Page:Encyclopædia Britannica, Ninth Edition, v. 6.djvu/52

42 club, one black ball in ten ordinarily excluding. In the Athenaeum, whilst the principle of election by ballot of the whole club obtains, the duty is also cast upon the committee of annually selecting nine members who are to be &quot; of distinguished eminence in science, literature, or the arts, or for public services,&quot; and the rule makes stringent provision for the conduct of these elections. On the com mittee of the same club is likewise conferred power to elect without ballot princes of the blood royal, Cabinet ministers, bishops, speaker of the House of Commons, judges, &c. The general concerns of clubs are managed by committees constituted of the trustees, who are usually permanent mem bers thereof, and of ordinarily twenty-four other members, chosen by the club at large, one-third of whom go out of office annually. These committees have plenary powers to deal with the affairs of the club committed to their charge, assembling weekly to transact current business and audit the accounts. Once a year a meeting of the whole club is held, before which a report is laid, and any action taken thereupon which may be necessary. The entrance fee varies from 40 at the United Service and Army and Navy clubs to 20 guineas at the Carlton club. The annual subscription in like manner ranges from 10 guineas in the Carlton, Reform, and several others, to 7 guineas in the United Service club. The largest income derived from these and all other sources may be stated to be that of the Army and Navy club, which in the year 1875 amounted to 30,813, of which 19,383 was raised by entrance fees and subscriptions alone. The expenditure is, however, most commonly of nearly equal amount, and of few of the clubs can it be said that they are entirely free from debt. The number of members included in a London club varies from 2200 in the Army and Navy to 475 in the St James s club. Numerous provincial clubs aro established throughout the country. In both Edinburgh and Dublin are clubs fully coming up to the metropolitan societies. Nor is this great public convenience lacking in the cities and towns of Europe, the United States, and the British colonies. Of a different nature and with widely different objects are the learned bodies designated publishing clubs, of which the Abbotsford, the Bannatyne, the Roxfatrghe, and others are examples. These societies dsvoted themselves solely to the editing of unpublished MSS., or the reprint- of rare and valuable works.

1em  {{ti|1em|{{larger|CLUB-FOOT}} (Talipes}. The pathology and treatment of the various deformities of the foot, which are included under the above general title, come strictly under ortho pedic surgery. Several forms of club-foot have been recognized by surgeons There are four primary forms : (1) Talipes equinus, in which the heel does not touch the ground, the child resting on the toes ; (2) Talipes varus, m which the foot is turned inwards and shortened, the inner edge of the foot raised, the outer edge of the foot only touching the ground ; (3) Talipes calcaneus, a rare form, in which the heel only touches the ground, the toes being raised; (4) Talipes valgus, in which the foot is turned outwards. The third and fourth varieties are so rare that they are of no practical interest, and need not be further alluded to. It is possible to confound true talipes valgus with flat-foot, a deformity which is the result of undue stretching, from weakness, of the fascial and ligamentous structures which maintain the arched form of the foot. In flat-foot the arch is lost, the patient is splay or flat-footed, and as a secondary deformity the foot is turned outwards, resembling and often confounded with true talipes valgus.}} The two common primary forms of club-foot are talipes equinus and talipes varus. These two varieties are frequently combined ; the deformity is then termed talipes equino-varus. A shortening or contraction of one group, or of allied groups, of muscles is always to be observed ; as, for instance, in talipes equinus, to which the muscles of the calf are con tracted, or in talipes varus, in which the group of muscles which turn the foot inwards are contracted, or in talipes equino-varus, in which both sets are at fault. This con traction is due either to excessive primary irritation of the muscular group implicated, or is secondary to and the result of paralysis of an opposing group of muscles. In certain cases thD paralysis affects more or less all the muscks of the limb ; the result of this is a deformity in the direc tion of the most powerful group. The primary cause of these diseased conditions is some irritation of the ceretro- spinal central nervous system, either occurring before birth, and termed congenital, or appearing after birth, generally during the periodof first dentition, and termed non-congenital. As a rule well-marked cases are congenital. Such deformities are frequently hereditary. Both feet may or may not be affected. Eecognition of club-foot is of import ance, because if not treated early a change takes place in the shape of the bones of the foot, which renders treatment much more difficult, and in some neglected cases it is impos sible to restore the foot to its normal shape. It is to Stromeyer in Germany (1837), and to Little and Adams in England, that we owe a true understanding of the pathology and treatment of these affections. The following broad principles, which govern the treat ment, are now universally understood and adopted by sur geons: (1) A subcutaneous division, by the operation of tenotomy, of the contracted tendons ; and (2) A stretching of the newly formed embryonic tissue which is deposited between the cut extremities of the tendons in the inter space, the result of their retraction after division. This is managed by means of a mechanical appliance termed a club-foot boot. Various forms of boot have been used by surgeons ; in all the essential feature is that the foot is fixed to the boot by sticking-plaster or by straps, and the stretching is gradually accomplished by the elasticity of Indian-rubber bands, or by steel springs, or by screws. In this way the foot gradually assumes a normal appearance. As a general rule, after it is evident that the deformity is a persistent one, the earlier the operation is per formed the better. Only in exceptional cases should interference bo delayed beyond the third or fourth month of life. If a change takes place in the bones, or if the child is allowed to walk before treatment of the deformity, the cure is rendered more difficult and more tedious. In many cases when the child is young the cutting operation will not be necessary ; the foot can be restored to its normal position by rr.echanical appliances alone. Various rules have been laid down for the proper performance of tenotomy. The simple rule to begin with the riost tense tendon, and to divide it where it is most tense, is of universal application. In talipes equinus the tendo ^ achillis, in talipes varus the tibialis posticits and tibialis anticus require division. In the common form. 