QUITTOR. 1071 



limate. To ensure the solution reaching the bottom of the sinus, 

 the syringe should be provided with a long, thin nozzle. 



The injections must be made daily, and continued until they 

 cause considerable pain, when they are discontinued for a time 

 and again resorted to until suppuration altogether ceases. Some- 

 times after a few days the swelling diminishes and pus ceases to 

 be discharged, both favourable symptoms, as they point to com- 

 mencing healing. 



When the sinus is old, deep, or very oblique, it is advisable to 

 make a counter-opening. The coronary band should not be divided. 

 After thoroughly thinning the wall a grooved director is passed to the 

 bottom of the sinus, the wall divided from without, a small piece 

 of the wall removed, and a short length of gauze passed through 

 the sinus and tied, to secure it in position. Sometimes two sinuses 

 exist, and require the insertion of two drains. Winkler recently 

 recommended spirituous sublimate solutions, followed at a later stage 

 by acetate of lead, also dissolved in spirit. 



Gamgee's mixture has again come into favour. It consists of 

 sublimate 17 parts, acetate of lead 34 parts, spirit 136 parts, hydro- 

 chloric acid 2 parts. After clipping away the hair and enlarging 

 the sinus, a dry dressing is applied. On the second or third day, 

 and again on the fourth, fifth, and sixth, the parts are injected. From 

 the seventh day onwards, the opening of the sinus on the coronet 

 is only disinfected and a dressing applied. In a fortnight recovery 

 is said to take place (Walter). Giesecke recommends a 5 to 20 per 

 cent, solution of protargol. Some endeavour to destroy the sinus 

 by inserting caustic crayons ; others employ the actual cautery 

 for the same purpose, a farrier's poker being made red hot and 

 introduced into the sinus. The poker must be carefully used, and 

 special precautions are required when inserting it at the forward 

 end of the cartilage. Though sometimes successful neither of these 

 methods is safe unless confined to quittors of the posterior half of 

 the cartilage. 



To diminish the pressure of the horny wall on the swollen parts, 

 Giesecke recommends applying linseed poultices containing creolin, 

 and afterwards removing the softened horn. The sinuses above 

 the coronet are scraped out with the curette, injected with 8 per 

 cent, solution of chloride of zinc, and finally a small mass of tow 

 covered with sulphate of copper is introduced. This procedure 

 may require to be repeated ; after-treatment consists of injection 

 with antiseptic fluids. 



Lignieres has recommended injections of " resinate of copper," 



