QUITTOR. 
579 
the cartilage to the heel, and completely separate the coronary 
band from the podophylons tissue and sever the inferior margin 
of the cartilage from its attachment to the wings of the pedal 
bone. The sage knife, with convexed surface outward, is then 
gently but firmly pushed under the coronary band and skin in 
the centre of the tumor in an upward direction until the supe¬ 
rior border of the cartilage is reached, which can be easily de¬ 
termined by the left hand, which should trace the movements 
of the point of the knife through the skin ; then by a slow and 
careful rotary motion the skin is separated from its underlying 
bed of indurated connective tissue over the entire length of the 
cartilage, care being taken that injuries to the coronary band 
are avoided. If the sub-coronary connective tissue be greatly 
thickened, which 'is indicated by the size of the tumor, that 
portion of it lying between the external surface of the cartilage 
and the skin should be removed, which leaves a space suffi¬ 
ciently large to introduce a finger and explore the cavity. 
The removal of the cartilage is next effected by beginning at 
the heel and introducing the blade of the sage knife carefully 
under its posterior border, and slowly and carefully separating 
the inner surface of the cartilage from its connective-tissue bed, 
from the ligaments and the synovial capsule of the coffin joint, 
which lies directly under and very close to the inner face of the 
anterior half of the cartilage. If the toe is extended and the 
movements of the sage knife carefully guided by the left hand 
there is but little danger of injuring the synovial capsule. The 
cartilage is then seized with a strong pair of forceps and pulled 
downward and outward from under the coronary band, and any 
small adhesions remaining are severed, until the cartilage is 
entirely liberated. The cavity is then carefully explored and 
all partly detached tissues removed, edge of coronary band 
trimmed, and the wound dressed in accordance with the well- 
established principles of aseptic surgery. 
If the quittor be caused by a quarter-crack, broken bar, deep- 
seated corn or accidental injury to the quarter or plantar surface, 
the basilar and retrosal processes of the pedal bone are very apt 
