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the toes or heels. Without this precaution the mechani­cal distortion due to the oblique position of the foot in high-heeled shoes would lead to evident error.

Our observations on the combined effect of high-­heeled shoes and corsets opened up a very complicated question that we have not yet bcen able to solve satisfac­torily, although it is a more important question clini­cally than the otherg, because the combination of high­heeled shoes anu corsets is what one meeh clinicallv. In all of our experiments, moreover, we found that models in corsets, and most markedly in bad corsets, were much more comfortable standing in high-heeled shoes than without them-a fact confirmed by clinical experience. In our work on this point each observation was taken of thc model without shoes or corsets, then with corsets of one of the various types, and then with both the corsets and shoes. The three tracings werc then overlaid for study. The mechanical complications involved were so many that at present we are not prepared to make a more definite statement than that the use of high-heeleu shoes seems to modify, toward the individual's normal, the position induced by corsets and particularly the position induced by bad corsets, already describen. Fig­ure 10 shows a record of this combination. Finally, in this connection, we wonld protest against the indiscriminate ad rice so generally given to patients with backache to avoid high-heeled shoes. In many instances coming under our observation, such a change has been followed by most uncomfortable results.

Our conclusions from the experimental part of our paper are: that the center of gravity can be determined in the living erect individual; that this center of gra"ity is so located in relation to the supporting structures that the erect position is maintained by the tonicity of the posterior musculature; that forward displacement of the ccnter of gravity leads to increased demand on the posterior musculature 'to maintain the erect position. . In the position induced by what we have designated as the good corset, the strain on the posterior musculature is lcssened by displacing the center of gravity backward, and more especially by the fact that the shoulders are moved back at least as far as are the hips. Though the bacl corset also displaces the center of grarity backward, the relief to the posterior musculature which would be expected from this is neutralizeu in the position which they induce, by the fact that the pelvis is moved much further backwarcl than the shoulders, thus inducing an inclined position of the back in which the weight of the trunk, considered hy itself. is thrown so far forward as to place undue strain on the posterior musculature of the lumbar and pelvic regions. In the position induced by the wearing of high-heeled shoes, without any other modifying apparatus, the strain on thc posterior musculature is relieved by motion of the center of gravity backward, through movemcnt of the body backward as a whole, chiefly from the ankle­joint. , The study of two forms of modifying apparatl13 upplied to the subject at the same time introduces so Jlliteh. complication of conditions that conclusions there­from must be drawn up with great "aution. Whcn high-heeled shoes arc ohservcd in conjunction "ith either form of corert we conclude that the attitude characteris­tic of cithcr form of corset is modified slightly toward

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CASE I.-Patient, single, 53 years old, was sent to E. R. by a prominent orthopedic surgeon for backache and sense of weight in the abdomen which in spite of evident static faults had been uncorrected by his treatment, and which he was acute enough to believe must be traceable to some pelvic condition. On examination it was evident that her forward posture Was due to an unconscious attempt to lessen pressure on a fibrqid which nearly filled the true pelvis, and that the orthopedic apparatus had been ineffective in correcting the attitude or in relieving symptoms because it had been applied in the face of the determining cause, the fibroid. The patient made a prompt convalescence from a hysterectomy, but on rising from bed was extremely discouraged to find that the backache, which had led her to seek treatment, was, if anything, worse than before; but when she returned to the orthopedic surgeon who had originally treated her he found that the same apparatus which had before been ineffective now gave prompt relief, and after a few months she was able to drop it gradually. When last heard from, some time afterward, she was entirely well with­out treatment.

In this case orthopedic treatmmt was unsl1Ce(',::,~flll till the primary calise was remoyed. Hysterectomy nlone might ultimatel;r Ilnye relieved the backache without orthopedic treatment. B.\ekaehe was, however, immediately and permanently cured b.)' orthopedic treatment following the operation.

CASE 2.-Patient of E. R., married, aged 35, llad undergone three major operations and prolon~cd local trcatmrnt without relief at the hands of three very p.I'ominent gynccolo)!ists, the chief s.)'mptoms being renal pain and sacral lJfickuchc. The operations were nephrorrhaphy, anatomic success, with thera­peutic failure, and two suspensions, both of them anatomic and therapeutic failun~s. Prolonged trials of pC5sarirs had been made by two of the gynecologists, always incffecti\'e, and always increasing pain and backache. Evident static fault:" too complicated for the gynecologist to treat, were prc,;cnt amI the l)atient was referred to the orthopedic surgeon of hcr choice nfter she had positively declined to allow replacement of the uterus and the insertion of a pessary on the gronn,l of her previous experience. After considerable orthopedic treatment she was relieved of all her symptoms except sacral backnclH~, which continued distressing. She t.hen allowed E. n. to insert a pcs;;ury, which for the first time in her bistory she wore not­only without pain but with immediate relief of the backache, and after wearing it for sC\'ernl months hccnrne ahle to main­tain a forward position of the uterus without the pcssaQ'. She is still under orthopedic treatment but is rclicvccl of her symptoms. Orthopedic treatment should have prccc(h~d an operation. The names of the other medical men conneetcli with thcse eai;es are omitted for obvious reasons.

CASE 3.-Patient, sent to E. R. b.)T Dr. Chandler of McdfonI in January, 1908, 40 years old, married; no children; dys· menorrhea alwa:rs; dyspareunia alwa)-s; indigestion with intcstinal gas three .)·earsj frequent frontal headache; occa· sionnl not very severe neuralgia in left saCrOSdl\tic region, along the distribution of the left sciatic nerve nnd oYer the inncr surface of thc left thigh, always increased by walking nnd standing. but l\lmost constnnt before and dllrin~ catnnl('llia. Pains and nches in all portions of thc bod,'.-. Patient did not seelll in very bl\d condition, but WftR yen' self-centel'ed. rllnnin~ from one spedalist to another. On e:o.::a"minlltion pelvic org:ln~ were normal. Diagnosis, orthopedic disability. Patient was