to diseases peculiar to orthopedic work, ex- cepting five. So, in 2440 cases treated in the dispensary and hospital there were only six deaths traceable to diseases peculiar to our specialty. When he states that 46 cases died, he states only a fraction of the truth, but on page 27, Table No. 2, if the reader will examine it closely he will find causes of death: Pott’s Disease: Cholera infantum i, tuber- cular meningitis 2, pneumonia and men- ingitis 2, general tuberculosis 1, typhoid fever 1, heart disease 1, unknown 5. Hip-joint Disease: Meningitis 1, diphtheria 1, general tuberculosis 1, unknown 5. Lateral Curvature: Diphtheria 1, unknown 2. Flat-foot: Unknown 1. Knee-joint Disease: Unknown 1. Bow-legs: Pneumonia 1, scarlet fever and diphtheria 1, unknown 1. Knock-knee: Diphtheria 1, scarlet fever and diphtheria 1, measles 1, Bright’s dis- ease 1. Club-foot: Unknown 1, diphtheria 1. Infantile Paralysis: Unknown 2. Other Orthopedic Cases: Pneumonia 2, per- tussis 1, unknown 6. Total 46. Whirlwinds, water-spouts, and railway accidents do not seem to appear in this tat le. In this table of 46 cases are to be found only 6 cases of death traceable to dis- eases for which they were treated, viz., orthopedic diseases. What have scarlet, diphtheria, and typhoid fever any more than whirlwinds, water-spouts, and railroad acci- dents to do with hip-joint disease? So it must be a source of gratification to Dr. Shaffer to have the profession know that in a series of 2440 cases, there died, according to his statement, both in the hospital and in all the dispensary work, only 6 cases as the result of the diseases for which they were admitted. This beats the health statis- 3 tics of any city, New York included. No doubt we will soon listen to a paper on the beneficial effects of suppurative hip-joint disease in childhood. We can understand how this report may be true. But where did the cases which were transferred, and were not admitted, die? Where were all the cases of bad sup- purating1 diseases sent to which were re- fused admission? How long do they re- main in the institutions where they are sent before they die? If his report is intended as a scientific work, why palm off such selected material upon the profession from which to quote statistics? Dr. Shaffer says in his “Reply” that he does open abscesses; his “Annual Report” savs that he does not open abscesses; he has repeatedly stated that he does not, on the floor of the Academy of Medicine, and he has been severely criticised in my presence there. Of course, all of the braggadocio which enters into the article which he calls “A Re- ply” is too transparent to hoodwink the scientific world. It is only another one of Dr. Shaffer’s plays to the gallery, and he is welcome to that position. He claims on the one hand to operate seldom, if ever; and he claims on the other hand that he is an orthopedic surgeon. In replying to him it would only be safe to take his reports as correct data, and that I have clone. Let us see just how the statements of Dr. Shaffer stand in his hvsterical effusion called “A 'Reply,” and in other writings I find the following: “And now about ab- scesses. Under the treatment pursued at the ‘New York Ortho-| pedic Dispensary and| Hospital’ there are few| abscesses in tubercular! disease.” (See his re-| ply.) “And when we find a| record of only 5 deaths| in 333 cases of hip- joint disease (1.5 per) cent.), he must open his, eyes in astonishment.”| (See his reply.) I am| not surprised at any| statement Dr. Shaffer! may make. Again I quote from) his “poem.” “The Le-I gend”; “No abscesses| were opened during the| year,” &c. “As I can- not italicise the word tubercular, I repeat it, so that Dr. Phelps will not accuse me of let-1 ting purulent abscess-1 es alone.” I In a paper on the “Ul- timate Results in the Mechanical Treatment of Hip-joint Disease,’’ | by Dr. Shaffer and Dr. Robt. W. Lovell (“N. Y. Med. Jour.,’’ May 21, 1887, p. 12), the follow- ling appears: “Of the 39 cases, 27 had one or more abscesses at some stage of the disease, and 12 had none.” (Nearly 70 per cent, had.) I again quote from the same address: “During | these five years 108, or (21.59 per cent., were dis- charged cured, and 50, lor 6.4 per cent, died | from conditions asso- ciated with, or depend- ing upon, the chronic [joint lesion.” ( On page 8 of the paper already quoted from, I I find: “And as a matter of experience, abscesses connecting with sup- purating hip-joints did no better under antisep- tic measures than those opened by simple Inci- sion, and neither did so well as those which twere allowed to open spontaneously.” Speaking boastingly of his results in hip- joint disease, I find in the same paper: “Nineteen cases” (not patients) “were found with practically anchvlosed joints: six with slight motion in flexion; seven with motion in flexion of from io to 45 degrees, and a certain amount of motion in other direc- tions; three with motion to right angle in flexion and good rotation and abduction; and three were found with perfectly free mo- tion in every direction.” (Tables say 5 “two.” These two cases were so remark- able that they received the italics of the writer’s pen.) Twenty-five ont of thirty- nine were practically anchylosed, and every case was still crippled excepting two. Com- pare these brilliant results with those of the late Dr. Thomas, of Liverpool, from whom I have already quoted: “No case of hip-joint need recover with angular de- formity, and anchylosis seldom appears." Dr. John Ridlon, Dr. Sidney Jones, and many others can testify to the truthfulness of the statement. I quote from “New York Letters on Orthopedic Surgery,—The Scope of Ortho- pedic Surgery,” by Stuart Leroy McCurdy, M.D., Dennison, Ohio. In speaking of the various institutions that he visited while in New York, he says: “The New York Ortho- pedic Hospital has an average daily clinic of about thirty cases. I was privileged to ex- amine cases here. It is the aim of this in- stitution to use the knife as little as possible, and to allow the mechanical treatment to have unbounded sway.” Every man who has ever visited the institution knows that this statement of Dr. McCurdy’s is a fact. Now, this is the practice followed by the gentleman who proposed a rule of practice for orthopedic surgeons. He tells us that “his definition” does not mean this kind of practice. If it does not mean this kind of practice, then it means nothing. A formula framed for a rule of conduct by any man should be fairly interpreted and lived up to by its founder, and, knowing now exactly the rule which Dr. Shaffer follows in prac- tice, the orthopedic profession of the world 6 would be entirely justified in refusing, as they have done, to be nailed to any such cross. Dr. Gibney’s definition is liberal enough to allow of orthopedic surgeons taking the same stand in their specialty as the ophthalmologist or the gynecologist does in his, and no amount of subterfuge or misstatement by Dr. Shaffer can change the intention of the impression which his defini - tion was intended to make, and which his practice thoroughly demonstrates. Dr. Shaffer has seen fit to criticise my ad- dresses. He does it entirely from a per- sonal standpoint, and not from that of an “orthopedic surgeon.” For his 'satisfaction I will print two or three from among the scores of letters of congratulation which I have received. The first is from one of our oldest and most distinguished orthopedic surgeons, who has, perhaps, done more for orthopedic surgery than any man in this century. His opinion, I think, will carry weight with it. Being a personal com- munication I do not feel that I can print his name, but I have no doubt he would have no objection to my printing the text of his letter: New York, May 15, 1895. My Dear Dr. Phelr)3: I have just read your most interesting- reply to Dr. Shaffer in the “New England Monthly.’’ I hope you will have reprints of it sent broadcast to the entire pro- fession, in order to correct the erroneous impres- sion of the definition of orthopedic surgery, which Shaffer tried to palm off on the profession at Berlin, and no one at the time corrected him. I was not present at the time, or I would cer- tainly have called him down, and I have been too ill since to pay much attention to his dan- gerous teachings; but have been surprised that the profession would submit to his arrogant as- sumption and ignorance. And I am glad that by his foolish attack on you, it has given you 7 the opportunity of showing him up in his true light to the profession, and I thank you for hav- ing done so. I am sincerely yours, Another letter, from a very distinguished orthopedic surgeon of Indianapolis reads: May 1, 1895. Dear Doctor: After reading your caustic answer to the “strictures” of the distinguished orthopedist my pen refuses to keep still until I have written you my congratulations. It is a great pity that the dust of buckle-and-strap sophistry should be scattered broadcast to in- jure the vision of those already myopic through ignorance, timidity, or arrogance. “Remunera- tive plantar fascia” is for history. I am sincere- ly yours, Dr. Shaffer says in his “Reply”: “I am glad Dr. Phelps harps upon the ‘remuner- ative tendo Achillis,’ as it shows how lightly he regards a distinct advance in orthopedic work, and how far from lofty is his stand- ard of judgment. And here again I am going to run a risk, for I am going to speak of the traction shoe. It will give Dr. Phelps another opportunity of applying his ambushed style of attack, to say ‘I did not mention the traction shoe.’ Neither did he, but he means it all the same.” “The traction shoe applied to the tendo Achillis is a most remunerative apparatus to a large class of patients. And a good many children with club-foot, condemned to amputation or osteotomy by surgeons of limited experience, have been cured in a few months at less than half the cost to them that Dr. Phelps would charge for an open incision.” To illustrate how remunerative the tendo Achillis and plantar fascia are to the pa- tients (and not to the orthopedist), I might here describe a series of three cases taken 8 from my notebook, where 1 have records of many scores treated by Dr. Shaffer by this same “traction method” so highly lauded alone by Dr. Shaffer. In these cases the traction shoe did not work “its mir- acle.” All of them were practically cured at once by operative measures, whereas years of “shoe traction” had not changed their condition, at least had not improved them. Two of these cases were presented at the Academy of Medicine, and I will take occasion to present the third to some society in the near future. No bracing whatever was required, and the only remuneration that I can see which has been derived from the plantar fascia and tendo Achillis has certainly not accrued to the patients themselves. The cases in question illustrate how remunerative it is to them to have the “traction shoe” applied for from 12 to 14 years. And thus I might continue, but enough. These cases were not relapse cases of club-foot. Every man has those, and in a series of cases which I treated bv open in- cision such relapses are recorded. It would be far from me to resort to so unfair a method, but cases which have been treated by a certain method, so-called “in- terrupted traction,” which is as old as or- thopedy itself, with its inevitable failure in these forms of club-foot, and which has been condemned and discarded by ortho- pedic surgeons the world over, might with profit be printed. I have nothing to say at present in re- gard to the “open incision method” of treat- ing club-foot, either for or against. That 9 is in the hands of the profession, and several interesting papers can be found in Vol. VII of the “Transactions of the American Orthopedic Association,” which Dr. Shaffer so much dislikes, that he might read with profit to his patients. It will be for the pro- fession to accept or condemn, and Dr. Shaf- fer’s traction shoe will be put to the same test, notwithstanding his enthusiastic mis- representation as to its value. One other personal statement made by Dr. Shaffer, and then I have done He says: “But nothing can be unethical which is true, and the reason that I used the lan- guage was that Dr. Phelps not infrequently surprises and amuses his audience by some very remarkable histories of his achieve mcnts m surgery. It would seem that he becomes overwhelmed with the exuberance of his own eloquence and egotism, and hypnotized by his own sense of greatness, on these occasions. When in this condi- tion he becomes a victim of amnesia pathc- mate, and while under its influence, he has been known to say before the surgical sec- tion of the New York Academy of Medi- cine, regarding excision of the knee-joint for tubercular disease, ‘the average time of operation in my recent cases has been 14 1-2 minutes, including the application of the dressings/ ” It would not be expected that a me- chanician or mechanic would understand a statement of this kind, and I can understand how a surgeon not familiar with Fen- wick’s operation might not understand it. In a series of sixty-five excisions of the knee-joint, without a death from the opera- tion, hundreds of men in. the medical classes of the University of the City of New York, Post-Graduate Hospital and School, Mary Fletcher Hospital, have held their watches, and from them the average of time has been made in a series of 45 excisions. This average has been less than 14 1-2 min- utes. Fenwick’s operation can be per- formed by almost any surgeon in that time, including the dressings. Very soon a pa- per by Dr. Plimpton will appear on this subject. For fear that in places where Dr. Shaffer is not known, my veracity might be questioned, I feel that I must, for the sake of my professional honor, print the follow- ing letters, corroborative of the above state ments: I. Dear Dr. Phelps: I have seen Dr. Shaffer’s statements in his answer to your reply to his at- tack reflecting upon the truth of your statement that the average time in your last 45 excisions of the knee-joint, from the time of the first in- cision to the application of the last bandage was 14y2 minutes. In justice to you I will say that I have assisted you in a very large number of cases, and only in an exceptional case were you more than 13 minutes, including dressings. Fenwick’s operation can be performed by al- most any surgeon in that time. I am, very truly yours, W. O. PLIMPTON, M.D., Lecturer on Orthopedic Surgery, New York Post- Graduate School and Hospital: Instructor in Orthopedic Surgery, University of New York, Medical Department. II. Dear Dr. Phelps: Dr. Shaffer’s statement is wholly incorrect and unwarranted. I have as- sisted you in excisions of the knee-joint, and your time in performing the operation, includ- ing dressings, has always been less than 14 minutes—in exceptionally bad cases a minute or two longer. I am very sincerely yours, CHARLES H. WALKER, House Surgeon, Post-Graduate Medical School and Hospital. 11 III. Dear Doctor: In answer to your letter I will say that I have been present and have assisted you in performing excisions of the knee-joint in extensive tubercular disease. Your time, from the first incision to the last bandage, has been less than 14 minutes. Very sincerely yours, JOHN B. WHEELER, M.D., Clinical Professor of Surgery, University of Ver- mont. IV. Dear Doctor: I have been present and have seen you perform an excision of the knee- joint in less than 14 minutes, including dressing. Very truly yours, CARTER S. COLE, M.D., Instructor in Surgery, Post-Graduate Medical School and Hospital. v. Dear Dr. Phelps: I wish to correct any un- favorable impression that Dr. Shaffer’s attack on you may make. He evidently does not un- derstand your methods, else he would not write as he does. I have assisted you in many ex- cisions of the knee-joint, and in some of exten- sive disease with many sinuses. Your average time, including dressing, will fall far below 14 minutes, as I have seen you perform the opera- tion in less than 12. I write this In justice to you. Very sincerely yours, FRED. GOODWIN, M.D., Assistant to the Chair of Surgery, Post-Grad- uate Medical School and Hospital. If Dr. Shaffer, or any other man, still has any doubt as to the truthfulness of my statement, I can demonstrate the fact to him in my clinics at any time, at the Post- Graduate or the City Hospital. One can well afford to operate against ether narcosis to reduce mortality. Ether administered for hours adds to shock, and the best record for excision in knee-joint excision shows a mortality of about 3 per cent.; 65 cases with- out a death due to the operation would war- rant me in still continuing to operate with the greatest rapidity. 12 I stated in my address that orthopedic surgery was a combination of mechani- cal and surgical work; that the orthop- edist had no right, moral or surgical, to violate well-established laboratory or clinical truths. The orthopedist who does not believe in operative work, but relies en- tirely on his mechanical genius, to cure his patients necessarily encounters a very large class of cases in which he must fail. The orthopedic surgeon claims the right to re- sort to any method to cure these exception- al cases. The orthopedist boasts that he “never opens abscesses.” The orthopedic surgeon claims that many abscesses, under certain circumstances, should be drained, to avoid the corroding effect upon the tissues: he believes also that these are suitable cases for his attention, and should not be trans- ferred to general hospitals, because they re- quire mechanical treatment after the opera- tions have been performed. The orthop- edist believes that the “remunerative plan- tar fascia and tendo-Achillis” should be stretched 14 years; the orthopedic surgeon believes that the cutting of this fibrous tis- sue (particularly in this class of cases') should be done, because then his patients escape from the torture of interrupted stretching and the wearing of braces for years. The “orthopedist,” no doubt in a few years, will begin to drain abscesses, and will be- gin to move on a higher plane of scientific work; and, as I said in my address, when this stand is taken, colleges will want ortho- pedic surgeons. The College of Physicians and Surgeons has verified this statement bv 13 appointing Dr. Gibney, who is an ortho- pedic surgeon. Dr. Sayre was called to the Chair of Orthopedic Surgery in Bellevue, where he has always taught orthopedic sur- gery. After Dr. Shaffer's retirement from the university, where he had for a few years inflated himself by listening to the echo of his own voice, as it reverberated from the empty benches, orthoped c surgery has since been taught. It is true that I teach gen- eral surgery in the University of Vermont, and if the “orthopedist” would apply ra- tional, surgical methods to the severer forms of diseases and deformities of joints, his results might be as good, in this class of cases, as those in the Daisyfield Home at Englewood. The class of cases treated there would be transferred by the “orthop- edist” to some institution where he would either prohibit their being operated upon or allow them to linger for years, and finally die of suppuration or become cripples. Dr. Shaffer seems to think that it is a detriment for a man to have a knowledge of surgery in the treatment of deformities. And then at once he begins to speak of the large number of operations he does. O Consistency! Dr. Shaffer says, “Why invade the do- main of surgery?” I ask him, why does he perform 12 tenotomies in a series of 2440 cases admitted? This is cutting. I ask him why he treats a large number of bow-legs and genu-valgum of “maturer age” for years with braces, when he knows that such cases are only to be cured by surgical work. Not one osteotomy or osteoclasis was reported in the 59th Streer Dispensary last year in a series of 280 cases •of knock-knee and bow-legs. Mechanics and surgery must be united, or else a man fails to do all that is possible for his pa- tients. There is no place in this world for the simple buckle-and-strap man—except in a limited number of “selected cases,” and the “orthopedist” ought to have good sense enough to confine himself to that class of cases. He has no more moral or scientific right to treat acute pyogenic or tubercular processes with extensive destruction of tis- sue, unless he is prepared to operate, than has the oculist, who only fits glasses, to treat glaucoma, cataract, or acute affections of the interior of the eye. His work will soon be known to the professional world, and such men will read themselves entirely out of the profession, and their writings and re- ports will be always looked upon with sus- picion by any man who cares to write for the sake of the profession, and who wishes to establish correct data. Dr. Shaffer made a statement in a dis- cussion at a meeting of the Orthopedic Sec- tion of the New York Academy of Medicine to the effect that he was pleased to say that in the 59th Street Orthopedic Dispensary and Hospital no abscesses had been opened during the year. It is fortunate for the profession that gag law can be no longer imposed by any medical pope, and Dr. Savre, who is inadvertently alluded to in an ambushed way in Dr. Shaffer’s “replv,” did have the courage and the conviction to force an issue, which has drawn the line be- tween orthopedy and orthopedic surgery. Dr. Shaffer says in his “reply” that he has 15 passed through all this, but it may be inter- esting to him to know that he has not yet entered the race with Willard, the Sayres, Gibney, Sherman, Ridlon, Kerr, Cook, Mc- Curdy, Wirt, Moore, Gillett, Griffith, Wil- son, Robert Bradford, and scores of others in our own country equally eminent that I might mention; and Owen, Schede, Kaptyn, Lorenz, Wolf, Hoffa, Kirmison, Ridard, and many others in foreign coun- tries. All of these still continue the work of orthopedic surgery; that is, the combina- tion of mechanical and surgical work, and Dr. S. and his satellites are to be found almost exclusively alone in the promulga- tion of the obsolete ideas, long since dis- carded by the advanced wing of the ortho- pedic profession Dr. S. attempts to make it appear that the seventh volume of the “Transactions of the American Orthopedic Association” was printed irregularly, which is as false as many of his statements printed, and he characterizes that volume as the “mud- and-mire” volume of the “Transactions of the American Orthopedic Association.” Probably there is not quite enough of the “buckle-and-strap” and “blacksmith” work in it to please the distinguished orthopedist, and for the information of the profession I will state to them that in response to a circular-letter sent to every one (Dr. Shaffer included) by myself, the following papers were received and bound in the volume which he so much dislikes: i. The paper of Edmund Owen, M.B., F.R.C.S., London, England, on the “Treat- ment of Severe Talipes Equino-varus in 16 Children,” in which paper the author al- ludes to Phelps's operation, and severely condemns the mechanical work of certain orthopedists. 2. The paper by Nicholas Grattan, F.R.C.S., of Cork, Ireland, on “Tarsoclases.” He had evidently found cases that would would not yield to the “remunerative meth- ods” of the orthopedists. 3. “Address on Phelps’s Operation for Club-foot,” by James E. Moore, of Minne- apolis. 4. “Phelps’s Method for Talipes Equino- varus and the Results in My Practice,” by H. P. Kaptein, M.D., of Abcouder, Hol- land. In this paper the author says: “Dur- ing the past few years I have seen but few cases of severe club-foot to deal with. It seems that the communications of Phelps at Copenhagen and Berlin started in many parts of Europe very great activity in the treatment of club-foot on his method. As a consequence we now meet fewer and fewer cases of inveterate club-foot.” 5. “Phelps’s Method for the Cure of Club- foot in Adults,” by William E. Wirt, M.D., of Cleveland, Ohio. 6. “Elastic Traction in the Treatment of Infantile Club-foot.” by Bernard Barlow, M.D., of Buffalo, N. Y. 7. “The Anterior Transverse Arch of the Foot; Its Obliteration as a Cause of Metatarsalgia,” by Joel E. Goldthwaite, M.D., of Boston. 8. “Treatment of Congenital Dislocation of the Hip,” bv E. H. Bradford, M.D., of Boston, in which he presents some interest- ing dissections that might interest even Dr. 17 Shaffer, and demonstrate to him that sense- less mechanical work in this class of de- formity should not be persisted in at the expense of the benefactors of any institu- tion. 9. “The Operative Treatment of Congen- ital Dislocation of the Hip-Joint,” by Prof. Adolph Lorenz, of Vienna. Lorenz’s re- sults, as printed (and, fortunately, the pro- fession have examined, and have already passed their opinion), would be a strong argument to present to any legislative body to secure laws to prevent the empirical work now followed in many orthopedic institu- tions. 10. The paper of T. Halsted Myers, M.D., of New York/on the “Treatment of Congenital Dislocation of the Plip.” An associate of Dr. Shaffer’s helps to make up this “mud-and-mire” volume, against which Dr. S. hisses his condemnation. 11. Further in this volume will be found the interesting paper by Louis A. Weigel, M.D., of Rochester, N. Y.: “Report on a Case of Congenital Dislocation of the Left Hip, associated with Spastic Paralysis of the Left Arm, Blindness, and Defective Mental Development.” 12. Henry Ling Taylor, M.D., of New York: “Infantile Scorbutus and Its Rela- tion to Orthopedic Practice.” 13. W. R. Townsend, M.D., of New York: “Tubercular Disease of the Shoulder- joint.” The scientific work done in this paper is somewhat refreshing, after examin- ing a report which is intended solely to “play to the gallery.” 14. The masterly paper by Dr. Jacobi, of New York, on "Rachitic Deformities,” would be read with interest by an ortho- pedic surgeon. 15. “Rachitis,” by Benjamin Lee, M.D., of Philadelphia. 16. “Rachitic Deformities: Mechanical and Constitutional Treatment,” by Samuel Ketch, M.D., of New York. 17. “Rachitic Deformities: Operative Treatment,” by De Forest Willard, M.D., of Philadelphia. Even Dr. S. might derive some information from this. 18. The paper by Dr. V. P. Gidney, M.D., of New York, on “The Correction of the Deformity of Hip Disease,” stands out in bold relief when compared with the black- smith methods of the orthopedists. 19. “The Need of Rest in the Treatment of Hip Disease,” by Robert W. Lovett, M.D., of Boston. 20. “A Splint for Hip Disease, with Re- marks on Mechanical Treatment,” by Wal- lace Blanchard, M.D., of Chicago. 21. “Lateral Traction in Hip Disease,” by Calvin Gates Page, M.D., of Boston. 22. “Excision of the Wrist-joint by a New Method,” by Herman Mynter, M.D., of Buffalo, N. Y. 23. “Etiology of Deformity of Knee- joint Disease,” by A. E. Hoadley, M.D., of Chicago. This is a conscientious criticism of a former paper by the present writer. 24. “Excision of the Knee for the Relief of Crippling from Infantile Paralysis,” by Ap. Morgan Vance, M.D., of Louisville. 25. The excellent paper by Royal Whit- man, M.D., on “Observations on Bending of the Neck of the Femur in Adolescence.” 19 26. “Rachitic Curvature of the Head of the Femur,” by E. H. Bradford, M.Dr,' of Boston, would compare very favorably with the demonstrations of mechanical work resurrected from the obsolete practice of European mechanics, which they them- selves had long since condemned. 27. “The Lorenz Osteoclast,” by F. S. Coolidge, M.D., of Chicago. 28. “A Case of Anchylosis of the Jaw in a Child; Recovery with Good Motion,” by Dillon Brown, M.D., of New York. 29. “Amputation of Both Legs at Knee- joint for Paralytic Club-foot in a Case of Spina Bifida Complicated by Congenital In- guinal Hernia,” by William J. Taylor, M.D., of Philadelphia. 30. “Old and Neglected Deformities Fol- lowing Spinal Paralysis,” by Stuart Leroy McCurdy, M.D., of Pittsburg, Pa. 31. “Treatment of Paralytic Deformities,” by De Forest Willard, M.D., of Phila- delphia. 32. “The Mechanical Treatment of In- fantile Paralysis,” by John Ridlpn, M.D., of Chicago. / 33. “Apoplexy of Infants; paralysis of Infants,” by'W. J. Little, of London, England. .* 34. “The Treatment of Roto-Lateral Curvature of the Spine by Non-restrictivc and Developmental Methods,” by R. E, McKenzie, B.A., M.D., Toronto. 35. “Fixation in the Treatment, of Frac- tures into Joints,” Ansell G. Cook, M.D., of Hartford, Conn. 36. Last, but not least, the paper by M. Schede, M.D., of Hamburg, one of the 20 ablest surgeons in this world, a former as- sistant of Volkman, who was a general sur- geon, and one of the ablest orthopedic sur- geons the world has ever seen, and from whose intellectual ocean many an orthop- edist and othopedic surgeon receives his inspiration, this volume closes. This volume is before the profession, and no doubt it will receive its proper criticism regardless of the personal spite which Dr. Shaffer wreaks against it. The only “mud- and-mirc” portion of the volume, if any ex- ist, may possibly be found in the paradoxi- cal statements made in his discussion, char- acteristic of him. The orthopedic surgeons of this world can truthfully say to him: “You may hiss, but remember the hissing of geese once saved the proud city ot Rome.” New York ; 40 West 34th street. 21 EIGHTH YEAR. A . $3.00 oer year. American Medico=Surgical Bulletin A SEMI-MONTHLY JOURNAL OF PRACTICE AND SCIENCE. Issued on the ist and 15th of each month. THE BULLETIN PUBLISHING COMPANY, 73 William Street, N.Y. The BULLETIN is the only journal that publishes regularly complete reports of a the meetings of the New York Academy of Medicine and its ten Special Sections. The BULLETIN is also the Official Organ of the Sections on Orthopedic Surgery, and on Laryngology and Rhinology. Editorial Staff. WILLIAM HENRY PORTER, M.D., Chief Editor. WILLIAM C. GUTH, M.D., Pathology and General Medicine. SAMUEL LLOYD, M.D., Surgery. ADOLPH ZF.H, M.D., Pathology and General Medicine. GEORGE G. VAN SCHAICK, M.D., Pathology and Clinical Medicine. W. TRAVIS GIBB, M.D., Gynecology. WILLIAM OLIVER MOORE, M.D., Ophthalmology and Otology. ADOLPH BARON, M.D., Diseases of Children. WILLIAM VISSMAN, M.D., Pathology and Bacteriology. T. HALSTED MYERS, M.D., Orthopedic Surgery. GEORGE THOMAS IACKSON, M.D., Dermatology, WILLIAM B. COLEY. M.D., General Surgery. JAMES E. NEWCOMB, M.D., Laryngology. GEORGE K. SWINBURNE, M.D., Genito-Urinary Surgery. HENRY T. BROOKS, M.D., Bacteriology. JOHN WINTERS BRANNAN, M.D. Neurology and Psychiatry. IRA VAN GIESON, M.D., Pathology of Nervous System. FREDERICK PETERSON, M.D., Associate Editor. T. S. SOUTHWORTH. M.D., Obstetrics, Gynecology, Pediatrics. WILLIAM FANKHAUSER, M.D., Materia Medica and Therapeutics. LEWIS A. CONNER, M.D., Neurology. ALBERT WARREN FERRIS, M.D., Neurology. PEARCE BAILEY, M.D., Neurology. MORTON R. PF.CK, M.D., Neurology. LOUIS HF.ITZMANN, M.D., General Medicine and Pathology. DANIEL B. HARDENBERGH, M.D., Obstetrics and Gynecology. OTTO H. SCHULTZE, M.D., Obstetrics and Gynecology. JOHN HOCH, M.D., General Medicine. HOWELL T. PERSHING, M.D., Neurology. THOMAS PECK PROUT, M.D., Psychiatry. B. FARQUHAR CURTIS, M.D., Surgery. CHARLES HENRY WALKER, M.D., General Medicine. ALBERT H. ELY, M.D., Gynecology. GEORGE G. WARD, M.D., Obstetrics. WALTER A. DUNCKEL, M.D., Diseases of Children.