LINE AND PUNCTURE FIRING. 165 



Superficial puncture or bud firing can often be performed in the 

 standing position. The points should 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 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 by the same indications 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 suc- 

 cessful, 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 or needle firing the cautery passes completely 

 through the skin and subcutaneous connective tissue into the diseased 

 part. 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 practi- 

 tioners 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 modifica- 

 tion, is now becoming more and more popular. Even if carefully 

 practised it is not without danger, especially for articular cavities, 

 but considering the intensity of its action and its therapeutic value 

 it constitutes a great advance on older methods. The point, however, 

 must be extremely fine, those usually employed not exceeding one 

 twenty-fourth to one sixteenth of an inch in thickness. When of 

 iron these are difficult to make and to keep in order ; platinum points 

 like those supplied with the zoo-cautery are preferable. The punctures 

 are best made in a regular design at intervals of about an inch. The 

 method of procedure is important : the needle, at a red heat, is 

 sharply thrust to the required depth, and immediately withdrawn. 

 There is no disadvantage in passing the needle more than once into 

 fibrous or osseous tissues, — indeed, this is necessary to produce intense 



