386 



and 110 lienioi'i'hage. The skin, tvom the knee to the foot, was thick- 

 ened from Avateiy infiltration (oedema), and on the inside quarter 

 three holes, each about one-half of an inch in diameter, were found. 

 All had ragged edges, while but one had gone deep enougli to per- 

 forate the coronary band. The loose connective tissue, found beneath 

 the skin, was distended with a gelatijious infiltration, over the whole 

 course of the flexor tendons, and to the fetlock joint over the tendon 

 in front. The soft tissues covering the coffin bone were loosened in 

 patches by collections of pus which had formed beneath the sensitive 

 laniin?e. The coffin and pastern joints were both inflamed, as Avero 

 also the coffin, navicular, and coronet bones, while the outside toe of 

 the coffin bono had become softened from suppuration, until it could 

 readily be crumbled between the fingers. The coronary band v/as 

 largely destroyed and completelj' separated from the other tissues of 

 the foot; the inner lateral cartilage was gangrenous, as was also a small 

 spot on the extensor tendon, near its point of attachment on the coffin 

 bone. Several small collections of pus were found deep in the connec- 

 tive tissue of the coronary region; along tlie course of the sesamoid 

 ligaments; in the sheath of the flexor tendons; under the tendon just 

 below the fetlock joint in front, and in the coffin joint. 



But all cases of tendinous quitter are by no means so complicated 

 as this one was. In rare instances the swelling is slight, and after a 

 few days' time the lameness and other S3-mptoms subside without an}^ 

 discharge of pus from an external opening. In most cases, however, 

 from one to half a dozen or more soft i^oints arise on the skin of the 

 coronet, open, and discharge slowly a thick, yellow, fetid, and bloody 

 matter. In otlier cases the suppurative process is largely confined to 

 the sensitive laminae and plantar cushion; in these cases the suffering 

 is intense until the pus finds an avenue of escape, which it generally 

 does by separating the hoof from the coronary band, at or near the 

 heels, Avithout causing a loss of the whole horny box. When the flexor 

 tendon is involved deep in the foot, the discharge of pus usually takes 

 place from an opening in the hollow of the heel; if the sesamoid liga- 

 ment, or the sheath of the flexors, are affected, the opening is nearer 

 the fetlock joint; although in most of these cases the suppuration 

 spreads along the course of the tendons until the navicular joint is 

 involved, and extensive sloughing of the deeper parts follows. 



Treatment.— ThQ treatment of tendinous quitter is to be directed 

 toward the saving of the foot. First of all, an effort must be made to 

 I)revent suppuration; and if the patient is seen at the beginning, the 

 cold irrigation, recommended in the treatment for cutaneous quittor, 

 is to be resorted to. Later on, when the tumor is forming on the cor- 

 onet, the knife must be used, ;ind a free and deep incision made into 

 the swelling. Whenever openings appear from which the pus escapes 

 they should be carefully probed ; in all instances these fistulous tracts 

 will be found leading down to dead tissue which nature is trying to 



