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best known are those cases in which the accident has rapidly proved fatal and so do not come under the category Comments, and of those who have described the disease from personal Notes, Short Answers experience. But of these martyrs to medical research the names of a few may be mentioned :-enteric fever: Allen to Correspondents. MacFadyen, H. J. Tylden, L. Jenner ; yellow fever: W. Myers; Rocky Mountain fever : T. B. McClintie ; plague: DISEASES DESCRIBED BY MEDICAL MEN Miiller ; spirillum fever : J. E. Dutton ; glanders : J. H. Wells WHO SUFFERED FROM THEM.1 (1909). Another group contains those who have deliberately inoculated themselves with infective or probably infective BY SIR HUMPHRY ROLLESTON, K.C.B., M.D CAMB., material; thus J. W. Lazear allowed mosquitoes to bite him F.R.C.P. LOND. and by his fatal illness proved the transmission of yellow the late Dr. P. T. Manson allowed infected ST. GEORGE’S HOSPITAL SENIOR fever ; mosquitoes EMERITUS PHYSICIAN, and thus malaria PHYSICIAN, VICTORIA HOSPITAL FOR CHILDREN. to bite him, by contracting proved that they transmitted the disease; his death, however, was due to an the late Dr. R. of IN the selection of a subject in response to your com- independent accident; Cory, St. Thomas’s vaccinated himself with invitation it was obviously unwise to encroach Hospital, frequently plimentary vaccine from infants and on those aspects of that your teachers deal with so lymph syphilitic eventually became and John Hunter inoculated himself much more advantageously, and I have accordingly chosen infected; with from a case of but one on which it is to be hoped that none of them-though pus gonorrhoea developed syphilis, and was in here I am not on safe ground-are personally competent to thus led to believe the unity of venereal speak with real authority-namely, diseases described by disease; it is, indeed, probable that his dramatic death from medical men suffering from them. Stephen Paget, in his angina pectoris was due to syphilitic aortitis. delightful Confessio Medici, says : 11 You cannot be a perfect Great Names Connected zrith Special Diseases. doctor till you have been a patient: you cannot be a perfect surgeon till you have enjoyed " (and he goes on to emphasise Bright, Addison, and Hodgkin-the great triumvirate of his choice of this verb) " in your own person some surgical Guy’s Hospital-did not suffer or die from the diseases so experience." According to this line of reasoning the perfect inseparablv connected with their names. Bright died at the author should be a man of many joys (or sorrows?) ; and age of 69 after four days’ illness attended with haematemesis, though I wish them well it is not this kind of joy that your and the-necropsy revealed pure aortic stenosis with healthy teachers deserve. kidneys. He was known to have some cardiac affection, but Victims to Tlaeir Specialty. it is said that inquisitive attempts to find out its exact nature Although the title, " Diseases Described by Medical Men were always frustrated by him ; at consultations between who have Suffered from Them," excludes the examples of several eminent physicians, including Bright, the problem was sometimes attacked to the medical men who have paid particular attention to a disease by proposing compare patient’s with that of a man but and fallen a victim to their a brief pulse presumably healthy (Bright); eventually specialty, the erudite touch of the was reference to this subject may perhaps be made. It has been inquiring colleague always said, the attractive that skilfully evaded. About Addison’s end kindly reticence possibly inspired by speculation drew a veil at the time of his but it that he is at work, that this sequence is common, death, appears auto-suggestion became insane and out of a window at and Sir William tells me that Sir Samuel jumped Brighton Hale-White Wilks, who was but never who was a doctors’ doctor, was convinced of this when 67 years old. Hodgkin, pathologist, firmly on the medical staff of died of at association. On the other hand, this coincidence is so Guy’s Hospital, dysentery Jaffa at the age of 68. Dr. Guillotin striking that there is a risk of exaggerating its frequency. Joseph Ignatius Writers of text-books would of swell this (1738-1814), who was a zealous advocate of vaccination and complete necessity a de Medecine in and must therefore be For the founder of short-lived Académie Paris, category disqualified. example, as well his Nothnagel died of what has from the toll it levies did not, poetic justice might demand, have been called the doctors’ head removed by the instrument to which his name is disease-namely, angina pectoris- attached. on which he was a but he recognised authority ; When of diseases from which was also the editor of a voluminous of giving descriptions they encyclopaedia to have had some writers medicine, and wrote on a number of other subjects. As may happen personal experience examples of authors unconscious that the future would add record their own sensations under a modest periphrasis such as "a man known to us ...... whose heart stands work a interest to their favourite grim personal professional well in all other but in whom intermittence of the subjects the following may be quoted: Laennec,who died respects from tuberculosis; Sir William Gull, with heart may occur for many days if he remain for an hour or pulmonary who, with smokers. He in a H. G. Sutton, described arterio-capillary fibrosis, from two many dare not sit close smoking cerebral Mikulicz from carcinoma of the room or in a smoking carriage." Or "a case is known to hæmorrhage; the writer in which the suffered from a severe S. 0. the author of a book on Diseases patient stomach ; Habershon, attack 18 from the onset of the disorder of the of ulcer ; G. R. Fowler, an years (bilharziasis), Stomach, simple gastric which had been in for some The late American surgeon, author of a " Treatise on the Appendix," abeyance years." and originator of the Fowler position, of appendicitis; L. G. Guthrie,4 propos of ophthalmic migraine, wrote: "In Corvisart and Lancisi of heart diseased The late Sir one case known to the writer permanent paralysis of the A. B. Garrod, who wrote in 1876 that, unlike Sydenham, ocular sympathetic appears to have been the result of he could not from personal experience describe the repeated migraine." The accurate observations of medical men on their own sensations of gout, became its victim, when 70 years in of the that " he has a fool for his of so his son the of medi- diseases, spite quip age, present Regius professor are human and add to cine at tells me. Trousseau, whose clinical patient," interesting documents, may lectures covered nearly the whole field of medicine, our knowledge of the earliest indications of disease. Such pointed are of value from the of out that if thrombosis occurred in a case of gastric disease, personal descriptions special point carcinoma might safely be diagnosed; when himself ill he view of the subjective manifestations or symptoms as opposed to The are best observed the was visited on Jan. his former physical signs. physical signs by lst, 1867, by pupil Peter, who, onlooker and the attention of the Thus when thus calling to express good wishes for the New Year, may escape patient. L. P. for some 15 or 20 each when he had the of hearing his teacher say: "It Mark, years, day painful experience looked into the to brush his hair or to shave had a is all up with me, the appearance of a of last glass patch phlebitis him in the as had leaves no for doubt as to the nature of typical acromegalic literally staring face,5 night loophole my been clear to his friends for and when 49 illness." Trousseau was right in applying his diagnostic professional years, was in a crowd Professor Pierre Marie, who deduction to his own case ; he lingered on for six months, spotted by described the disease, while in for a dying at the age of 66 years on June 23rd, 1867. originally medical entente cordiale. His graphic account of his sensa- Occupational Diseases among Medical 3ren. tions and sufferings, on the other hand, give much fresh Attention may be called to examples of what might be information, especially as regards the occurrence of exacer- called occupational diseases among medical men ; medical bations in the disease, or of periods which he calls the , officers specially interested in infectious diseases, including acromegalic state during which the symptoms, like the tuberculosis, syphilis, and tropical affections, on which they physical signs, are accentuated; these symptoms varied may have written, are naturally liable to contract these from malaise to complete incapacity to do anything and diseases, and radiologists have suffered much in the past, mental depression. especially from carcinoma. Those who have worked at the Julius Thomsen’s6 description (1876) of the disease of the laboratory aspects of infections may fall victims to these diseases, and many examples might be given. Probably the 3 Works of John Hunter with Notes, edited by J. F. Palmer, 1835, vol. ii., pp. 146, 417. 1 A paper read before the St. Mary’s Hospital Medical Society on 4 Guthrie, L. G.: The Diseases of Children (Garrod, Batten and Feb. 23rd, 1921. Thursfield). Vide also Clinical Journal, August 5th, 1896. 2 For an interesting paper on "Diseases of Great Physicians of 5 Mark L.: Acromegaly, a Personal Experience. Baillière, Tindall, the Past" see William Pepper (Tertius), Medical Library and and Cox. 1912. Historical Jour., December. 1907 : abstract in New York Med. Jour., 6 Thomsen, J. (of Kappeln, Schleswig): Tonische Krämpfe 1908, lxxxvii., 231. (Ataxia Muscularis ?), Arch. f. Psychiat., Berlin, 1876, vi., 702, 837 muscles (myotonia congenita) hereditary in his family first Another instance, certainly interesting on account of the drew attention to this disease. This is the best, if not the correspondents, is to be found in a letter written from only, example of a disease first brought to our knowledge by York on June 3rd, 1795, by Dr. Thomas Fowler (1736-1801) a sufferer, for it is not certain that John Bostock gave the whose name is so familiar in Fowler’s solution (liquor ’ first account of hay fever. Otherwise the nearest approach arsenicalis) to Dr. William Withering, of Birmingham, the to such an original document is probably that by Dr. R. introducer of digitalis, detailing his symptoms as those of Druitt,7 who gave a full description, especially as regards angina pectoris and asking for advice; Dr. Withering the early symptoms, of paroxysmal haemoglobinuria under endorsed the letter with his opinion that the disorder was the title Paroxysmal Haematinuria in 1873, a year after the spasmodic asthma. Turning now to later authorities, Hyde disease had compelled him to retire from active practice. But Salter wrote a treatise on asthma in 1859; C. H. Blackley, as far back as 1831 Elliotson s briefly referred to a case as in his monograph (1873) on Catarrhus Aestivus or Hay connected with malaria, and in 1865, at the same meeting Fever, refers to T. Wilkinson King, G. T. Gream, and W. P. (on May 9th) of the Royal Medico-Chirurgical Society, Kirkman as fellow sufferers, and Trousseau 12 described his G. Harley 9 and W. H. Dickinson 10 read papers on inter- own experience; W. E. Steavenson in his published thesis mittent hæmaturia; Harley recognised that the red blood for the M.B. at the (1879), says, corpuscles were dissolved, but he believed that the under- 11 I have never been prevented by an attack of asthma from lying factor was hepatic derangement, apparently on account going in for or completing any examination ; but when com- of the accompanying icteric tint; Dickinson, on the other pleted and the strain on my mind relieved, it has always been hand, more nearly approached our present views in saying followed the succeeding night and day by a severe attack." that we must be content to regard the disorder as something Many famous medical men have suffered from gout, and sui generis and the blood itself as the seat of the primary some of them have made their experiences public. Thomas change. Druitt’s symptoms began when he was 52, six Sydenham (1624-1689), the English Hippocrates, was a years before his account of the disease was published, and chronic victim of gout, and towards the end of his life, lasted until his death in 1883 at the age of 68 ; he was the when suffering from renal and hæmaturia, author of a once well-known handbook, " The Surgeon’s Vade brought out his Tracta,tus de Podagra et Hydrope (1685) Mecum," which went through 11 editions. Benjamin Franklin (1706-1790) was also plagued with and vesical wrote a curious and Go2ct. gout calculus and pam- Migraine, Asthma, phlet "A Dialogue between Franklin and the Gout." Dr. The diseases most often described medical are by patients (1687-1765), not only a distinguished those of a chronic and those naturally character, especially physician, but so eminent in and druidical with intervals of fair health between acute attacks of history that his friends familiarly spoke of him as the’ such as and paroxysms, migraine, asthma, gout. "Arch- of this age, became so overpowered by the Migraine, or sick headache, has the distinction of having fatigues of his profession and repeated attacks of gout that been more victims than has portrayed by distinguished any he turned his thoughts to the church and was appointed to other even and it is that some of disease, gout, noteworthy the living of All Saints, Stamford, in 1730, where he was the most careful accounts of the visual phenomena have treated by Dr. Rogers with his oleum arthriticum. The been given, not by medical men, but by the leading lights of successful result of this external application induced such as Sir G. pure science, especially astronomers, Airy, Stukeley to publish " A Treatise on the Cause and Cure of Sir John Sir D. and Sir C. Wheatstone. Herschell, Brewster, Gout, with a New Rationale (1734). It should, however, be In 1886 Hilton wrote : " I do not know of other Fagge any noted that in addition to rubbing on the oil Stukeley which within the has been malady present (XIXth) century adopted a proper regimen and left off the use of fermented the of two admitted into the subject papers Philosophical liquors. A famous example of a physician recounting his as well as to the Philo- Transactions, of communications own ailments is that of George Cheyne, who described his and other scientific in this sophical Magazine publications obesity, neurasthenia, and hyperchlorhydria and his cure country and abroad." It may therefore be said of it, as in "The English Malady" (1733). In "An Essay of the Sydenham feelingly remarked of gout, that it attacks more True Nature and Due Method of Treating the Gout " (1720)’ wise men than fools. well-known medical con- Among he also drew on his own experience. tributors to the literature of the disease are W. H. The late Sir Robert M. Simon suffered from Ménière’s Wollaston, interim President of the Royal Society in 1820, disease, and a graphic description of his symptoms from his threw the in when he who, however, up profession disgust own hand was published posthumously. was rejected as a candidate for the post of physician to Sir George Murray Humphry of Cambridge, had phlebitis St. George’s Hospital in 1800; John Fothergill, the Quaker on three occasions-in 1843 after right-sided pleurisy, in 1846 physician and philanthropist, of whom Benjamin Franklin after typhoid fever, and again in 1851 after pleurisy. He said, " can hardly conceive that a better man has ever laughed at those who kindly told him that he would die, and existed"; Caleb Hillier Parry, the "distinguished old Bath wrote his M.D. thesis on "The Formation of Clots in the physician " ; Dr. E. Liveing, who wrote a classic on megrim Venous System during Life," 14 recording his own case : "My Dr. a (1873), Sir Samuel Wilks and Alexander Haig, life-long attention was first called to it by its occurrence in a member until himself. Dr. sufferer he dieted Hubert Airv and Sir of the medical profession, a delicate man." James Mackenzie have published coloured represertations of their own spectra. Mackenzie mentions that the scintilla- Other Diseases, Infections, and Accidents. tions once came on when he was about to operate on a case Alimentary canal.—Merycism or rumination has been of appendicitis, but in the concentrated attention given to described by several medical sufferers : Nacke, Cambay, the operation they disappeared, only to return about a Blanchard, and Halliday.15 J. H. Keay,16 from frequent of an hour after the was finished. quarter operation personal experience, insisted that the initial pain of biliary , Asthma and hay fever, being examples of toxic idiosyn- colic, presumably due to the entrance of a stone into the crasies on which Dr. John Freeman has thrown the light of cystic duct, is felt in the back and not, as is commonly the laboratory, may be considered together. In 1819 John stated, in the right hypochondrium or epigastrium, and Dr. Bostock,ll later Vice-President of the Royal Society, Kraus, of Carlsbad, expressed the same opinion on similar described his own case as a " periodic affection of the eyes grounds. Professor Lewellys Barker,17 in an article on the and chest," and nine years later, now under the new name diagnosis of gall-bladder disease, mentions that when 8 years " Catarrhus aestivus, or summer catarrh," was able to old he had enteric fever, and that 35 years later four gall- collect 28 examples of a similar nature, but the only stones giving cultures of B. typhosus were removed from his reference to a previous description of the disease that he gald-bladder. Dr. E. A. Cockayne 18 detailed his own could find was one by Heberden. But asthma, which it experience of catarrhal jaundice. must be admitted is a rather vague term, as it may include Cardiac and renal dzsease.-The late Sir W. T. Gairdner, many causes of dyspnoea, was previously well known. Thus who wrote much on the cardio-vascular system, gave an Sir John Floyer described his own case in his " Treatise on account19 of his own symptoms in Stokes-Adams’s disease. Asthma" (1698) ; and in Hutchinson’s Biographia Medica W. C. Wells (1757-1817), the famous author of "The Essay (1799) it is stated that John ’s "Essay on the on Dew," suffered from dropsy and cardiac asthma; he Effects of Air on Human Bodies " (1733) was apparently the wrote on scarlatinal and other forms of dropsy, pointed out outcome of consideration of his own case, " an asthma which that the urine contained albumin in scarlatinal and cutaneous gradually increasing with his years became shortly after dropsy, but not in primary hydrothorax or ascites. He unmanageable and incurable." noted that in some of his cases the kidneys were diseased, Arbuthnot, in his political skit " The History of ," and thus nrepared the way for Bright’s generalisation; he originated this familiar personification of the English nation: anticipated Blackall, who subsequently elaborated the "Bull in the main was an honest, plain-dealing fellow, choleric, observations on the presence of albumin in the urine. bold, and of a very inconstant nature." It may be added that in the first to Guy’s Hos- one of his lighter touches the late Sir Victor Horsley described our (1684-1750), physician three British institutions-John Bull, Father Christmas, and King Henry VIII.-as examples of fatty degeneration due to chronic 12 Trousseau : Clinical Lectures, p. 625, vol. i. , 1868, New Sydenham alcoholism. Soc. 13 Vide Brit. Med. Jour., 1915, i., 53, 282. 14 Ibid., 1859, 582. 15 Vide Brockbank, E. M. : Brit. Med. Jour., 1907, i., 421. 7 Druitt, R. : Med. Times and Gaz., 1873, i., 403, 461. 16 Keay, J. H. : Medical Treatment of Gallstones, p. 75, 1902. 8 Elliotson: THE LANCET, 1832, p. 300. 17 Barker, L. : Jour. Amer. Med. Assoc., Chicago, 1920, lxxv., 1105. 9 Harley, G.: Med. Chir. Trans., 1865, xlviii., 161. 18 Cockayne : Quart. Jour. Med., Oxford, 1912-13, vi., 8. 10 Dickinson, W. H. : Ibid., 1865, xlviii., 175. 19 Vide "Life of Sir W. T. Gairdner," by G. A. Gibson M.D., 11 Bostock, J.: Med.-Chir. Trans., 1819, x., 161, and 1828, xiv., 437. pp. 138-152, 1912. 838 pital {1725-1732), suffered severely from renal calculus, and It was, he continued, impossible to find in a civilised described his painful experience in his " Account of the adult a perfect foot-one of ideal shape, which would do its Effects of Soap-Lye, taken Internally, for the Stone," work properly and gracefully, and give no trouble. To keep published in 1740. the feet healthy it was necessary to "catch them early," Infections.—Murchison, who had typhus twice, graphically and the most effective work for reform can be carried out described his own sensations and delusions during the by the provision of proper footwear for children. Growing delirium of the disease, and quoted similar personal accounts children must not be on their feet all day long, and should by Hildenbrand and Gueneau de Mussey. Benjamin Rush, not be required to follow laborious occupations, entailing " the American Sydenham," after advocating bleeding and heavy lifting. Standing about was more harmful than purgation with good results in yellow fever, contracted the prolonged vigorous walking, and in any collection of women, disease, had his own treatment, and recovered. Surgeon- such as nurses, who had to stand about during their work, General G. M. Sternberg, who investigated many outbreaks foot troubles were numerous. of yellow fever, and wrote much, especially about the Flatness and Falling-in of Foot.—Height of Heels. of the disease, had an attack after oetiology and prevention Flat-foot was the commonest of such troubles. But the third outbreak and was as as ever in energetic advocating and in the first trouble measures for its Sir James in his generally, nearly always children, prophylaxis. Paget was not flat-foot—that a of the account of his illness contracted from examination of a really is, giving way long a the dead of " Sir William Lawrence arch-but falling-in of the foot, just below ankle-joint, patient pyaemia remarked, a condition often referred to as weak to more used to that he had not known anyone to recover on ankles, leading say strain on the inner border of the to the arch whose case more than seven had been consulted. Our art foot, and, later, itself The best for flat or weak has I bad the of attended giving way. exercise foot improved. happiness being by was correct until it becomes automatic. ten." In his own as a case of walking, developed recording experiences staphylo- out of the toes was correct when coccic infection Sir Lauder Brunton 20 noted that the pain Slight turning standing easy, but in the feet should be The was worse after meals, when hydrochloric acid was walking kept parallel. absorbed from the and that relief followed essential use of a boot was to protect from over-strain the being stomach, which bind small and conse- the of sodium bicarbonate and its local ligaments the bones together, ingestion application the boot or shoe the to the he referred to the diminished of quently should correspond to shape of pustule ; alkalinity the foot. Instead of the shoe the it the but did not use the term fitting foot, however, blood, acidosis, which, though was the case that the foot is to was not then in Alexander unfortunately compelled invented, popular parlance. the conventional standard of the to was a adopt shape shoemaker, Ramsay (1754-1824) who, according some, compound narrower than the human a of immense uncontrollable actual foot, producing pointed personal deformity, learning, toe in which the toe was turned and inordinate wrote " Personal portion great cramped, temper, vanity, Experiences and not to move. So-called the Bite of a Rattle-snake." 21 outwards, permitted squared- from toes were a delusion and a it was not the Tuberculosis has attracted its medical victims to snare ; part pro- naturally the toes which mattered, the its and has been for a number of jecting beyond important point study, recently responsible that none of the toes must be to side medical officers to sanatoriums. Sir Andrew Clark, when being subjected pressure. A good shoe should also have a well-curved and ypung, was gravely ill with tuberculosis, and when given an stiffened waist. at the London in 1853 was not appointment Hospital thought With regard to heels, Mr. Trethowan said the Cuban was likely to survive a year; no doubt his own condition led the most for the Louis heel him to undertake inoculation with tuberculous satisfactory general use, being experiments bad on account of its curved mechanical shape and material, a subject to whichVillemin’s researches were then inefficient and also because it weakened the whole much but his work was support, (1865) calling attention ; interrupted sole of the shoe. In a strong foot the lower, brogue heel. by an attack of haemoptysis. He also did much to establish could be used. Children with normal feet did not require the existence of a non-tuberculous destructive disease of the much heel. Women, however, favoured high heels, and, under the name of fibroid as it is now lung phthisis or, while there was no doubt that some did so for cosmetic chronic E. L. Trudeau purely called, (interstitial) pneumonia. reasons, it was certain that the majority of women wore tuberculosis in 1871 and was the developed pulmonary high heels as a response to the relief afforded to the pioneer of the open-air treatment of the disease at his of the foot. sanatorium at Lake in the where ligaments Women, being hampered by skirts, Saranac, Adirondacks, could not get such freedom of movement in the hips as men R. L. Stevenson was for a and to time, where, according are able to and it be from this cause needed E. V. Lucas 22 is in and "that do, might they simplified spelling vogue the more efficient afforded heels. The action of most and of the functionaries of the support by august mysterious life, the foot in man was not so marked as in as is to watch his dwindle and his nearly women, physician, able divinity men themselves with the movement of under the Fizisn." Dr. James propelled hip long dignity disappear style strides, while women walked more with their feet. It was a Hughes Bennet went to Mentone for disease of the lungs universal and traditional idea that the majority of troubles was the chief in Mentone as a health and agent establishing occurring in the feet are the evil results of the use of resort; he wrote a book on " The Treatment of Pulmonary heels, but the and movements of the foot showed and Medicine." anatomy Consumption by Hygiene, Climate, that the strain on the arch must lessen in of his tendo Achillis about 1762 led Alexander fully long propor- Rupture tion as the heel is raised ; this was the experience of the Monro, primus (1697-1767) of Edinburgh, to record his vast of in of medical advice to the Hunter’s majority women, spite accident; and John similar experience while The most measure in relief in in him to contrary. important giving dancing 1768 inspired investigate experimentally cases of weak or overstrained feet was to raise the of the of tendons in Percivall Pott’s height healing dogs. fracture, the heels, and not to lower it, as was nearly always advised. due to a fall from his horse in has his name in 1756, kept The height of the heel for remedial purposes should not perpetual recollection. exceed 2 inches, and in house-shoes should not be less Lastly, most of the writers on old age and its infirmities, than 1¼ inches. Naturally, the height should do no more such as Cornaro, Sir Anthony Carlisle, Charcot, Sir George than afford relief. In cases of overstrained feet slippers must Humphry, Sir Hermann Weber, and Dr. R. Saundby, have be avoided. Heels not less than 1¼ or 1½ inches in height been approaching the sere and yellow. A few dying were suitable for general use in healthy feet. have recorded their until the physicians experience pen Selection Footwear. slipped from their fingers, and it is difficult to find a more of comforting last word than that of the great William Hunter, Most ready-made boots, Mr. Trethowan said, failed miser- in the inner "If I had strength enough to hold a pen, I would write how ably the support afforded to border of the foot, and this with waists that are thin and easy and pleasant a thing it is to die." fact, together unyielding, and which bulge downwards after use for two or three was for the inefficient HEALTHY FEET. weeks, largely responsible and breakdown of the foot. Where such an evil " support ON April 6th a lecture on Healthy Feet " was delivered arrangement was combined with a flat heel, the shoe is of at the Institute of Hygiene by Mr. W. H. Trethowan, who the worst description. The majority of people habitually said that during and after the war, as surgeon to one of the wore shoes too narrow across the toes and the balls of the great military orthopeadic hospitals, he had had an extended toes. Up to a point, just behind the balls of the toes, the opportunity for noticing how frequently deformities and snugger and narrower the shoe the better, for a good tight disabilities of the feet contributed to the C 3 element grip of the instep was very desirable. enrolled in the new army, and also the effect of these foot In selecting shoes important points to be borne in mind conditions on active service. A great number of cases of were length, breadth of soles, the pointing inwards of the so-called "trench feet were reported, but when, from the toe portion or straight inner border, and the roominess of cases thus grouped, those really due to frost-bite were the toe portion of the upper. In conclusion, Mr. Trethcwan eliminated, the remainder were ordinary mechanical dis- pointed out that pressure effects began very early in children, abilities common in civil life, such as fiat-feet, too arched and that a single pair of ill-fitting shoes might be the cause feet, clawed toes, hammer toes, and similar troubles. Apart of a considerable degree of permanent deformity. Socks and never himself from frost-bite, he had been able to convince stockings were of some importance also, and were often too that such a disease as trench feet existed. short, narrow, and made of unyielding materials. Socks, in order not to have should be 20 Brunton, L. : St. Bart. s Hosp. Rep., 1903, xxxix., 227. any deforming effects, large, 21 American Medical Biographies (Kelly and Burrage), p. 951, 1920. not pointed at the toes, and made of material that will 22 "From an American Note-book," Times, Sept. 24th, 1920. readily expand.