THE AUTHOR'S OPERATION FOR QUITTOR 327 



pedal articulation is one of the accidents that might occur 

 while resecting the cartilage. When the foot is flexed the 

 cul-de-sac protrudes against the cartilage and is easily in- 

 cised with the knife. The accident is prevented by careful 

 dissection and by keeping the joint well extended while oper- 

 ating, and when it does occur its seriousness depends upon 

 whether or not the wound becomes infected. It is of no 

 consequence whatever if asepsis prevails during the healing 

 of the wound. 



(3) Laying bare the pedal articulation occurs when the 

 cartilage, already transformed into cicatricial tissue, is insep- 

 arable from its internal relations, which in turn are fused 

 with the capsular ligament. In trying to remove the carti- 

 lage the whole side of the articulation may suddenly appear 

 in the foreground. The prevention of this accident is found 

 in the chief contra-indication, i. e., old quittors accompanied 

 with pronounced structural changes of the region. 



(4) Claudication following the operation varies in se- 

 verity and duration. Sometimes it is permanent and will 

 yield to no other treatment than unilateral plantar neuro- 

 tomy, although it will generally subside gradually with time. 

 In most cases there is no lameness except a slight tenderness 

 manifested in walking, until the foot is taxed by work, then 

 the hypersesthetic state of the region is announced by an 

 annoying claudication that only time or neurotomy will 

 eradicate. 



The Author's Operation for Quittor. 



GENERAL REMARKS.— Extensive observations on all 

 imaginable forms of treatment, medical and surgical, indi- 

 cate beyond doubt that simple operations ingeniously exe- 

 cuted, bring better general results than the radical opera- 

 tions of Bayer, Moller and Frick, even if the most extrava- 

 gant claims of the adherents of the latter methods are 

 granted as a basis for comparison. In the first place, total 

 resection of the lateral cartilage is by no means universally 

 indicated for quittors, since there are quittors and quittors 

 in which such intervention is little less than an invitation 

 of disaster. Furthermore, if it could be claimed without fear 

 of successful contradiction, that these procedures were uni- 

 formly curative, and that they never endangered life and 

 never caused permanent disability, there still exists the dif- 

 ficulty of successful performance against them. Moreover, 

 the time required to restore the patient to full and complete 



