NINTH ANNUAL YEAR BOOK— PART X 427 
scess from below, and treatment must consist of caustic solutions care- 
fuly injected into all parts of the suppurating sinuses. A very effective 
remedy for this purpose consists of 1 ounce of chloride of zinc in half 
a pint of water, injected three times a week, after which a weak solution 
of the same may be occasionally injected. Injections of Villate's solu- 
tion or alcoholic solution of corrosive sublimate, strong carbolic acid, or 
possibly oil of turpentine will also prove beneficial. Pressure should be 
applied from below, and endeavors made to heal the various pipes from 
the bottom. 
Should the swelling become general, without forming a well-defined 
tumor, the placing of 20 to 30 grains of arsenious acid, wrapped in a 
single layer of tissue paper, in a shallow incision beneath the skin will 
often produce a sloughing of the affected parts in a week or ten days, 
after which the formation of healthy tissue follows. The surrounding 
parts of the skin should be protected from any damage from escaping 
caustics by the application of lard or oil, as previously suggested. 
Although the successful treatment of fistulas requires time and pa- 
tience, the majority of cases are curable. The sinuses must be opened 
at their lowest extremity and kept open. Caustic applications must be 
thoroughly used once or twice, after which mild astringent antiseptic 
washes should be persistently used until a cure is reached. 
It sometimes happens that the erosions have burrowed so deeply or 
in such a direction that the opening of a drainage passage becomes im- 
practicable. In other cases the bones may become attacked in some in- 
accessible location, or the joints may be affected, and in these cases it is 
often best to destroy the horse at once. 
The reappearance of the fistula after it has apparently healed is not 
uncommon. The secondary attack in these cases is seldom serious. The 
lesion should be carefully cleansed and afterwards injected with a solu- 
tion of zinc sulphate, 20 grains to the ounce of water, every second or 
third day until a cure is effected. 
In fistula of the foot we see the same tendency toward the burrowing 
of pus downward to lower structure, or in some cases upward toward the 
coronet. Prior to the development of a quittor there is always swelling 
at the coronet, accompanied by heat and pain. Every effort should now 
be made to prevent the formation of an abscess at the point of injury. 
Wounds caused by nails, gravel or any other foreign body which may 
have become lodged in the sole of the foot should be opened at once 
from below so as to allow free exit to all purulent discharges. Should 
the injury have occurred directly to the coronet the application of cold 
fomentations may prove efficient in preventing the formation of an abscess. 
When a quittor becomes fully established it should be treated precisely 
as a fistula situated in any other part of the body; that is, the sinuses 
should all be opened from their lowest extremities so as to afford con- 
stant drainage. All fragments of diseased tissue should be trimmed 
away, antiseptic solutions injected, and, after covering the wound with 
a pad of oakum saturated with some good antiseptic wash, the whole foot 
may be carefully covered with clean bandages, which will afford valuable 
assistance to the healing process by excluding all dirt from the affected 
part. 
