1068 DISEASES OF THE FOOT. 



through which the discharge escapes are extremely difficult to heal. 

 From time to time the inflammation becomes more intense, and leads 

 to destruction of further portions of cartilage, so that, unless energetic 

 treatment be resorted to, the condition usually continues three to 

 five months. 



A similar affection occurs in the subcoronary and subcutaneous 

 connective tissue at the coronet, and has been termed " coronary 

 fistula." In the same way the French discriminate between " Javart 

 cittane " and " Javart cartilagineux." 



The process is caused by infection of the connective tissue with 

 bacteria (staphylococci, necrosis bacillus). Sometimes the organisms 

 enter through the skin, as in treads, in gangrenous dermatitis, and 

 similar diseases, but direct injury of the lateral cartilage is a rare 

 cause of quittor formation if the wound be at once properly treated, 

 and in by far the majority of cases the condition has its origin in 

 suppurating corns, or nail punctures. The infective inflammation 

 thus excited extends to the connective tissue lying above the sensitive 

 sole, or a crack forms in the horn of the wall, in consequence of which 

 the sensitive laminse may become inflamed. 



On examining the parts, the parachondrium is found to be thickened 

 and infiltrated with larger or smaller abscesses, while portions of the 

 surface of the cartilage are necrotic, some being still adherent, others 

 completely separated ; they are generally of a greenish colour. 



The course of the disease is always chronic. Recovery generally 

 occurs, though sometimes only after complete destruction of the 

 cartilage, a process which takes three to five months. As a rule, 

 quittor remains confined to one side of the hoof, i.e., to one lateral 

 cartilage, the inner cartilage being most frequently affected, because 

 primary disease is commoner at this point. For a similar reason 

 the destruction of cartilage commences at the posterior end and extends 

 forwards. The necrotic fragment may separate partially, but, as 

 a rule, it maintains connection with the healthy tissue in front, to 

 which the process gradually extends. Nevertheless, spontaneous 

 separation with recovery is possible when disease is limited to the 

 posterior third of the cartilage. The cartilage so called is composed 

 of two tissues : the superficial layer being truly cartilaginous, the 

 deep fibrous. The cartilaginous layer is thickest in front. At the 

 back it forms small plates, separated by septa of connective tissue, 

 an arrangement which favours delimitation, inasmuch as these 

 septa constitute boundaries at which necrosis is sometimes arrested. 



Necrosis of the os pedis, suppuration of the pedal-joint, and 

 cellulitis of the subcoronary connective tissue or fibro-fatty frog 



