MR. PRESIDENT AND GENTLEMEN,-The subject I have chosen for this year's Bradshaw Lectura is " The Correction of Certain Deformities by Operative Measures upon Bones." To Mr. Wm. Adams, of orthopaedic surgery fame, must be ascribed the distinction of first placing before the profession -certainly in this country-a definite and carefully matured plan for correcting faulty position in cases of synostosis at the hip joint, for which he proposed to saw through the neck of the femur. Mr. Adams called

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... is operation-which by the way was performed for the first time on Dec. lst, 1869subcutaneous osteotomy, since he operated upon the lines of subcutaneous tenotomy, making an incision only just large enough to admit of the introduction of a fine saw he had devised, then sawing in great part through the neck of the femur, and finally wrenching forcibly, he in this way fractured the bone. He instantly closed the wound, and all through the operation carefully excluded the entrance of air. Adams's operation was introduced before the days of antiseptic surgery and although in his cases I believe suppuration rarely occurred other surgeons who followed his teaching were not so fortunate, suppuration following in not a few instances ; whilst even Mr. Adams himself, Mr. John Croft, and I had each to record a fatal result. At the time Mr. Adams claimed the highest surgical importance for the subcutaneous character of his operation as introducing a new feature and a wider scope for the principles of subcutaneous surgery-for by open wounds other surgeons, both in this country and in the United States, had divided bones, taking away even wedge-shaped portions in close proximity to joints for the correction of deformities, the result of synostosis in faulty position after arthritic disease. I only allude to the importance then claimed for the subcutaneous principle in Adams's operation to say how entirely it has vanished under the universal acceptance of the Listerian law of asepsis in operative surgery. Osteotomy has since been performed in many similar deformities such as faulty position after fracture, the division of, or removal of wedge-shaped portions from, curved rachitic bones and the like. In 1879 Prof. Macewen, of Glasgow, brought before the profession a new method of dividing bones by mallet and chisel, applying it specially to the correction of knock-knee. But with the advent of antiseptic surgery more extensive operations by open wounds of sufficient magnitude for the necessary manipulation have been introduced, so that now, with but little risk to life or limb, operative measures are adopted for the radical treatment of a large number of deformities. Yet another measure must be mentioned-an operation having for its object the production of a simple fracture by a powerful specially contrived apparatus such as was a few years since introduced by the late Dr. Grattan, of Cork. He gave the name "osteoclasia" " to the operation and of "osteoclast" to the instrument. Rapidity of action in an osteoclast is essential ; sudden impact also seems necessary to make a bone crack across as well as to avoid seriously damaging the soft parts by continuous pressure. In all these points i Thomas's osteoclast has the advantage over Grattan's. Osteo-I tomy is the most reliable operation for deformities involving long bones and is the one I invariably select for patients over the age of fourteen years. Its performance is characterised by great precision ; it is most effective in accomplishing the desired object and has but very rarely been associated with disaster of any sort. Whilst, however, its risk in children is almost nil, I must confess that I undertake Macewen',3 operation with some misgivings in young No. 3877. adolescents who are growing rapidly and whose bones are very vascular, as it is in such patients as these I have seen osteomyelitis and necrosis supervene twice, whilst not infrequently a sharp rise in temperature has caused anxiety for a few days. Personally, as between saw and chisel I prefer, where choice may be said to exist, the chisel. (Mr. Willett here stated that he considered it very important not to close the osteotomy wound so that no tension might result from the accumulation of blood.] . One objection taken against osteoclasia is that tte operator cannot ensure the line of fracture being at a given level with the exactness that is attained in osteotomy, but I must say I regard it as immaterial to the success of the operation whether the fracture takes place an inch higher or lower in the bone, for after both operations a fining down of the irregularities in outline may be confidently expected to follow. And by the growth of the bone the original situation of the fracture is altered. I regard the age of thirteen or fourteen years as about the highest limit at which osteoclasia should be practised. Above this age there must be, owing to the strength of resistance in the bones of the thigh and leg, so much risk of lacerating the soft parts that osteotomy is preferable. But as acquired deformities are mostly seen under this age limit and as genu valgum and rachitic curved tibiae form a large, proportion of the deformities coming under treatment it follows that I have adopted osteoclasia very generally at St. Bartholomew's Hospital. I should add that even in young subjects the osteoclast occasionally fails. This seems to be due to the yielding condition of the bones in the primary stage of rachitis rather than to any defect in the osteoclast. Only once have I seen any skin lesion beyond simple bruising occur. In the comparatively few instances where I have subsequently performed osteotomy when osteoclasia has faited, the operation has been carried through just as satisfactorily and completely as if no previous attempt had been made to fracture the bone. As the correction of deformities in the upper extremity ia so seldom called for, except for faulty position after fracture, I propose only to take into consideration the application of the operations I have mentioned to the deformities of the lower extremities. Upon investigation I ,find I have performed 634 operations on 383 patients. The proceedings have been as follows: viz : -1. For' deformities due to ankylosis at the hip 11 Adams's and 20 Gant's operations, making a total of 31 operations performed on 28 patients ; 2. For knock-knee and allied deformities 232 AQaceweL'a operations were performed on 137 patients, 159 osteoclasia operations on 83 patients, and 21 Reeve-Ogston operations on 16 patients, 'making a total of 412 operations on 236 patients. 3. For bow-leg 40 osteotomy operations were performed on 32 patients, 105 osteoclasia operations on 55 patients, total 145 operations on 87 patients. 4, For inveterate club-foot 2a astragalectomy operations (tarsotomy and tarsectomy) were performed on; 14 patients. 5. For hallux valgu.s and its allied conditions 14 operations were performed on 9 patients. 6. For deformities resulting from fractures of long bones 9 operations were performed on 9 patients. There have been 2 deaths-1 after Adams's and 1 after Macewen's osteotomy.