SUPPURATIVE TENOSITIS--TENDINOUS QUITTOR. 293 
flammation of the large sesamoid sheath. Pathological anatomy tells us 
that there is at times tenositis and again teno-synovitis. 
The suppurative inflammation of the tendons of the extremities has 
infection as its essential cause. As a frequent complication of ab- 
scesses, overreaching, cutaneous quittors, synovitis and wounds of all kinds 
affecting tendons, it is early manifested by positive phenomena: by very 
great lameness, excessive dumbness, tumefaction and induration of the 
region, and by the presence of one or two fistulz, and a large amount of 
pus escaping from them. A necrotic center is soon formed ; by infection 
of surrounding parts, the disease spreads gradually ; the weak vascularity of 
the tendinous tissue, the density of its structure, and its slow vitality render 
the entire separation of the slough very difficult. 
This affection always admits of a strict prognosis; it may, however, 
vary with some circumstances. ‘The necrosis of the anterior extensor of 
the phalanges is much less severe than that of the flexors, and among those 
the lesions of the perforans are the most dangerous. Whatever be the organ 
affected, the disease is so much the more alarming as it is located nearer 
to the hoof ; and also one must always count upon possible complications, 
especially bony lesions, synovitis and arthritis. The necrotic lesions of 
the metacarpal sheath and the bands of the aponeurosis of the perforans 
and of the plantar cushion are less serious than true tendinous quittor—at 
least they give rise to less lameness and less pain than tendinous quittor. 
When tendinous quittor exists with all the conditions for its development, 
it may nevertheless in some cases be arrested. Cutaneous quittors treated 
antiseptically (baths, damp compresses and wadded dressings) rarely be- 
come complicated. If the case is neglected, the dividing fissure between 
the slough and the healthy tissues spreads deeply, the pus reaches the 
tendons, remains on their surface and often starts a partial necrosis. 
Peri-tendinous abscesses. must be opened early, disinfected and drained. 
In suppurative synovitis tendinous alterations are also prevented by free 
cuttings and antiseptic treatment. We have already stated how wounds 
of tendons are to be treated. (See Zendinous Wounds.) 
For tendinous quittor itself, several therapeutical methods are offered. 
Let us mention only to condemn the method of treatment in which poultices 
or warm compresses are applied to the diseased region without a free opening 
first of the fistulae. Some practitioners have recourse still to this method ; 
but it is insufficient and dangerous. It does not arrest the necrosis, 
but gives exposure to the most serious complications. 
To assist the flow of the pus and insure the action of the medical 
agents as directly as possible upon the diseased parts are the rules common 
to all cases. The direction and the situation of the fistule should be 
carefully noticed, Some are deep, undermining, and the pus filtrates 
