WOUNDS 241 
coronet have their starting-point in one or other of the 
diseases to which the foot is lable, 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 834 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 
svith. In this case, small and encysted foci of inspissated 
16 
