by the aid of a sage-knife
and a stout pair of forceps, the same precaution of holding the foot well
forward being again taken in order to avoid wounding of the articular
capsule.

At this stage in the operation considerable care is required. The operator
must remember that close beneath him, and more particularly in front, is
the pedal articulation. It is better, therefore, to excise the cartilage
piecemeal, and to do it carefully, than to attempt, at the risk of injury
to the joint, to make the operation 'showy.'

During removal of the cartilage, the terminal branches of the digital
arteries are wounded, as also are the veins of the coronary plexus. Should
either of these stand out with extra prominence from the others, it should
be picked up with a pair of forceps, and ligatured with either carbolized
gut or silk.

Attention should then be given to the flap of skin and coronary cushion.
Wherever a sinus has existed in it, it is to be carefully scraped, and all
dead portions of tissue removed. This done, the flap is allowed to fall
into position, and is there carefully sutured, not only at the skin of the
coronet, but along the whole circumference of the incision.

_Dressing of the Wound and After-Treatment_.--The whole secret of the
success of this operation is in afterwards maintaining a strict asepsis
of the wound. Unless there is reasonable room for belief that this may be
done, the operation had far better not be advised, for if the wound is
afterwards suffered to get into a suppurating and dirty condition, the last
stage of the case may be worse than the first Synovitis and arthritis, with
certain anchylosis of the joint, and a probable loss of our patient, is
almost bound to follow.

We cannot, therefore, too strongly insist upon the advice that the whole of
the preliminary antisepticising of the foot that we have described, and the
after maintaining 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 a