s occurring later, from standing if the general condition improves.

Treatment.--Should be begun early and both general and local treatment
should be given. The quicker the treatment is begun, the quicker will be
the recovery and the deformity will be less. The ordinary medical and
hygienic treatment should be given for rickets.

Local Treatment.--This is mechanical, supplemented by baths, rubbing,
friction, electricity and preceded, if necessary, by attending to the
bones. If the rickets is still active, and the bones are soft and
yielding, standing and walking should be forbidden, the limb should be
straightened by manipulation and the correct position secured and
maintained by an outside splint and bandage. Sometimes operative measures
are needed.

BOW LEGS. (Genu Varum).--This is the opposite of knock knees, and the
deformity usually affects both limbs, the knees being widely separated.
The disease begins in early childhood; the cause is rickets, and the
deformity is the direct result of the weight of the body and muscular
action.

[DEFORMITIES 371]

Treatment.--Spontaneous recovery occurs; but if the case is at all severe,
and the child is young enough that the bones have not become firmly set in
the abnormal curves, mechanical treatment should be employed to bring the
limbs to a better position. This may be done by plaster of paris or
braces. This must be used intelligently and continuously. Children should
not be allowed to walk so early, especially those of slow development.

CLUB FOOT (Talipes).--Varieties:

1. The heel may be drawn up and the foot extended (Talipes Equinus).

2. The foot may be flexed, bent up, (Talipes Calcaneus).

3. The foot may be drawn inward, adducted, (Talipes Varus).

4. The foot may be drawn outward, abducted, (Talipes Valgus); or, two may
be combined, extended, and drawn inward (Equino Varus).

In the congenital (born with it) variety the displacement is almost always
one of adduction, that is, drawn inward, with commonly some elevation of
the heel. It generally affects both feet, but it may be confined to one
and if only one is affected, the right is oftener affected than the left.
The deformity varies. At the time of birth and for some months afterwards
the deformity can usually be corrected by proper manipulation, but later,
if left to itself, it becomes in greater or less measure fixed, because of
the muscular contraction, and developed changes in the shape of th