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;;/ birth, or at a later period, the variationsbetween the ditferentcl-asses of patients wereortioned to the state of their health.then children are born with great consti.al weakness, and have their feet dis-- .°.ed either little or much, I have alwaysbeen able to restore them to their natural ’,D, by using a small power, and for a

wr,te portion of time ; but, in these

.-t., the after treatment, as I shall call it,:a.,ar, been, and will always be, more:;cus and vexatious to the mere bystander,ue the alterations are not visible, andthe anxious parent can only have the assu-rance of the operator that it is in a fair way,;:.],Itimatelv will do well. 1 have, in someof these cases, had occasion to attend themfor years before they were quite well.When the children are born with good

constitutions, high health, bodies stronglyformed, large, perhaps, and with their feetrindly fixed in their deformed state, thecase is very different; the deformed condi-tion of such feet can only be overcome byMtfe means, long continued, and with.htt caution. The strength of the bodies: such patients renders them peculiarly:able to mflammation, if a strong power isapplied; it was a case of this kind, which Ihave already alluded to, that destructive in-flammation was brought upon a patient bythe nse of much power by a very ignorantperson. The operator was the wrongSheldrake, as Dr. Neale called him.lo treat cases, of the species that I am

tcrv describing, successfully, when themalformation is great, the contraction isrigid, and the patient evidently of great!!length in proportion to his age and size, avery small power should be employed verygently at first ; it should not be suffered toremain more than twenty-four hours in the:ame situation, it should then be removed,ard cbanged so that it shall act in a differentwreetion and different degree. By pro-C,eding carefully in this manner, after somet.M the distortion will yield gradually andgently, and after some time the contractionwll: yield, and by perseverence in this nlodeof proceeding, be finaily eradicated.

There is a very great distinction to bemade between these cases, where strengthof constitution is the leading characteristic,and taase in which the principal character-is is debility: in the latter, the reduc-. by what 1 have called the first process,a very easily made, but the after treatment’-ry tedious; but in the former, the re-

is is necessarily tedious, and the after’-Mut quite the reverse. I have known of these cases where the distortion- .=:n very great and rigid, and where- anent had high health and great bodily:._:, after a long and great exertion to.:: a foot into its natural form, for a

few months, and sometimes a less time,confinement has given to the patient thefull use, and permanent form of his legs,and he has never had a relapse of the formerdistortion.

I am now entitled to conclude, from whathas been said, that in every case, whatevermay be the degree of distortion, if it doesnot originate in some constitutional disease,or is not co-existent with any local diseasein the same part, and where it can be easilyascertained that the apparent loss of power,and change of form, have been produced bythe cessation of action, may, whatever isthe extent of the infirmity, be restored tothe form and use of their limbs, by steadilypursuing the plans that have been now ex-plained, and which I have always foundsuccessful in my very long and extensivepractice. This can only be done, however,when the well-educated and skilful practi-tioners of surgery will take the, manage-ment of these cases into their own hands ; -,when this is done, the persons who labourunder these misfortunes will no longer bethe dupes of a set of persons to whom theyhave long been a prey : these persons wereonce generally known as truss-makers andshape-menders, but now, by an exertion ofimpudence, call themselves surgical me-

chanicians and mechanical surgeons, a titlewhich, if the Royal College of Surgeonssuffers to exist before their faces, will bringupon themselves merited disgrace.

I will, if you approve, in my next, sendan account of some cases which, in theirgeneral appearance, resemble those whichhave now been mentioned, bat differ fromthem in being absolutely incurable; this beingthe case, it appears to be important that themeans of distinguishing them should beknown.

I am, Sir, yours, &c.

T. SHELDRAKE.

No 73, Great Titchfield Street,Portland Place.

T. SHELDRAKE.

OPERATION OF LITHOTOMY.—REMOVAL OF

A CALCULUS WEIGHING FOUR OUNCES.

MR. HODSON, of Lewes, performed the ope-ration of lithotomy on the 28th ultimo, andextracted a calculus, weighing four ounces.The patient, a middle-aged man, has donewell. The double-edged gorget was used onthis occasion.