441 of habit usually assume a position of the head as if reading I from their book. In the case of leading men at the Bar, elocutionary efforts are often both severe and prolonged, and immunity from throat affection cannot in their case be claimed on the ground of the lightness of their labours in this direction. The attitude of the barrister, with his head erect when speaking in court, is widely different from that of the officiating clergyman. It is not difficult, therefore, to see in this

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... t alone a possible explanation of his immunity from this particular affection of the throat. Further, it is equally probable that failure to maintain the head erect in the performance of the services of the Church, furnishes the explanation of that chronic inflammation of the pharynx, fauces, and palate to which the clergy are so especially liable. It is desirable that communications to a medical journal should be limited in length, and these remarks will be coneluded by only a brief allusion to the cases of two clergymen, the most recent which have come under observation. One officiated in the East-end of London, the other in the midland counties; both suffered from the throat affection under consideration. The duties of the latter were performed under peculiarly trying circumstances, in that the country round was low-lying, damp, and often flooded; his church was a large one and " very difficult to preach in," and in the winter months was extremely cold and damp. In consequence of this he frequently caught severe colds. His throat, when he first came under notice, had been at various times a source of trouble and annoyance for eleven years; he was a good preacher, and was given to deliver long sermons. In the other case the symptoms were of shorter duration, and had commenced two years and a half previously-a time at which he had renounced alcohol for example's sake, and had entered on his ministrations at the East-end. The tonsils were especially affected in this instance, but the pharynx and pillars of the fauces were involved in the inflammatory process. Local applications-e.g., glycerin. boracis at first, and subsequently astringents, were prescribed, with rest and change of air in the latter case. Both patients, who confessed to a habit of " hanging the head" when in the readingdesk or pulpit, were duly cautioned against the practice; both subsequently expressed in strong terms their sense of " speedy relief to their sufferings," owing to the ease and comfort with which their services were performed with the head in the natural position for phonation, and both were satisfactorily relieved for the time. Instances might be multiplied from among those engaged in reading to the sick or in teaching, but the two mentioned may, it is thought, be considered typical and of sufficient interest to direct the attention of the clerical profession to what may prove to be a simple though important factor in the treatment of a most distressing malady. A glance at a vertical section of a normal foot will immediately convince one that such must be the case. The concavity on the under surface of the astragalus fits the saddle-shaped articular surface on the upper aspect of the os calcis accurately, permitting no gliding movement forwards, but only a rotation of the astragalus inwards on the sustentaculum tali as an axis. A movement forwards of the astragalus on the os calcis in the normal position of the foot is impossible, as the sustentaculum tali fits into the concavity between the two articular facets on the under aspect of the astragalus. A movement forwards is impossible when the sole of the foot is resting on a horizontal surface. As proof (if need be) of this assertion, in the normal position of the os calcis the astragalus, being unconnected by ligaments or other structures, will support any appropriately arranged weight, without slipping forwards or becoming displaced. In the light of these facts, it is perfectly evident that the chief cause of " flat-foot" " cannot be due, as stated by most authors, to " a general want of tone in the fibrous structures of the body." The plantar fascia and ligaments maintain the normal position of the os calcis, and these in their efforts are assisted by the tendons passing under the lesser process of the os calcis. Ligaments are only capable of bearing a certain strain, and when continually stretched will atrophy and yield. They yield because they are over-strained 1irst; they perform their function satisfactorily as long as they have their normal duty to perform. They do not grow weak or atonic first, and then stretch, but after being unduly strained they then grow weak and stretch. I wish to point out and maintain that the flattening of the foot is not due primarily to weakness and laxity of the ligaments, but to an antecedent alteration in the position of the os calcis. I have stated that the os calcis is capable, in its normal position, of supporting the astragalus and any reasonable superimposed weight, without the intervention or necessity of ligaments or other bonds of union. This statement holds good as long as the foot rests on a horizontal surface. If the foot rests on a surface, so that the heel is raised above the level of the toes, the weight of the body is not transmitted so directly to the posterior half of the os calcis. The saddle-shaped surface on the upper aspect of the os calcis becomes an inclined plane, sloping downwards and forwards, and, consequently, favours a sliding movement forwards of the astralagus, thus throwing the weight of the body on the calcaneo-scaphoid,interosseous, and plantar ligaments. An intermittent and occasional strain these ligaments can well stand, but a constant and continuous strain ends in atrophy, weakness, and stretching. In pointing out how constantly this cause of flat-foot is at work, we have only to reflect that each and all of us walk aud stand under these abnormal conditions ; the heel always being raised above the level of the sole of the foot. and with some missuided individuals to the extent of several inches. In most cases the strain is intermittent, but where constant and continuous, as in omnibus and tram-car conductors, operatives in factories, shop assistants, and others, where constant standing is necessitated, how common is this affection! Dr. Little says, "a slight degree of atonic valgus is common in girls, especially in those of the upper and middle classes ; less common in boys." Why not in the less fortunate and often badly nourished females of the lower classes? Because the high heel is less prevalent in the lower than in the upper classes, and less common with men than women. For the prevention of flat-foot I would say, Don't wear a heel: let the sole of your boot be perfectly flat. One word about treatment. It is a constant practice with surgeons in cases of flat-foot, when not too far gone-when the patient is capable of walking, although with discomfort, -to order a pad of leather or other material to be placed on the inner side of the boot to support the arch. Does this support the arch? And how can it? In flat-foot the arch is destroyed. It may compress the internal plantar nerve between the pad and the head of the astragalus, and so become intolerable; but if it does not do so, it is a source of considerable comfort to the patient. Why a pad in the boot on its inner side is a source of comfort to the patient is that it belts up the anterior extremity of the os calcis, and maintains it in its nearly normal position, counteracting the effect to some extent of the displacement, directing the weight of the body to the inner tuberosity of the os calcis, and removing the strain from the plantar I structures. The treatment of these cases is simple when