724 OPERATIONS ON THE FOOT. 



were essential to the success of the treatment. H. Bouley and 

 Viseur also strongly insisted upon the same point, viz., that of en- 

 larging the fistula in order that the liquid should not be allowed 

 to remain at the bottom of the fistulous tracts, by which all possi- 

 bility of the extension of the disease from that cause might be 

 avoided. These enlargements of the fistulte, or counter openings, 

 close, however, very rapidly; as a remedy to which, Hivernat has 

 suggested the introduction into the tracts of little wedges of wood 

 pointed like pencUs, for the purpose of lacerating the walls of the 

 fistula, followed by the insertion in them of small setons, moist- 

 ened with Villate's solution. Guerrapain introduced a fine meche 

 of oakum, a seton in the tract, by means of a curved needle. If 

 the fistula runs downward its bottom is under the wall, and he 

 thins this down and makes a counter opening through the hoof 

 thus thinned. This seton prevents the closing of the counter 

 opening, and enables the operator to push through the injection 

 regularly. 



Other precautions are also necessary. One, especially, is rest. 

 The animal must not be put to work. Lafosse says that these 

 liquid caustics act with regularity and cure with certainty. A bar 

 shoe, not pressing on the diseased quarter, is also useful. Emol- 

 lient poultices are sometimes necessary after the injection, to 

 diminish the irritation. Mariage also recommends them. If the 

 fistula extends under the coronary band, or the podophyllous tis- 

 sue, it becomes necessary to thin, or to remove altogether, the 

 hoof of the diseased quarter. 



After fifteen days of this treatment, the exfoliation often takes 

 place, and recovery follows. Often, however, twice this length of 

 time is necessary. After the first eight days the pus becomes 

 more abundant, white and laudable ; the tumor softens and dimin- 

 ishes, as the pain subsides. Later, the injections penetrate with 

 greater difficulty, which is a good sign. The injections constantly 

 attack the germ of the disease and leave it vnthout chance to re- 

 form or to spread; the gangrenous structure which develops in 

 the cartilage is changed into an inert substance ; the pyogenic 

 membrane of the fistulous tract is stimulated; the process of 

 granulation becomes more rapid ; the wound becomes more and 

 more healthy, and the diseased process ceases. If, however, it 

 continues, the wound changes its character, large granulations 

 develop themselves, and in their center the openings of the fistu- 



