LINE AND PUNCTURE FIRING. 127 



is still adherent. In the second the lines are deeper, their base 

 yellowish brown, exudation is more marked, and the epidermis is 

 loosened. In the third the epidermis is almost cut through, the 

 margins of the lines tend to gape and produce irregular cicatrices, 

 the serous discharge from their base is abundant, and the skin 

 is often covered with blisters. In the French system the iron is 

 heated to a cherry red, and is passed along each line five or six times 

 in light firing, eight to ten in ordinary firing, and twelve to fifteen 

 in severe firing. It is clear, however, that the number of passages 

 must vary with the weight and temperature of the cauter}-, the 

 judgment of the operator, and the thickness of the skin. 



Superficial puncture or bud firing can often be performed in 

 the standing position. The points must form a regular figure, 

 those of one line corresponding to those of others adjacent. As 

 a rule the points are separated by intervals of three eighths to 

 half an inch, though they may be massed a little more closely 

 where the most intense action is required. Here again the French 

 prefer to apply the iron a number of times to the spots seriatim. 

 The completion of the process is judged of b}- the same indica- 

 tions as in line firing. In England, however, it is unusual to apply 

 the iron more than once, or at the most twice, a method which 

 appears to be perfectly successful, and when combined with the 

 after-application of a blister, to have the advantage of leaving less 

 mark than the French method. 



In deep point firing the cautery passes completely through the 

 skin and into the subcutaneous connective tissue. The points must 

 be disposed regularly, and at equal distances, though they may be 

 placed rather more closely together than when firing the skin 

 alone. With gentle pressure the cautery rapidly perforates the skin.. 

 This method has the advantage of being easy and rapid to carry 

 out, and of producing a more intense and deeper action than that 

 previously considered. The iron should never be applied more than 

 twice. A light blister may be applied a few days after operation. 



Until comparatively recent times the danger of penetrating 

 synovial' sheaths, etc., was regarded as excessive, and although a 

 few practitioners like Basch, Fischer, and Robertson recommended 

 puncture with fine pointed irons, the method was never extensively 

 accepted, and when practised not infrequently led to disaster. In 

 1867 Bianci recommended puncture of dropsical synovial sheaths 

 with the red-hot needle, a system which, after long discussion and 

 some modification, is now becoming more and more popular. Care- 



