TREATMENT OF NAVIGULARTHRITIS. 179 



the bloodvessels of the foot in general, that abstraction to any amount 

 from one may be said to exert more or less influence on all. 



Preparatory to the operation of opening the artery, the horny sole 

 of the lame foot should be pared with a sharp drawing-knife until 

 every part of it be made thin enough to give with facility under 

 the pressure of the thumb ; which being done, with a small draw- 

 ing knife (a searcher) a groove should be made crosswise a little 

 behind the junction of the front border of the horny sole with the 

 toe of the crust of the hoof, deep enough to penetrate to the quick, 

 through which, with a common bleeding lancet, the circumflex 

 artery is readily stabbed ; and the stab is to be made obliquely, such 

 wound yielding blood more freely and plentifully, generally speak- 

 ing, than either a transverse or a linear puncture. The stab should 

 not be made before free passage has been opened through the horn 

 with the drawing-knife for the lancet, and sharp and forcible should 

 be the movement of the hand in making the stab. Upon this move- 

 ment, and upon the direction of the point of the lancet, as well as 

 upon hitting the precise spot for puncture, depends the success of 

 bleeding from the toe of the foot. 



Mr. Turner is an advocate for commencing the treatment with 

 blood-letting; and he would have blood abstracted locally "until 

 the system is affected generally — six quarts of blood to be drawn 

 at one operation." Excellent, however, as my friend's practice in 

 general is acknowledged to be, I cannot help thinking that in the 

 present instance he has stepped a little beyond the bounds of the 

 requirements of the case, or even of prudence. It must be borne 

 in mind that the inflammation we have to treat, rarely, if ever, ma- 

 nifests an acute character, and that in some cases ulceration rather 

 than inflammatory action is prevailing ; a state of joint in which 

 blood-letting cannot be expected to afford that relief which as a 

 remedy for inflammation is naturally looked for from it. For these 

 reasons T commonly limit my blood-letting to the abstraction of six 

 or eight pints, repeating this in cases which exhibit any unusual 

 amount of inflammatory action; and while the wounds resulting 

 from these bleedings are healing, I administer a brisk cathartic. 

 An excellent rule for general practice is to immediately succeed the 



