Chopart's amputation, after an interval of comparative neglect, was introduced into this country by Mr. Syme in 1829. His method of performance is simpler and easier than Chopart's. He thus describes it:--"The blade of the knife employed should be about six inches long, and half an inch broad, sharp at the point and blunt on the back. The tourniquet ought to be applied immediately above the ankle, having compresses placed over the posterior and anterior tibial arteries. The surgeon should measure with his eye the middle distance between the malleolus externus and the head of the metatarsal bone of the little toe, which is the situation of the articulation between the os cuboides and os calcis. Placing his forefinger here, he ought to place his thumb on the other side of the foot directly opposite, which will show him where the os naviculare and astragalus are connected. An incision (Plate II. figs. 4 and 5) somewhat curved, with its convexity forward, is then to be made from one of these points to the other, when, instead of proceeding to disarticulate, the operator should transfix the sole of the foot from side to side at the extremities of the first incision, and carry the knife forwards so as to detach a sufficient flap, which must extend the whole length of the metatarsus to the balls of the toes. The disarticulation may finally be completed with great ease, as the shape of the articular surfaces concerned is very simple, and nearly transverse."[38] Regarding the method of disarticulating at the astragalo-calcaneal joint, and removing all the foot except the astragalus, no detail need be given. Malgaigne advises an internal flap, thus sacrificing the valuable pad of the heel. Roux, Verneuil, and others endeavour to save the pad. This operation, however, has now fallen almost completely into disuse. SUBASTRAGALOID AMPUTATION has been highly recommended. In it the flap is made as in Syme's, then anterior bones removed as in Chopart's, and os calcis grasped by lion forceps and twisted off, its attachment and the insertion of tendo Achillis being cautiously avoided. If flaps are scanty, head of astragulus may be cut off with a small saw.--Hancock and Ashurst. TRIPIER'S AMPUTATION[39] is a modification of above, the skin incisions being made as in Chopart's amputation, and then the calcaneum is sawn through on a level with the sustentaculum tali on a plane at right angles to the axis of the leg.