546 
NAVICUL ARTHRITIS. 
Brauell, whose observations on this point are worth our record- 
ing, says, — “ the consequences of inflammation of the navicular 
bone are, in all cases, a diminution in its magnitude ; and caries 
is the primary cause of this. The caries is rather deep or super- 
ficial, and is found invading one or more points, particularly the crest 
(or transverse eminence) of the navicular bone and its lateral de- 
pressions. Prior to the development of the caries, little eminences 
about the size of millet seeds are discoverable upon the surface : 
after maceration they look like so many exostoses .” — “As the 
caries increases in depth and breadth, the holes in the bone enlarge, 
sometimes attaining a capacity to hold a hazel nut. In this porous 
condition the bone is exceeding liable to fracture, an accident the 
more likely to happen from the caries being accompanied by fria- 
bility of the substance of the bone.” — “And, while the navicular 
bone is experiencing loss of substance on the one side, it is very 
seldom that any new-formed osseous matter is deposited upon the 
opposite (articulatory) surface. It is around the borders, posterior, 
superior, and inferior, where such deposits are generally found. 
And it is the union which takes place between such incrustations 
shooting out from the posterior and inferior borders of the navicu- 
lar bone, and similar spiculce issuing from the back part of the 
coffin-bone, that constitutes anchylosis between one and the other.” 
Adhesion. — At this period of the disease, the synovial covering 
of the perforans tendon being likewise in a state of exulceration, 
adhesion is very likely to take place between it and the navicular 
bone ; though in a case where ulceration of the cartilages prevails 
this is not so likely to happen as in one wherein the primary ul- 
cerative action in the membrane is immediately succeeded by a 
granulative or adhesive process. And it is most usual for this ad- 
hesive action, which, be it noted, may ensue without any previous 
ulceration, to take place around the circumferent borders of the 
bursa rather than in the middle or articulatory parts. 
An appearance I have observed adhesion to take on in cases of 
not very old date or chronic character, is, a membranous sort of 
morbid production spreading from the border of attachment of the 
tendon upon the circumferent surface of the bone : the new forma- 
tion being of a pink colour, and apparently organised, looking like 
converted albuminous effusion. Mr. Mogford, of Guernsey, who 
happened to be with me while I was examining into a case of this 
description, informed me he had frequently observed a similar con- 
dition of the joint. 
Brauell’s observations hereupon are, — “the flexor tendon fre- 
quently contracts adhesions with the navicular bone, but not 
throughout its whole extent of contiguous surface, but only at 
those places bare of synovial membrane, and where separation and 
