WOUNDS 241 



coronet have their starting-point in one or other of the 

 diseases to which the foot is liable, in which the cause 

 remains, and a low type of inflammation persists. 



In chronic and neglected suppurating corn, in untreated 

 quittor, and in long-standing complicated sand-crack, for 

 instance, we have conditions in which pus and other septic 

 matters find ready entrance into the subcoronary tissues. 

 Should either of these be negletced, or should the pus 

 formation from the onset take on a slow but gradually 

 spreading form (in other words, should either of these 

 cases run a chronic rather than an acute course) then, with 

 the persistance of the inflammatory phenomena so caused, 

 is bound to result a steady and increasing growth of in- 

 flammatory fibrous connective tissue. This, as it grows, 

 becomes in its turn penetrated by. the ever-invading pus, 

 and, under the stimulus thus caused, itself throws out new 

 tissue. And so, constantly excited, the tumor-like mass 

 tends to steady increase in size, until enlargements are 

 formed which one may sometimes truly term enormous. 



Symptoms. — The appearance of the growth is, of course, 

 immediately evident. Usually these swellings are slow in 

 forming, so that the size of the enlargement depends 

 entirely upon its age. We may thus meet with growths 

 of this description, varying in weight from 4 or 5 pounds 

 to the almost incredible size of 33^ pounds. In the majority 

 cf cases a discharging sore is to be found upon it — in some 

 cases several. Explored, these sores reveal their true 

 nature. Their lip-like openings, and the ready manner in 

 which they may be searched by the probe, show them to be 

 sinuses. 



In a few cases, however, the outer surface of these 

 tumours is intact. When this is the case, it is possible that 

 the growth is a true fibroma — that is to say, a non-inflam- 

 matory new growth of fibrous connective tissue. On the 

 other hand, it may have resulted from one or other of the 

 causes we have enumerated, and its exact diagnosis have 

 been impossible until operative measures had been proceeded 

 with. In this case, small and encysted foci of inspissated 



