restrictions in such a direction. The idea would be unworthy of attention because of its ridiculous character, but for the fact that just at present there is a class of medicophobiacs, or anti-medical cranks who will grasp at anything and make it an issue, provided only it be against the medical profession.

In the present instance, a few men are probably responsible for this insult to the physicians of America, and until the attitude of the above association as a whole is learned from the action that will be taken at its Pittsburg meeting, the pharmacal profession should be held blameless. Unless we are much mistaken the matter will be quickly disposed of and the association forced by its intelligent members to take a position of dignity and common sense similar to that of the strong American Pharmaceutical Association, as embodied in the following clear cut resolutions passed at the last meeting:

RESOLVED, That we recommend tnat any movement for the reform of medical practice be allowed to originate and proceed within the medical profession.

FURTHER, That we are opposed to any attempt on the part of the pharmacal press to dictate or compel any such reform, believing as we do that the medical profession is qualified to institute and carry out its own necessary reforms.

The American Pharmaceutical Association is made up of many of the same pharmacists who compose the N. A. R. D., gentlemen of refinement, scientific attainments and broad, far-seeing intelligence. This Association has been a powerful factor in the splendid advance that pharmacy has made during the past quarter century. It has been closely allied with every upward movement in medicine and pharmacy, and not a few of the tangible advances in the fields of chemistry, therapeutics and pharmaceutical science can be traced to the

work of the Association and its members, and the impetus it has given in many ways to scientific investigation.

While the objects and activities of the N. A. R. D. are obviously somewhat different from those of the American Pharmaceutical Association, and we have no desire to depreciate the laudable aims and praiseworthy work of the first named organization in any way, shape or fashion, we still believe that without the slightest impertinence we can earnestly commend the resolutions of the American Pharmaceutical Association as offering valuable food for thought for the members of the N. A. R. D., ere they place their Association on record on the subject of medical dispensing, or any other of the problems belonging to the medical profes

sion.

(1)

The question of drug dispensing by the medical practitioner is one that can properly concern nobody but the individual physician and his patients. With the individual physician the question: whether he will supply no medicines whatsoever; or (2) a part, such as tablets and the medication he wishes to give immediately, writing prescriptions to be filled by the pharmacist for the balance and more important part of the treatment; or (3) whether he will furnish everything and ignore the druggist entirely, can only be decided by each physician according to the exigencies of his practice, such as location, nearness to or distance from well-equipped and trustworthy drug stores, the custom of the community, his personal needs, etc., or his inclination and belief.

We doubt very much if the most rabid opponent of medical dispensing will deny its necessity for the physician in the small country town far away from even the poor

, 1910

Series, Vol. V., No.

est drug stores. Here the needs of the patient decide the matter and the physician would be delinquent if he did not dispense everything he makes a practice of using. Likewise in a community where all of the physicians dispense and always have, patients expect their doctor to furnish the medicines, and he is either obliged to do so or suffer the consequences.

In the larger communities where there are plenty of well-equipped and trustworthy drug stores, the question becomes one for each physician to decide solely on his inclination or belief. We insist, if a doctor wants to dispense his remedies exclusively, it is his right. It may qualify his professional position, cheapen his services, and in some communities seriously jeopardize his standing, for he may be classed with the quack vendor of medicines. Under such conditions, the inclination of few physicians would lead them to dispense their own remedies exclusively. Indeed, it is always good judgment to adjust one's methods to the local requirements, even to the extent of writing a prescription for a single tablet, granule or pill, if to dispense the same tends to cheapen the service or lower the physician in the estimation of the patient.

There is a factor in the situation that has grown in importance as pharmacy has extended and that is the difficulty of obtaining pure drugs or drugs of dependable and uniform strength. Many a physician, therefore, has been driven to dispensing by the discovery that his prescriptions were being substituted or compounded with inferior drugs by inferior, ignorant and unscrupulous clerks. In such cases, dispensing of a more or less complete line has been a matter not only of self-protection, but of real duty to one's patients; and while the extra work entailed has been distasteful and much of it

actually humiliating, more than one physician has been exceedingly gratified to note how rapidly his knowledge of therapeutics has extended and how materially his armamentarium has increased.

Fortunately, pharmacologic efficiency and drug store integrity have been extending and most pharmacists have recognized the advantages of making the most of an unswerving honesty. Today it is the exception to fail to find one or more thoroughly reliable and well-equipped drug stores in any town or city of one to three thousand inhabitants. It is usually a good policy for each and every physician to arrange with the local drug stores to carry the remedies he intends to prescribe regularly. Then with the tactful dispensing of such tablets, pills, granules and other drugs as he wishes to administer himself under his own immediate supervision and control, the average physician will be able to maintain his professional standing free from every criticism, he will be able to meet every need of his patient from his own and his druggist's equipment, his knowledge of drugs and their physiologic actions will increase, his prescription writing will wonderfully improve, and last, but by no means least, he will establish relations with his druggists, that cannot fail to prove of the most far reaching benefit.

The clean, honest, capable pharmacist and the clean, progressive, upright physician have need of each other and the service that each can render to each other. Their interests surely need never to conflict and working conscientiously they will never trespass on each other's legitimate field of activity. It will require no law to keep physicians from dispensing when they can feel sure of their druggists' cooperation, nor

will it require a law to prevent druggists from counter-prescribing and dispensing when they know they are receiving the patronage of honorable physicians. The whole proposition of how to correct and overcome the evils-medical dispensing and counter-prescribing-that have so long interfered with closer and more practical more practical relations between the medical and pharmacal professions, resolves itself into a problem, the solution of which is the cultivation of mutual confidence, respect and esteem, with the development of an efficiency each in their own field which shall command the fullest respect of each for the other-the druggist for the doctor's therapeutic knowledge and ability to prescribe-the doctor for the druggist's chemical and pharmacologic knowledge and ability to compound a prescription with skill, accuracy and-most important of all-conscience.

The white slave investigation has brought one astounding fact to light France is the leading source of supply for our imported prostitutes. There is much food for thought in this for all those who have had so much to say about the diminishing French birth-rate. Why are these women forced out of France? Is is because too many are born and they cannot be supported or find honest work themselves? France is one of the richest countries in the world and constantly growing richer from dividends of world wide investments. She could easily feed these outcasts by importing food, but who will pay the bill? It won't do to increase taxes and feed the unemployed at public expense, because taxes. come indirectly from the poor to a large extent, in spite of all efforts to make the rich shoulder the burdens. It does seem that the French really have a surplus popu

lation which is allowed to sacrifice itself, in order that the balance may have more wealth per capita. We thus come to the curious conclusion that any increase in the birth-rate will only supply more surplus for sacrifice. It would be a blessing if the birth-rate were so small that none were forced into prostitution. The diminishing birth-rate then is not the curse which so many imagine it to be.

The sterilization of milk by ultraviolet rays is reported to be practicable and if true, there is doubtless a decided advance in this vital matter. The changes caused by heat of sufficient degree to kill pathogenic organs are quite generally considered to interfere with digestibility of the milk, so that there is a widespread desire

to secure uninfected milk which can be administered raw, but as such perfection is still far off, some kind of sterilization seems desirable wherever there is doubt. It is not

likely that ultra-violet light will injure the milk but the possibility must be kept in mind, lest we prematurely conclude that the problem of perfect sterilization has been solved. The enormous expense of treating a city's milk supply this way, rules out the method for universal use; indeed the expense of any method is found prohibitive. Experience also seems to show that a certain amount of money and labor expended on improving dairies and methods of distribution, does far more good in saving life and health than if spent on sterilization or pasteurization. So the new method even if found perfect has a very limited sphere. Our duty is clear-we must continue the crusade for clean milk, and that means clean cows, clean farms, clean handlers, clean receptacles and the milk kept cold until delivered at our doors.

ORIGINAL ARTICLES.

OBSERVATIONS ON THE TREATMENT OF FLAT FOOT.1

BY

ROBERT E. SOULE, A. B., M. D., Attending Surgeon to the New York Orthopedic Dispensary and Hospital; Surgeon-in-Chief of The New Jersey Orthopedic Hospital and Dispensary, Orange, N. J.

For convenience of consideration we divide this deformity into weak feet and rigid feet.

Weak feet, due to hereditary influences, injury, illness or occupation, we frequently

see in children as well as in adults.

Rigid feet represent a class of cases which may deviate but a degree in the progress of the condition or originate from disease or injury direct.

The deformity or disability is a matter of degree to which the condition has advanced, due to whatever cause it may be referable. The variation and adaptability of treatment to the requirements of the varying degrees of indications contain the key to success or failure in treatment.

Pathology-The chief cause of the condition of weak or flat foot is the sluing inward of the astragalus on its perpendicular axis, the tilting inward of the os-calcis on its horizontal axis, changing the plane of weight bearing from that considered normal as passing through the three points, namely centre of patella, centre of ankle joint and second toe. The increasing malposition of the foot tends to increase the internal rotation of this perpendicular plane upon its axis, increasing more and more the strain. directly placed upon the longitudinal arch, causing the head of the astragalus to become

'Read before the Orthopedic Section of the New York Academy of Medicine, March, 1910.

more prominent, pronation more marked, abduction of the foot anterior to the mediotarsal joint and increasing protective contraction of the abductor muscles.

Etiology may be congenital defects in the contour of the bones, or faulty development of ligaments and muscle supports, or acquired defects which include those cases produced from wrongly constructed shoes, or from occupation requiring the feet to support unduly heavy weights or when the individual stands long hours and upon hard surfaces, as well as cases seen in convalescence from severe illnesses or suffering from debilitating conditions, also cases resulting from injury. To any one or to a combination of the above factors the given deformity or disability can usually be readily traceable.

Symptomatology is comparatively easy, demonstrated by range of movements, as compared to the normal arcs, deformity demonstrated by the attitude in standing and walking and pain which may or may not appear proportionate to the stage of the given case. A very painful foot may appear comparatively normal in contour and have slight variations from the apparently normal arcs of motion but as the normal arcs are not absolutely constant experience has to be our guide in judging. Again, an extremely flat foot may not have the slightest pain, so that the symptom pain is usually an accompanying indication of progressing deformity and disability but which is the chief cause of bringing the case to the attention of the orthopedist. Practically the only other symptom to attract marked attention is the deformity which is variable from the slightest to the most marked pronation, flattening and eversion of the foot.

These foregoing conditions are very clear indications of static error even to the patient himself but it seems to me we should point