733 



is more difficult and more important than the former ; any excess 

 in the sanguineous circulation must be prevented, and excessive 

 granulations must be kept under control. The dressing, then, 

 must be somewhat compressive, without being excessively rigid, 

 in order to ob^date possible danger of excessive inflammation ; not 

 too loose or so soft as to allow hemori-hage, or the undue pro- 

 liferation of granulations. It must be both supple and firm, and 

 of an even and uniform px'essiu'e. The proper material is balls of 

 oakum for the subcutaneous wound, and pads of the same mate- 

 rial for the sub-horny, the first being moistened with alcohol, 

 while the others are made dry. 



It is in question whether we should aim to obtain immediate 

 adhesive union of the wound resulting from the removal of the 

 cartilage, or in other words, whether it is good treatment to in- 

 troduce some material of dressing between the skin and the bot- 

 tom of the wound. Here opinions vary. Our belief is, that this 

 union is by no means easy to secure ; and that the removal of the 

 cartilage, more or less altered, prevents it at various points. Still, 

 we must not raise the skin too much, and choosing a middle course 

 between, only a small, soft ball of oakum is now placed in the 

 deepest part of the wound, or a thin pad is placed between the 

 two parts, sufficient to represent about the natural form of the 

 part, being enough, however, to 

 prevent the immediate reunion 

 from taking place. 



A Hght, thin shoe having been 

 prepared (Figure 528), adapted 

 to assist the application of the 

 dressing and its holding prop- 

 erly, it is j)ut on with one of its 

 branches cut off short on the 

 side where the operation has been 

 performed, while the other branch 

 projects backward beyond the 

 heel, to support the roUers of the 

 bandage of the dressing. Des- 

 plas had thought to turn up that 

 long branch of the shoe (Fig. 529) 



in the shape of a hook to assist in . ^'''- 52^--Truncated Shoe for Dressing 



holding the dressings. This is plicated corn. 



