January 22, 1903] 



NA TURE 



■15 



with more or less success. Buckminsler Broun in 

 America, William Adams, Noble Smith and others in 

 England, have published cases in which they have been 

 successful, not only in reducing the deformity, but in 

 producing a permanent cure. The chief difficulty has 

 always been the retention of the head of the bone in its 

 normal position after reduction, and, in some of the 

 cases so reduced, a relapse is said to have occurred. 

 The less defective the joints, the better the prospect of 

 success. Noble Smith recorded in the British Medical 

 Journal, November 6, 1897, the case of a girl, aged six, 

 whose left leg was affected and was two inches short in 

 walking, but which was brought down by extension to a 

 normal position in about three months. The patient 

 was kept from bearing any weight on the affected limb 

 for two years, and was then dismissed as cured. Three 

 years later she was well, and walked perfectly, with so 

 trifling a shortness of the limb that it was not noticeable. 



Prof. Lorenz has, it seems, perfected this method of 

 treatment. In double displacement, when the children 

 are not more than seven years of age, and in single 

 displacement up to the age of nine, he effects immediate 

 reduction. He forcibly tears the contracted adductor 

 muscles (in which operation he effects the division by 

 manipulating and chopping the muscle with his hand), 

 he then flexes the thigh on the body in order to stretch 

 or tear the posterior muscles, and he extends the leg 

 backwards in order to do the same to the anterior 

 muscles. By these means he so loosens the joint that, by 

 manipulation with the thigh flexed and abducted, lie 

 rotates the head of the femur into the depression of the 

 acetabulum. He then forcibly abducts the limb in order 

 to enlarge the anterior part of the capsule of the joint, 

 and fixes the limb in this position. This fixation is, 

 perhaps, the most important part of his treatment, from 

 the demonstration of which the few English surgeons 

 who had previously tried to follow out Dr. Lorenz's 

 methods have learned much. 



The tendency to redisplacement of the head of the 

 femur backwards and upwards is counteracted by the 

 extreme abduction and outward extension ot the thighs. 



Thus the thigh, or thighs, are held out at right angles 

 to the body to prevent displacement upwards, and they 

 are held more backwards than forwards to prevent dis- 

 placement of the heads of the femora backwards, '['his 

 position is maintained by plaster of Paris bandages 

 encircling the pelvis and extending to just above the 

 knees. In a few days, the child is allowed to walk in its 

 enforced squatting position. This she — most cases are 

 girls — can do by supporting herself with a stick held by 

 both hands in front, or she can be seated on a stool with 

 castors and move herself about the floor. Lorenz has 

 found it necessary to keep up this position for six 

 months, then to bring down the thighs to a less angular 

 position with regard to the body, so that the child can 

 walk more easily, while, at the same time, the heads of 

 the femora still press inwards and help to produce 

 stability of the joint. The whole treatment must last for 

 two years, and this length of time has been found neces- 

 sary by surgeons in the past. In older patients, Lorenz 

 advocates preparation by continued extension and, if 

 necessary, by division of muscles, and in all cases this 

 preparation is helpful. 



The word "bloodless" is applied to this treatment 

 merely in comparison to the operation of opening the 

 joint in order to replace the head of the bone. It does 

 not indicate the slightest opposition to the use of the 

 knife when such is desirable. 



Whatever may be the view of the surgeons of general 

 hospitals, there seems to be no doubt among the leading 

 orthopaedic surgeons, such as Mr. Robert Jones, of 

 Liverpool, and Mr. Noble Smith and his colleagues at 

 the City Orthopaedic Hospital in London, that the treat- 

 ment so ably advocated and perfected by Prof. Lorenz 



NO. 1734- VOL. 67] 



is, at the present moment, the most satisfactory means 

 known for dealing with these deformities. 



The objections raised by these surgeons to the "open" 

 method are : — (1) That it is a very severe operation and 

 dangerous to life ; (2) that the results often lead to 

 ankylosis of the joints operated on. One stiff joint may 

 be sustained with comparative impunity, but if two stiff 

 joints should occur, sad, indeed, is the condition of the 

 patient, for walking. is for ever after impossible. 



The accidents which Prof. Lorenz so outspokenly 

 referred to as having happened to him in first trying his 

 bloodless method are matters of the past, and he asserted 

 that, with due care on the part of the surgeon, such 

 accidents ought never to occur again. 



THE EGYPTIAN MEDICAL CONGRESS. 

 HP HE increased interest which is now being taken in 

 ■* the diseases of warm climates was clearly shown 

 at the medical congress held in Cairo last month. 

 Egypt, the recognised home of epidemics in the past, is 

 the victim of many plagues to-day which constitute it an 

 excellent field for medical study ; and the proceedings of 

 the congress bore ample testimony to the scientific 

 importance of the research work which is being diligently 

 carried on in the valley of the Nile. 



Out of a large mass of communications read before the 

 meetings, we may select as worthy of special notice the 

 papers on cholera, and the account of recent discoveries 

 in connection with the Bilharzia and Ankylostomum 

 parasites. 



The reports on the late outbreak of cholera showed 

 what admirable results had attended the work of the 

 sanitary authorities. The enlightened and up-to-date 

 methods now employed by them in combating the 

 epidemic stand out in strong contrast to the mis- 

 directed efforts of their predecessors. Nowhere can we 

 see more clearly the practical benefits which have been 

 conferred on mankind by modern progress in bacteri- - 

 ological science. It is now incontestably established 

 that cholera is spread by the infected water of the Nile 

 and by the wells and drinking-fountains in the mosques 

 to which the natives have common access, and the 

 measures of the sanitary authorities are mainly directed 

 towards preserving the purity of drinking-water as the 

 best defence against epidemics. A general opinion now 

 prevails, founded on the latest reports, that internal 

 supervision and hygienic measures are of more value 

 than quarantine regulations, which so often prove in- 

 effective, and such measures are becoming increasingly 

 important on account of the growth of population and 

 crowded condition of the big towns. One great difficulty 

 still remains — the problem of educating the natives up 

 to the reforms which are being introduced for their 

 benefit. Their ignorance of the elementary laws of 

 health, combined with an innate indifference, still con- 

 stitutes the main obstacle with which the authorities 

 have to contend. At the same time, the recent epidemic 

 would never have been dealt with so successfully if there 

 had not been a growing enlightenment among the lower 

 classes and a readiness to cooperate with the Govern- 

 ment in its work of sanitary reform. 



The scientific importance of Prof. Looss's papers on 

 Bilharzia and Ankylostomum, particularly for students 

 of tropical diseases, can hardly be overestimated. The 

 diseases produced by these parasitic worms work the 

 most terrible havoc among the native population of 

 Egypt, and attempts have been made for some time past 

 to find out by what means these parasites enter the human 

 system and lodge in the intestine. The story of Prof. 

 Looss's remarkable discovery is of the greatest interest. 

 While making some experiments in the cultivation of 

 ankylostomum worms, he accidentally allowed a drop of 



