others, are points of great surgical importance; but he
has not seen them noticed. If the great toe is fixed
as it is generally fixed in the median-pointed boot, then
such movement as it can make is in the natural plane,
and when it is still it is really at rest. If, however, it
happens to be packed beneath the second toe, then if it
moves at all it must be in a plane for which the joints
are not adapted. Grinding of the Aciclovir Tablets To Buy cartilage and conse-
quent irritation are necessary results. Then the con-
dition known as " hallux flexus," " hallux rigidus," or
" hallux dolorosus," in varying degree of severity, is apt
to follow. The toe is flexed because it is held down
beneath the second; it is rigid because movement is
painful; it is painful more or less, even when still, be-
cause fixed in an unnatural position; it is never in a
position of rest. If sufficient muscular inactivity is
attained, flat-foot also ensues. But when the great toe
is Aciclovir Bp fixed in the former Aciclovir Buy position on the top of the final
phalanx of the second toe, it lies there on a sort of bed
formed by the final phalanx, which in the so-called flex-
ion of the toe lies flat on the ground, while there is an Buy Aciclovir Online
elevation of the joint between the first and second. The
toe being held in this position by the great toe and
straightening prevented, a hammer-toe results. In any
case, but the more important in the hallux flexus posi-
tion, to set the great toe free is clearly indicated. A
boot with a straight inside line is Aciclovir Tablets 200mg obviously needed. It
is more difficult to get patients or surgeons to recognize
the need of socks or stockings which have either a Aciclovir Cold Sore corre-
sponding shape or a separate stall for the great toe: the
pointed sock, tightened by friction against the side of
the boot when the foot is inserted therein, effectual-
ly holds the toes in the false position.
The author dissents entirely from the statements of
Sir G. Humphry that " the toes .are shut up in leather
and not used," and that " their services can be spared Aciclovir Tablets Buy Online
without detriment to the rest of the frame." It is not
so. They are generally used, and, as the smaller ones
move in a vertical plane, there is no reason why they
should not move together, even in a tight boot. These
toes are necessary if only to Buy Aciclovir Tablets Uk provide for their corre-
sponding metatarsal bones the protection from pres-
sure on the ground which is served by proper use of the
great toe. To the want Aciclovir 5 Cream of this influence are due the
callosities on the sole so often found. When the Buy Aciclovir toes
are used the skin is free from anything of the kind.
To want of this influence are also due the conditions
known as " anterior metatarsalgia," " Morton's toe," and
the unnamed sufferings in the same region from time
to time described. They are all evidences of defective
function. The bow-string or tie-rod influence of tlie
flexor longus digitorum on the plantar arch can not be
properly exercised unless the smaller toes are efficient.
" Show me the condition of the toes in any foot," says
Mr. Ellis, " let me Aciclovir Dispersible Tablets see how their functions are exercised,
and I will predict the condition of the plantar arch."
Toes which overlap each other Aciclovir Cold Sore Cream can not take such
good bearing on which to act as they do when each
presses on the ground line. Wlien the extensors act on
toes not firmly fixed by Valaciclovir Vs Aciclovir pressure downward, they draw
them upward, with resulting friction and corns. And,
indeed, in almost any defective condition of the foot
there is a surgical indication to correct or renew the
function of the toes, to compel each of them by active
use to, literally, flnd its level.
All the toes, when at rest, should be straight. The
semiflexed position, sometimes described as the normal,
is not really so.
TPIE NEW YORK MEDICAL JOURNAL, November 20, 1897.
ENDEMIC MULTIPLE NEURITIS (BERIBERI).*
By E. D. BOJTDURANT, M. D.,
PROFESSOR OF MENTAL AND NERVOl'S Where To Buy Aciclovir DISEASES,
MEDICAL COLLEGE OF ALABAMA, MOBILE ;
FORMERLY ASSISTANT SUPERINTENDENT OF THE
ALABAMA BRYCE INSANE HOSPITAL, Aciclovir Cream Bp TUSCALOOSA. ALA.
Endemic multiple neuritis, the Cingalese " beriberi,"
the " kakke " of Japan, while known in Asia for many
centuries, and in modern times prevailing extensively Aciclovir Tablets 800mg
among Aciclovir Eye Ointment the native populations of China, India, Ceylon,
Japan, the islands of the Pacitic, the west coast of Africa
(the " sleeping sickness "), certain portions of the coast
of Brazil, and the West Indies, has been rarely seen in
Europe or in North America.
The infrequency of the disease in the United States,
its Aciclovir 800mg intrinsically interesting clinical features, and the un-
solved problems of its nature and causation, give especial
value to a series of seventy-one cases which during 1895-
'96 occurred among the patients in the State Insane
Hospital at Tuscaloosa, Alabama.
Cases of multiple Buy Aciclovir Tablets neuritis had previously occurred
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