THE AUTHORS OPERATION FOR QUITTOR " 329 



Direction of the Sinus. — The probe is passed carefully into 

 the orifice and a patient search is made for the lowest point 

 of the tract, by bending its end to different curvatures and 

 attempting to pass it downward in different directions until 

 the tract is traced to the bottom, which generally corre- 

 sponds to the level of the attachment of the cartilage to the 

 os pedis. Thus gauged the position of the bottom of the 

 tract is determined externally by measuring with the part 

 of the probe that was buried. 



Second Step. — Opening the Bottom of the Tract.— A 

 crescent-shaped piece of hoof about one inch long is then re- 

 moved with the hoof knife from the point indicated as the 

 bottom of the tract by the probe. When the laminse and cor- 

 onary cushion have been thus exposed and the oozing blood 

 bailed out, the probe is again passed into the tract, and an at- 

 tempt made to feel its point beneath them, to insure that the 

 hoof has been stripped off at the proper place. If the probe 

 now seems to pass beyond the limits of the removed hoof, 

 additional paring is done until the bottom of the tract is 

 reached. The laminse are then incised transversely and a 

 small rectangular or elliptical piece removed. Sometimes, 

 when the tract is not deep, a part of the coronary cushion is 

 included with the laminse, the object of the incision being to 

 open the bottom of the tract by sacrificing as little hoof- 

 forming tissue as possible. The probe is again passed into 

 the tract, and now its point can easily be felt beneath the 

 loose connective tissue exposed by removing the laminae. 

 This connective tissue is the outer wall of the tract, and 

 when incised a few drops of bloody pus escapes and the shiny 

 end of the probe appears. 



Third Step. — Search for and Resection of the Necrotic 

 Part of the Cartilage. — With the protruding probe in the 

 tract as a guide at first, the foreground is curetted gently 

 by careful outward strokes to unmask the cartilage beneath. 

 As a certain amount of blood will flow into the wound de- 

 spite the tourniquet, incessant bailing is essential. The 

 curettage, and sometimes dissection with the sca'pel and 

 forceps, continues until the outlines of the diseased portion 

 of the cartilage appear in the foreground. The diseased car- 

 tilage is recognized by its marble white color, fringed here 

 and there with pea-green portions which are sometimes free, 

 detached bodies, and by being easily separated from its sur- 

 roundings. The curette is now passed under the edge of the 

 diseased portion and a systematic resection piece by piece 

 effected, always cutting outward, As much of the cartilage 



