Almost invariably these symptoms are added to by a more or less diffuse and oedematous swelling of the lower portion of the limb, extending in some cases to as high as the fetlock or the upper third of the cannon.

With the casting off of the slough the phenomena of inflammation to a great extent subside, the pain ceases, and the case under ordinary conditions commences to mend.

Pathological Anatomy.—­In its early stages the condition of simple or cutaneous quittor is really a condition of acute coronitis (see p. 229), and consists in an inflammation of the subcutaneous tissue, and the more superficial portions of the coronary cushion.  The tissues implicated are destroyed outright, become infiltrated with the inflammatory exudate and escaped blood, and act as a source of irritation to the still living tissues around.  Under the irritation the latter, as we have said before, cast the necrosed portion away by a process of sloughing.

Always, however, it is found that the portion to be sloughed off, while easily separated from the tissues adjacent to its sides, is closely connected on its lowermost or deeper face with the structures below, and cannot be torn away without haemorrhage and the causing of acute pain.

Prognosis.—­With wounds about the feet our forecast should always be guarded.  Even with this, the most simple form of quittor, no decided opinion should be given until the progress of the case warrants one in reasonably assuming that complications are absent.  Once this point is decided, a favourable prognosis may be given.

Complications.—­With cutaneous quittor various complications may arise, according to the extent of the invasion of the septic matter.  Necrosis of tendon, of ligament, or of cartilage, caries of the bone, or a condition of synovitis and arthritis may be met with.  As these complications are equally common to sub-horny quittor, we shall reserve their description until dealing with that condition. Treatment (Preventive).—­Immediately after the infliction of an injury in this position, more especially if it is such as to lead one to judge that necrosis will follow to any large extent, the patient should be rested.  Ill effects may then be probably warded off by having the foot immersed in a cold antiseptic solution, and afterwards bound with an antiseptic pad and bandage.

Curative.—­When the condition has gone undiscovered until commencing necrosis and suppuration are plainly discernible, then the wisest course we can follow is to do all we can to hasten removal of the necrosed portion.

This is best done by promoting the suppurative process by means of warmth or stimulant applications.

To this end hot poultices, or, better still, hot baths, should be resorted to.  Under their influence a greater supply of blood is directed to the still healthy tissues enabling them to actively continue the inflammatory processes necessary to the detaching of the portion necrosed, while, at the same time, the pus organisms, stimulated by the heat, are stirred into greater activity, and the readier accomplish their purpose of destroying the adhesion still existing between the necrotic portion and the surrounding living tissues.