PRACTICAL PODIATRY
BY
ALFRED JOSEPH
_Senior Professor of Podiatry, The First Institute of Podiatry;
Ex-President, Nat’l. Ass’n. Chiropodists; Editor, Pedic Items._
E. K. BURNETT
_Professor of Clinical Podiatry, The First Institute of Podiatry;
Vice-President, Nat’l. Ass’n. Chiropodists; Editor, The Podiatrist._
REUBEN H. GROSS
_Professor of Didactic Podiatry and Registrar, The First Institute of
Podiatry; Associate Editor, Pedic Items._
EDITED BY
MAURICE J. LEWI, M.D.
_President, The First Institute of Podiatry; Ex-Secretary, N. Y.
State Board of Medical Examiners; formerly Professor of Medical
Jurisprudence, Albany Law School; Ex-President, Albany Co. Medical
Society; formerly Instructor, Albany Medical College; Member, American
Medical Association; Member, N. Y. State Medical Society; Member N. Y.
Co. Medical Society, etc._
PUBLISHED BY
THE FIRST INSTITUTE OF PODIATRY
213-215-217 WEST 125TH STREET
NEW YORK
COPYRIGHT, MAURICE J. LEWI, 1918
THE WILLIAM G. HEWITT PRESS
BROOKLYN, N. Y.
TO THE MEMORY OF
GEORGE ERFF
AND
ELLIOTT W. JOHNSON,
builders of the foundation upon which
the edifice of modern podiatry is
reared, this book is reverently and
appreciatively dedicated.
The beauties of contour of the human foot, coupled with its strength
to perform the functions for which it was created, caused the ancient
Greeks to glorify it in song and in art. Medically and surgically
it has always been a negligible factor in the world of science,
notwithstanding the burdens which it is made to bear and in spite
of the interference with locomotion and with general health which
this non-care has occasioned for all centuries since creation. Our
propaganda recognizes the importance of this part of the anatomy and is
causing the race to realize the need for foot care in health and for
scientific foot treatment in disease.
CONTENTS
FOREWORD ix
I THE RECENT HISTORY OF PODIATRY 1
II THE SKIN 11
III ASEPSIS AND ANTISEPSIS 19
IV STERILIZATION 39
V THE CARE OF THE FOOT 46
VI DRESSINGS AND BANDAGING 60
VII INSTRUMENTS 78
VIII SHIELDS AND SHIELDING 96
IX LOCAL ANESTHESIA 143
X HELOMA 149
XI CALLOSITAS 182
XII VERRUCA 185
XIII CALLOUSED NAIL GROOVE 205
XIV ONYCHOCRYPTOSIS OR INGROWN TOE NAIL 210
XV DISEASES OF THE NAILS 237
XVI FISSURES, BLISTERS, AND BURNS 248
XVII BURSITIS 263
XVIII CHIMATLON 283
XIX DISEASES OF THE SWEAT GLANDS 297
XX ULCERS 306
XXI CUTANEOUS MANIFESTATIONS OF SUPER-ACIDITY 329
XXII VOCATIONAL FOOT DISORDERS 339
XXIII LOCOMOTION AS AN AID IN DIAGNOSIS 343
XXIV MISCELLANEOUS FOOT LESIONS 357
XXV X-RAYS IN PODIATRY 385
XXVI THE PODIATRIST’S OFFICE 405
GLOSSARY 411
INDEX 433
FOREWORD
This volume has been compiled by men who started out in life as
chiropodists. They have lived to see the genesis of podiatry from the
trade which was theirs, and each of them has taken active part in the
efforts which marked the transition from the old to the new order
of things. The period of evolution has been extremely brief. Five
short years have sufficed to transform the corn-cutters’ trade to the
podiatrists’ profession.
One of the programmed features of the educational development of
podiatry was the creation of a scientific literature bearing upon
the practice of this branch of medicine. The earliest manifestation
along the lines of this progress was the production of “The Text Book
of Chiropody.” This ponderous tome (1183 pages) contained matter
pertaining to the teaching of medical and other scientific subjects
that led up to the study of chiropody and to practical chiropody
itself. The chapters on this latter topic were the first attempts of a
scientific nature to collect material relating to podiatry practice.
In consequence, the articles were few and their contents were meagre.
Nevertheless this pioneer attempt to array chiropodical facts and
methods of treating foot lesions proved efficacious in stimulating
members of the chiropody profession to the higher educational needs,
and all over the english speaking globe this literature was hungrily
masticated and digested by individual practitioners and by chiropody
societies.
Bright and intelligent members of the profession utilized the material
thus furnished them by practically applying suggested treatments and
methods. Aspiring to augment their own knowledge and to add to this
literature, they wrote up their experiences and, from time to time,
their matured deductions were given publicity through the columns
of “The Pedic Items” and “The Podiatrist.” The instructors on the
faculties of the various chiropody teaching institutions, utilized
these chapters in their pedagogic work, and medical practitioners
turned to them to gain their first concrete knowledge of the subjects
which they treated. These initial chapters thus filled an acute want
and so proved their worth.
In this volume, a more serious task has been undertaken. Each article
will be found to have been prepared with a view to presenting the
subject matter in its entirety, in scientific order and with accuracy.
There has been no guessing as to cause and effect. Empiricism finds
no place in these pages. The medical and surgical viewpoint is
continuously in evidence and “Practical Podiatry” thus becomes the
first medical work of its kind ever published, a sad commentary on the
negligence of medical teachers and medical practitioners who have thus
permitted non-medical graduates to compile the first facts relating to
an important branch of medicine. The erstwhile tabooed “corn-cutter”
thus becomes a leader in a collateral branch of medicine, and medical
practitioners are compelled to glean their knowledge of this subject
from laymen, who, without their material, moral or monied support--yes,
often in spite of obstacles which medical practitioners have placed
in their way--have succeeded in clearly and scientifically portraying
features of essential medical practice which are to aid materially in
creating a better species of the genus homo, and in relieving the woes
of our race. Podiatrists may well feel a pride in this achievement
and medical practitioners would do well to take home the lesson of
indifference which this incident discloses.
Podiatry has not alone enriched the scholastic literature of medicine,
but has also augmented the language of science. New terms have had to
be coined to properly designate conditions, diseases and instruments.
In order that these may be understood by the readers of this volume,
their purport is given in the general glossary which will be found
in the book. The etymologic construction of these new words is not
explained because their origin will be readily apparent from their
definitions.
“Surgery with special reference to Podiatry” was the first volume of
this series to be published. In presenting “Practical Podiatry” to the
profession and to the public, the second rung in the ladder of podiatry
literature has been created and within two years it is hoped that the
“System of Podiatry,” of which both of the above volumes are a part,
will have been completed.
Thus will be constituted a library for practitioners and students of
podiatry which it is hoped will ever prove creditable to its sponsors,
profitable to the profession and helpful to humankind.
M. J. L.
CHAPTER I
THE RECENT HISTORY OF PODIATRY
The first steps in the movement for the enactment of a law governing
the practice of chiropody in the United States were made in the state
of New York, when, in 1895 C. S. Levy, H. Levy, L. B. Rosenberg, H.
Mayer, E. Werther and M. M. Marks met at the residence of C. S. Levy
to discuss this matter. As a result of this meeting, a bill drafted by
Maurice Marks, a well known New York lawyer, was subsequently presented
to the New York State legislature. John B. Stanchfield, leader of the
assembly, spoke at length on the question of “feet” and amid mirth and
laughter (the question was considered somewhat of a joke), the bill was
passed by the lower house. Shortly thereafter, the senate took similar
action on the bill, whereupon Governor Morton promptly signed it.
In accordance with the provisions of the law, the Pedic Society of the
State of New York was organized on the 3rd of June, 1895, and R. H.
Westervelt was elected president, George Erff, treasurer and Louise
Hartogensis, secretary. Wm. D. Gaige, Jonas M. Heimerdinger and L. B.
Rosenberg were selected as the first board of examiners.
R. H. Westervelt served as president of the society for a period of two
years, when he was succeeded by Elliott W. Johnson, who acted as chief
executive officer for fifteen years. George Erff was the next president
and he in turn was succeeded by Alfred Joseph, J. P. Solomon and Ernest
Graff.
The affairs of the society improved with each succeeding year, and
much of the credit of its success should go to Maurice M. Marks, who
acted as attorney for the society, and in addition, assisted wherever
he could.
BIRTH OF “THE PEDIC ITEMS”
“The Pedic Items,” which has done so much to advance the calling of
podiatry, is the child of Alfred Joseph. In 1906 he outlined a plan
to the members of the Pedic Society of the State of New York, whereby
a journal could be created and conducted profitably. On January 1st,
1907, a leaflet called the “Pedic Society Items” was sent to the
members. On April 1st, 1907, a four page paper was published, and after
that Alfred Joseph was offered the position of editor. The “Items”
appeared every four months for the first few years of its existence,
and finally became a monthly paper which has grown to a sixty-four
page book, and even this is inadequate to convey all that is new and
of interest to the members of the profession. This book is now current
podiatry literature in every english speaking country in the world. A
number of chiropody publications have appeared from time to time, most
of them, of no scientific value, and they died an early death. The
newest paper, “The Podiatrist,” is a thoroughly scientific journal,
that has already found a place in the profession; it is edited and
published by E. K. Burnett, one of the progressive members of the
podiatry profession, and appears once each month.
FIRST SCHOOL OF CHIROPODY
At the March, 1911 meeting of the Pedic Society of the State of New
York, Alfred Joseph, as chairman of a committee appointed to take the
matter under advisement, read a report on the question of organizing
a school, and asked that moneys be subscribed for the purposes of
incorporating such an institution. In a short time, over $1,200.00 was
subscribed and the corporation known as “The Chiropodists of America”
came into existence, with George Erff, president and Alfred Joseph,
secretary.
This school was conducted along commercial lines, and although its
purposes were good, it did not meet the standards which its promoters
were hopeful of establishing for it and which it later secured through
the action of the Regents of the University of the State of New York.
THE NATIONAL ASSOCIATION OF CHIROPODISTS
The October, 1911, issue of “The Pedic Items” contained the first
announcement of a proposed plan to organize a national association
of chiropodists. All chiropodists were invited to become members,
and after a mail vote, Chicago was selected as the first convention
city. On July 1st, 2nd, and 3rd, after the usual preliminaries, the
organization was completed, and Alfred Joseph, who was the organizer
of the association, was elected president. Ernest Graff was elected
secretary-treasurer. This organization has grown from 225 members at
its first meeting, to the present large society of over 1,000 members.
The influence of the N. A. C. is and has been decidedly salutory, and
its organizers can well be proud of the work they have accomplished.
CHANGE IN THE CHIROPODY LAW OF NEW YORK
The members of the Pedic Society of the State of New York, after a
brief experience, realized the shortcomings of the original law which
governed the practice of chiropody. They sought to advance their
calling and to provide so that those entering the profession should be
properly equipped.
A committee of the Pedic Society of the State of New York composed of
George Erff, Maurice Marks and Alfred Joseph, called upon Edward Milton
Foote, M. D., a prominent surgeon, for advice as to procedure. Dr.
Foote, in turn, advised that the secretary of the N. Y. State Board
of Medical Examiners be consulted. Thus it came to pass that these
gentlemen met Maurice J. Lewi, M. D.
Dr. Lewi listened attentively to the request of the committee that he
devise ways and means for improving the then inefficient chiropody
law, fell in heartily with their objects and after outlining a plan
of procedure, drafted a bill which, after receiving the sanction of
the State education authorities, was introduced in the legislature.
The bill was unanimously passed and became a law September 1st, 1912.
Thereupon the State Education Department delegated Dr. Lewi to outline
a standard for chiropody schools which they promptly adopted. Much to
the surprise of the officials of the New York School of Chiropody,
these standards were so high that they feared it would be impossible
for them to carry them into effect.
Conducting a school along the lines set by the State made it necessary
to engage as its head one who was a medical practitioner, an educator,
an executive and a man of character. Where was such a man to be found?
After much deliberation and numerous consultations, the committee of
the Pedic Society decided that there was but one man known to them
who combined all of these attributes and he was the very individual
who had guided them in seeking to advance their profession, Dr. Lewi.
When the proposition was put to Dr. Lewi, he declined with thanks
on the ground that his position as Secretary of the State Board of
Medical Examiners was to his liking. The committee was insistent and
pleaded with him to reconsider his determination. For three months
the committee and their friends labored with Dr. Lewi and finally,
after making certain stipulations which placed the management of the
school in his sole charge, he capitulated, and on January 1st, 1913, he
assumed the presidency of the reorganized School of Chiropody of New
York. With meagre funds, but with earnest zeal he commenced his task
and soon surrounded himself with a splendid faculty and with a modest
but sufficient equipment. The school has flourished. It behooves every
member of the profession of podiatry to remember that had it not been
for the broad-mindedness and the foresight of Dr. Lewi, this calling
which is gradually taking its place as a legitimate branch of medicine,
would still be the trade it was, and the podiatrists of today would
still be the “corn-cutters” of yesterday.
On September 27th, 1917, the Regents of the University of the State
of New York granted a provisional charter to The First Institute of
Podiatry and henceforth the School of Chiropody of New York will be
known by that title.
THE DEVELOPMENT OF OTHER SCHOOLS
After the organization of the new regime in podiatry education, the old
system of conducting schools for gain only, was gradually eliminated
and the need for schools to teach foot ills in a scientific manner,
became apparent. Since the organization of The First Institute of
Podiatry, several other institutions have come into existence whose
purpose is to equip their students to be true podiatrists. The
California College of Chiropody, situated in San Francisco, is the only
institution west of Chicago, imparting knowledge of this character. In
the middle west, the City of Chicago boasts of two schools, viz.: the
Illinois College of Chiropody and the Chicago School of Chiropody. The
State of Ohio is well represented by the Ohio College of Chiropody in
the City of Cleveland. Temple University of Philadelphia, Pa., has a
Department of Chiropody and is educating specialists in conjunction
with its medical course. The latest addition to chiropody teaching
institutions is the University of Massachusetts in East Cambridge, Mass.
All of these institutions are endeavoring to educate their students
along ethical and scientific lines, and it is but a question of time
when they will have attained the status and educational influence of
The First Institute of Podiatry.
ORGANIZATION OF PEDIC SOCIETIES
After the Pedic Society of the State of New York had been conducting
its affairs for several years, podiatrists throughout the country,
recognizing the advantages to be derived from a conjunction of
individual interests into groups, created organizations in thirty-seven
States of the Union. It is safe to predict that within the next five
years, there will be a podiatry organization in each of the remaining
States not now so organized.
Activities along these lines have not been limited to the United
States alone. In England, the Incorporated Society of Chiropodists
is a flourishing body, boasting a large membership. Ernest G. V.
Runting is president of that organization and he and many others in
the British Isles are helping to make podiatry a real profession. The
other European countries are not progressive in podiatry work (possibly
due to the war situation), but as the United States and Great Britain
advance, so will the other nations follow. It is unfortunate that the
people of many of these European countries do not fully appreciate
the value of scientific foot treatment, but, as in other educational
branches, it is only a question of time when every government in the
civilized world will recognize the necessity for a full study of this
important branch of medical science, and will also pass laws regulating
podiatry practice.
In the United States, one of the first states to follow the example of
New York, was California. In July, 1901, George Koenigstein called a
meeting of the chiropodists in San Francisco, and an organization known
as the San Francisco Chiropodists Association was formed. This society
had for its prime purpose, the passing of a law governing the practice
of chiropody in the State of California; the organization elected no
regular set of officers but held desultory meetings once or twice a
month at the office of Charles L. Scharff.
The bill that this society formulated was presented to the legislature
at Sacramento and Drs. Scharff and Koenigstein were delegated to press
it to passage. They worked like Trojans but to no avail. The bill was
pigeon-holed and nothing more was heard of it. Subsequently the Society
died a peaceful death.
In 1907, following the great fire in San Francisco, a few chiropodists
again attempted to pass legislation in California, but this endeavor
was also fruitless. In the latter part of 1911 and in the early part
of 1912, stimulated by an article relating to the subject which
appeared in “The Pedic Items,” and fully realizing the benefits of
chiropody organization, if properly conducted, several California
practitioners were elected to membership in the National Association.
Among these were Oscar L. Gruggel, S. Rutherford Levy, and Charles
L. Scharff. These men became N. A. C. propagandists, and secured the
applications of others in California for membership in the National
Association. On January 12th, 1912, The Pedic Society of the State
of California was permanently organized and chartered. Its first
officers were, S. Rutherford Levy, President; William F. Leck, First
Vice-President, Oscar L. Gruggel, Second Vice-President; H. H. Katz,
Third Vice-President; Charles L. Scharff, Secretary-Treasurer; Z. L.
Comet, Sergeant-at-arms, and F. Schilling, Counsel for the Society.
This society attempted to pass a State law regulating the practice
of chiropody (in 1913) and a bill drafted for the purpose by Mr.
Schilling, was presented to the legislature. By almost superhuman
effort on the part of every member of the society, the bill passed both
houses of the legislature, but the Governor vetoed it on the ground
that he was opposed to the creation of new State Commissions.
Dismayed, but not disheartened, the legislative committee immediately
made arrangements to carry on the fight at the next session of the
legislature. The new bill introduced, instead of creating a separate
commission, placed the supervision of chiropody practice in the hands
of the existing State Board of Medical Examiners. Changes agreeable to
all concerned were made, and in the 1915 session of the legislature,
the Benson Medical Act, 443, to regulate the practice of podiatry in
California, was passed by both houses. On June 8th, the bill was signed
by the Governor and the law became effective August 8th, 1915.
In the State of Illinois, the first organization was effected in
September, 1904. A charter was applied for and granted to Charles
Kenison, Nicholas Von Schill, Frank Johnson and Ignace J. Reis. The
officers elected were, Charles Kenison, President; Leonard Lower,
Vice-President; C. G. Sims, Treasurer and Ignace J. Reis, Secretary.
On September 18th, 1912, the temporary organization of The Illinois
Pedic Association was effected. The organization was made permanent on
October 2nd, 1912, and the following were elected as the first officers:
President, Ignace J. Reis; Vice-President, Maximilian Pincus, M. D.;
Secretary, Henry Schmidt; Treasurer, John Kenison; Trustees, Leonard
A. Lower; Henry J. Riegelhaupt; Charles Kenison; Counsellors, Frank S.
Lower, M.D., H. P. Kenison, M. Pincus, M.D.
In the year 1906, S. L. Lawton of Fall River, Mass., consulted with
F. J. Coughlin of Boston as to the advisability of forming a state
chiropody association. Harry P. Kenison of Boston was advised with
and readily fell in with the plans. As a result, a meeting was called
at the office of the latter and the Massachusetts Association was
created. The first officers were J. P. Buntin, Boston, President;
S. D. Lawton, Fall River, Vice-President; F. J. Coughlin, Boston,
Secretary-Treasurer, and the following Directors: H. P. Kenison, F. E.
Davis, C. R. Watkins, A. M. Brackett, W. E. Lee and G. M. Pettingill.
This society has flourished and, due to the efforts of several of
its members, including the present president of the N. A. C., H.
P. Kenison, the present law governing the practice of chiropody in
Massachusetts was passed. This was accomplished in spite of strenuous
opposition on the part of medical practitioners and a few disgruntled
chiropodists within and out of the organization.
In the West, there is gradually springing up a progressive spirit in
all that pertains to podiatry. Much of this spirit has been created
through the efforts of a few practitioners in the State of Colorado who
have been extremely active in the past few years. In 1914, Bertha De
Wolfe, having taken a course at the School of Chiropody of New York,
located in the City of Denver. Realizing the necessity of organization,
she immediately set to the task, and in December of that year, the
Colorado Pedic Society held its first meeting. It was incorporated,
January, 1915. Its first officers were, C. S. Rees, President; A. M.
Parker, first Vice-President; Lucy Ballou, second Vice-President;
Bertha De Wolfe, Secretary-Treasurer.
The late Benjamin Oelsner of Bridgeport, Conn., was always an active
member of the profession, and through his efforts, the Connecticut
Pedic Society was organized, in the city of New Haven, March 23rd,
1910. This organization has grown rapidly, and because of its
activities, Connecticut now has a chiropody law on its statute books.
The Rhode Island Chiropodists Society was organized November 8th, 1914,
largely through the efforts of Alfred C. Moran, who represented the
National Association of Chiropodists in that section of the country.
This organization is gradually growing, and since the convention of the
N. A. C. which was held in Providence, R. I., many practitioners who
previously showed no interest in the union of podiatry forces, have
become active workers in the interests of the profession. The officers
of The Rhode Island Chiropodists Society are Charles T. Heilborn,
President; Henry S. Batchelder, first Vice-President; F. S. Sargent,
second Vice-President; Alfred C. Moran, Secretary-Treasurer.
LAWS GOVERNING PODIATRY PRACTICE
Since the first law governing the practice of podiatry passed in the
State of New York, eighteen other states have taken similar action.
The National Association of Chiropodists has been largely responsible
for most of the success along these lines. The committee in charge
of legislation has been a most active one, and its usefulness may be
realized, when it is recorded that during the period from August,
1916, to July, 1917, six states in the union passed laws regulating
the practice of podiatry. As the profession advances, and the academic
requirements are increased, the laws are so changed as to create a
greater scope of endeavor for our practitioners. Thus in some states
the law permits the podiatrist to perform operations of a major nature,
while in others the practice is limited to structures involving the
true skin only. It is safe to predict that in a few years, every state
in the union will have enacted legislation regulating the practice of
podiatry. The states now governed by such laws (New Jersey was the
first) are Colorado, California, Connecticut, Illinois, Louisiana,
Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York,
Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, West
Virginia and Wisconsin.[1]
Educators and the public generally throughout the entire country are
beginning to realize the value of scientific foot care, and where the
chiropodist was derided and scoffed at years ago, the podiatrist of
today is gradually taking the place he so rightly deserves, at the
side of the members of the other professions, honored and respected as
a well trained, educated man who is proving a benefactor to the human
race. So it is, that the schools of chiropody are being developed, and
in a few years when the academic requirements will have become the same
as for the other professions, the courses of study at these schools
will run on all fours with the schedules of study maintained at medical
schools.