546 
A. ZUNDEL. 
ness of the tissues all round the longitudinal cut he has just made, 
transforming the fistulous tract into a conical infundibulum, 
whose apex is at the bottom of the wound. If then the aponeu¬ 
rosis is not yet exposed, the operator removes with the forceps 
and bistoury whatever tissues still cover it. 
Then follows the excision of the aponeurosis. This is meas¬ 
ured by the extent of the necrosis. As a rule, it must reach a 
little beyond the diseased part, and by that operation the puru¬ 
lent synovia finds a free chance to escape. 
If the sesamoid is sound it must be left alone, but if the 
diathrodial surface is roughened, ulcerated and on the way to des- 
quammation, it must be scraped off with the narrow and long 
drawing knife. 
The complications of arthritis cannot be interfered with by 
the surgeon. It is by general antiphlogistic treatment, and by 
local and external applications that they must be treated. 
The operation ended, the dressing follows, and becomes one 
of the most important parts of the means of recovery. As 
light a shoe as possible is placed on the foot, a coat of hoof 
ointment, Venice turpentine, or tar, is applied upon the thinned 
sole ; pads of oakum wet with alcohol, carbolized or not, are then 
carefully laid on the soft parts. 
Some practitioners cover them with oegyptiacum, (Mandel); 
others simply with Venice turpentine (Lafosse.) 
The pads or balls of oakum must not be too thick or hard, as 
no pressure is needed. The whole dressing is retained by plates, 
and several circular straps of tape above the coronary band. Cold 
water baths are always good afterwards. 
In the subsequent dressings one must bear in mind that the 
work of repair, the granulating, is more rapid in the tissues of 
the plantar cushion and fleshy sole than upon the bone and ten¬ 
dinous tissue ; and that in this case it is longer than upon bone 
if this has been scraped. The result of this is a wound which 
presents various aspects in its progress of cicatization. It often 
has a handsome granulating appearance over its entire surface, 
while at the bottom there may be a clot of coagulated synovia 
covering the surface of the sesamoid and the edges of the wound 
