DISEASKS OF THK IKTI.OCK, AXKLK, AND FOOT. 407 



QUITTOR. 



Quitter is a term applied to various affections of the foot wherein 

 the tissued which are involved undergo a process of degeneration 

 that results in the formation of a slough followed by the elimination 

 of the iliseased stnictures by means of a more or less extensive sup- 

 puration. 



For convenience of consideration quittors may be divided into four 

 classes, as suggested by (lirard: (1) Cutaneous quittor, which is 

 known also as simple quittor, skin quittor, and carbuncle of the coro- 

 net; (2) tendinous quittor : (o) subhoniy ([uittor; and (4) cartilagi- 

 nous quittor. 



CUTANEOUS QUITTOR. 



Simple quittor consists in a local inllannnation of the skin and 

 subcutaneous connective tissue on some pa it of the coronet, followed 

 by a slough and the formation of an ulcer which heals by suppura- 

 tion. 



It is an extremely painful disease, owing to the dense character of 

 tlie tissues involved; for in all dense structures the swelling which 

 accompanies inflammation alwa^'s produce^j inten.se pressure. This 

 pressure not only atlds to the patient's suffering but may at the same 

 time endanger the life of the affected parts by strangulating the 

 blood ves.sels. It is held by some writers that simple quittor is most 

 often met with in the hind feet, but in my expeiience more than two- 

 thirds of the cases have developed in the fore feet. While any part 

 of the corftnet may become the seat of attack, the heels and ipiarters 

 are undoubtedly most liable. 



Causes. — Bruises and other wountls of the coronet are often the 

 cause of cutaneous <iuittor, yet there can be no question that in the 

 great majority of cases the disease develops without any known 

 cause. For some reason not yet satisfactorily explained most cases 

 happen in the fall of the year. One explanation of this fact has 

 been attemi)ted in the statement that tlie disease is due to the injuri- 

 ous action of cold and uuul. This claim, however, seems to lose 

 force when it is remembered tiiat in many parts of this country 

 the most mud, acconq)anied with freezing and thawing weather, is 

 seen in the early springtime without a corresponding increase of 

 quittor. Furthermore, the serious outbreaks of this disea.s<', in the 

 mountainous regions of Colorado, Wyoming, and Montana are seen 

 in the fall and winter seasons, when the weather is the driest. It 

 may be claimed, and perhaps with justice, that during these seasons, 

 when the water is low, animals are compelled to wade through more 

 mud to drink from lakes and i>ools than is necessary at other seasons 

 of the year, when these lakes and pools are full. Adil to tlie-n; condi- 

 tions the fuither fai't that much of this mud is impregnatetl with 



