ObjectiveThis study aims to assess the current antipsychotic prescribing trends for the treatment of schizophrenia and to compare them with available guidelines and research evidence.DesignAn observational retrospective quantitative analysis.SettingData were collected from the prescribing cost analysis for the period between 2007 and 2014, including all drugs from the British National Formulary 4.2.1 and 4.2.2. Prescriptions were included from primary and secondary healthcare settings in England and Wales.ParticipantsNone.Main outcome measuresDefined daily doses of antipsychotics were used to compare popularity of individual drugs and classes of antipsychotics.ResultsThere is a consistent increase in the proportion of atypical antipsychotics prescribed, compared to typical antipsychotics, between 2007 and 2014, with atypicals accounting for 79.9% of total antipsychotics prescribed in 2014.ConclusionThe consistent popularity of atypical antipsychotics is not concordant with the current National Institute for Health and Care Excellence guidelines for the treatment of schizophrenia or the most recent research evidence.

explanation of the unknown was ever wrapped in mystery, and the mind that sought it was often attuned to mysticism. The IN this article I want to state the case for the toes; the attention of the public, both lay and medical, has for too long been concentrated on the arches of the feet alone.The toes are designed to perform two functions, prehensile and ambulatory, and because of this their structure and musculature are more complicated than appears on the surface.The mechanism of the foot is that of a lever of the second order with the fulcrum at the metatarsal heads, and for any system of levers to work efficiently the fulcrum must be stable and the lever rigid. When walking on soft, crumbling soil, it is easier to progress barefooted because the toes can grip the ground and stabilize the fulcrum, but for ordinary walking on a firm, smooth surface, the necessity to stabilize the fulcrum no longer exists.The important consideration, then, is how to prevent wear and tear of the fulcrum from constant use; for it is a matter of common knowledge that when all the weight constantly falls on the metatarsal heads, metatarsalgia, in varying degrees of acuteness, inevitably occurs.To avoid this Nature has devised a method of enlarging the area of the fulcrum which operates effectively at whatever height the heel is raised from the ground.

REGISTRAR, ORTHOPBDIC DEPARTBfENT, GUY'S HOSPITAL, LOSDON.TIrouCH successful operations have been devised for almost every deformity of the foot, an entirely satisfactory one for the relief of drop-foot has not yet been found.Tenodesis is unsatisfactory because the tendon invariably stretches. Astragalectomy with backward displacement of the foot, though excellent for a flail-foot, is not successful where the gastrocnemius is active, because the backward displacement lengthens the lever, and thereby increases the power of the muscle whose over-action it is desired to correct. The same applies to Dunn's operation. Arthrodesis of the ankle-joint is useful in some cases; but, since a large number of paralytic drop-feet are also associated with unstable subastragaloid joints and consequent valgus or varus deformity, arthrodesis of this joint is also required. This double arthrodesis produces an extremely rigid and uncomfortable foot, and on the whole is not recommended by orthopaedic surgeons.A year ago, at the Meeting of the British Orthopsedic Association a t Manchester, Ollerenshaw showed cases of the bone-block operation originally recommended by Campbell in America. This consists in excising the scaphoid, displacing the foot backwards, arthrodesing the subastragaloid joint, and making a pillar of bone with a graft at the back of the 0s calcis. The foot is stable and the patient walks very well ; but, looking at the skiagrams in Campbell's original paper in the Journal of Bone and Joint Surgery, I am impressed by the fact that the graft looks extremely attenuated and atrophic. That this graft should undergo a pressure atrophy seems a reasonable thing to expect. I cannot think of any joint where two bones coming together, as a natural mechanism of locking, are not covered by articular cartilage. If the constant pressure of an aneurysm will erode the sides of the bodies of the vertebrse, it seems likely that the constant pressure of the tibia will do the same to the small graft. Indeed, Ollerenshaw reported that in tw,o or more of his cases the graft had fractured.Principle of the New Operation.-The normal locking of the ankle-joint in full equinus is produced by the posterior tubercle of the astragulus coming in contact with the posterior margin of the articular surface of the tibia, both covered by cartilage. This is a natural bone-block, and more effective than any bone-graft possibly could be. Consequently, if the ankle-joint remained locked in full equinus, and the correction were made for the deformity a t the joint below, the foot could not drop any further. The idea originally occurred to me after experiencing great difficulty in correcting a paralytic equinus of long standing. Eventually, after having recourse to open division of the posterior ligaments of the ankle-joint, I succeeded ; but, in order to 13 VOL. XV.-NO.58.

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