DISEASES. 661 



fays iises an ordinary shoe, thick and narrow, and then further 

 narrowed at the toe, if it is to be used on a foot regularly con- 

 tracted. When it is thus affected, at five or six centimetres of the 

 heels if the contraction exists at the quarters, at the end of each 

 branch. This shoe carries on the inside border a strong, resisting 

 chp, made at right angles, to rest on the internal border of the 

 waU of the heels. The shoe is flat, grooved, Uke an English shoe, 

 with nail-holes slightly tui-ned inward ; the last nail-hole made as 

 far as possible from the heels. It is made of the best quality of 

 iron, in order to resist, when cold, the greatest amount of forced 

 spreading by the dilator ; it is the expansive slipper of Defay's 

 {pantoitfle expansive). 



The foot upon which this sUpper is to be fixed must have both 

 heels pared evenly, the sole and the bars pared down to a spring, 

 and the hoof round the frog, on each side, thinned down as much 

 as can be borne. Then, the shoe, flattened and without curvature 

 on its faces — resting, therefore, on a strictly horizontal plane — is 

 put on the foot in such a manner that the cUp of the heels rests 

 against the internal face of the quarters. This done, the space 

 between the two heels is measured with a compass, and then the 

 dilator is appUed (Fig. 511). This instrument represents a true 

 vice, with jaws reversed, moving from, instead of approaching 

 each other. It is formed of two jaws which can be made to ap- 

 proach or separate by a transverse screw put in motion by a mov- 

 able lever. The degree of separation is regulated by a graduated 

 rule placed horizontally, which serves also to maintain the jaws at 

 the same point when separated. The two jaws being introduced 

 between the heels of the shoe, the vice being held perpendicularly 

 to the plantar face, the screw is slowly turned untU the branches 

 are opened, say, eight or nine millimetres ; then at the point or 

 points of the shoe which have yielded to the pressure of the in- 

 strument, one or more blows are struck with a hammer on the 

 outside of the branch of the shoe, to loosen the instrument, until 

 it di-ops down, without disturbing the screw, a record being made 

 of the degree of dilatation secured, upon the graduated register. 

 After three or four days the same operation is repeated, the spread- 

 ing being then not more than four or five miUimetres. It must 

 be less than at the first, because at the beginning the less perfect 

 contact between the projection of the heels of the shoe and the 

 wall has allowed a considerable amount of dilatation without pro- 



