'On the second day following the shoe should be removed, and the foot redressed. To effect this it is necessary to recast the horse. Commencing at the edge of the sound horn, at the most dependent part of the foot, all new horn, no matter what its condition, must be pared to the quick, especial care being taken to effectually remove any lingering disease. Want of success is frequently attributable to neglect of this precaution. A small particle of canker remains undetected, forms a new centre of infection, and just when success is anticipated, much to your chagrin you have to deal with a fresh outbreak of canker, instead of a rapidly-healing foot. Parenthetically, I may here remark that the amount of more or less imperfect new horn produced by a cankered surface after an effective but not too destructive cauterization is almost incredible, and one cannot fail to be struck with the very active proliferation here compared with the meagre production of new horn by the healthy surface.

'After all disease has been excised, carefully clean the foot with waste, thoroughly protect any raw surface resulting from overcauterization by some mild agent, such as a saturated calomel ointment, reapply an astringent dressing over the whole affected surface, and nail on the shoe. This method of procedure should now be thoroughly carried out daily for a time, and as it is proceeded with a successful issue soon becomes assured in nearly every case. Where, in spite of these efforts, the disease still persists, depend upon it the fault is with the operator, who has failed to eradicate some centre of infection. Under these circumstances it may be necessary to recast the patient, repare the foot, and by the aid of eye, knife, and cautery, endeavour to find the cause, and having found it, which can invariably be done, remove it. The usual treatment will then speedily become successful. As the case proceeds dressing every other day will soon be sufficient, then twice a week, and finally, once a week until sufficiently cured.

'During this healing process, and after the complete eradication of canker it may be again repeated, no agent seems to have a more beneficial effect than calomel, and for this purpose it is best used as a dry powder. Under this dressing any remaining spot of canker is readily detected by the wet condition of the calomel when the shoe is removed the next day. In dealing with such a spot, a very good plan, after all apparently diseased tissue has been excised, is to touch the cankered part with solid nitrate of silver, or a feather dipped in one of the strong mineral acids, and then reapply calomel over the surface. The result of this treatment is frequently very gratifying.

'In successful treatment the shoe must be removed each time - an adjustable plate will not do, as no man can thoroughly pare and examine a foot with the shoe on, and imperfect dressings are worse than useless. Indeed, it is better not to pare or thin the horn at all, than to imperfectly pare, since canker, if undestroyed, develops far more rapidly under thin horn than under thick.

'In conclusion, I would again urge the necessity, at the very first operation, when the horse is down, of removing every single particle of the diseased tissue, either by excision or effectual cauterization, but at the same time taking very great care to guard against the latter being too destructive. The cautery should be laid aside as soon as the tissue cauterized ceases to burn white. The moment at which the canker has thus been eradicated without destroying sound tissue is indicated by the appearance of healthy horn, by the intimate union of that with the secreting surface, and by the healthy aspect of the exuded blood when paring has been carried to the quick.

'Should subjacent healthy structures be destroyed during the process, that is shown by the production of a raw sore, or of a sore to which a "sit-fast," coextensive to the injury, is firmly attached. This seriously retards recovery. The secreting surface having been destroyed, no new horn can be produced directly from the part, and a new secreting surface and new horn have now to grow inwards from the surrounding undestroyed tissue, and that is a slow process. At the same time, on the principle of choosing the least of two evils, practical experience teaches that it is better to produce a small sore or a "sit-fast" than to leave a part of the canker undetected; but, on the other hand, it is better to leave a small part of canker undetected, which can be recognised and removed at the next examination, than to cause a large slough. The object of the skilful surgeon is, naturally, to avoid both extremes; and if trouble be taken to carry out the procedure described, there need be no fear of the result.'[A]

[Footnote A: Journal of Comparative Pathology and Therapeutics, vol. iv., p. 24.]

Treated in this way, the horse with cankered feet may be usually kept at work during the whole time that treatment is carried out, and a cure is obtainable in periods varying from six weeks to six or even twelve months.

The same essentials in treatment - namely, removal of diseased horn, antiseptic dressings, and pressure - are insisted on by other writers. Bermbach,[A] in 1888, treats canker as follows: The horse having been cast, the undermined hoof-horn is removed with the knife, and the hypertrophied sensitive structures, if necessary, reduced in the same manner. The chief difficulty in removing the latter is experienced in the lateral lacunae of the frog, where it is most conveniently scraped away with a spoon or sharp curette. Professors Hoffmann and Imminger also operate in the same way, applying an Esmarch's haemostatic bandage, and using the knife and curette freely.[B]

[Footnote A: Ibid., vol. ii., p. 68.]

[Footnote B: Veterinary Journal, vol. xxxv., p. 433.]

Haemorrhage is afterwards arrested, and a dressing of perchloride of mercury (a solution, 1/2 per cent., in equal parts of alcohol and water) applied. The after-dressings succeeding best are those of slightly caustic and astringent agents, preferably in the form of a powder, and held in position by carbol-jute pads and linen bandages applied with a certain amount of pressure.