propositions for our study, although often one of the most difficult ones for solution. The idea that is thoroughly impressed on the public as well as the medical mind is that a person with a deformity "was born so," and that the condition is to be endured, not cured, or if cured at all it must be through force or surgical operation; that the normal or healthy side of the deviation must be reduced to the weakness of the weaker side in order that the balance may be established. It is generally supposed that the tissues on the short side of the extremity are contracted by some inherent condition, and that contraction must be overcome by the application of strong force or by diversion of everything that is shortened; and even in the after treatment little or no attention is paid to the weaker side of the difficulty. In cases that are not congenital the condition is ascribed to something that causes active and continuous contraction of the muscles on the side toward which the bottom of the foot is directed or deflected; the effect of the weight of the body crowding the top of the foot in the opposite direction toward the weaker side, and the natural shortening of the muscles and fascia to adapt themselves to the position assumed by the foot, receives little attention. It is considered that the contraction of the muscles on one side leads to the giving way of those on the opposite side. In all cases the treatment must be an attack upon the shortened muscles and fascia by diversion or forcible rupture, and a long confinement of the part in some immovable, and usually air-tight dressing (almost invariably plaster of Paris), for from two to six months or more, followed by a few years of braces. At the end of all this the whole part is much weakened and atrophied, and must be brought back to usefulness by exercise, electricity, and massage. Now let us look at the matter from another point of view. Is it not possible that the primary condition was a weakness of the muscles on the side of the leg from which the foot departed, which allows the weight of the body to crowd the top of the foot in the direction of that weakened muscle; this would cause the bottom of the foot to point in the opposite direction and admit of the shortening of the muscles on the side toward which the bottom of the foot was directed. If we can now adapt a shoe to the case so that the weight of the body will not crowd the top of the foot,which first receives that weight, toward the weakened side, but in the opposite direction, the weakened muscles will not be further weakened by stretching, the stronger ones will not have an opportunity to contract, both sides will grow stronger during the treatment by the natural rise of the foot in its normal position, and the cutting operation that always destroys some tissues will be avoided. This may seem an unreasonable proposition, but I will cite two cases which are quite characteristic: Master B., about nine years of age; five years ago was operated on for talipes varus in both feet. Everything was divided from the inner malleolus down to and across the bottoms of the feet. The feet were then forced into an over corrected position and retained by a plaster bandage. The use of the plaster was continued for eight months, and then the boy wore braces for four years, and he came to me wearing this shoe on his left foot. There was a very large, deep scar occupying the whole length of the incision, which resisted every effort to place the foot in its normal position. Both legs were decidedly atrophied and had the characteristic shape, larger just below the knee than at any other point, and gradually smaller all the way down to the ankle. I measured the feet, and had a pair of shoes made, one of which, the left one, is here shown; there is no stiffening in the shoe, the upper being as soft as any. The sole on the inside is like any shoe, but the outer half of the shoe, upper and sole, are built well out beyond the leg. The boy imediately walked on the bottoms of these shoes and was never able to turn them over. When the bottom was worn through a new one replaced it. The foot is gradually growing into a normal condtiion and the leg growing and assuming the more normal contour. The next case I will mention is that of a boy nineteen years of age, whose entire muscular development was deficient. He had an extreme case of talepes varus; his feet turned so far over that the sole of the shoe was turned upward at a right angle to the floor, and he walked on the uppers of the shoes, where extra pieces of leather had to be placed; as fast as these pieces were worn through they were replaced by others. This boy had been operated in a hospital, had received all kinds of treatment and worn braces for many years, but in spite of all he could not stand up without a crutch. With the first pair of shoes I made for him he walked about the room without his crutch and only support enough to balance him. This was September 1, 1902. These shoes were a temporary pair, for his foot had been crowded together by walking on the edge of the foot, the weight of the body resting on the other edge, and when he walked on the bottoms they were straightened out so much that in two months he had to have a new pair. The second pair he is still wearing and the whole breadth of the bottom of the sole and heel are worn evenly. He soon began to walk some without his crutch or any support, and in January he walked freely about my office for half an hour, with his crutch in another room. This boy is an inmate of a home for incurables, and the management were very incredulous as to any benefit, but they are now very enthusiastic. His leg has grown an inch and a half in measurement and he walks on the bottoms of his feet. He has had absolutely no treatment except the wearing of his shoes. This principle operates just as well in the reverse condition or talipes valgus, which is actually the condition in all cases that are commonly called flat foot. In all these cases the top of the foot is crowded inward by the weight of the body overpowering the normal muscles that hold up the inside of the foot, or a partial paralysis of these muscles and their failure to support the normal weight of the body. I will not discuss the question of flat foot in this article. My views will be found in the transactions of the New York State Homeopathic Society for 1901. This condition is quite common in girls, stout women, and fat men, and is assisted, if not produced, by the wearing of "Common Sense Shoes," shoes with that "beautiful long shank" that shoemakers say so much about, and has been much more in evidence since these shoes came into use. My shoes for these cases are built full on the inner side and the sole and heel extended beyond the upper. I could cite many cases, but one of each variety will do. A physician's wife, who had been lame for many years, and had been examined by surgeons in New York and Boston, as well as others, was at their wits' end as to what to get for her feet. She was often so lame that she had to go downstairs backward. I found much edema of the leg, as I do in most of these cases and a talepes valgus. I had a pair of shoes made for her in the summer of 1902, and she has worn nothing else since. The shoe was made with a wide shank; the outside of the shoe was fitted close to the foot, while the inner border extended beyond the foot, especially at the heel. The leg was carefully massaged until all edema was removed, and the lady has had no difficulty in walking. This case has had no treatment aside from the shoe and the massage for the edema. A poor girl was sent to me. Her right leg and hip were much atrophied and would hardly support her weight. Her foot was small and the top turned inward whenever she rested any weight upon it. This side was about two inches shorter than the other, and when she walked she turned this toe outward and dragged the leg behind. It was a good example of dangle or flail leg. As she could not afford to pay for a special shoe, I had her get a strong shoe with a wide shank and had the heel taken off and a new one built that extended beyond the shoe to the inside and forward on the shank for about an inch. No inside brace was used. In this shoe she began to get the use of her foot, and had a firmer foundation on which to stand. This gave the muscles of the leg a chance to act. The leg has grown larger and stronger, she uses the foot as she does the other, and the whole side has filled out so that she looks quite symmetrical. I have never used a metal brace in the treatment of these cases, but have removed many. Gnaphalium.-Dr. Cartier finds this medicine, given in drop doses of the tincture, effective in other rheumatisms besides sciatica. Pains in the joints as if they lacked oil; chronic muscular rheumatism of the back and neck, the rheumatic form of neurasthenia-these are the conditions in which he has cause to praise it.-Revue Hom. Française, November. Kali Carbonicum.-A woman, aged 50, has suffered for ten years from rheumatism. She was incapable of working, could not go upstairs, had to get out of bed for two or three hours at night owing to the pains. Kali carb. 2x cured her in six weeks.-A. h. Z., cxliii., 206. Sabal serrulata.-A girl, aged 13, wetted her bed constantly. After the ordinary remedies had been employed without benefit she got sabal ser. This medicine completely cured her. She never had a relapse.-A. h. z., cxliii., 14. Trillium. Dr. Hawkes relates a case of menorrhagia of long standing, occurring in a young girl, where, after failure of ordinary remedies, trillium Ix and 2x brought complete and lasting success. -Monthly Hom. Rev., November, p. 674. |