604 
TREATMENT OF NAVICULARTHRITIS. 
the circumflex artery of the foot. Not that this vessel supplies the 
navicular joint, its arteries coming principally from the artery of the 
frog : there, however, exists so free an intercommunication between 
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 I 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 first blood-letting, as soon as the wound in the sole is suffi- 
ciently healed, by what is familiarly known as “a sweating blister.” 
Now, to make myself in this matter understood — in a case brought 
for treatment, as soon as lameness is discovered, and which has 
been preceded by no previous lameness in the same foot from the 
same cause — in other words, by no relapse — as I have before 
