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 neglected, 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 

 persistence of the inflammatory phenomena so caused, is 

 bound to result a steady and increasing growth of inflamma- 

 tory 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 tumour-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 of 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 



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