333 
DURING THE SCHOLASTIC YEAR 1851-52. 
than to resort to neurotomy, which must ever be looked at as 
the ultima ratio of practice — the last of our resources. The 
disease to which it appears to be especially suited is navicul- 
arthritis, wdiich may be regarded as one of the most formid- 
able to which the foot is liable. 
Obscure in its cause, mysterious in its progress, not under- 
stood as to its proper nature, it is essentially characterised 
by this process, viz. the gradual obstruction, through the 
means of dry ulceration, of the navicular bone and the aponeu- 
rotic expansion of the tendon playing over its surface. In 
this it differs remarkably from analogous diseases of synovial 
cavities, both articular and tendinous, wherein we observe 
such destructions of the articular surfaces to be uniformly 
accompanied by a profound modification of the functions of 
the synovial membrane, which becomes transformed into a 
pyrogenic surface, whose secretion bears a proportion to the 
intensity of the ulcerative action. But it is not so in navi- 
cularthritis. Thus, the synovial secretion, instead of becom- 
ing augmented under ulcerative changes that take place in it, 
dries up completely from the very time the disease com- 
mences, leaving the ulcerative process to extend over dry 
surfaces. We never find either altered synovial secretion, or 
even pus, within the synovial sheath, though the altered 
structure of the bone and tendon be in the most advanced 
stages. Does not this want of secretion seem to imply that 
the navicular disease is of another order, and that it proceeds 
from some other cause than inflammation ? What, then, is 
the nature of the navicular disease ? 
Anatomy shows us that when the disease has been of very long 
standing, the under surface of the navicular bone displays that 
sort of perforation as though it had been punctured with an 
awl, some of the poles being as large as pins 5 heads, others of 
the magnitude of lentils, while others range between the two 
sizes. These perforations run nearly perpendicularly, and 
penetrate through the thickness of the cortical substance of 
the bone. The bones are studded with granulations of the 
buttony character, small and rosaceous. They abound most 
upon the central part of the bone, where they destroy the 
middle eminence in several places ; so that, the further we go 
from this eminence, the smaller and fewer become the ulcera- 
tions. Whenever they exist in great numbers, and are close 
together, the bone becomes much diminished in weight 
through their excavations, and may be reduced to such a 
state of tenuity, through loss of substance, as to break under 
efforts of pressure in rapid locomotion. 
The white fibrous bed upon which the navicular bone re- 
xxvi. 44 
