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NOTES ON THE USE OF A CANE ALFONSO BASTÓN* I The neurologist, after an admirable and skillful examination, explained that he had found mild impairment of equilibrium. It was probably —but not certainly—attributable to peripheral neuropathy, and would get worse. Perhaps there was a lesion in the cerebellum. His final words were, "I strongly urge you to get a cane." Later that afternoon I borrowed my wife's. It is made of brown wood and is shaped like an inverted J. II ". . . get a cane." How long a cane? In which hand should it be carried? How should it be incorporated into the act of walking? Are there any precautions? In medical school, during internship, residency, and laboratory work, and during half a century of subsequent medical activity, and during 8 years of busy retirement, these questions had never presented themselves . Nevertheless, I ventured forth into the streets, a biped converted into a tripod. The streets were the first problem. Apparently the neighborhood harbored many more dogs than an anthropoid could have surmised. Some evidently were huge. Perhaps other fauna lurked nearby. In addition there was occasional reason to suspect the proximity of camels or mound-building elephants. Some creatures apparently excreted chewing gum, and some deposited small rocks. All had engaged in exterior decorating. Evidently seismic disturbances had occurred, since there was no other adequate explanation for the numerous elevations, depressions, gaps, fractures, chinks, and potholes which deformed the pavement. On cold *Alfonso Bastón is the pseudonym of an octogenarian internist.© 1990 by The University of Chicago. All rights reserved. 0031-5982/90/3303-0689$01.00 Perspectives in Biology and Medicine, 33, 3 ¦ Spring 1990 \ 457 days, puddles of canine urine became sliding-ponds. Another hazard was produced by pieces of plastic in the form of strips, sheets, bunches, knots, fragments, and wisps, all of which were slippery. Mondays were bad, because pages of Sunday supplements drifted along the pavements. Like the pieces of plastic, they made the cane slip, or else they entangled it. Sometimes a page of the demagogue's tabloid newspaper drifted over a hole in the asphalt, creating a compound hazard. Ill Whoever starts to carry a cane sees at once that there are many unnoticed fellow-traveling cane bearers. Immediately it strikes him that the blind are much more numerous than he had suspected and have more difficulties than are obvious. In addition, if he walks abroad about 10 a.m. or 1 1 a.m., he sees how populous is the group to which neuropathology and osteopathology have relegated him—people with arthritis, amputations , or broken bones, or lesions of the brain, spinal cord, or nerves, and people who hobble or stumble or stagger along under errors of diagnosis and failures of treatment. Sometimes, but not often, the victims peer at one another. Many appear to be stolid, grim, or numb. He recognizes, further, that the corners of some pavements have been beveled away and that this proves helpful. He notices also—at first with horror and presently with gratitude—that the wheelchair symbol on doorways and on special conveniences signifies valuable relief at special times. He learns in addition that on buses and in crowded streets the cane may make him stumble, but much more often it attracts deeds of generosity from strangers. He learns at the same time that he must try to avoid chronic dependency. IV These adventures and experiences did little to solve the main problem : what is the best way to use a cane? From an ophthalmologist it was learned that persons who are about to become blind are sent to "cane schools" for special instruction, there being more aids in this world than Horatio had dreamt of in his philosophy . Next, the ill-balanced peripatetic observer remembered a very bright lady physiotherapist. In the institute in which she helps the aged, she and her colleague provided necessary instruction, emphasizing that the cane should be advanced simultaneously with the contralateral foot. The skill acquired through their guidance made it possible for their faltering pupil to stride forward with new determination and new balance. 458 I Alfonso Boston ¦ The Use ofa Cane THE TALE OFJILL...


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