Other practitioners have recommended the use of sticking plaister, or of rollers moistened by a mixture of flour and white of egg: but these plans have been given up as inefficient.

It is the object, however, of this paper to show, that sticking plaister, if properly applied, is generally sufficient to remedy the deformity, and that, therefore, the want of success, mentioned above, has arisen from an improper manner of application. The following is the method which is now recommended. For an infant, take a strip of plaister an inch broad and nine inches long. Place one end of it on the outside of the foot; carry the plaister over the middle of the instep, and down under the foot, so that it shall cover the end which lies on the outer edge of the foot: then twist the foot strongly so as to turn the sole outwards instead of inwards, and secure it in that position by carrying the plaister round the inner ankle to the outside of the foot. This plaister must be changed every day, and be further kept in its place by means of a roller. Moreover, at night, it is necessary to put both on the inside and outside of the leg and foot a strong splint of pasteboard, like a leg for drying stockings on, shaped at the bottom to the foot, and reaching up to the knee. These splints are to be removed every morning.

Sticking plaister, when thus applied, answers perfectly the two indications of turning the outside of the foot outwards and upwards, and of keeping down the heel (the latter it does by holding up the foot); and, whilst it allows at the same time of the limb being moved in every direction, it avoids the weight and inconvenience of irons and complicated apparatus. Moreover it is not subject to be made injurious by being wetted by the child's urine; and whilst all evil effects from the friction of hard bodies like splints, &c. are avoided, the slight inflammation which often results from the application of sticking plaister to the skin, is prevented from occurring by adding a small quantity of soap cerate to the sticking plaister.

Many cases have occurred in which this plan has succeeded

perfectly. The last was that of a little girl now nearly three years old, both whose feet were deformed, one of them very much so; and she now walks with the soles of her feet naturally flat to the ground, and her toes properly turned out.

The cure was begun in this case at eleven months old, and the apparatus was reapplied every day for two months, and then every day or two for three or four weeks. The distortion was found to be cured at this period; but the sticking plaister was reapplied some time afterwards in consequence of the foot having become again a little distorted.

Of course the plaister should be applied as soon after birth as possible; but cases have occurred in which the deformity has been perfectly and permanently removed in older patients. A boy, six years of age, who had been under the care of Mr. Chessher for three or four years, came under my treatment on Aug. 13, 1818. This boy left Derby quite well on November 15, he having been apparently cured for some time before. He walked with a perfectly flat foot immediately after the shoe with an extended sole was applied. Care was taken to practise him in turning his toe out in walking, which is of consequence in the treatment.

This case is mentioned in a previous page, in consequence of the foot which had been distorted having become the subject of that species of lameness which is caused by the falling of the arch of the foot.-Vide p. 263.

Other modes of applying the sticking plaister may be adopted. In one little girl, born last year, with one foot moderately distorted, the plaister was passed round the foot as is described above, and then the remaining piece was divided longitudinally down to the foot, and both slips were carried round the outer ankle, and outside of the leg, instead of round the inside of the limb, the one below, and the other above; so that the foot hung as it were in a stirrup. This child's foot was permanently recovered within six weeks from its birth, although no splint was used at night.

OBSERVATIONS

ON

A SERIES OF CASES

OF

INFLAMMATORY DIARRHEA,

WHICH OCCURRED DURING THE WINTER OF 1820-1821; WERE APPARENTLY CAUSED BY CONGESTION AND OBSTRUCTION OF THE LIVER, JOINED TO AN IRRITATED OR INFLAMED STATE OF THE MUCOUS MEMBRANE OF THE INTESTINAL CANAL; AND WERE INTIMATELY CONNECTED WITH THE INFLAMMATORY BILIOUS DISORDERS WHICH MARKED THE PREVAILING DISEASES OF THE SAME PERIOD.

BY CHARLES THOMAS HADEN,
Surgeon to the Chelsea and Brompton Dispensary, &c.

It is proposed to give, in the present paper, some account of a series of cases, in which diarrhoea and other symptoms of bowel complaint were present, and which were remarkable, first, on account of the time of year at which they appeared; secondly, because they almost invariably put on the inflammatory character; and, thirdly, because they were closely connected with numerous cases of an inflammatory or congested state of the liver which happened at the same period.

It is exceedingly useful, as Sydenham taught long ago, to study diseases not only individually but collectively; to mark the links which connect the diseases of particular seasons; and to observe the effect which each particular season

has in causing certain classes of disease to prevail, as well as its power of modifying the type and form of disorders, so as to give them a different character from that which would belong to them, if they occurred at any other period of the year.

So great is this modifying power of season and of climate, that it might easily be illustrated by a reference to the history of almost every disease; but its effect is peculiarly striking in that of the numerous diseases classed together under the head of bowel-complaints.

Not to dwell on the dysenteries and other violent epidemics of hot climates, in which excessive heat, joined to some, perhaps unknown, peculiarity of the season, or other accidental circumstance, gives the disease an intensely inflammatory character, it is sufficient to remark, that in this country, bowel-complaints would appear to occur under opposite states of the atmosphere, and, as may be expected, to put on nearly an opposite cast of character under particular circum

stances.

Cholera, as it is called, is generally supposed to be a disorder of hot weather; but it is very frequently epidemic in the cold weather of winter, and the symptoms of these two forms of the disease are, on the whole, essentially different. It is rare to witness inflammatory symptoms in the bowel-complaints of autumn; whilst they form, as it were, the essential character of those of winter. In the autumn the violence of the vomiting and purging generally reduces the patient to a state of great weakness and of absolutely depressed powers; in the winter the inflammatory symptoms are too evident to be mistaken.

It does not necessarily follow, however, that these complaints, though really different in symptoms, and requiring a different mode of treatment, should vary as to their cause. Indeed, I have long been of opinion, that the majority of the bowel-complaints of every season of the year are either essentially inflammatory, or are produced by such states of

irritation of the mucous membrane of the intestines, or of congestion of the liver, as are very nearly akin to inflammation.

Our pathology of these diseases is confessedly very imperfect, and therefore our practice is, in a great degree, empirical. For the same reason it is also various and so inconsistent, that whilst one set of remedies, chalk and opium, for instance, is successful in the hands of one practitioner, an opposite plan, as repeated doses of Epsom salts, is successfully followed by another.

It would perhaps be easy to show how these several methods of cure may each become proper, under certain circumstances, if the complaint be considered as one essentially of inflammation; how, if the complaint arise from a congested state of the liver, a bilious purging may cure it; or how, if inflammation of the mucous membrane be the cause, the purging may, in like manner, form the cure, by depleting the irritated surface of the intestine; how, therefore, a bowelcomplaint may run itself off, or stimulants and aromatics may, by good fortune, be given just at the time when the irritating cause is removed, and the system is only suffering from the debility which has been occasioned by the evacuations.

But this is not the place to enter into the consideration of bowel-complaints in general. It is convenient, however, thus to allude to the subject; because it will serve as an apology for the cases and observations which follow, by showing the possibility of the bowel-complaints of this country being of an inflammatory nature.

The decidedly inflammatory form of diarrhoea, then, occurs principally in cold weather; and it is so common, that few medical men pass over the winter-season without witnessing more or less of it in their practice.

During the winter of 1820-1821, however, such cases were more numerous, and were in some instances attended by such peculiar circumstances as were sufficient to arrest the attention very decidedly.

In the preceding autumn, affections of the mucous mem