1050 DISEASES OF THE FOOT. 



sufficient to allow of the thin fluid pus escaping, after which the cavity 

 is washed out and injected with a disinfectant. Foot-baths are 

 sometimes useful, but only clean water containing a disinfectant 

 should be used. The opening should be covered, first, with a mass 

 of cotton-wool saturated in a disinfecting solution, and then with a 

 proper cotton-wool dressing to exclude dirt, and plenty of clean, 

 dry straw given as bedding. The dressing must be renewed several 

 times a day. As a rule, with these precautions, recovery occurs 

 in five to eight days. As already remarked, particular care is required 

 when inflammation affects the bars. 



The treatment of parenchymatous pododermatitis, accompanied 

 by suppuration, requires greater care. To prevent the occurrence 

 of purulent cellulitis, pus must be allowed free exit. The diseased 

 area should, therefore, be exposed as far as possible, and neighbouring 

 parts thinned, though without removing more horn than is absolutely 

 necessary. Thinning the horn relieves inflammatory swelling around 

 the suppurating centre. The next precaution is to remove all putre- 

 fying material from the inflamed cavity. For this purpose the parts 

 are carefully washed with sublimate solution, or, if necessary, 

 immersed in a disinfectant foot-bath. They are next rinsed with 

 sublimate or carbolic solution, a tampon saturated with the same 

 material applied to the exposed soft tissues, and a pressure dressing 

 fastened over all. It is often necessary to inject the parts with 

 10 per cent, chloride of zinc solution, or hydrogen peroxide. 



A pressure dressing answers the double purpose of protecting 

 the inflamed spot from dirt and the entrance of fresh infective material, 

 and of preventing protrusion of granulations. To remedy this, nothing 

 succeeds better than steady pressure, assisted, if necessary, by 

 astringents like alum and tannin, or even by nitrate of silver. Dusting 

 the granulations with iodoform or other disinfectant powder also 

 helps to combat the inflammation. Very special care is called for 

 when the pus is offensive. Foot baths are useful on account of their 

 cleansing the point attacked, but as they favour prolapse of soft 

 tissues, a pressure dressing should be applied. As soon as sup- 

 puration stops, the soft parts must be protected by means of a dressing 

 of tar and tow, until they again become covered with horn. This 

 dressing should not be removed until the wound has thoroughly 

 cicatrised, when a well-fitting shoe, protecting the diseased point 

 until the new horn becomes sufficiently strong, is applied, 



In necrosis of the sensitive sole the affeoted point must be 

 completely exposed, the dead tissue removed, and the freest possible 

 exit given to discharge, Necrotio portions of tissue are grasped 



