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 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 dressing 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[A] 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 always from the coronet, and carefully applied so as to exert an even and uniform pressure. (4) The bandages should be of clean, unused linen.

[Footnote A:  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.]

Once the bandages are adjusted, the hobbles may be removed, and the tourniquet loosened.  Directly the tourniquet is removed there is a steady oozing of blood through the bandages, no matter how many we have put on.  This should occasion no alarm, as experience has taught that the careful attention to antiseptic measures observed throughout the operation has the effect of maintaining the lowermost dressings, those next to the wound, in a state of asepsis.  The bandaged foot should now be wrapped in a piece of thick clean cloth or placed in a boot.