KERATOMA. 1089 



only be removed by excision of the keratoma or by neurectomy. 

 The affected spot may be thinned with the rasp, and the keratoma 

 removed by means of knife and forceps. 



Frohner and Gutenacker divide the wall around the keratoma, 

 remove the growth completely, and seek to assist healing of the 

 operation wound by antiseptic precautions. 



The great difficulty of this method is to determine the extent of 

 the keratoma by examining the outer surface of the wall. To obviate 

 this, the wall may be trephined and the extent of the growth ascer- 

 tained by probing. The growth may also be removed by starting 

 from the bearing surface of the wall and working upwards until its 

 upper margin is reached. If the keratoma is small this concludes the 

 operation. But when it is extensive and has produced inflammatory 

 processes in the laminae and os pedis it may be necessary to excise 

 the diseased laminae and to freely curette the bone. 



The operation wound should be treated antiseptically. Complete 

 recovery, however, is far from being the rule. The cavity in the 

 os pedis may possibly be filled up again, but as the tendency to new 

 growths exists in the sensitive laminae, and is not removed with 

 removal of the keratoma, the disease not infrequently returns. 



Similar growths occasionally affect the sole. They are commonest 

 in flat or "dropped" feet. The tumour is usually hemispherical, the 

 base intimately united to the velvety tissue of the sole. Treatment 

 may be confined to paring the growth, applying poultices, and shoeing 

 in leathers. Radical treatment necessitates opening the sole, fully 

 exposing and excising the tumour, and is generally successful. 



Considerable spaces sometimes form between the sensitive and horny 

 laminae, whilst the surface of the sensitive laminae becomes covered with 

 a thin, turbid, fluid secretion, and not infrequently granulations appear. 



The process, described by Schleg as chronic ulceration of the sensitive 

 laminae, is usually confined to a spot the size of a shilling in the lower parts 

 of the sensitive wall. Sometimes, however, it extends upwards along 

 the laminae, and may even reach the coronet, but there seems no tendency 

 to penetrate more deeply. The chrome irritation around the diseased spot 

 sometimes causes formation of keratomata. 



The condition generally develops after acute inflammation caused by 

 pricks, separation, or Assuring of the wall. Schleg saw the disease result 

 from separation. Should the inflammatory centre become infected, healing 

 is delayed, and the disease may become chronic. This is shown by the 

 fact that after removal of the infected portion of wall and careful cleansing 

 of the surface of the sensitive laminae, healing generally follows in three 

 to four weeks. 



Attention is first attracted by the lameness or escape of discharge 

 through the white line during shoeing. The extent of diseased tissue can 

 be detected by probing. Lameness is not a constant feature, but appears 



