quick relief for flat feet

792

mendation and; the Surgeon-General then makes a

decision. A grant may be from 25% to 50% of the cost,including equipment. There may be a loan of a further

25%. The National Advisory Hospital ConstructionCouncil is to consist of the Surgeon-General as chairmanand of 8 members appointed after consultation with theNational Advisory Medical Policy Council and selectedfrom leading medical or other authorities who are out-standing in matters pertaining to hospitals, public healthand other health services, and from among other personswho are concerned with the need for hospitals in urbanand rural areas. In the case of both councils the mem-bers are to be appointed " without regard to the civilservice laws."

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Unemployment insurance, previously dealt with byStates under State legislation, becomes a federal responsi-bility in continuation of the organisation of man-powerfor war purposes. It is to be associated with a nationalsystem of employment -service.

In presenting the Bill much emphasis is laid upon theextensive consultation which has already taken placewith responsible representatives in many spheres ofnational life. It is designed to avoid any interferencewith the broad basis of free enterprise ; indeed it isclaimed that social security of the right kind will makethe system of free enterprise operate more smoothlyand effectively.

ELECTRON MICROSCOPY OF CELLSTHE application of electron microscopy to the study

of cells has lagged behind its use for bacteria and viruses.This is due in part to the war, which began soon afterthe electron microscope became at all widely distributedin laboratories, and partly to difficulties inherent in thenew tool. One of these is the need to place the objectto be examined in a vacuum, a procedure ill adapted tocytology. A second difficulty arises from the thicknessof most cells. It occurred to Porter, Claude, andFullam 1 at the Rockefeller Institute that the tenuousstate of cells in tissue-culture might make them moresuitable for electron microscopy. They have now

evolved a technique for growing the cells on a plasticfilm which can be transferred on to a fine wire meshafter growth has taken place in culture tubes. The

preparations have to be fixed, preferably in osmic

vapour, and dried before being photographed. It seemsa simple step to proceed from the examination ofnormal fibroblasts to those containing the Rous sarcomavirus but evidently this is not the case. The amountof new detail revealed in fixed fibroblast-like cells withinitial magnifications .of 1600 to 4500 times is such thata new interpretation of the normal fixed cell is neededbefore any progress can be made in the identification of

pathological inclusions such as viruses. Moreover, thecells which are to be photographed are selected forthinness by previous examination with the ordinary

_ microscope. In the fixed and dry state these vary from.

30 to 60 micro a, and they may or may not be the onesthat contain virus. The nucleus itself is usually toothick for detailed study. Hope of seeing a tumour virusin an electron micrograph must thus be deferred a littlelonger..

QUICK RELIEF FOR FLAT FEETI THE use of procaine hydrochloride infiltration, advo-

cated by Leriche, is now an accepted method of treatingsprains, though there is still doubt about how it works.The anaesthetic effect may not be the one in every case.Sometimes benefit may come from the mechanicalbreaking up of adhesions, the relaxation of local musclespasm, or the simple dispersal of tissues, for injections ofsaline or sterile water can be equally effective, thoughthe pain they cause, due to the absence of the anaesthetic,makes them unpopular.1. Porter, K. R., Claude, A., Fullam, E. F. J. exp. Med. 1945, 81,

233.

The latest use for procaine hydrochloride injectionsis for the relief of pain in flat foot. Hipps and Neely,l ofthe United States Navy, maintain that pain in the soleof the foot after exercise or unaccustomed exertion is dueto overstretching and spraining of supporting ligaments.If the foot is structurally abnormal it becomes painfulmore quickly than a normal one. In the absence ofinfective, degenerative, metabolic, or gross traumaticcauses they have found injections of great value. An

injection shortens the average period of treatment from33 to 6 days, halves the number of cases requiringadmission to hospital, and reduces recurrences from 70%to 2%. Their method is to inject 15 c.cm. of 2%procaine hydrochloride into any painful or tender places-usually close to the plantar surfaces of the internal andmiddle cuneiform bones and the adjacent joints. This isfollowed by five minutes’ alcohol massage to the sole,and a-gentle quarter-of-a-mile walk. The injections arerepeated every third day if necessary and are followed by2-3 weeks of light duty. Since the average period oftreatment was 6 days there can have been few casesneeding more than three injection’s. In the controlseries the same routine was carried out with the exceptionof the injections. Each of the two periods under reviewextended over 9 months.The suggestion which Hipps and Neely put forward,

that the sprained ligaments of the painful foot " hyper-trophy " under the stimulus of ambulation, which theinjections have rendered free from pain, is difficultto accept. Blundell Bankart, it will be recalled,advocated the stretching of painful ligaments in flat feet.He attempted to make the feet so flat that no furtherstretch could occur. It is possible that the two methods

relieve pain by similar means-by allowing or assistingthe strained ligaments to stretch until all the ligamentsare under the same tension, and none under excessivetension. One of the curiosities of the procaine treatmentof sprains and fractures is that once the pain is relievedby the injection it seldom returns, although the tender-ness persists undiminished for about three weeks.Hipps and Neely note the first half of this fact, andprobably it is because of the second half that they findinjections under the painful metatarsal heads of pescavus of little value. Their report adds yet anotherpiece of evidence to show that the old principle of restingpainful parts is not always the most rapid and certainway of cure. Hilton’s classic " Therapeutic Value ofRest " and Hugh Owen Thomas’s dictum of " Rest, restand still more rest " ’still apply to diseased structures.But sprains, strains, and many fractures do best if theycan be made sufficiently painless for the patient to workthem off.

LEGAL ASSISTANCE

WHILE a national medical service is nearer realisationthan a national legal service, the Rushcliffe Committeehas published its recommendations for improving thelegal aid available. Poor persons committees andorganisations which provide a "poor man’s lawyer" arenot regarded as adequate. The " poor person " (whoshould, it is suggested, be called in future an " assistedperson ") ought to have help in. all the criminal courts, ifthe interests of justice make it desirable, and in all theusual civil courts. He ought to be able to get legaladvice for half a crown. Subject to payments by way ofcontribution from the person assisted, the upper limit ofincome should be raised to E420. The bachelor with E3a week or the married man with 4 a week should not beasked to pay. The cost should be borne by the Stateand the scheme should be operated through the LawSociety, with whole-time legal advice offices in populouscentres. The president of the Law Society wrote’at onceto the Times to pledge the support of the solicitors, buthe naturally asked for the release of solicitors and clerks

1. Hipps, H. E., Neely, H. Nav. med. Bull., Wash. 1945, 44, 262.