Bismarsen (Bismuth Arsphenamine Sulfonate) for Treatment of Syphilis

Abstract

for flat foot are performed in young children. The congenital flat foot should be looked on as a foot which became arrested in the earlier stages of ontogenetic development and failed to grow as old as the individual himself. The hypermobility of the flat foot in an adult due to ligamentous laxity cor¬ responds to similar hypermobility of the foot in a young child and in an adult ape. The generally accepted possibility of the development of an idiopathic flat foot from an originally normal one is doubtful. The development of a perfectly normal arch toward adulthood from a decidedly flat foot in childhood has been observed by me in several cases. Immobilization in plaster of paris and braces should be reserved for cases of extreme deformities, which fortunately are rare. The rigidity of the foot associated with peroneal spasm and osteoarthritic changes is a late secondary condition superimposed on the original deformity. Operative treatment of common flat foot, especially talonavicular fusion, should be discouraged. The results of twenty-seven operations with variable technics per¬ formed on twenty-four idiopathic flat feet between 1930-1935 and reported by me before the New York Academy of Medi¬ cine about six years ago were rather disappointing. On the other hand, several children in the same series with pronounced deformity in whom no consent for operation was obtained developed toward adulthood practically normal looking and much more serviceable feet than did those in whom operations had been performed. The number of poor postoperative results increased with the number of years elapsing since operation was performed. Therefore for the past six years I have not operated in a single case of idiopathic flat foot.Dr. Guy A. Caldwell, New Orleans : Dr. Kuhns has adequately described this group of cases. I have employed the plan of treatment practically as Dr. Kuhns has outlined it. Treatment of congenital flat foot during infancy is certainly beneficial in many cases and I have observed that in growing children conservative treatment is not always satisfactory. I have noted that with indifferent treatment some children have improved whereas others who followed most of the same measures prescribed by Dr. Kuhns failed to progress satisfac¬ torily. I have been fatalistic about this condition, and I must confess that it has seemed to me that some literally outgrow it while others do not. Those who do not should be operated on, because their disability in later life is real. I believe that the age at which Dr. Kuhns has indicated operative treatment is correct. I have tried all the procedures described by Dr. Kuhns and I usually institute one of them. The Lowman operation for transplanting the anterior tibial tendon has given good results in a number of cases, and in a few the results have been poor. Operations which involve some change in the contour of the tarsal bones with fusion of the astragaloscaphoid and other joints, such as Miller and White have described, have been followed by good results in some cases and i...