ed into another will confer immunity. On the other hand, Sanarelli, in 1894, conducted a series of experiments regarding the production of immunity in animals by the use of serum of immune animals, and came to the conclusion that such serum has no protective power, and seemed even to render animals vaccinated by it more susceptible to the disease. Chantmesse has injected the serum of immunized guinea-pigs into patients suffering from typhoid fever with no favorable results whatever. At the present day we can report no success with the serum treatment of typhoid fever. (To be Continued.) Errata. In the contribution upon "The Bacillus of Diphtheria" in the August issue of the MONTHLY the sentence under "staining," p. 353, "These bacilli do not stain by Gram's method,etc.," should read, "These bacilli stain by Gram's method, but not well by the ordinary aniline dye solu tions." -:0: Society Reports. NEW YORK ACADEMY OF MEDICINE. SECTION OF ORTHOPEDIC SURGERY. Meeting of Oct. 15, 1897. Congenital Absence of the Radius.Abstract of a paper read by Dr. H. L. Taylor. The absence of imperfect development of the radius in the new born 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 fore-arm. 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 II. 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 III. 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 IV. Girl. Two and one-half years old. Absent ulna and the fourth and fifth digits with their metacarpal bones. Radius thickened and bent towards the ulna side. The hand usually turns toward the ulnar side but is sometimes held straight. The elbow has abnormal lateral mo bility and hyper extension, as might be expected from absence of the ulna. Children with deficiencies of this kind are usually premature or stillborn. If alive, they seldom live many weeks. There are about 200 recorded cases of absent fibula and 100 of absent radius; but the deficiency shown in case iv, 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 foetal 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 made in the corpus. DR. A. M. 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 of 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. removed and when the boy was 12 years old there was only about onefourth 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 became 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 DR. R. WHITMAN was reminded of a man whose tibia had been shortened by an operation when he was 13 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 showed that reproduced bone did not cease to grow. The patient had been exhibited to this Section by Dr. L. A. Sayre. Four inches of the neck and head of the femur had been 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 12 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 knee was done. CLUB-FOOT CAUSED BY ABSENCE OF THE FIBULA. DR. WHITMAN exhibited a child, 8 months old in whom 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 12 years, the shortening was the same, and increasing. This progressive shortening took place in the forearm as it did in the leg. SOUND VIEW HOSPITAL.--A The most distinct and distinguishing tendency of medical inquiry at the present time, especially in this country and in Germany, is seen in multiplying experiments of all sorts to achieve the transmission of some element or power of the blood from robust animals into the system of patients who have failed to develop sufficient blood power for themselves to withstand all the thousand natural shocks that flesh is heir to, and are therefore sick in one way or another. That this "effect defective" is at the bottom of every surrender of the human system to the assaults of infection or premature decay, is no longer doubted by the scientific pathologist of whatever school. It is therefore natural that the most modern, as well as the most plausible direction of therapeutic research should be towards the appropriation of extraneous blood, in some form or in part, to reinforce the defensive and reparative functions of the failing system.; An advanced school of blood therapeutics, numbering many of the best physicians and surgeons of the United States and Canada-more in number and eminence than is known to the members of that as yet unorganized school themselves-have convinced themselves by physiological reasoning, and quiet but long continued clinical proof, that the entire blood of the bovine male, in its natural condition, contains all the defensive and constructive forces that can be found or developed in blood native or supplied; that it is at once more powerful in protective and reparative vital energy, and freer from unhealthy or toxic incidents than any other blood that is well understood and available, or than any of the artificialized elements of blood that have been introduced into therapeutics; in short, that as the whole is more than any of its parts, and often practically more and better than all of its parts, so in the case of the blood, there is no part that can be spared; or that in its normal relations can be harmful; or that can be as potent when artificially isolated as when naturally combined; or that can be as salutary on the whole, for any purpose, in a condition resulting from disease or infection, as in the pure normal condition of entire blood, which is acknowledged to be the condition and the only condition of invincible vitality. This school of therapeutics was referred to as unorganized. However, a possible germ of organization has recently been planted in our neighbor town of Stamford, by Dr. T. J. Biggs, an accomplished surgeon from New York City, who has had probably more experience in the development and practice of blood treatment than any other individual. "Sound View Hospital," at Stamford, Conn., is the first established nucleus of the blood practice which, in widely scattered individual hands, has undeniably been attended with a startling uniformity of success, in a great variety of the most desperate conditions that had previously baffled both medical science and surgical skill. This hospital is avowedly designed to put the new practice to crucial test under every condition of disease or injury that confronts the practising physician or surgeon. To this end, the hospital, though at present small, has been thoroughly equipped for the most advanced medical and surgical practice and research, on all lines equally with that of blood treatment; and has been planned and provided to carry all cases through to a finish, and so to demonstrate the ultimate results, as well as the immediate effects of "Hæmatherapy;" in other words, to discover and reveal the truth and the whole truth of the matter, in the true spirit of medicine, independent of bias from self-interest or commercial incidents. A novel system has been adopted to place the entire work of the institution, with its farthest results for better or worse, on record before the eyes of all medical teachers and editors, by a monthly abstract for private professional circulation only, of the treatment and final issue of every case admitted and discharged, continuing the observation and re. port for an indefinite period so far as subsequent history can be obtained. As, in many cases, such as the tuber. cular class, for instance, this subsequent history is really the whole question, the medical profession will have in the new system a completeness of information and test which has long been the desideratum in the clinical reports by which new methods are supposed to be judged. The "after-cure" reports so far have been highly satisfactory, and sometimes exceedingly instructive; notably in consumption, lupus, tubercular osteomyelitis and necrosis, chronic ulceration, etc. The visiting staff and reference are made up from the front ranks of coming men, as well as of their present predecessors, in the metropolitan profession; several of whom have already, in the first quarter of its existence, taken important operations to the unsurpassed equipment and environment of the Sound View operating room. Among the visiting staff, it is fair to note such names as Dr. Percy Friedenberg, Dr. J. Stafford, and Dr. J.J. Dooley, of New York, and the western consultant at Chicago, Dr. R. W. Conant. A CURIOUS CASE. Among "freaks of lightning" and bullets, few more singular have transpired than that of the bullet which Mr. Ora Rogers, of Corona, N. Y., had suffered from in the kneejoint, for three years prior to his admission to Sound View, in September last. There was no doubt that the bullet had entered the knee, and from the pains so long experienced, the surgeons, although none of them had been able to find it, even with the x-ray, had been still of the opinion that it was lodged somehow in the popliteal space. We quote the abstract of the operation at Sound View, which cleared up the mystery in so remarkable a manner, and also reveals a remarkable operation of supplied blood in the physiological rebuilding of destroyed bone. "September 21st, after thorough sterilization of the leg, and etheriza tion of the patient, an incision was made six inches long, extending from two inches above the knee joint on the inner side, down to about two and a half inches below the head of the tibia, and a careful dissection was made exposing finally the tibia head. After dissecting the periosteum aside, a small trephine was applied, and a button of bone was taken out of the head of the tibia. I now found that the head of the tibia was diseased throughout; having, as I had surmised, developed tubercular osteomyelitis. The entire head of the tibia was then cleaned out with a heavy bone curette, leaving it a mere shell. Fortunately this condition had not extended into the fibula, femur, or patella, but was confined as yet to the head of the tibia; neither had the joint been opened. Just at this stage of the operation, there was discovered a most remarkable circumstance; the course of the ball after striking the head of the tibia had been around the knee, and had actually made its exit at its point of entrance without being observed, and of course without being looked for outside of the wound, since there and the conviction of its three years' was no apparent apertrue of exit, lodgment in the knee had naturally been invincible until now. The cavity of the bone was at once cleansed out with the bovinineperoxide reaction, and the product washed out and sterilized thoroughly with Thiersch's solution, and then packed with iodoform-bovinine in sterilized gauze. The wound was closed for half its length equally above and below; using four sutures, two above and two below the kneejoint. This packing was changed every twenty-four hours, for one week, with daily cleansing and sterilization as before, when the bone cavity was found beginning to fill up with healthy material. But so much necrosed bone had been removed, that I deemed it necessary for a complete and rapid cure, to employ sponge grafts. From the finest quality of sponge,after being specially prepared, a small layer about the thickness of a finger nail was shaved off with a sharp scalpel, gently laid in the bone cavity, and fed with bovinine by a dropper, the wound being kept open. In five days of this continued treatment, the first sponge graft had become vitalized; healthy granulations having sprouted like little vines, ramifying through the pores of the sponge. On the seventh day after the first, another sponge graft was applied, and treated in the same way. This also became vitalized, and had pretty nearly filled up the bone cavity with new bone, within seven days, or on the 3d of October. Ten days later, a third sponge graft was applied; keeping up the bovinine-peroxide and Thiersch sterilization and bovinine dropping, from day to day. Ten days more sufficed for this last graft, as nourished by supplied blood, to become not only vitalized but converted to solid bone, like its predecessors, and to fill the cavity entirely. Periosteum was now dissected up and brought in apposition over the site of the late cavity, by means of continuous horse hair sutures. This united completely and firmly, fed with the blood-conserve, in five days. The edges of the external wound were then freshened and brought in apposition by strapping and two heavy catgut sutures; dressing with pure bovinine. The wound was entirely healed, November 2d; but the patient was kept two weeks longer to watch for sequelæ-of which none appeared but those of perfect health and soundness." All very well indeed, so far. But a few weeks later of the system of protracted observation of discharged cases, adopted at Sound View, illustrated its utility and importance, especially in a tubercular case. Early in December, as we learn from the abstract under "Condition of Discharged Cases under Observation," a sinus was detected in another part of the leg, working out from another point of tubercular osteomyelitis, beyond doubt; for which the patient was again admitted to the hospital, to undergo the radical cure of the infection, which is never lost sight of or given up. Of the latter remark, a case of lupus that had been pursued for eighteen months without operative interference and with purely blood and medical treatment, affords example. This case (of Miss Mary Noble) came as an incurable from the hands of a succession of able physicians, into the private practice of the surgeon-in-chief of Sound View, about two years before this institution was established. His reports during that period show a succession of successful conflicts with the tubercular infection at the many different points at which it would reappear; until the last enemy appears to have been destroyed about eight months ago; and the current note of observation in this case today reports the young lady still perfectly whole, and likely to remain free from flesh-devouring tuberculosis for life. The note says: |