358 DISEASES OF THE HOESE'S FOOT 



that the whole of the preHminary antisepticising of the foot 

 that we have described, and the after maintammg of asepsis 

 that we are now about to relate, must be methodically and 

 thoroughly carried out. It is of even more importance than 

 little details in the operation itself. 



In the first and second methods of operating, directly the 

 actual operation is over, the surface of the wound and both 

 surfaces of the skin-flaps should first be thoroughly douched 

 with a 1 in 1,000 solution of perchloride of mercury. Bayer 

 prefers a 1 in 5 solution of iodoform in ether. 



Next, either iodoform or chinosol in the powder should be 

 dusted over the whole surface, including again both inner 

 and outer faces of the reverted skin-flaps. This done the 

 flaps are allowed to fall into position and sutured there 

 with carbolized silk or gut. 



Another liberal application of an antiseptic dressing 

 follows this. Iodoform, iodoform and boracic acid, or 

 chinosol, is freely dusted over the wound and for some 

 distance around it. Bayer, however, again prefers a dress- 

 ing of the wound, and especially the moistening of the line 

 of sutures with the 1 in 5 solution of iodoform in ether. 



Over the wound is then placed a protective layer of 

 gauze, impregnated either with boric acid, with a mercuric 

 salt, or with iodoform. 



Finally, numerous small and lightly-rolled balls of dry 

 carbolized tow are packed regularly over the whole of the 

 operation wound, and the foot bandaged. 



Practical points to be remembered in this after-dressing 

 are : (1) The balls* of tow should be numerous enough to 

 exercise pressure upon the sutured flap when the foot is 

 finally bandaged. (2) The bandage should be run on from 

 the coronet downwards, in order to insure pressure being 

 exerted in the exact position over the sutured flap. 

 (3) Bandages should be used in abundance, commencing 



* Bayer recommends that the tow be rolled into cylindrical tampons, 

 each long enough to cross the wound. These are placed on the wound 

 in alternate horizontal and vertical layers, so that when rolled round 

 by a bandage they are pressed into an even and compact pad. 



