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+The Project Gutenberg eBook, Lameness of the Horse, by John Victor Lacroix
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: Lameness of the Horse
+       Veterinary Practitioners' Series, No. 1
+
+
+Author: John Victor Lacroix
+
+
+
+Release Date: July 27, 2005  [eBook #16370]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+
+***START OF THE PROJECT GUTENBERG EBOOK LAMENESS OF THE HORSE***
+
+
+E-text prepared by Juliet Sutherland, Julia Miller, and the Project
+Gutenberg Online Distributed Proofreading Team (https://www.pgdp.net)
+
+
+
+Note: Project Gutenberg also has an HTML version of this
+      file which includes the original illustrations.
+      See 16370-h.htm or 16370-h.zip:
+      (https://www.gutenberg.org/dirs/1/6/3/7/16370/16370-h/16370-h.htm)
+      or
+      (https://www.gutenberg.org/dirs/1/6/3/7/16370/16370-h.zip)
+
+Transcriber's Note:
+
+      The original text was inconsistent in the use of accents and
+      hyphenation. These variants and a small number of typographical
+      errors were maintained in this transcription. A complete list
+      of the variant spellings is found at the end of the book along
+      with the list of typographical errors.
+
+      The Table of Contents lists the Authorities Cited section as
+      preceding the Index, but it was printed following the Index.
+      This order has been retained in this transcription.
+
+
+
+
+
+Veterinary Practitioners' Series
+
+No. 1
+
+LAMENESS OF THE HORSE
+
+by
+
+J. V. Lacroix, D.V.S.
+
+Professor of Surgery, The Kansas City Veterinary College
+Author of "Animal Castration"
+
+Illustrated
+
+Chicago
+American Journal Of Veterinary Medicine
+
+1916
+
+
+
+
+
+
+
+PREFACE
+
+
+All that can be known on the subject of lameness, is founded on a
+knowledge of anatomy and of the physiology of locomotion. Without such
+knowledge, no one can master the principles of the diagnosis of
+lameness. However, it must be assumed that the readers are informed on
+these subjects, as it is impossible to include this fundamental
+instruction in a work so brief as this one.
+
+The technic of certain operative or corrective procedures, has been
+described at length only where such methods are not generally employed.
+Where there is no departure from the usual methods, treatment that is
+essentially within the domain of surgery or practice is not given in
+specific detail.
+
+Realizing the need for a treatise in the English language dealing with
+diagnosis and treatment of lameness, the author undertook the
+preparation of this manuscript. That the difficulties of depicting by
+means of word-pictures, the symptoms evinced in baffling cases of
+lameness, presented themselves in due course of writing, it is needless
+to say.
+
+It is hoped that this volume will serve its readers to the end that the
+handling of cases of lameness will become a more satisfactory and
+successful part of their work; that both the practitioner and his
+clients may profit thereby; and last but by no means least, that the
+horse, which has given such incalculable service to mankind and is
+deserving of a more concrete reward, will be benefited by the
+application of the principles herein outlined.
+
+In addition to the consultation of standard works bearing on various
+phases of the subject of lameness, the author wishes to thankfully
+acknowledge helpful advice and assistance received from the publisher,
+Dr. D.M. Campbell; to appreciatively credit Drs. L.A. Merillat, A.
+Trickett and F.F. Brown for valuable suggestions given from time to
+time. Particular acknowledgment is made to Dr. Septimus Sisson, author,
+and W.B. Saunders & Co., publishers of The Anatomy of Domestic Animals,
+for permission to use a number of illustrations from that work.
+
+                                                             J.V.L.
+
+Chicago, Illinois, October, 1916.
+
+
+
+
+_Justice shows a triumphant face at the works of humane practitioners,
+who give serious thought and expend honest effort, for the alleviation
+of animal suffering._
+
+
+
+
+TABLE OF CONTENTS
+
+
+                                                             Page
+Illustrations                                                   7
+Introduction                                                   11
+
+                            SECTION I
+
+Etiology and Occurrence                                        15
+Affections of Bones                                            15
+Rarefying Osteitis, or Degenerative Changes                    16
+Fractures                                                      16
+Affections of Ligaments                                        20
+Luxations--Dislocations                                        21
+Arthritis                                                      22
+Affections of Bursae and Thecae                                27
+Affections of Muscles and Tendons                              28
+Affections of Nerves                                           30
+Affections of Blood Vessels                                    31
+Affections of Lymph Vessels and Glands                         32
+Affections of the Feet                                         34
+
+                            SECTION II
+
+Diagnostic Principles                                          37
+Anamnesis                                                      38
+Visual Examination                                             39
+Attitude of the Subject                                        41
+Examination by Palpation                                       43
+Passive Movements                                              47
+Observing the Character of the Gait                            48
+Special Methods of Examination                                 53
+
+                           SECTION III
+                    Lameness in the Fore Leg
+
+Anatomo-Physiological Review of Parts of the Fore Leg          55
+Shoulder Lameness                                              61
+Fracture of the Scapula                                        62
+Scapulohumeral Arthritis                                       65
+Infectious Arthritis                                           66
+Injuries                                                       66
+Wounds                                                         67
+Luxation of the Scapulohumeral Joint                           67
+Inflammation of the Bicipital Bursa                            68
+Contusions of the Triceps Brachii                              71
+Shoulder Atrophy (Sweeny)                                      73
+Paralysis of the Suprascapular Nerve                           75
+Radial Paralysis                                               77
+Thrombosis of the Brachial Artery                              81
+Fracture of the Humerus                                        82
+Inflammation of the Elbow                                      84
+Fracture of the Ulna                                           86
+Fracture of the Radius                                         87
+Wounds of the Anterior Brachial Region                         90
+Inflammation and Contraction of the Carpal Flexors             93
+Fracture and Luxation of the Carpal Bones                      96
+Carpitis                                                       98
+Open Carpal Joint                                             100
+Thecitis and Bursitis                                         104
+Fracture of the Metacarpus                                    106
+Splints                                                       107
+Open Fetlock Joint                                            110
+Phalangeal Exostosis (Ringbone)                               118
+Open Sheath of the Flexors of the Phalanges                   124
+Luxation of the Fetlock Joint                                 125
+Sesamoiditis                                                  127
+Fracture of the Proximal Sesamoids                            128
+Inflammation of the Posterior Ligaments of the Pastern
+    Proximal Interphalangeal Joint                            129
+Fracture of the First and Second Phalanges                    131
+Tendinitis (Inflammation of the Flexor Tendons)               135
+Chronic Tendinitis and Contraction of the Flexor Tendons      137
+Contracted Tendons of Foals                                   143
+Rupture of the Flexor Tendons and Suspensory Ligament         146
+Thecitis and Bursitis in the Fetlock Region                   150
+Arthritis of the Fetlock Joint                                152
+Ossification of the Cartilages of the Third Phalanx           155
+Navicular Disease                                             157
+Laminitis                                                     160
+Calk Wounds (Paronychia)                                      170
+Corns                                                         172
+Quittor                                                       174
+Nail Punctures                                                178
+
+                           SECTION IV
+                    Lameness in the Hind Leg
+
+Anatomo-Physiological Consideration of the Pelvic Limbs       185
+Hip Lameness                                                  195
+Fractures of the Pelvic Bones                                 196
+Fractures of the Femur                                        199
+Luxation of the Femur                                         201
+Gluteal Tendo-Synovitis                                       203
+Paralysis of the Hind Leg                                     204
+Paralysis of the Femoral (Crural) Nerve                       204
+Paralysis of the Obturator Nerve                              206
+Paralysis of the Sciatic Nerve                                208
+Iliac Thrombosis                                              209
+Fracture of the Patella                                       212
+Luxation of the Patella                                       213
+Chronic Gonitis                                               217
+Open Stifle Joint                                             220
+Fracture of the Tibia                                         222
+Rupture and Wounds of the Tendo Achillis                      224
+Spring-Halt (String-Halt)                                     225
+Open Tarsal Joint                                             229
+Fracture of the Fibular Tarsal Bone (Calcaneum)               230
+Tarsal Sprains                                                232
+Curb                                                          233
+Spavin (Bone Spavin)                                          235
+Distension of the Tarsal Joint Capsule (Bog Spavin)           242
+Distension of the Tarsal Sheath of the Deep Digital Flexor
+    (Thoroughpin)                                             246
+Capped Hock                                                   251
+Rupture and Division of the Long Digital Extensor (Extensor
+    Pedis)                                                    253
+Wounds from Interfering                                       255
+Lymphangitis                                                  257
+Authorities Cited                                             265
+Index                                                         267
+
+
+
+
+ILLUSTRATIONS
+
+                                                             Page
+Fig.  1--Hoof Testers                                          53
+Fig.  2--Muscles of Left Thoracic Limb, Lateral View           56
+Fig.  3--Muscles of Left Thoracic Limb, Medial View            57
+Fig.  4--Sagital Section of Digit and Distal Part of
+         Metacarpus                                            59
+Fig.  5--Ordinary Type of Heavy Sling                          62
+Fig.  6--A Sling Made in Two Parts                             63
+Fig.  7--Paralysis of the Suprascapular Nerve of Left
+         Shoulder                                              76
+Fig.  8--Radial Paralysis                                      78
+Fig.  9--Merillat's Method of Fixing Carpus in Radial
+         Paralysis                                             79
+Fig. 10--Contraction of Carpal Flexors, "Knee Sprung"          95
+Fig. 11--Pericarpal Inflammation and Enlargement Due to
+         Injury                                                99
+Fig. 12--Hygromatous Condition of the Right Carpus            100
+Fig. 13--Carpal Exostosis in Aged Horse                       101
+Fig. 14--Exostosis of Carpus Resultant from Carpitis          102
+Fig. 15--Distal End of Radius, Illustrating Effects of
+         Carpitis                                             102
+Fig. 16--Posterior View of Radius, Illustrating Effects of
+         Splint                                               108
+Fig. 17--Phalangeal Exosteses                                 120
+Fig. 18--Rarefying Osteitis in Chronic Ringbone               121
+Fig. 19--Phalangeal Exostoses in Chronic Ringbone             122
+Fig. 20--Contraction of Superficial Digital Flexor Tendon
+         Due to Tendinitis                                    138
+Fig. 21--Contraction of Deep Flexor Tendon Due to
+         Tendinitis                                           139
+Fig. 22--Chronic Case of Contraction of Both Flexor Tendons
+         of the Phalanges                                     140
+Fig. 23--Contraction of Superficial and Deep Flexor
+         Tendons                                              141
+Fig. 24--Contraction of Superficial Digital Flexor and
+         Slight Contraction of Deep Flexor Tendon             142
+Fig. 25--"Fish Knees"                                         145
+Fig. 26--Extreme Dorsal Flexion                               146
+Fig. 27--A Good Style of Shoe for Bracing the Fetlock         148
+Fig. 28--The Roberts Brace in Operation                       149
+Fig. 29--Distension of Theca of Extensor of the Digit         151
+Fig. 30--Rarefying Osteitis Wherein Articular Cartilage
+         Was Destroyed                                        153
+Fig. 31--Ringbone and Sidebone                                156
+Fig. 32--Position Assumed by Horse Having Unilateral
+         Navicular Disease                                    159
+Fig. 33--The Hoof in Chronic Laminitis                        165
+Fig. 34--Effects of Laminitis                                 166
+Fig. 35--Cochran Shoe, Inferior Surface                       168
+Fig. 36--Cochran Shoe, Superior Surface                       169
+Fig. 37--Hyperplasia of Eight Forefoot Due to Chronic
+         Quittor                                              176
+Fig. 38--Chronic Quittor, Left Hind Foot                      177
+Fig. 39--Skiagraph of Foot                                    179
+Fig. 40--Sagital Section of Eight Hock                        186
+Fig. 41--Muscles of Right Leg; Front View                     187
+Fig. 42--Muscles of Lower Part of Thigh, Leg and Foot         189
+Fig. 43--Right Stifle Joint; Lateral View                     190
+Fig. 44--Left Stifle Joint; Medial View                       191
+Fig. 45--Left Stifle Joint; Front View                        193
+Fig. 46--Oblique Fracture of the Femur                        200
+Fig. 47--Fracture of Femur After Six Months' Treatment        201
+Fig. 48--Aorta and Its Branches Showing Location of
+         Thrombi                                              210
+Fig. 49--Thrombosis of the Aorta, Iliacs and Branches         211
+Fig. 50--Chronic Gonitis                                      218
+Fig. 51--Position Assumed in Gonitis                          219
+Fig. 52--Spring-halt                                          226
+Fig. 53--Lateral View of Tarsus Showing Effects of Tarsitis   228
+Fig. 54--Right Hock Joint                                     231
+Fig. 55--Spavin                                               235
+Fig. 56--Bog Spavin                                           243
+Fig. 57--Thoroughpin                                          247
+Fig. 58--Fibrosity of Tarsus in Chronic Thoroughpin           248
+Fig. 59--Another View of Case Shown in Fig. 58                249
+Fig. 60--"Capped Hock"                                        252
+Fig. 61--Chronic Lymphangitis                                 258
+Fig. 62--Elephantiasis                                        259
+
+
+
+
+INTRODUCTION
+
+
+Lameness is a symptom of an ailment or affection and is not to be
+considered in itself as an anomalous condition. It is the manifestation
+of a structural or functional disorder of some part of the locomotory
+apparatus, characterized by a limping or halting gait. Therefore, any
+affection causing a sensation and sign of pain which is increased by the
+bearing of weight upon the affected member, or by the moving of such a
+distressed part, results in an irregularity in locomotion, which is
+known as lameness or claudication. A halting gait may also be produced
+by the abnormal development of a member, or by the shortening of the leg
+occasioned by the loss of a shoe.
+
+For descriptive purposes lameness may be classified as _true_ and
+_false_. _True lameness_ is such as is occasioned by structural or
+functional defects of some part of the apparatus of locomotion, such as
+would be caused by spavin, ring-bone, or tendinitis. _False lameness_ is
+an impediment in the gait not caused by structural or functional
+disturbances, but is brought on by conditions such as may result from
+the too rapid driving of an unbridle-wise colt over an irregular road
+surface, or by urging a horse to trot at a pace exceeding the normal
+gait of the animal's capacity, causing it to "crow-hop" or to lose
+balance in the stride. The latter manifestation might, to the
+inexperienced eye, simulate _true lameness_ of the hind legs, but in
+reality, is merely the result of the animal having been forced to assume
+an abnormal pace and a lack of balance in locomotion is the consequence.
+
+The degree of lameness, though variable in different instances, is in
+most cases proportionate to the causative factor, and this fact serves
+as a helpful indicator in the matter of establishing a diagnosis and
+giving the prognosis, especially in cases of somewhat unusual character.
+An animal may be slightly lame and the exhibition of lameness be such as
+to render the cause bafflingly obscure. Cases of this nature are
+sometimes quite difficult to classify and in occasional instances a
+positive diagnosis is impossible. Subjects of this kind may not be
+sufficiently inconvenienced to warrant their being taken out of
+service, yet a lame horse, no matter how slightly affected, should not
+be continued in service unless it can be positively established that the
+degree of discomfort occasioned by the claudication is small and the
+work to be done by the animal, of the sort that will not aggravate the
+condition.
+
+Subjects that are very lame--so lame that little weight is borne by the
+affected member--are, of course, unfit for service and as a rule are not
+difficult of diagnosis. For instance, a fracture of the second phalanx
+would cause much more lameness than an injury to the lateral ligament of
+the coronary joint wherein there had occurred only a slight sprain, and
+though crepitation is not recognized, the diagnostician is not justified
+in excluding the possibility of fracture, if the lameness seems
+disproportionate to the apparent first cause.
+
+The course taken by cases of lameness is as variable as the degree of
+its manifestation, and no one can definitely predict the duration of any
+given cause of claudication.
+
+Because of the fact that horses are not often good self-nurses at best,
+and that it is difficult to enforce proper care for the parts affected,
+one can not wisely state that resolution will promptly follow in an
+acute involvement, nor can he predict that the case will or will not
+become chronic. Experience has proved that complete or partial recovery
+may result, or again, that no change may occur in any given case, and
+that in some instances even where rational treatment is early
+administered, a decided aggravation of the condition may follow
+unaccountably.
+
+However, because of the economic element to be reckoned with, it is of
+some value to be able to give a fairly accurate prognosis in the
+handling of cases of lameness, as in the majority of instances the
+treatment and manner of after-care are determined largely by the expense
+that any prescribed line of attention will occasion.
+
+A case of acute bone spavin in a horse of little value is not generally
+treated in a manner that will incur an expense equivalent to one-half
+the value of the subject. The fact is always to be considered in such
+cases, that even where ideal conditions favor proper treatment, the
+outcome is uncertain. Where less than six weeks of rest can be allowed
+the animal, one affected with bone spavin would therefore not be treated
+with the expectation of obtaining good results, as six weeks' time, at
+least, is necessary for a successful outcome. If the cost attending the
+enforced idleness of an animal of this kind is considered prohibitive
+for the employment of proper measures to affect a cure, and if lameness
+is slight, the animal should be given suitable work, but in cases of
+articular spavin in aged subjects, they should be humanely destroyed and
+not subjected to prolonged misery.
+
+A thorough knowledge of the structure and functions of the affected
+parts is necessary to proceed in cases of lameness; likewise, the age,
+conformation and temperament of the subject need to be taken into
+consideration; the presence or absence of complications demand the
+attention; the kind of care the subject will probably receive directly
+influences the outcome; and the character of service expected of the
+subject, too, needs to be carefully considered before the ultimate
+outcome may reasonably be foretold.
+
+The practitioner is often confronted with the problem of how best to
+handle certain cases. Will they do better under conditions where
+absolute quiet is enforced, or is it preferable to allow exercise at
+will? The temperament of the animal must be considered in such cases,
+and if a lame horse is too active and playful when given his freedom,
+exercise must be restricted or prevented, as the case may require. In
+cases of strains of tendons, during the acute stage, immobilization of
+the affected parts is in order. In certain sub-acute inflammatory
+processes or in instances of paralytic disturbance where convalescence
+is in progress, moderate exercise is highly beneficial.
+
+Consequently, each case in itself presents an individual problem to be
+judged and handled in the manner experience has taught to be most
+effective, appropriate and practical, and the veterinarian should give
+due consideration to the comfort and welfare of the crippled animal as
+well as to the interests of the owner.
+
+
+
+
+SECTION I.
+
+ETIOLOGY AND OCCURRENCE.
+
+
+In discussions of pathological conditions contributing to lameness in
+the horse, cause is generally classified under two heads--_predisposing_
+and _exciting_. It becomes necessary, however, to adopt a more general
+and comprehensive method of classification, herein, which will enable
+the reader to obtain a better conception of the subject and to more
+clearly associate the parts so grouped descriptively.
+
+Though _predisposing_ factors, such as faulty conformation, are often to
+be reckoned with, _exciting_ causes predominate more frequently in any
+given number of cases. The noble tendency of the horse to serve its
+master under the stress of pain, even to the point of complete
+exhaustion and sudden death, should win for these willing servants a
+deeper consideration of their welfare. Too frequently are their
+manifestations of discomfort allowed to pass unheeded by careless,
+incompetent drivers lacking in a sense of compassion. Symptoms of
+malaise should never be ignored in any case; the humane and economic
+features should be realized by any owner of animals.
+
+In the consideration of group causes, lameness may be said to originate
+from affections of bones, ligaments, thecae and bursae, muscles and
+tendons, nerves, lymph vessels and glands, and blood vessels, and may
+also result from an involvement of one or several of the aforementioned
+tissues, caused by rheumatism. Further, affections of the feet merit
+separate consideration, and, finally, a miscellaneous grouping of
+various dissimilar ailments, which for the most part, do not directly
+involve the locomotory apparatus but do, by their nature, impede normal
+movement.
+
+
+AFFECTIONS OF BONES.
+
+The bony column serving as the framework and support of the legs,
+probably constitutes the most vital element having to do with weight
+bearing and locomotion, and therefore during the acute and painful stage
+of bone affections, the pain becomes more intense in the process and
+pressure of standing than when the member is swung or advanced.
+
+Certain bones are so well protected by muscular structures that they are
+not frequently injured except as a result of violence which may produce
+fracture. However, there are certain bones which receive the constant
+shock of concussion when the animal is subjected to daily, rapid work on
+hard road surfaces. Splints, ringbones and spavins are the most general
+examples produced by these conditions.
+
+Varying pathological developments often result from concussion,
+contusion or other violent shocks to the bony structures. In such cases
+there either follows a simple periostitis which may resolve
+spontaneously with no obvious outward symptom, or osteitis, which may
+occur with tissue changes, as in exostosis; or the case may produce any
+degree of reaction between these two possible extremes.
+
+
+Rarefying Osteitis, or Degenerative Changes.
+
+Certain bone affections, such as osteomalacia or osteoporosis, are in
+the main, responsible for distortions and morphological changes of bone,
+causing lameness, permanent blemish and even resulting in death of the
+affected animal. The climatic conditions in some localities favor these
+occurrences but they may also be ascribed to improper food constituents
+and to possible infective agencies.
+
+Rarefying degenerative changes manifested by exostosis involving the
+phalanges of the young, causing ringbone, are fairly common in
+occurrence throughout this country. This is due, supposedly, to a lack
+of mineral substance in the bony structure of the affected animals, and
+is known as rachitis--commonly called rickets. Since the affected
+subjects suffer involvement of several of the extremities at the same
+time, the theory of rachitic origin seems well supported.
+
+
+Fractures.
+
+Fractures of bones constitute serious conditions and are always
+manifested by lameness. A sub-classification is essential here for the
+student of veterinary medicine who would comprehend the technic of
+reduction and subsequent treatment in such cases.
+
+Fractures are classified by many authorities as being _simple_,
+_compound_, and _comminuted_. This method is practical because it
+separates dissimilar conditions. There are also grouped fractures, the
+pathologic anatomy of which is similar. Classification on an etiological
+basis would attempt to associate conditions, the morbid anatomy and
+gravity of which would justly preclude their being combined.
+
+Simple Fracture is a condition where the continuity of the bone has
+been broken without serious destruction of the soft structures adjacent,
+and where no opening has been made to the surface of the flesh. Such
+fractures do not reduce the bone to fragments. Long bones are frequently
+subjected to simple fracture, while short thick bones, such as the
+second phalanx, may suffer multiple or comminuted fractures.
+
+Compound Fracture designates a break of bone with the destruction of
+the soft tissues covering it, making an open wound to the surface of the
+skin. This form of fracture is serious because of the attendant danger
+of infection, and in treatment, necessitates special precaution being
+taken in the application of splints that the wound may be cared for
+without infection of the tissues. These fractures generally occur as a
+result of some forceful impact through the flesh to the bone, or where
+the bones are driven outward by the blow. Common examples are in
+fractures of the metacarpus and metatarsus of the first phalanx. This
+kind of injury in mature horses usually produces an irreparable
+condition, and viewed economically, is generally considered fatal.
+
+Comminuted Fractures, as the term implies, are those cases wherein the
+bone is reduced to a number of small pieces. This kind of break may be
+classified as simple-comminuted fracture when the skin is unbroken, and
+when the bone is exposed as a result of the injury, it is known as a
+compound-comminuted fracture. Such fractures are caused by violent
+contusion or where the member is caught between two objects and
+crushed.
+
+
+Multiple Fractures.
+
+Fractures are called _multiple_ when the bone is reduced to a number of
+pieces of large size. This condition differs from a comminuted fracture
+in that the multiple fracture may break the bone into several pieces
+without the pieces being ground or crushed, and the affected bone may
+still retain its normal shape.
+
+Further classification is of value in describing fractures of bone with
+respect to the manner in which the bone is broken--the direction of the
+fissure or fissures in relation to its long axis.
+
+A fracture is _transverse_ when the bone is broken at a right angle from
+its long axis. Such breaks when simple, are the least trouble to care
+for because there is little likelihood that the broken ends of bone will
+become so displaced that they will not remain in apposition. _Simple
+transverse_ fracture of the metacarpus, for instance, constitutes a
+favorable case for treatment if other conditions are favorable.
+
+_Oblique fractures_, as may be surmised, are solutions of continuity of
+bone in such manner that the fissure crosses the long axis of a bone at
+an acute or obtuse angle. These fractures are prone to injure the soft
+structures adjacent, and are frequently compound, as well. Moreover,
+because of the fact that the apposing pieces of bone are beveled, the
+broken ends of bone are likely to pass one another in such a way as to
+shorten the distance between the extremities of the injured member.
+Contraction of muscles also tends to exert traction upon a bone so
+fractured, resulting in a lateral approximation of the diaphysis and
+thus preventing union because the broken surfaces are not in proper
+contact.
+
+Fractures are _longitudinal_ when the fissure is parallel with the long
+axis of the bone. This variety of break is not infrequent in the first
+phalanx; and a vertical fracture of the second phalanx is also said to
+be longitudinal, however, there is little difference (if any, in some
+subjects) between the vertical and transverse diameters of this
+particular bone.
+
+_Green stick fractures_ are essentially those resulting from falls to
+young animals. They are usually sub-periosteal and when the periosteum
+is left intact or nearly so, no crepitation is discernible. If this
+fracture is _simple_, prompt recovery may be expected. Bones of young
+animals, because they do not contain proportionately as much mineral
+substance as do bones of adults, are more resilient and less apt to
+become completely fractured. They are, however, subject to what is known
+as green stick fracture.
+
+_Impacted fractures_ are usually occasioned by falls. When the weight of
+the body is suddenly caught by a member in such manner as to forcefully
+drive the epiphyseal portions of bone into and against the diaphysis,
+_multiple longitudinal_ fractures occur at the point of least
+resistance. Parts so affected undergo a fibrillary separation,
+increasing the transverse diameter of the bone; or if the impact has
+been sufficiently violent, the portion becomes an amorphous mass.
+
+In a treatise on the subject of lameness, the bones chiefly concerned
+and most often affected must be especially considered. The shape and
+size of a bone when injured, determines in a measure, the course and
+probable outcome in most cases, but of first and greater importance is
+the function of the bone. A fracture of the fibula in the horse need not
+incapacitate the subject, but a tibial fracture is serious and generally
+proves cause for fatal termination. The body of the scapula may be
+completely fractured and recovery will probably result in most cases
+without much attention being given to the subject, yet a fracture of the
+neck of this same bone constitutes an injury of serious consequence. The
+difference in the function of different parts of this same bone, as well
+as its shape and mode of attachment, determine the gravity of the case;
+so it is in fractures of other bones with respect to the course and
+prognosis of the case--function is the important factor to be
+considered.
+
+Next in importance is the age of the animal suffering fracture of the
+bone. Capacity for regeneration is naturally greater in a vigorous,
+young animal than in aged or even middle-aged subjects. A healthy
+condition of the bone and the body favor the process of repair in case
+of fracture, and prognosis may be favorable or unfavorable, depending
+upon these factors mentioned for consideration. Individuals of the same
+species, differing in temperament, may comport themselves in a manner
+that is conductive to prompt recovery, or to early destruction. This
+feature cannot be overestimated in importance, as it is sometimes a
+decisive element, regardless of other conditions. A horse suffering from
+an otherwise remediable pelvic fracture may be so worried and tortured
+by being confined in a sling that the case calls for special attention
+and care because of the animal's temperament. Sometimes, the constant
+presence of a kind attendant will so reassure the subject that it will
+become resigned to unnatural confinement, in a day or two. This
+precaution may, in itself, determine the outcome, and the wise
+veterinarian will not overlook this feature or fail to deviate from the
+usual rote in the handling of average cases. Recovery may be brought
+about in irritable subjects by this concession to the individual
+idiosyncrasies of such animals.
+
+
+AFFECTIONS OF LIGAMENTS.
+
+Ligaments which have to do with the locomotory apparatus are, for the
+most part, inelastic structures which are composed of white fibrous
+tissue and serve to join together the articular ends of bones; to bind
+down tendons; and to act as sheathes or grooves through which tendons
+pass, and as capsular membranes for retention of synovia in contact with
+articular surfaces of bones.
+
+Ligaments are injured less frequently than are bones. Because of their
+flexibility they escape fracture in the manner that bones suffer. They
+are, however, completely severed by being cut or ruptured, though
+fibrillary fracture the result of constant or intermittent tensile
+strain is of more frequent occurrence.
+
+Simple inflammation of ligaments is of occasional occurrence but, unless
+considerable injury is done this tissue, no perceptible manifestation of
+injury results. No doubt many cases wherein fibrillary fracture of
+ligaments (sprain) takes place some lameness is caused, but because of
+the dense, comparatively nonvascular nature of these structures, little
+if any manifestation, except lameness, is evident. And such cases, if
+recognized are usually diagnosed by excluding the existence of other
+possible causes and conditions which might also cause lameness.
+
+Certain ligaments are subjected to strain more than are others and
+therefore, when so involved, frequently cause lameness. Examples of this
+kind are affections of the collateral (lateral) ligaments of the
+phalanges. Because of the leverage afforded by the transverse diameter
+of the foot, when an animal is made to travel over uneven road surfaces,
+considerable strain is brought to bear on the collateral ligaments of
+the phalanges. A sequel to this form of injury is a circumscribed
+periostitis at the site of attachment of the ligaments and frequently
+the formation of an exostosis--ringbone--results.
+
+Where sudden and violent strain is placed upon a ligament and rupture
+occurs, the division is usually effected by the ligament being torn from
+its attachment to the bone. In such cases, a portion of periosteum and
+bone is usually detached and the condition may then properly be called
+one of fracture. In some cases of this kind recovery is tardy, because
+of the difficulty in maintaining perfect apposition of the divided
+structures, and reactionary inflammation is not of sufficient extent to
+enhance prompt repair. In fact, some cases of this kind seem to progress
+more favorably, when no attempt at immobilization of the affected member
+is attempted.
+
+If some freedom of movement is allowed, acute inflammation resulting in
+nature's provisional swelling soon develops and repair is hastened
+because of increased vascularity. But where luxation of phalanges
+accompanies sprain, reposition and immobilization are necessary--that is
+if cases are thought likely to benefit by any treatment.
+
+
+Luxations--Dislocations.
+
+Luxation or dislocation is a condition where the normal relation between
+articular ends of bones has been deranged to the extent that partial or
+complete loss of function results. When a bone is luxated (out of
+joint), there has occurred a partial or complete rupture of certain
+ligaments or tendons; or a bone may be luxated when an abnormal or
+unusual elasticity of inhibitory ligaments or tendons obtains.
+
+Luxations may be practically classified as _temporary_ and _fixed_. In
+temporary luxations, disarticulation is but momentary and spontaneous
+reposition always results; while a fixed luxation does not reduce
+spontaneously but remains luxated until reposition is effected by proper
+manipulation and treatment. Fixed luxation may be of such character as
+to be practically irreducible because of extensive damage done to
+ligaments or cartilage. Where a complete luxation of the
+metacarpophalangeal joint exists, it is probable that in most cases
+sufficient injury to collateral and capsular ligaments has been done to
+render complete recovery improbable, if not impossible.
+
+Temporary luxation of the patella is a common affection of the horse and
+fixed luxation of this bone also occurs. As a matter of fact, in the
+horse, patellar luxation is the one frequent affection of this kind.
+
+As a rule, complete disarticulation immobilizes the affected joint and
+in most instances there is noticeable an abnormal prominence in the
+immediate vicinity--in patellar luxation, the whole bone. In other
+instances the articular portion only, of the affected bone is
+malpositioned. Usually, luxation and fracture may be differentiated in
+that there is no crepitation in luxation and more or less crepitation
+exists in fracture.
+
+It is evident, when one considers the symptomatology and nature of the
+affection, that fixed luxation is usually caused by undue strain or
+violent and abnormal movement of a part. Joints having the greater
+freedom of movement are apt to suffer luxation more frequently.
+
+
+Arthritis.
+
+The study of arthritis in the horse is limited to a consideration of
+joint inflammations which, for the most part, are of traumatic origin.
+Unlike the human, the horse is not subject to many forms of specific
+arthritis--tubercular, gonorrheal, syphilitic, etc.
+
+A practical manner of classification of arthritis is _traumatic_ and
+_metastatic_.
+
+_Traumatic arthritis_ may result from all sorts of accidents wherein
+joints are contused. Such cases may be considered as being caused by
+direct injuries. Instances of this kind, depending on the degree of
+insult, manifest evidence of injury which ranges from a simple
+synovitis to the most active inflammatory involvement of the entire
+structure and adjacent tissues.
+
+The reactionary inflammation which attends a case of tarsitis caused by
+a horse being kicked is a good example of the result of direct injury.
+Such cases, if the contusion is of sufficient violence, result in
+arthritis and periarthritis. In inactive farm horses, during cold
+weather, this condition becomes chronic, swelling remains for weeks
+after all lameness and pain have subsided and occasionally hyperthrophy
+is permanent.
+
+Arthritis occasioned by indirect injury, such as characterizes joint
+inflammation from continuous concussion, is seen in horses that are
+worked at a rapid pace on city streets or other hard road surfaces. Such
+affections may be acute, as in some cases of spavin, but are usually
+inflammatory conditions that do not occasion serious disturbance when
+these affections become chronic. If the involvement persists with
+sufficient active inflammation, there may follow erosion of cartilage
+and incurable lameness. If extensive necrosis of cartilage takes place,
+the attendant pain will be sufficient to cause the animal to favor the
+diseased part and such immobilization enhances early ankylosis--nature's
+substitute for resolution in this disease.
+
+Wounds invading the tissues adjacent to joints, when these wounds are of
+considerable extent, cause inflammation of such articulations by
+contiguous extension of inflammation. As long as an injury remains
+practically aseptic, or if infected and the septic process does not
+involve the joint proper by direct extension, no more serious
+disturbance than a simple synovitis will result. If, instead, a
+periarthritic inflammation is serious or destructive in character, the
+type of arthritis will be grave--even though due to an indirect cause.
+
+Where a vulnerant body penetrates all structures and invades the
+interior of the joint capsule the result is that a more or less active
+disturbance is incited. The introduction of a sterile instrument into a
+joint cavity, under strict asepsis, where a perfect technic is executed,
+does not cause perceptible manifestation of the injury, if the opening
+so made is small--such as a suitable exploratory trocar makes. But a
+puncture made in a similar manner and with the same instrument without
+due regard to asepsis is likely to cause an infectious synovitis and
+arthritis usually follows.
+
+A larger opening than is produced by means of an exploratory trochar may
+be made into a joint cavity, causing escape of synovia as it is secreted
+for days and even for weeks and no serious or permanent trouble is
+experienced in some cases. If the synovitis or arthritis remains
+non-infected and the wound, traumatic or surgical, is not too large,
+healing by granulation occurs, and the discharge of synovia ceases.
+However, if synovial discharge persists too long because of tardy
+closure of an open joint, there is great danger of infection gaining
+entrance into the synovial cavity, or in some instances, desiccation of
+endothelial cells of the articulation occurs, in areas, and the
+reactionary inflammation eventually results in ankylosis.
+
+A small puncture which introduces into the synovial cavity infectious
+material of active virulence will cause an arthritis that is more
+serious, much more painful and more difficult to handle than is
+occasioned by a wound of moderate size, that affords ready escape of
+synovia even through the virulence of the infection be the same.
+
+Synovia is a good culture medium and the environment is ideal for
+multiplication of bacteria; consequently, the grave disturbances which
+may attend the introduction of pathogenic organisms into a synovial
+cavity as the result of a puncture wound are not to be forgotten. The
+veterinarian is in no position to estimate the virulency of organisms so
+introduced; neither can he determine the exact degree of resistance
+possessed by the subject in any given case. Therefore, he is uncertain
+as to the best method of handling such cases where an injury has been
+recently inflicted and positive evidence of the existence of an
+infectious synovitis is not present. If one could determine in advance
+the degree of infection and injury that is to follow small penetrant
+wounds of joint capsules, it would then be possible to select certain
+cases and immediately drain away all synovia and fill the cavity by
+injection with suitable antiseptic solutions.
+
+This offers a broad field for experimentation which will in time be
+productive of a radical change in the manner of treating such cases.
+
+_Metastatic arthritis_ is seen more frequently in colts or young animals
+than in mature horses and we here take the liberty of classifying with
+the arthritis of omphalophlebitis and strangles the so-called rheumatic
+variety.
+
+A specific polyarthritis or synovitis which attends navel infection of
+foals is perhaps the most frequent form of arthritis that is to be
+considered metastatic. This condition is truly a disease of young
+animals and, while it is a specific arthritis, the cause is yet to be
+attributed to any definite pathogenic organism with certainty. This
+condition is well defined by Bollinger as quoted by Hoare,[1] when he
+calls it a purulent omphalophlebitis due to local infection of the
+umbilicus and umbilical vessels, by pyogenic organisms, causing a
+metastatic pyemia.
+
+This affection is grave; its course is comparatively brief; the
+prognosis is usually unfavorable; and omphalophlebitis occasions a form
+of lameness which at once impresses the practitioner that serious
+constitutional disturbance exists. Its consideration properly belongs to
+discussions on practice or obstetrics and diseases of the new born, and
+it has received careful attention and is discussed at length in these
+works.
+
+A second form of metastatic arthritis is met with in strangles.
+Strangles occurs in the young principally and is not a frequent cause of
+synovitis or arthritis in the adult animal.
+
+Strangles or distemper is, according to most pathologists, due to the
+Streptococcus equi. Hoare[2] states that in this type of specific
+arthritis the contagium is probably carried by the blood. He gives it as
+his opinion that even laminitis has occurred as a result of the
+streptococcus-equi. This, indeed, would point toward probable extension
+by the blood as well as by way of lymph vessels.
+
+Septic synovitis and infectious arthritis are always serious affections
+even in young animals and much depends upon individual resistance and
+early rational treatment in such cases, if recovery is to follow.
+
+The same general plan of treatment is indicated in this kind of septic
+synovitis as is employed in all cases of infective synovitis and septic
+infection in open joints. There is to be considered, however, the fact
+that the young animal is more agile, a better self-nurse, and in a
+general way more apt to recover than is the adult, under similar
+conditions.
+
+_Rheumatic arthritis_, if one is justified in classifying rheumatic
+inflammation of joints as a metastatic form of arthritis, is not a
+common condition, though seen in mature and aged animals. Cases that may
+be diagnosed with certainty are usually advanced affections wherein
+dependable history is obtainable and the symptoms are well marked.
+
+Rheumatism may be thought of, with respect to arthritic inflammation
+caused thereby, as a sort of pyemia. Undoubtedly, exposure to wet and
+cold weather is an active factor, but probably a predisposing one only.
+Likewise a member that suffers from chronic inflammation due to
+recurrent injury or to constant or repeated strain is less able to
+resist the vicissitudes of climate and work.
+
+Consequently, rheumatic arthritis is to be seen affecting horses that
+are in service, more often at heavy draft work where they are exposed to
+severe straining of joints; where stabling is insanitary; and where they
+are obliged to lie down (if they do not remain standing) upon cold and
+wet ground or upon hard unbedded floors or paving.
+
+Where such inhumane and cruel treatment is given animals those
+responsible ought to be impressed with the unfairness to the animal as
+well as the economic loss occasioned by inflicting such unnecessary and
+merciless treatment upon their helpless and uncomplaining subjects. The
+very nature of the veterinarian's work affords him constant and frequent
+opportunity to convince those who are responsible for keeping animals in
+this manner, that it is inhumane and unprofitable.
+
+Cases of this kind are not uncommon about some grading and lumbering
+camps and in contract work where, often, shelter for animals is given
+little thought; the result is a cruel waste of horseflesh.
+
+Chronic articular rheumatism is occasionally observed in young animals
+that have never been in service. In these cases it seems that there
+exists an individual susceptibility and in some instances the condition
+is recurrent. Each attack is of longer duration, and eventually death
+results from continued suffering, emaciation and intoxication.
+
+
+AFFECTIONS OF BURSAE AND THECAE.
+
+Acute bursitis and thecitis is of frequent occurrence in horses because
+of direct injury from contusion, punctures and other forms of
+traumatism. These synovial membranes, with few exceptions, when inflamed
+occasion a synovitis that may be very acute, yet there is less
+manifestation of pain than in arthritis.
+
+It is only in structures such as the bursa intertubercularis or in the
+sheath of the deep digital flexor that an inflammation causes much pain
+and is apt to result in permanent lameness. This is due to the peculiar
+character of the function of such structures.
+
+An acute inflammation of a small bursa may even result in the
+destruction of such synovial apparatus without serious inconvenience to
+the subject, either at the time of destruction or thereafter.
+Obliteration of the superficial bursa over the summit of the os calcis
+is not likely to cause serious inconvenience or distress to the subject
+unless it be due to an infected wound. Even then, with reasonably good
+care given the animal, recovery is almost certain. Complete return of
+function of the member and cessation of lameness takes place within a
+few weeks in the average case.
+
+Where an infectious synovitis involves a structure such as the sheath of
+the tendon of the deep digital flexor (perforans) the condition is grave
+and because of the location of this theca the prognosis is not much more
+favorable than in an articular synovitis.
+
+Inflammation of bursae and thecae may be classified on a chronological
+basis with propriety because the duration of such affections, in many
+cases, materially modifies the result. A chronic inflammatory
+involvement of a theca through which an important tendon plays may cause
+adhesions to form. Or there may occur erosions of the parts with
+eventual hypertrophy and loss of function, partial or complete.
+
+However, in general practice a classification on an etiological basis
+is probably more practical and we shall consider inflammation of bursae
+and thecae as _infectious_ and _noninfectious_.
+
+_Infectious_ bursitis and thecitis is usually the result of direct
+introduction of septic material into the synovial structure by means of
+injuries. Infection by contiguous extension occurs and also metastatic
+involvement is met with occasionally.
+
+The noninfectious inflammation of bursae and thecae usually result from
+contusions or strains and generally run their course without becoming
+infective in character, where vitality and resistance of the subject are
+normal.
+
+In a general way, inflammation and other affections of bursae and thecae
+are considered very similar to like affections of joints.
+
+
+AFFECTIONS OF MUSCLES AND TENDONS.
+
+Muscles and tendons having to do with locomotion are more frequently
+injured than are any of the other structures whose function is to propel
+the body or sustain weight. This is due in part to the exposed position
+of muscles and tendons. They serve as a protection to the underlying
+structures and in this manner receive many blows the force and violence
+of which are spent before injury extends beyond these tissues.
+
+Muscles of the breast, shoulder and rump are most frequently the
+recipient of injuries of various kinds. The abductors of the thigh are
+subjected to bruising when horses are thrown astride of wagon poles or
+similar objects. Thus in one way or another muscle injuries are
+occasioned and cause lameness.
+
+Traumatic affection of muscles of locomotion may be surface or
+subsurface--subsurface with little injury done the skin and fascia, but
+with subsurface extravasation of blood and masceration of tissue.
+Puncture wounds wherein the vulnerant body is of small diameter, are
+observed, and they occasion deep seated infectious inflammation of the
+parts affected, with surface wounds that are often unnoticeable. Such
+injuries--puncture wounds--are always serious, and because of the fact
+that, there exists little evidence of injury at the time of their
+infliction, treatment is usually deferred several days and often
+infection has become quite extensive when the practitioner is consulted.
+
+Where infective wounds of muscles of locomotion occur, the course and
+gravity of the affection are directly influenced by the proximity of the
+injury to lymph plexuses. For instance, injuries causing an infectious
+inflammatory involvement of the adductors of the thigh may result in a
+generalization of the infection by way of the inguinal lymph glands.
+
+Large open wounds that extend deep into muscles, render inactive such
+structures, and even where division is not complete, the pain occasioned
+causes the subject to favor the part in every way possible. Contraction
+of muscular fibers of such parts increases pain and because of this fact
+groups of muscles are at times disabled because of injury done to one
+muscle. Instances of this kind are frequently seen where shoulder
+injuries, which affect but one muscle, exist; yet because of such injury
+a marked swinging-leg lameness is present.
+
+Tendons, because of their inelasticity, are subjected to injuries
+peculiar to themselves. In addition to being affected as are muscles,
+wounds of many kinds are found to affect tendons--contusions,
+interference wounds, penetrant wounds, incised wounds and lacerations.
+
+However, the commoner form of injury done tendons, is strain or sprain.
+Because of the sudden tensile strain brought to bear upon tendons in the
+shocks of concussion, as well as in propulsion of the body, there
+frequently occurs a rupture of fibers and this we know as sprain.
+
+Sprains may be considered as fibrillary fractures of soft structures and
+since this form of injury is subsurface, and limited to fractional
+portions of tendons, the inflammation occasioned usually remains an
+aseptic one. Reaction to this form of injury is characterized by
+inflammation, the course of which is erratic and variable. In chronic
+inflammation of tendons, where animals are continued in service, the
+usual sequel is contraction, or shortening of these structures.
+
+The degree of contraction as well as its import varies in different
+subjects and in the various tendons which may be affected. Contraction
+is a slow-going process that is progressive, gradually causing a
+decrease in the length of the affected structure and eventually
+rendering the animal useless.
+
+The practice of applying shoes with extended toe-calks for the purpose
+of "stretching" contracted deep digital flexor tendons (flexor pedis
+perforans) cannot be too strongly condemned. While the addition of an
+extension such as is ordinarily employed to the toe of a shoe of this
+kind, prevents for a time, frequent stumbling in such cases, the
+increased tensile strain which is thus occasioned hastens further
+contraction and subjects animals so shod to much unnecessary pain.
+
+
+AFFECTIONS OF NERVES.
+
+Because of their being protected by other structures, nerve trunks,
+which supply muscles of locomotion, are not subjected to frequent
+injuries such as contusions. However, they do become injured at times
+and the result is lameness, more or less severe.
+
+Lameness originating from nerve affection, may involve central
+structures as, for example, the spinal cord, medulla oblongata or parts
+of the brain. In making an examination of some lame animals it is
+necessary to distinguish between cases of lameness that are of central
+origin and marked by incoördination of movement, and disturbances caused
+by other affections. Tetanus in its incipiency should not be confused
+with laminitis involving all four feet, or with certain forms of
+pleuritis, when careful examination is made, yet, in a way, to one not
+trained, the clinical symptoms are similar.
+
+Disturbances of nerve function are caused in a variety of ways. It is
+not within the scope of this work to discuss central nervous
+disturbances caused by ingestion of mouldy provender, or disturbances of
+the brain or cord occasioned by infectious diseases, but mention of the
+existence of such conditions is appropriate.
+
+By direct injury the result of blows, certain nerves are injured and
+muscles supplied by such nerves are rendered inactive. Depending upon
+the nature and extent of an injury thus inflicted, so the manner in
+which the affection is manifested varies. The suprascapular nerve is
+rather frequently injured causing partial or complete loss of function
+of the structures supplied by this nerve, and abduction of the
+scapulohumeral joint naturally results.
+
+In some cases of dystocia the obturator nerve, (or nerves, if the
+involvement is bilateral), becomes injured by being caught between the
+maternal pelvis and some dense part of the fetus. This results in
+paralysis of the adductors of the thigh if sufficient injury is done.
+
+It is said that nerves become over-stretched and held tense, in certain
+positions in which animals are obliged to remain while cast in
+confinement such as in some instances where unusual methods of restraint
+are employed. When the fore feet are drawn backward in such manner that
+great strain is put upon the radial nerve, it suffers more or less
+injury, and this is followed by partial or complete paralysis which may
+be temporary or permanent.
+
+Degenerative changes affecting nerves, as in other tissues, occur and
+more or less locomotory impediment will follow--this depending upon the
+nerve or nerves affected and the nature of such involvement. Tumors may
+surround nerves and eventually the nerve so exposed becomes implicated
+in the destructive process. Before degenerative changes take place in
+the nerve substance, in such cases, pressure may completely paralyze a
+nerve when it is so situated. Melanotic tumors in the paraproctal tissue
+in some cases, because of the large size of the new-growths, cause
+paralysis of the sciatic nerve. The author has seen one case of brachial
+paralysis occasioned by an enormous development of fibrous tissue
+involving the structures about the ulna.
+
+
+AFFECTIONS OF BLOOD VESSELS.
+
+Lameness caused by disturbances of circulation may be due to structural
+affection of vessels, or functional disorders of the heart, and in some
+instances, a combination of these causes may be active.
+
+Direct involvement of vessels is the commoner form of circulatory
+disturbance which occasions lameness, and the most frequent cause is of
+parasitic origin. Sclerostomiasis with attendant arteritis, thrombus
+formation and subsequent lodgement of emboli in the iliac, femoral, or
+other arteries, causes sufficient obstruction to prevent free
+circulation of blood, and the characteristic lameness of thrombosis
+results.
+
+Indirect injury to vessels may occur because of contused wounds and
+subsequent inflammation of tissues supplied by such vessels. If the
+injury be of sufficient extent, considerable extravasation of blood will
+take place and the painfully swollen parts necessarily impair
+locomotion. In such instances lymph vessels participate in the
+disturbance, and the condition then becomes one wherein lymphangitis is
+the predominant disturbing element.
+
+Angiomatous tumors are occasionally found affecting horses'
+legs--usually the result of some injury; and because of their size or
+position, they mechanically interfere with function. Furthermore, when
+such tumors are located on the inner or flexor side of joints, enough
+pain is occasioned that affected animals show evidence of distress,
+usually by intermittent lameness.
+
+Horses do not suffer from distension of veins as does man, that is,
+there is rarely to be seen a case wherein much disturbance from this
+source exists.
+
+
+AFFECTIONS OF LYMPH VESSELS AND GLANDS.
+
+Inflamed lymph vessels and glands, the result of various causes, is a
+rather common source of lameness of horses. When one considers the
+proportion of tissue that is composed of lymph vessels and glands, it is
+then obvious that inflammation of these structures should cause a
+painful affection of members, when so affected, and that marked lameness
+and, in some instances, general constitutional disturbance such as
+anorexia, hyperthermia and general circulatory disorder are to follow.
+
+Lymphangitis is most frequently occasioned by the introduction of septic
+material into the tissues; consequently, infectious lymphangitis is more
+frequently observed than the non-infectious type.
+
+Specific infectious forms of lymphangitis are seen in glanders and in
+strangles; infectious types of this disturbance are found in many
+instances where, initially, a localized or circumscribed infection has
+occurred--the contagium having been introduced by way of an injury. An
+example of this kind is to be seen in a wound perforating the tibial
+fascia, where the injury is inflicted by means of a horse being kicked
+by another animal shod with sharp shoe-calks. Cases of this kind
+invariably result in a septic lymphangitis, and frequently lymphadenitis
+also occurs, for the inguinal lymph glands are so situated that their
+becoming contaminated is almost certain.
+
+The trite phrase that "the tissues are bathed in lymph" should make
+clear the reason for the frequent occurrence of infectious lymphangitis
+and lymphadenitis. Foreign substances, bacteria and their products,
+inorganic material and in fact, anything that is introduced into the
+tissues, if soluble or miscible, will be taken up and conveyed by the
+afferent lymph vessels and disseminated throughout the system--hence the
+constitutional disturbances so frequently thus caused.
+
+A non-infectious type of lymphangitis is frequently seen in the heavy
+draft breeds of horses and in such cases one or both hind legs are
+involved--it is very seldom that the thoracic limbs become so affected.
+Law[3] refers to this ailment as "Acute Lymphangitis of Plethora in
+Horse." When one takes into consideration that these cases so frequently
+occur in heavy draft animals that are not worked regularly, that the
+pelvic limbs are the ones involved, and that the disorder often runs a
+short course (recovery often taking place within two or three days, with
+no treatment given other than a purge, circulatory stimulants and
+walking exercise) it is plausible to ascribe the condition to idiopathic
+factors.
+
+Admitting the frequency of non-infectious lymphangitis, the practitioner
+must not confuse this type with similar lymphatic inflammation
+occasioned by nail punctures of the foot. It is very embarrassing indeed
+to make a diagnosis of lymphangitis--expecting that the disturbance will
+terminate favorably and uneventually--and later to discover a sub-solar
+abscess caused by a nail prick in the region of the heel.
+
+Recurrent attacks of this disturbance cause hypertrophy of the lymph
+vessels and in some cases lymphangiectasis. In old subjects used for
+dissection or surgical purposes, it is very evident that in the ones
+which have suffered from chronic lymphangitis there exists an excessive
+amount of sub-facial connective tissue, making subcutaneous neurectomies
+quite difficult in some instances.
+
+A sequel of chronic lymphangitis is a condition known as elephantiasis.
+In such cases there occurs a hyperplasia of the skin and subcutaneous
+tissues, resulting in some instances, in the affected member attaining
+an enormous size. Sporadic cases of this kind are to be seen
+occasionally, and are apparently caused by repeated attacks of
+lymphangitis. The affection is not benefited by treatment, and while a
+horse's leg may become so heavy and cumbersome as to mechanically impede
+its gait, as well as to fatigue the subject when made to do service even
+at a slow pace, elephantiasis causes no constitutional derangement. The
+hind legs, in elephantiasis, are affected and a unilateral involvement
+is more often seen than a bilateral one. The legs may be enlarged from
+the extremity to the body, but ordinarily the affection does not extend
+higher than the hock or the mid-tibial region.
+
+A chronic, progressive, hyperplastic-degeneration exists in some cases
+and the subjects are in time rendered unserviceable because of the
+burden of getting about encumbered by the affected extremity. In other
+animals hyperplasia progresses for a time--until the parts become
+greatly enlarged and conditions apparently attain an immutable state.
+Nevertheless animals so affected may continue in service for years
+without being distressed.
+
+
+AFFECTIONS OF THE FEET.
+
+Lameness is very often due to affections of the feet, and in all foot
+diseases probably the most constant cause is injury inflicted in some
+manner. Resultant from injury, there frequently develops complications
+and the one most often seen is infection.
+
+Because of the fact that the feet are constantly exposed to germ-laden
+soil and filth, if not actually bathed in such infectious materials, it
+naturally follows that septic infection of some part of the feet must be
+of frequent occurrence.
+
+Subsequent to being obliged to stand in mud and other damp or wet media,
+exposure to desiccating influences such as stabling upon dry floors, or
+at service on hot and dry road surfaces causes the insensitive parts of
+the feet to become dry, hard and brittle. This favors "checking" of the
+protecting structures and it frequently results in the formation of
+large fissures which expose the underlying sensitive parts of the feet
+and lameness is the inevitable outcome.
+
+The function of the feet--bearing the weight of the animal at all times
+when the subject is not recumbent, and in addition to this, the
+increased strain put upon them at heavy draft work, together with the
+concussion and buffeting occasioned by locomotion, make the feet
+susceptible to frequent affections of various kinds.
+
+Being almost completely encased by a somewhat inexpansible and
+insensitive wall and sole, renders the foot subject to pathologic
+changes peculiar to itself. The very nature of the structure of the foot
+together with the function of the sensitive lamina is sufficient cause
+for an affection unlike that seen involving other tissues--laminitis.
+
+An exhaustive consideration of foot affections is a study in itself and
+one that comes within the realm of pathologic shoeing; nevertheless, a
+practical knowledge of diseases of the foot is indispensable in the
+diagnosis of lameness wherein the foot may be at fault.
+
+The peculiar nature of foot affections renders them difficult of
+classification on any sort of basis that is helpful in the consideration
+of this subject. Injuries are the most constant cause of foot lameness,
+yet one must admit that there results complications because of infection
+in most instances; and that in some cases the injury is slight--just
+enough to permit the introduction of vulnerant organisms into the
+tissues. Therefore, one might well classify affections of the feet as
+infectious and non-infectious. There can be grouped in the class of
+infectious affections such conditions as nail pricks, calk wounds and
+canker. In the class of non-infectious affections one may consider
+conditions such as laminitis, strain and fractures.
+
+FOOTNOTES:
+
+[Footnote 1: A System of Veterinary Medicine by E. Wallis Hoare,
+F.R.C.V.S., Vol. I, page 519.]
+
+[Footnote 2: Ibid, page 807.]
+
+[Footnote 3: Vol. I, page 534, Veterinary Medicine, by James Law,
+F.R.C.V.S.]
+
+
+
+
+SECTION II.
+
+DIAGNOSTIC PRINCIPLES.
+
+
+_To observe attentively is to remember distinctly._--_Poe_.
+
+Before treatment is administered in constitutional disturbances
+resulting in disease, _cause_ is logically sought; so, in order to
+handle effectively any case of lameness, it is necessary first to
+discover the source of the trouble and contributing conditions affecting
+the structures. Hence, diagnostic ability is the prime requisite; and a
+thorough knowledge of pathologic anatomy or of surgical technic is of
+little value if this knowledge is not applied with the insight of the
+trained diagnostician.
+
+The cruel and unnecessary methods employed by those untrained for
+diagnostics, cannot be too vigorously condemned. For instance, the
+application of an active and depilating vesicant upon a large area on
+the gluteal or crural region, in a case where the practitioner "guesses"
+the condition to be one of "hip lameness," constitutes an exposition of
+gross ignorance, and at once stamps the perpetrator as a crude bungler
+without scientific insight whose works are no credit to his profession.
+How much better it would be, if the practitioner does not see fit to
+call in a competent consultant, to prescribe a suitable agent to be
+given internally, and to recommend complete rest for the subject.
+
+In establishing a diagnosis in such cases, the student or practitioner
+seldom has recourse to laboratory assistance, and his work is done by
+means of physical examination; therefore, a thorough knowledge and a
+clear conception of the physiology of locomotion are essential.
+Memorizing nosological facts without an understanding of underlying
+principles is of no more practical benefit for qualification as a
+diagnostician in cases of lameness, than is the employment of similar
+methods in the study of theory and practice. A knowledge of the dosage
+of drugs does not in itself qualify one as being competent to administer
+such therapeutic agents to a proper effect. How much is a practitioner
+benefited by the knowledge that a high temperature is usually present in
+septic intoxication, if he is not possessed of a scientific
+understanding of anatomy, physiology, bacteriology and pathology, as
+well as the principles of clinical diagnosis?
+
+In order to determine the reasons for certain symptoms manifested by the
+subject, an analysis of these symptoms is the proper method of
+procedure, insofar as this is possible. If one may reason that an animal
+assumes a certain position while at rest to allow relaxation of an
+inflamed tendon or ligament, such a fact enables the diagnostician to
+recall that this is indicative of some specific ailment. In acute
+tendinitis, the subject while at rest, maintains the affected member in
+volar flexion because this position permits relaxation of the inhibitory
+apparatus, including the inflamed tendon. Likewise, the various abnormal
+positions assumed,--adduction, abduction, undue flexion or
+pointing--have their own significance and are taken into account by the
+trained diagnostician in the course of an examination.
+
+In the examination of lame subjects, where the cause is not obvious, a
+systematic method of diagnosis is pursued even by the most expert
+practitioners. In all obscure cases of lameness a methodical and
+thoroughly practical examination of the animal according to an
+established procedure is necessary to determine the nature and source of
+the affliction.
+
+
+Anamnesis.
+
+The first thing to be given consideration in diagnosis is the fact that
+related history of the case is not always dependable, because of lack of
+accurate observation or wilful deceit on the part of the owner or
+attendant. The successful veterinarian soon acquires the faculty of
+obtaining information in a manner best adapted to his client,--either by
+direct interrogation or by subtle means of suggestion, and in this way
+he draws out evaded facts essential to his diagnosis. In time he learns
+to make allowance for misstatements made to shield the owner or driver
+and to hide the facts of apparent neglect or abuse that the subject may
+have experienced. A suppurating cartilaginous quittor, complicated by
+the presence of a large amount of hyperplastic tissue, cannot be
+successfully represented to be an acute and recently developed
+affection, where a trained practitioner is left to judge the validity of
+the statement.
+
+In complicated conditions, where there is evident a chronic disturbance
+which could not be conceived as sufficient cause for a marked
+manifestation of lameness, accurate history of the case may be of great
+aid in arriving at a diagnosis. An aged animal, having recently become
+very lame, showing a small exostosis on the first phalanx, and with the
+history given that the osseous deposit was of long standing, should at
+once lead the veterinarian to seek the source of trouble elsewhere.
+
+
+Visual Examination.
+
+As in all diagnostic work, a careful visual examination of the subject
+should be made before it is approached. The novice is given to hasty
+examination by palpation, not realizing how much may be revealed by a
+careful scrutiny of the subject. In this way he is led to erroneous
+conclusions which the skilled diagnostician has learned from experience
+to avoid. _Too much emphasis cannot be placed on the importance of
+making a thoughtful visual examination in every instance before the
+subject is approached._ In this examination, type, conformation and
+temperament are taken into account at once, for each of these qualities
+is in itself, a determining factor in predisposing a subject to certain
+ailments or inherent attributes, which may exert a favorable or
+unfavorable influence upon existing conditions and thus make recovery
+probable or otherwise.
+
+Draft animals are less likely to be permanently incapacitated as a
+result of tendinitis, than are thoroughbreds. Likewise, one would not
+expect to find this affection present in heavy harness horses as
+frequently as in light harness animals.
+
+Mal-formation of a part, or an asymmetrical development of the body as a
+whole, may render an animal susceptible to certain affections which
+cause lameness. A "tied in" hock predisposes the subject to curb, and an
+animal having powerful and well-developed hips and imperfectly formed
+hocks, will, if subjected to heavy work, be a favorable subject for bone
+spavin.
+
+The matter of temperament cannot be disregarded in diagnosis, for in
+some instances, it is the chief determining factor which materially
+influences the outcome of the case. A nervous, excitable animal, that is
+kept at hard work, may, under some conditions, be expected to experience
+disturbances which more lethargic subjects escape. Nervous subjects, it
+is known, are more prone to azoturia than are those of lymphatic
+temperament. Furthermore, the lymphatic subject often recovers from
+certain bone fractures which are successfully treated only when the
+animal is sufficiently resigned by nature to remain confined in a sling
+for weeks without resistance.
+
+The physiognomy of a subject is often indicative of the gravity of its
+condition. The facial expression of an animal suffering the throes of
+tetanus, azoturia, or acute synovitis, is readily recognized by the
+experienced eye, and upon physiognomy alone, in many instances, may the
+opinions regarding prognosis be based. Particularly is this true where
+death is a matter of minutes, or at most is only a few hours distant.
+
+Due allowance should be made for restiveness manifested by some more
+nervous animals when the surroundings are strange and unusual. In such
+instances, even pathognomic symptoms may be masked to the extent that
+little, if any, sign of pain or malaise is evinced. In these cases the
+subject should be given sufficient time to adjust itself to the new
+environment, or it should be removed to a more suitable place for
+examination. Animals quickly detect the note of friendly reassurance in
+the human voice and can very often be calmed by being spoken to.
+
+By visual examination one may detect the presence of various swellings
+or enlargements, such as characterize bruises and strains of tendons
+where inflammation is acute. Inflammation of the plantar
+(calcaneocuboid) ligament in curb is readily detected when the affected
+member is viewed in profile. Spavin, ringbone, splints, quittor and many
+other anomalous conditions may all be observed from certain proper
+angles.
+
+The fact that the skins of most animals are pigmented and covered with
+hair, precludes the easy detection of erythema by visual examination,
+consequently this indicator of possible inflammation is not often made
+use of in the examination of equine subjects.
+
+
+Attitude of the Subject.
+
+The position assumed while the subject is in repose, is often
+characteristic of certain affections and this, of course, is noted at
+once. The manner in which the weight is borne by the animal at rest,
+should attract the attention of the diagnostician and if the attitude of
+the subject is abnormal or peculiar, the examiner tries to determine the
+reason for it. If weight-bearing causes symptoms of pain, the affected
+member will invariably be favored and held in some one of a number of
+positions. The foot may contact the ground squarely and yet the leg may
+remain relaxed and free from pressure; volar flexion, in such cases, is
+indicative of inflammation of a part of the flexor apparatus. If the
+condition be very painful, position of the afflicted member is
+frequently shifted, but in all cases where the pain is not so keenly
+felt, the inflamed member is held in a state of relaxation. There is
+need then, for a knowledge of anatomy and certain principles in physics
+to enable the observer to determine just which structures are purposely
+eased in this manner. Where palpation of parts is possible, one does not
+need to depend on visual examination alone, and it is always wise to
+take into consideration every factor that may influence conditions.
+Manipulation or palpation of the structures thought to be involved,
+should not be resorted to until a careful and thorough observation of
+the subject has revealed all that it can reveal to the diagnostician.
+
+In all conditions where extreme pain is manifested by the constant
+desire of the animal to keep its foot in motion off the ground,
+examination should be made for local cause. This is seen in certain
+septic inflammations of the feet such as those caused by nail punctures
+invading the navicular joint, or in newly made wounds where nerves have
+been divided and the proximal end of such a nerve is exposed to pressure
+or irritation.
+
+"Pointing" affords a comfortable position in some cases of navicular
+disease, and in a unilateral affection, one may observe the subject
+bearing weight with one sound member, while the affected foot is planted
+well ahead of the sound one. In a bilateral involvement of this kind,
+weight may be frequently shifted from one foot to the other, or in
+chronic cases, where no marked pain is experienced, the subject stands
+squarely upon both front feet and no peculiar shifting of weight or
+pointing is evident.
+
+In some cases of hip or shoulder involvement, complete relaxation of all
+parts of the affected member may be noticed. In brachial paralysis, the
+pectoral member is held limply; if the patient is made to move, it is
+evident there is lack of innervation to the afflicted part. In some
+cases where contusion has caused acute inflammation of the member, the
+subject instinctively tries to keep it inactive to relieve the pain
+which movement occasions.
+
+Where there is an active and painful inflammation of the prescapular
+lymph glands and contiguous structures, in some cases of "levator-humeri
+abscess," the scapulohumeral joint is extended. This is brought about by
+flexion of the elbow and carpal joints.
+
+There are some cases of bi-lateral affections which occasion such pain
+during weight-bearing that the subject shifts its weight from one
+affected leg to the other; an example of this condition may be observed
+in any acute case of gonitis which affects both patellar regions, making
+it equally painful to bear the weight on either member.
+
+A peculiar characteristic position is assumed in acute laminitis of the
+fore feet. In such instances, the hind feet are brought forward under
+the body sufficiently to relieve the front feet of the weight, insofar
+as is possible by the abnormal position taken in cases of acute
+laminitis.
+
+So in each position that is abnormal to any degree, assumed by a
+suffering animal, there may be deduced, the fact that the subject is
+attempting to relieve the affected structures, and in each clinical
+picture of this kind, the trained diagnostician sees some index to the
+nature and source of the trouble. Further examination is rendered more
+effective because of this preliminary visual examination which has
+precluded the unnecessary annoyance of the animal by manipulating
+unaffected structures.
+
+It has been presupposed in the foregoing, that the one making visual
+examination of a lame animal for diagnostic purposes, will remember that
+with the normal animal the weight is borne equally well with both fore
+legs; and that this is done without shifting from one to the other; and
+that the pelvic limbs do not support the body in this manner. Normal
+subjects shift their weight from one hind leg to the other and the one
+relaxed, rests in a state of flexion with the toe on the ground and the
+heel raised.
+
+
+Examination by Palpation.
+
+In nearly every case where lameness exists an examination of the
+affected parts, by palpation or by digital manipulation, is necessary
+before an accurate conclusion may be drawn; but in making this kind of
+an examination one needs to exercise good judgment lest he fail to
+acquire a correct impression of the actual existent conditions. There is
+need for the diagnostician, here, as well as in other conditions where
+physical examination is made, to approach the subject in a manner that
+will not excite or disturb to the extent that the animal will, in one
+way or another, resist or object to the approach of the diagnostician,
+thereby masking the symptoms sought. The practitioner would best acquire
+skill as a horseman--if he is not possessed of such--and handle each
+individual subject in the manner calculated to best suit the temperament
+of the animal examined. The unbroken subject is not handled as
+satisfactorily as is the intelligent family horse; in the former, in
+some cases, little dependence is placed upon digital examination.
+
+By palpation one is enabled to recognize hyperthermia and this, _in
+lieu_ of dependable history, is at times sufficient evidence upon which
+to determine the duration of any given inflammatory affection.
+
+By comparison of different parts of the same member or with an analogous
+portion of another member any marked increase in the apparently normal
+temperature of a part at once signalizes inflammation. In this manner,
+in examining a case where laminitis or other inflammation of the feet is
+suspected, one may arrive at a fairly accurate conclusion without the
+employment of other means. Throbbing vessels are not always easily
+recognized if the subject is a victim of chronic lymphangitis.
+
+In some instances, where a moderate degree of lameness exists and cause
+is apparently obscure, the recognition of hyperthermia may be the
+deciding factor in establishing a diagnosis. In cases of sprained
+ligaments in the phalangeal region, because of the dense character of
+the structures involved, little if any evidence of the cause of
+lameness, other than local heat, may be found twenty-four hours after
+the injury has been inflicted.
+
+In order to determine the amount or extent of hyperthermia with a fair
+degree of accuracy in any given case, one must make due allowance for
+external conditions affecting temperature; also the effect of a
+considerable amount of hair covering an area, as well as any possible
+dirt contacting the surface of the skin must be taken into account. All
+dirt should be removed if practicable, so that the diagnostician's palms
+may come as nearly in contact with the inflamed structures as possible.
+Then, too, the sense of touch if the operator's hands are chilled, is
+not dependable. In such instances the novice will need to be deliberate
+as to his findings--whether or not hyperthermia really exists. Such an
+examination is of little value where the subject's feet are wet and an
+examination is hurriedly made, as in cases of suspected laminitis.
+
+Often, before being able to distinguish the presence of a hyperthermic
+condition, one is impressed with the fact that an animal manifests
+evidence of being supersensitive. In fact, some animals in the
+anticipation of pain at the touch of an injured part, will instinctively
+withdraw--in self-protection--such an ailing member or resist the
+approach of the practitioner. This sensitiveness is more apparent in
+animals that have been subjected to previous manipulation or treatment
+which has occasioned pain, and consequently, allowance must be made for
+this exhibition of fear. No better example of this condition can be
+imagined than is present in cases of "shoe boil," where there exists an
+extensive area of acute inflammation of the elbow. There is always more
+or less surface disturbance wherever vesication has been produced, and
+in cases where irritants of any kind have been employed for several days
+or a week previous to an examination, more or less supersensitiveness is
+to be expected.
+
+One must not lose sight of the fact that unscrupulous
+dealers,--"traders"--make use of their knowledge of this principle in
+various way usually for the purpose of attracting attention to a part,
+which, presumably might have been blistered in order to intentionally
+produce inflammation of tissues, in this way, causing lameness which is
+not manifested until an animal has been kept by its new owner for
+twenty-four hours or more. This, to be sure, usually makes a
+dissatisfied purchaser who is willing to dispose of his newly acquired
+animal at a sacrifice, thus enabling the original owner or his agent to
+regain possession of the victimized animal at less than its real value.
+
+Some nervous animals, because of the manner of approach of the
+practitioner, are wont to flinch, and there is manifested a
+pseudo-supersensitiveness. Young animals not accustomed to being handled
+are likely to be timorous, and one must not hastily conclude that a part
+is painful to the touch because the subject resents even gentle digital
+manipulation of such parts. In instances of this kind, one needs to
+compare sensibility by manipulation of different parts of the subject's
+body in a careful and gentle manner; and by exercising patience and good
+judgment in such work, it is possible to actually distinguish between
+normal sensibility and abnormal sensitiveness, in most cases. Here,
+again, the diagnostician needs to possess skill as a horseman and good
+judgment as to individual temperament of different animals, under any
+condition which may exist at the time he makes his examination.
+
+By palpation alone, one can recognize the presence of fluctuating
+enlargements; one may not only recognize such conditions, but
+distinguish between a fluctuating mass such as exists in
+non-strangulated hernia and a large fibrous tumor. By palpation, for the
+recognition of density and for determining the presence or absence of
+hyperthermia, one may decide that there exists an abscess and not a
+tumor. Edematous swellings are recognized by palpation,--the
+characteristic indentations which may be made in dropsical swellings are
+pathognomonic indicators. In this manner it is easy to differentiate
+post-operative or post-traumatic edemas which may or may not cause
+lameness. At any rate, it is essential to take into account all
+determinate conditions that may assist in the prognosis of any given
+case, for the purpose of being able to outline rational remedial
+measures. To be able to distinguish between the generalization of a
+septic infection in its incipiency, and a more or less benign edema, is
+largely possible by digital manipulation alone. An extremity may be
+greatly swollen because of the existence of chronic lymphangitis,
+influenza, or an acute septic infection occasioned by the introduction
+of pathogenic and aerogenic organisms. Since the effect produced by
+these dissimilar ailments are productive of conditions that may
+terminate favorably or unfavorably, it becomes necessary for the
+diagnostician to develop a trained, discriminating, tactile-digital
+sense, in order to correctly interpret existing conditions, and handle
+cases in a rational and skillful manner.
+
+In order to ascertain the extent and exact location of a tumor, an
+exostosis, or other enlargements, the diagnostician, here also, needs to
+be in possession of a trained tactile sense and in addition if he be
+fortified with an accurate knowledge of normal anatomy and pathology, he
+is able to arrive at proper conclusions, when digital manipulations have
+been employed. Fibrous tumors are sometimes located in the inferior part
+of the medial side of the tarsus--exactly over the seat of bone-spavin.
+Such tumors, when the affected member is supporting weight, are not to
+be distinguished from exostoses; but as soon as the affected leg ceases
+to bear weight, it may be passively flexed and the nature of the
+enlargement recognized because it may be slightly displaced by digital
+manipulation. Displacement, of course, is not possible with an
+exostosis.
+
+A necessary qualification, which the diagnostician must possess, is that
+of being able to judge carefully the nearness of any given exostosis to
+articular structures. Also, the extent or area of the base of an
+exostosis as well as its exact position, needs be determined before one
+may estimate the probable outcome in any case,--whether treatment should
+be encouraged or discouraged by the practitioner. Periarticular ringbone
+may, because of the size and location of the exostosis, constitute a
+condition which cannot be relieved in any way in one case, and in
+another, because of the manner of distribution of such osseous
+deposits, the condition may be such that prompt recovery will follow
+proper treatment. In the examination of an exostosis of the tarsus, it
+is particularly important to determine the exact location of the
+exostosis--whether or not the spavin involves the tibial tarsal
+(astragulus) bone very near its tibial articular portions. Obviously, if
+articular surfaces of joints are involved, complete recovery cannot
+result despite the most skillful attention given the subject.
+
+
+Passive Movements.
+
+Wherever it is possible to gain the confidence of a tractable animal to
+the extent that it will relax the structures sufficiently to make
+possible passive movement of affected parts, much is to be learned as a
+result of such manipulation. By this method one may differentiate true
+crepitation, false crepitation, luxation and inflammation of ligaments
+that have been injured, as in sprains of such structures in the
+phalangeal region.
+
+_True crepitation_ is recognizable by the characteristic vibration which
+is interpreted by tactile sense. It is possible to recognize fracture by
+the use of other methods--auscultation, tuning fork tests, etc., but in
+ordinary veterinary practice one must rely upon the sense of touch for
+recognition of crepitation.
+
+Where pain is not so great that relaxation of parts does not occur, one
+can, by gently moving an extremity in various directions--as in flexion,
+extension and lateral motion as well as by rotation--cause to be
+manifested this peculiar grating,--the friction of newly broken bone.
+This is known as _true crepitation_. Where the subject, suffering
+phalangeal fracture, manifests evidence of pain due to tensing the
+structures about a fractured part, one may anesthetize the parts by
+using about two cubic centimeters of a two per cent. solution of cocain
+upon the plantar nerves, proximal to the fracture. It is perhaps best to
+deposit the cocain solution by means of two hypodermic punctures at
+different points along the course of each nerve, though closely situated
+to one another, thereby making more sure of the solution actually
+contacting the nerve. In some multiple fractures of the first or second
+phalanx this is quite necessary; otherwise, pain produced by passive
+manipulation causes the subject to keep the tendons so tense that
+crepitation may not be detected. The unnecessary infliction of pain is
+always to be avoided.
+
+We know as _false crepitation_ a vibrating impulse occasioned by normal
+contact of articular portions of bones such as in the metacarpophalangeal
+joint when this structure is passively moved, where the subject permits
+the parts to remain in a state of complete relaxation.
+
+Attempts to recognize supersensitiveness or inflammation by means of
+passive movement of the shoulder or hip, whether gently or forcefully,
+is not productive of good, in any case, in large animals. Because of the
+bulk and weight of parts so manipulated, as well as the resistance the
+subject offers even in normal cases, no accurate conclusion is to be
+arrived at in this manner in the average instance. Animals nearly always
+resist the placing of members in any position that is so unusual and
+uncomfortable as that which is required to materially displace the
+component tissues of the shoulder or hip; therefore, such practice is
+useless because one can not distinguish between normal resistance and
+flinching caused by painful sensations in injured parts. Such
+manipulations are practical in small animals.
+
+
+Observing the Character of the Gait.
+
+In order to determine the degree of lameness as well as its character,
+it is necessary to cause the subject which is being examined, to move in
+some manner. The degree of inconvenience or distress experienced by a
+lame animal that is being so examined is manifested by the character of
+the claudication; and where much pain is occasioned in locomotion there
+is disturbance of respiration; perspiration may be noticeable and in
+some instances manifestation of nervous shock are very evident--this in
+timid, nervous animals that anticipate being punished when approached
+and, consequently, make every effort possible to move when urged to do
+so. An animal, then, should be moved only sufficiently to cause it to
+exhibit the degree of lameness present in any given case, and if a
+marked impediment is manifested it is not necessary to cause the subject
+to be exerted to the extent of inflicting, in such manner, unnecessary
+punishment. Further or conclusive examination is made by palpation. To
+cause the subject to move, an assistant may simply lead the animal with
+a halter and compel it to walk a few steps. In this way, lameness,
+whether manifested during the weight-bearing period of an affected
+member, or when such a member is being advanced, or whether a
+combination of the two conditions exists, is made apparent. In the words
+of Dollar, one is thus enabled to recognize the existence of
+"supporting-leg-lameness," "swinging-leg-lameness" or "mixed lameness."
+
+When the cause of lameness is not strikingly apparent it becomes
+necessary to have the subject moved farther than a few steps and at
+different paces. Depending then, upon the character of lameness
+manifested, as well as upon its degree of intensity, one needs to
+exercise the subject in various ways, but this should not be overdone.
+
+The first thing apparent in the lame subject in action, is the lame leg.
+If this is not readily determinable, as in some complicated cases, the
+leg or legs which are at fault are to be discovered by further
+examination, and to do this,--word-pictures convey little that is
+helpful in difficult cases,--long practice is the one route by which one
+may become efficient; that is, by experience gained after fundamental
+principles in the diagnosis of lameness have been mastered.
+
+For a careful study of supporting-leg-lameness involving a fore limb,
+the subject is driven or led _toward_ the one making such examination.
+If a hind leg is to be observed, the animal is made to travel _away
+from_ the examiner. Where there exists swinging-leg-lameness, the
+subject should be caused to move past the diagnostician, so that he may
+get a side view of the subject while it is in motion.
+
+In every case such examinations are made to the best advantage if the
+practitioner can view his patient from a little distance. Here, again, a
+visual examination is made but this cannot be successfully executed, in
+difficult cases, if the practitioner is stationed at too close range.
+
+The average subject is best observed by being led, rather than being
+ridden, and in so doing the animal should be given moderately free
+rein. A close grasp on the lead may interfere somewhat with head
+movements. Nodding of the head with the catching up of weight by a sound
+member in supporting-leg-lameness of a fore leg, constitutes the chief
+symptom considered in detecting the lame leg.
+
+Where supporting-leg-lameness affects a hind limb the head is raised at
+the time weight is caught by the sound member--here the long axis of the
+subject's body may be likened unto a lever of the first class. The
+posterior part of the body, at the time weight is taken upon the sound
+leg, is as the long arm: the fore limbs the fulcrum, and the subject's
+head the weight, which is lifted. The head movements of a horse at a
+trot, in supporting-leg-lameness of a front leg, synchronize with the
+discharge of weight from a lame leg to the opposite one if sound; but in
+pelvic limb affections, the head is thrown or jerked upward as weight is
+caught by the sound member,--this peculiar nodding movement is
+_opposite_ in the two instances.
+
+In pacing horses, since front and hind legs of the same side are
+advanced at the same time, there occurs in supporting-leg-lameness, a
+nodding of the head with discharge of weight from the lame leg, and a
+dropping of the hip as weight is caught by the sound pelvic member. In
+observing animals that are limping, (as in supporting-leg-lameness) one
+notices particularly the sacro-iliac region in hind leg affections and
+the occipital region in lameness of the front legs.
+
+Where there exists a bilateral affection, (such as characterizes some cases
+of navicular disease or other affections causing supporting-leg-lameness)
+there occurs no nodding of the head; weight is supported for an equal
+length of time upon each one of the two legs, but the stride[4] is
+shortened. The gait, in such cases, is peculiar, animals appearing stiff
+and they are said, by horsemen, to have a "choppy" gait.
+
+It is desirable, in some cases, to cause an animal to move from side to
+side; in other instances the subject is best made to walk or trot in a
+circle, and if the circle be very small the animal then particularly
+employs the inner fore leg as a pivotal supporting member. To augment
+the manifestation of certain affections, it is necessary to cause the
+patient to walk backward, and each one of these tests of locomotion
+serves to point out in a more or less characteristic manner, the site of
+the affection which is causing lameness in different cases.
+
+Sprains or injuries of lateral ligaments of the extremities, ringbone
+and certain foot affections, are made manifest by a side to side
+movement or a pivotal movement. In fact, wherever it is possible to
+cause undue or unusual tension to be exerted upon an inflamed structure,
+manifestation of pain is the response. In an inflamed condition of the
+lateral side of the phalanges, unequal weight-bearing such as a rough
+road surface will, by virtue of the leverage which the solar surface of
+the foot affords, cause undue strain upon such inflamed parts, and
+increased lameness is evident.
+
+When an animal is made to travel in a circle, when a member affected
+with supporting-leg-lameness is on the inner side of the circle,
+lameness is accentuated because weight is borne by the lame leg for a
+greater length of time, the result of such circuitous manner of
+locomotion. In swinging-leg-lameness, on the other hand, because pain is
+increased at the time an affected member is being advanced, lameness is
+increased when the subject is made to travel in a circle, with the lame
+leg on the outside of a circle thus described.
+
+In supporting-leg-lameness, the transientness of the weight-bearing
+period upon the affected member is the determining factor in the
+production of lameness. This unequal period of weight-bearing upon the
+front legs, for instance, causes an acceleration in the advancement of
+the sound member, in order to relieve the diseased one which is bearing
+weight. In other words, when an animal that is affected with
+supporting-leg-lameness travels in a straight line, since weight is
+borne by the diseased leg for an abnormally short period of time, the
+sound member needs be in the act of advancement a correspondingly short
+period. The result is then, an unequal division of stride; a nodding of
+the head with the catching up of weight by the sound leg,--in front leg
+affections--and this is termed _limping_.
+
+With continuous exertion as in travel for a considerable distance, in
+some cases, lameness becomes less evident--as in spavin. This "warming
+out" process is due in a measure to the parts becoming less sensitive
+upon exertion, and is to be seen, to a limited extent, in all
+inflammatory affections that are not too severe; consequently, in some
+cases, examination of a lame animal should begin in the stall, for in
+instances where the impediment is not marked, there may be no evidence
+of lameness after the subject has walked a few steps. In other cases,
+lameness increases as the subject continues to travel, and often to the
+extent that the impediment becomes too severe to allow the animal being
+serviceable. Therefore, one can not, in every case of lameness observed,
+positively determine the gravity of the situation, without having seen
+the affected animal in action for a sufficient length of time to
+understand the nature of the condition existing. This necessitates
+driving the animal for several miles in certain cases.
+
+Sometimes it is impossible to arrive at any definite conclusion, as the
+result of a single examination, and it then becomes necessary to see the
+subject again at a later date, or under more favorable circumstances.
+This is to be expected in some conditions where there exists rheumatic
+affections, and also in some foot diseases.
+
+In the examination of young animals, unused to harness and to other
+strange incumbrances, one is obliged to make allowance for impediments
+of gait, which are not occasioned by diseased conditions. Such
+affections have been termed "false lameness." Young mules that are not
+well broken to harness, are difficult subjects for examination and in
+some cases it is necessary to have them led or driven for a considerable
+distance before one can definitely interpret the nature of the
+impediment in the gait when lameness is not pronounced. It is especially
+difficult to satisfactorily examine such subjects, for the reason that
+their normal rebellious temperaments cause resistance whenever a strange
+person approaches them, as it is necessary to do for an examination by
+palpation. In such cases--if an examination does not reveal the cause of
+trouble, rest must be recommended and further examination made at a
+later date, whereupon any new developments may be noted, if such changes
+exist.
+
+
+Special Methods of Examination.
+
+After having completed a general examination of a lame animal--obtaining
+the history of the case, noting its temperament, type, size,
+conformation, position assumed while at repose, swellings or
+enlargements if present, causing the subject to move to note the degree
+and character of lameness manifested; palpating and manipulating the
+parts affected to acquire a fairly definite notion of the nature of an
+inflammation or to recognize crepitation it becomes necessary in some
+cases to employ peculiar means of examination in singular instances.
+This may be done by making use of cocain in solution for the production
+of local anesthesia as in lameness of the phalanges. Such means are not,
+in themselves, dependable but are valuable when used in conjunction with
+all other available and practical methods.
+
+Trial use of various shoes in order to shift the weight from one part of
+the foot to another or to cause an animal to "break over" in a different
+manner so that the gait may be changed, constitutes a special test
+procedure. The use of hoof testers or of a hammer to note the degree or
+presence of supersensitiveness is another means that is of practical
+service. No examination, in any case of lameness, is complete without
+having removed the shoe and scrutinized the solar surface of the foot.
+
+[Illustration: Fig. 1--Hoof testers with special jaws of sufficient size
+to grasp the largest foot.]
+
+Diagnosis by exclusion, finally, is resorted to, and, as in any other
+case where the recognition of cause is difficult, exclusion of the
+existence of conditions,--one at a time, by an analysis of
+symptoms--generally enables the practictioner to eliminate all but the
+disturbing element.
+
+FOOTNOTES:
+
+[Footnote 4: By stride is meant the distance between two successive
+imprints of the same foot. The term is not used in this work as being
+synonymous with step.]
+
+
+
+
+SECTION III.
+
+LAMENESS IN THE FORE LEG.
+
+
+Anatomo-Physiological Review of parts of the Fore Leg.
+
+For supporting weight, whether the subject is at rest or in motion, the
+bony column of the leg, together with attached ligaments, tendons and
+muscles, is wonderfully well adapted by nature for the function which
+they perform. The several bones which go to make up the supportive
+portion of the leg, are so joined at their points of articulation, that
+a minimum degree of strain is put upon each attachment.
+
+The upper third of the scapula, with its cartilage of prolongation, is
+sufficiently broad and flattened that it fits snugly against the thorax
+without necessity for a complicated method of attachment--the clavicle
+being absent, attachment is muscular.
+
+Smith[5] has very aptly stated that:
+
+"It seems quite legitimate to regard the muscular union between the
+thorax and forelimb as a joint. There are no bones resting on each
+other, no synovia; but where the scapula has its largest range of
+movement there is a remarkable amount of areolar tissue, which renders
+movement easy. The whole central area beneath the scapula and humerus
+not occupied by muscular attachment, is filled with this easy-moving,
+apparently gaseously distended, crepitant, areolar tissue over which the
+fore legs glide on the chest wall as freely as if the parts were a
+large, well lubricated joint."
+
+The scapulohumeral articulation (shoulder joint) is an enarthrodial
+(ball and socket) joint but because of its being held more or less
+firmly against the thoracic wall by muscular and tendinous attachment,
+and because a part of this attachment affords a means of support for the
+body itself, there is no need for binding ligaments and movement is
+possible in all directions even though restricted as to extent.
+
+[Illustration: Fig. 2--Muscles of Left Thoracic Limb from Elbow
+Downward; Lateral (External) View.
+
+a, Extensor carpi radialis; g, brachialis; g', anterior superficial
+pectoral; c, common digital extensor; e, ulnaris lateralis. (After
+Ellenberger-Baum, Anat. für Künstler.) (From Sisson's "Anatomy of the
+Domestic Animals").]
+
+[Illustration: Fig. 3--Muscles of Left Thoracic Limb from Elbow
+Downward; Medial (Internal) View.
+
+The fascia and the ulnar head of the flexor carpi ulnaris have been
+removed. 1, Distal end of humerus; 2, median vessels and nerve. (From
+Sisson's "Anatomy of the Domestic Animals").]
+
+Undue extension, (by extension is meant such movement as will cause the
+long axis of two articulating bones to assume a position which
+approaches or forms a straight line--opposite to flexion), of the
+scapulohumeral joint is impossible while weight is borne, because of the
+normally flexed position of the humerus on the scapula; whereas flexion,
+beyond desirable limits, is inhibited by the biceps brachii (flexor
+brachii or coracoradialis) muscle.
+
+The distal end of the humerus, however, articulating with the radius and
+ulna in a fashion that no support is lent by any sort of contact with
+the body, is a ginglymus (hinge) joint and lateral motion, because of
+the long transverse diameter of its articular portions, is easily
+prevented by the medial and lateral ligaments (internal and external
+ligaments). Flexion of this, the humeroradioulnar joint (elbow), is
+restrained by the triceps brachii and extension is checked by the biceps
+brachii (flexor brachii).
+
+The carpal joint (erroneously called the knee joint), is composed of the
+several carpal bones which interarticulate and, when taken as a group,
+serve as a means of attachment and articulation for the radius and
+metacarpal bones.
+
+The transverse diameter of this joint is long, thus giving it contacting
+surfaces that are sufficiently extensive to minimize the strain upon the
+mesial and lateral ligaments (internal and external lateral common
+ligaments). Motion is that of flexion and extension; slight rotation is
+possible when the position is that of flexion. While supporting weight
+the carpus is fixed in position by a slight dorsal flexion, but undue
+dorsal flexion is prevented by the flexor muscles and tendons and
+volar-carpal or annular ligament, together with the superior check
+ligament.
+
+The metacarpophalangeal articulation (fetlock joint), is a hinge joint
+and its articular surfaces contact one another, with respect to their
+having a long bearing surface from side to side, as do all ginglymus
+(hinge) joints. Two common lateral ligaments bind the bones together.
+While bearing weight, there is assumed a position of slight dorsal
+flexion, undue flexion being checked by the inhibitory apparatus of the
+joint--check ligaments, and their tendons and the suspensory ligament.
+The inhibitory apparatus of the fetlock joint is materially reinforced
+by the proximal sesamoid bones. Situated as they are, between the
+bifurcating portions of the suspensory ligament and the posterior part
+of the distal end of the metacarpus--with which they articulate--the
+sesamoid bones serve to change the course of the branches of the
+suspensory ligament in a manner that they give firm support to this
+joint. Volar flexion is limited by the extensors of the phalanges.
+
+[Illustration: Fig. 4--Sagital Section of Digit and Distal Part of
+Metacarpus.
+
+A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third
+phalanx; E, distal sesamoid bone; 1, volar pouch of capsule of fetlock
+joint; 2, inter-sesamoidean ligament; 3, 4, proximal end of digital
+synovial sheath; 5, ring formed by superficial flexor tendon; 6, fibrous
+tissue underlying ergot; 7, ergot; 8, 9, 9', branches of digital
+vessels; 10, distal ligament of distal sesamoid bone; 11, suspensory
+ligament of distal sesamoid bone; 12, 12', proximal and distal ends of
+bursa podotrochlearis. (From Sisson's "Anatomy of the Domestic
+Animals").]
+
+The first phalanx (os suffraginis) normally sets at an angle of about
+50 to 55 degrees from a horizontal plane while weight is being
+supported. Its distal end articulates with the second or median phalanx
+(os corona) and forms the proximal interphalangeal (pastern or
+suffraginocoronary) joint. This also, is a ginglymus joint, having but
+slight lateral motion, and that only when it is in a state of flexion. A
+rather broad articular surface--from side to side--exists here,
+lessening the strain on the collateral ligaments somewhat. Dorsal
+flexion is checked by the flexor tendons and dorsal ligaments. Volar
+flexion is restrained by the extensor tendons.
+
+The distal end of the second phalanx (os corona) has but slight lateral
+motion and this is manifested principally when it is in a state of volar
+flexion. Undue dorsal flexion is prevented by the deep flexor tendon
+(perforans) and volar flexion is inhibited by the extensor of the digit
+(extensor pedis). Thus it is seen, that when the leg is a weight-bearing
+member, weight is supported by the bony framework whose constituent
+parts are joined together by ligaments and tendons and each one of the
+several bones articulates in such manner that the joint is locked. The
+articular parts of bones rest upon or against an inhibitory apparatus,
+and are slightly flexed, as in the carpus, or considerably flexed such
+as in the fetlock joint when weight is being supported. In the first
+instance, for example, the flexors of the carpus and the superior check
+ligament assisted by the flexors of the phalanges constitute the
+inhibitory apparatus.
+
+It will be noted that provision for weight bearing is so arranged that
+muscular energy is not required except in the matter of suspension of
+the body between the scapulae and here tonic impulses only are necessary
+to maintain an equilibrium[6], yet in every instance where weight is not
+supported by bones, inelastic ligaments or tendinous structures relieve
+the musculature of this constant strain. This explains the fact that
+some horses do not lie in the stall, yet in spite of their constant
+standing position, they are able to rest and sleep.
+
+The student of lameness is interested in the function of the legs in the
+rôle of supporting weight and as propelling parts, and not particularly
+in the capacity of these members for inflicting offense or as weapons
+of defense. Yet, in the exercise of their functions other than that of
+locomotive appliances, injury often results, but usually it is the
+recipient of a blow that suffers the injury, such as an animal may
+receive upon being kicked. Therefore, we do not often concern ourselves
+with strains or other injuries that the subject experiences as the
+result of efforts put forth in kicking or striking. Where such injuries
+occur, however, a diagnosis is established by making use of the
+principles heretofore discussed.
+
+As propelling members the front legs bear weight and are advanced
+alternately when the horse is walking or trotting--in cantering this is
+not so. When the normal subject travels in a straight line, at a walk or
+a trot, the length of the stride is the same with the right and left
+members. The stride of the right foot then, for example, is equally
+divided by the imprint of the left foot, in the normal horse, when
+traveling at a walk and in a straight line.
+
+
+Shoulder Lameness.
+
+This enigmatical term is frequently employed by the diagnostician when
+he is baffled in the matter of definitely locating the cause of
+lameness; when he has by exclusion and otherwise arrived at a decision
+that lameness is "high up." Shoulder lameness may be caused by any one
+or several of a number of conditions, e.g., fractures of the scapula or
+humerus; arthritis of the shoulder or elbow joint; luxation of the
+shoulder or elbow joint (rarely); injuries of muscles and tendons of the
+region due to strains, contusions or penetrant wounds; paralysis of the
+brachial plexus or of the prescapular nerve; involvement of lymph
+glands; arterial thrombosis; metastatic infections; rheumatic
+disturbances; and as the result of inflammation, infectious or
+non-infectious occasioned by collar bruises. In some instances such
+inflammation is due to the manner of treatment of collar injuries.
+Therefore, when one considers the numerous and dissimilar possible
+causes of shoulder lameness, it behooves the practitioner to become
+proficient in diagnostic principles.
+
+A principle which is elemental in the diagnosis of locomotory
+impediment, is that lameness of the shoulder or hip is usually
+manifested by more or less difficulty in swinging the affected member.
+Swinging-leg-lameness, then, is usually present in shoulder affections.
+In some instances lameness is mixed as in joint ailments, involvement of
+the bicipital bursa (bursa intertubercularis), etc. In affections of the
+extremity there exists supporting leg lameness. Consequently, we employ
+this elemental principle, and, by a visual examination of the subject,
+which is being made to travel suitably, one may decide that lameness is
+either "high up"--shoulder lameness or, "low down"--of the extremity.
+
+[Illustration: Fig. 5--Ordinary type of heavy sling.]
+
+To make practical use of this principle, the examiner must be thoroughly
+familiar with the anatomy of the various structures concerned in
+advancing the leg--those which support weight as well as those concerned
+both in weight bearing and swinging the member.
+
+
+Fracture of the Scapula.
+
+Etiology and Occurrence.--Fractures of the body of the scapula are of
+infrequent occurrence in horses for the reason that protection is
+afforded this bone because of its position. Its function, too, is such
+that very unusual conditions are necessary to subject it to fracture.
+The spine is occasionally broken due to blows such as kicks, etc., and
+here frequently a compound fracture exists.
+
+[Illustration: Fig. 6--A sling made in two parts so that horses may be
+supported without use of central part or bodice. This sling is more
+comfortable than is the ordinary style and is particularly useful in
+cases that require a long period of this manner of confinement.]
+
+Where fractures of the body of the scapula occur, heavy contusions have
+been the cause as a rule, and serious injury is done the subject;
+consequently, treatment of fracture of the body of the scapula is seldom
+successfully practised. Fractures of the body of this bone resulting
+from accidents not involving internal injury or other disturbances and
+which would not seriously interfere with the vitality of the subject,
+are not necessarily serious unless compound.
+
+Fractures of the neck of the scapula are serious because of the fact
+that there occurs displacement of the broken parts and perfect
+apposition of the fractured ends is difficult, if not impossible.
+
+Fractures that extend to the articular surface are very serious, and
+complete recovery in such instances is practically impossible. The
+cartilage of prolongation of the scapula is sometimes seriously involved
+in certain cases of fistulous withers, and in some instances it has been
+separated from its attachment to the rhomboidea muscles, and lameness
+has resulted. In such instances, the upper portion of the scapula is
+disjoined from all attachment, and with every movement the animal makes,
+the scapula is moved back and forth. Complete recovery in such cases
+does not occur.
+
+Symptomatology.--Fractures of the scapular spine are ordinarily
+readily recognized because there is usually visible displacement of the
+broken part. Crepitation is also detected without difficulty.
+
+In fractures of the body of the scapula where an examination may be made
+before much swelling has taken place, and in subjects that are not
+heavily muscled, one should have no difficulty in recognizing the
+crepitation.
+
+Fractures of the neck of the scapula are recognized by crepitation, by
+passively moving the leg, but it is necessary to exclude fractures of
+the humerus when one depends upon the finding of crepitation by this
+means. However, unless undue swelling exists, the exact location of the
+crepitation is recognized without serious difficulty.
+
+Treatment.--The treatment of compound fractures of the scapular spine
+consists in the removal of the broken piece of bone by way of a
+cutaneous incision so situated that good drainage of the wound will
+follow.
+
+Simple fractures of the body of the scapula are best treated by placing
+the subject in a sling, if the animal is halter broken, and enforcing
+absolute quiet for a period of from three to six weeks. Splints or
+similar appliances are not of practical value in scapular fractures.
+
+Compound fractures of the scapula usually result from violence, which at
+the same time does serious injury to adjacent structures, and it then
+becomes necessary to administer an expectant treatment, observing
+general surgical principles and providing in so far as possible for the
+comfort of the patient.
+
+
+Scapulohumeral Arthritis.
+
+Anatomy.--The scapulohumeral joint is an enarthrodial (ball and
+socket) joint wherein the ball or humeral articulating head greatly
+exceeds in size the socket or glenoid cavity of the scapula. The
+capsular ligament surrounding this joint is very large and admits of
+free and extensive movement of the articulation. There exist no lateral
+or common ligaments jointing the scapula and humerus as in other joints,
+but instead the tendinous portions of muscles perform this function. The
+principal ones which are attached to the scapula and humerus that act as
+ligaments are the supraspinatus (antea-spinatus), infraspinatus
+(postea-spinatus) biceps-brachii (flexor brachii) and subscapularis
+muscles.
+
+Etiology and Occurrence.--Inflammation of the scapulohumeral
+articulation results from injuries of various kinds, including punctures
+which perforate the joint capsule, bruises from collars, metastatic
+infections and involvement as a result of direct extension of infectious
+conditions situated near the joint.
+
+Classification.--Acute arthritis may be septic or aseptic, and there
+seems to be a remarkable tendency for recovery in cases of septic
+arthritis involving this joint in the horse.
+
+Chronic arthritis with destruction of articular surfaces and ankylosis,
+is seldom observed. It is only in cases of severe injury, where the
+articular portions of the bones are damaged at the time of infliction of
+the injury, and where the articulation remains exposed for weeks at a
+time, together with immobility of the parts because of attending pain,
+that permanent ankylosis results.
+
+Scapulohumeral arthritis may result then from _infections_, local or
+metastatic; from _injuries_, such as contusions of various kinds; from
+_wounds_, which break the surface structure or perforate the joint
+capsule; or from _luxations_.
+
+
+Infectious Arthritis.
+
+Infectious arthritis of the scapulohumeral joint the result of local
+causes other than produced by septic wounds, seldom causes serious
+inconvenience to the subject. Where such occurs, however, there is
+manifested mixed lameness and complete extension of the extremity is
+impossible. Local swelling is present and manifestations of pain are
+evident upon palpation of the affected area.
+
+Treatment.--During the first stage of the infection, local
+applications, hot or cold, are indicated. A hot poultice of bran or
+other suitable material contained within a muslin sack, may be supported
+by means of cords or tapes which are passed over the withers and tied
+around the opposite fore leg. Such an appliance may be held in position
+more securely by attaching it to the affected member. Following the
+acute stage of such an infection, any local counter-irritating
+application or even a vesicant is in order.
+
+Where abatement of the infectious process does not take place, and
+suppuration of the structures in the vicinity of the joint occurs, it is
+necessary to provide drainage for pus. In some cases of strangles, for
+instance, large pus cavities are formed and drainage is imperative.
+However, metastatic inflammation of this joint is seldom observed except
+in cases of strangles. The animal should be kept perfectly quiet until
+recovery has taken place.
+
+
+Injuries.
+
+Injuries to the scapulohumeral joint may be the result of kicks, runaway
+accidents or bruises from the collar, and there may result, because of
+such injuries, reactionary inflammation which will vary in intensity
+from the mildest synovitis to the most severe arthritis, causing more or
+less lameness.
+
+Treatment.--The general plan of treatment in this form of arthritis is
+the same as has been outlined under the head of infectious arthritis,
+with the exception that there is seldom occasion to provide for drainage
+of pus.
+
+
+Wounds.
+
+Wounds which cause a break of the skin and fascia overlying the
+scapulohumeral joint are usually of little consequence, unless the blow
+is of sufficient force to directly injure the articulation, and in such
+cases, the treatment of the injury along general surgical principles,
+such as cleansing the area, providing drainage for wound secretion, and
+the administration of suitable dressing materials such as antiseptic
+dusting powder, is all that is required for the wound. The symptoms
+manifested by the subject in such cases are the same as have been
+discussed heretofore and merit no special consideration.
+
+Prognosis.--Unless very serious injury be done the articular portions
+of the scapula or the humerus, resulting in the destruction of the
+capsular ligament, prognosis is entirely favorable.
+
+Open Joint.--Where the capsular ligament is perforated and the
+condition becomes one of open joint, then a special wound treatment
+becomes necessary. The surface of the skin is first freed from all hair
+and filth in the vicinity of the wound. The wound proper is cleared of
+all foreign material either by clipping with the scissors, curetting or
+mopping with cotton or gauze pledgets. The whole exposed wound surface
+as well as the interior of the joint cavity, if much exposed, is
+moistened with tincture of iodin. Subsequent treatment consists in a
+local application of a desiccant dusting powder, which should be applied
+five or six times daily. The composition of the powder should be such as
+to permit of its liberal use, thereby affording mechanical protection to
+the wound as well as exerting a desiccative effect. Equal parts of boric
+acid and exsiccated alum serve very well in such cases.
+
+Animals suffering from open joints of this kind should be confined in a
+standing position, preferably in slings, and kept so confined for three
+or four weeks. Since they usually bear weight upon the affected member,
+there is no danger of laminitis resulting.
+
+
+Luxation of the Scapulohumeral Joint.
+
+Because of the large humeral head articulating as it does with a
+glenoid cavity, scapulohumeral luxations are very rare in the horse.
+According to Moller[7], luxation is generally due to excessive flexion
+of the scapulohumeral joint. In such cases the head of the humerus is
+displaced anterior to the articular portion of the scapula and remains
+so fixed.
+
+Symptoms.--Complete luxation of the scapula is recognized because of
+immobility of the scapulohumeral joint and of the abnormal position of
+the head of the humerus, which can be recognized by palpation, unless
+the swelling be excessive. Immobility of the scapulohumeral joint is
+noticeable when one attempts to passively move the parts.
+
+Treatment.--Reduction of the luxation is effected by making use of the
+same general principles that are employed in the reduction of all
+luxations, and they are--the control of the animal so that the
+manipulations of the operator are not antagonized by muscular
+contraction, which is best accomplished by anesthesia; placing the
+luxated bones in the position which they have taken to become unjointed;
+and then making use of force which is directed in a manner opposite to
+that which has effected the luxation.
+
+In a forward luxation of this kind, the operator should further flex the
+humerus, and while it is in this flexed position, force is exerted upon
+the articular head of this bone, and it is pushed downward and backward
+into its normal position.
+
+After-care consists in restriction of exercise and, if necessary,
+confining the subject in a sling and the application of a vesicant over
+the scapulohumeral region.
+
+
+Inflammation of the Bicipital Bursa.
+(Bursitis Intertubercularis.)
+
+Anatomy.--There is interposed between the tendon of the biceps brachii
+(flexor brachii) and the intertubercular or bicipital groove a heavy
+cartilaginous pad, which is a part of the bursa of the biceps brachii.
+This synovial bursa forms a smooth groove through which the biceps
+brachii glides in the anterior scapulohumeral region. Great strain is
+put upon these parts because the biceps brachii is the chief inhibiting
+structure of the scapulohumeral articulation--the one which prevents
+further flexion of the humerus during weight bearing. Passing, as it
+does, over two articulations, the biceps brachii has a somewhat
+complicated function, being a flexor of the radius and an extensor of
+the humerus. Thus it is seen, the biceps brachii is a weight bearing
+structure, as well as one that has to do with swinging the leg.
+
+Etiology and Occurrence.--Because of the exposed position of the
+bicipital bursa (bursa-intertubercularis) it is occasionally injured.
+Blows and injuries received in runaway accidents do serious injury to
+the bursa and because of the peculiar and important part it plays during
+locomotion, serious injuries are not likely to resolve, and too often
+chronic lameness results. It is to be noted that the tendon of the
+biceps brachii (flexor brachii) is always involved in cases of
+inflammation of the bicipital bursa, and according to the late Dr.
+Bell[8] strain of the biceps brachii is a frequent cause of lameness in
+city horses, more frequent than is generally supposed.
+
+Pathological Anatomy.--More or less destruction of the cartilaginous
+portion of the bursa, sometimes involving the tendinous portion of the
+biceps, takes place and, according to Moller, in some instances there
+occurs ossification of the tendon. Autopsies in some old horses reveal
+the presence of erosions of cartilage and hyperthrophy of the inflamed
+parts.
+
+Symptoms.--In acute inflammations, there is always marked lameness.
+This is manifested to a greater degree when the subject advances the
+affected leg. There is incomplete advancement of the member; the toe is
+dragged when the horse is made to walk and the foot kept in a position
+posterior to the opposite or weight bearing foot while the subject is at
+rest. Lameness is disproportionate to the amount of local manifestation
+in the way of heat, swelling and pain that is to be recognized on
+palpation. In fact, in some cases so much pain attends the condition
+that no weight is borne by the affected member, and when compelled to
+walk, the subject hops on the sound leg.
+
+Chronic inflammation of the bicipital bursa is occasionally met with
+wherein both members are affected. Because of the nature of the
+structures involved, when inflamed, chronic inflammation is a more
+frequent termination than is complete recovery. Bilateral affections are
+seen in horses that are driven for years, regularly at a fast pace on
+paved streets. In such cases, the gait is stilted, that is, there is
+incomplete advancement of both members and, of course, the period of
+weight bearing is correspondingly shortened; hence the short strides.
+
+In chronic cases, little if any evidence of inflammation is to be
+detected by digital manipulation of the parts. If flinching occurs, one
+is often unable to interpret the manifestation as to whether it is due
+to inflammation or not.
+
+There is no marked "warming out" in this condition, and animals are
+nearly as lame after having been driven a considerable distance as when
+started, although the lameness is not as a rule very great.
+
+Treatment.--In very painful cases acute inflammation is treated by
+employing cold applications during the initial stage. Cracked ice when
+contained in a suitable sack may be held in contact with the affected
+part and the pack is supported by means of cords or tapes as suggested
+in the discussion on treatment of scapulohumeral arthritis on page 66.
+Later, hot applications may be employed to good advantage.
+
+In the course of ten days or two weeks, if the acute painful condition
+has entirely subsided, vesication is indicated. The ordinary mercury and
+cantharides combination does very well. Depending upon the course taken
+in any given case, one is guided in the treatment employed. If prompt
+resolution comes to pass, the subject may be given free run at pasture
+after three or four weeks confinement in a box stall. If, however, the
+case does not progress in a prompt and satisfactory manner, absolute
+quiet must be enforced for six weeks or more. Repeated blistering is
+beneficial, although it is doubtful if firing is of sufficient benefit
+in the average chronic case of intertubercular bursitis to justify the
+punishment which this form of treatment inflicts, unless infliction of
+pain is the thing sought, to enforce repose in restless subjects.
+Patients are best given a long rest at pasture and returned to work for
+two or three months after an acute attack of inflammation of the bursa,
+lest the condition become chronic. When due consideration is given the
+pathology of such cases, the frequent unsatisfactory termination under
+the most careful treatment, is readily understood.
+
+
+Contusions of the Triceps Brachii.
+(Triceps Extensor Brachii: Caput Muscles.)
+
+Anatomy.--The triceps brachii is the principal structure which fills
+the space between the posterior border of the scapula and the humerus.
+The several heads originate for the most part on the border of the
+scapula, the deltoid tuberosity of the humerus and the shaft of the
+humerus. Insertion of this large muscular mass is effected by means of
+several tendons to the olecranon. A synovial bursa is situated
+underneath the tendinous attachment of the posterior portion of the
+triceps brachii--the long head or caput magnum.
+
+The function of the triceps as a whole is to flex the shoulder joint and
+extend the forearm. The triceps brachii is the chief antagonist of the
+biceps brachii.
+
+Etiology and Occurrence.--Owing to the exposed position of this
+structure, it is not infrequently contused, the result of falls, kicks
+and other injuries. The function of the triceps is such that it becomes
+strained upon rare occasions when a horse resists confinement of
+restraint in such manner that the parts are unduly tensed in
+contraction. This sort of resistance may stretch the radial nerve or its
+branches in a way that paralysis results. A condition known as "dropped
+elbow" is described by Henry Taylor, F.R.C.V.S., in the Veterinary
+Record[9], wherein a two-year-old colt while resisting confinement was
+so injured.
+
+The triceps group because of its convenient location, constitutes the
+site for hypodermic injection of drugs and biologic agents, with some
+practitioners; and as a result, more or less inflammation may occur. The
+author has observed and treated some twenty cases where an intensely
+painful infectious inflammation of the triceps brachii was caused by
+the intramuscular injection of a caustic solution by a cruel and
+unscrupulous empiric, whose object was to increase his practice.
+
+Symptomatology.--As the triceps brachii is not particularly taxed
+during weight bearing in the subject at rest, there may be no unnatural
+position assumed during inflammation of the triceps. More or less
+swelling and supersensitiveness is always present, however, and great
+care and discrimination must be exercised in digital manipulation of the
+triceps region because many animals are normally sensitive to palpation
+of these parts. It is sometimes difficult to correctly interpret the
+true state of conditions because of this peculiarity.
+
+There is always swinging-leg-lameness, which is accentuated when the
+subject is urged to trot. Where symptoms are pronounced, it is
+unnecessary to cause the subject to move at a faster pace than at a walk
+to recognize the condition. The forward stride is shortened and in
+extremley painful conditions, no attempt is made to extend the leg. It
+is simply carried _en une piéce_--flexion of the shoulder and elbow
+joints is carefully avoided.
+
+Treatment.--During the early stage of inflammation, hot or cold
+applications are beneficial. Long continued use of moist
+heat--fomentations--allays pain and stimulates resolution. Keeping in
+contact with the painfully swollen parts a suitable bag filled with
+bran, which can be moistened at intervals with warm water, constitutes a
+practical and easy means of treatment. By employing this method, one is
+more likely to succeed in having his patient properly cared for, in that
+less work is entailed than if hot fomentations are prescribed.
+
+After the acute and painful stage has subsided, a stimulating liniment
+is of benefit. The subject should be kept within a comfortable and roomy
+box stall for a sufficient length of time to favor prompt resolution.
+Wild and nervous subjects, if not so confined, will probably overexert
+the affected parts if allowed the freedom of a paddock or pasture.
+
+Where the inflammation becomes infective, surgical interference is
+necessary. The prompt evacuation of pus, with adequate provision for
+wound discharge, should be attended to before extensive destruction of
+tissue takes place. Resolution is prompt as a rule in such cases because
+of the vascularity of the structures and the ease with which proper
+drainage may be effected. No special after-care is necessary if drainage
+is perfect, except that one should avoid injecting the wound cavity with
+aqueous solutions unless it be absolutely necessary to cleanse such
+cavity, and then it is best to swab the wound rather than to irrigate it
+freely.
+
+
+Shoulder Atrophy.
+(Sweeny or Swinney)
+
+No satisfactory consideration of the pathogeny of this condition is
+recorded, but practitioners have long distinguished between muscular
+atrophies which are apparently caused without doing serious injury to
+nerves and muscular atrophy which seems to be due to nerve affection. In
+the first instance, recovery when proper attention is given, is prompt;
+whereas, in the latter, regeneration of the wasted tissues requires
+months in spite of the best sort of treatment.
+
+The parts more frequently affected are the supra- and infrascapularis
+(antea- and posteaspinatus) muscles. But in some cases the triceps group
+is involved; however, this occurs in unusual and chronic affections. No
+doubt, these chronic cases are due to suspended innervation and are not
+to be classed with the ordinary case of atrophy of the abductor muscles
+of the humerus (supra- and infraspinatus) as in the usual case of
+"sweeny."
+
+Occurrence.--Shoulder atrophy such as the general practitioner
+commonly meets with, is an affection, more often seen in young animals
+and it seems to be due to injuries of various kinds which contuse the
+muscles of the shoulder. Ill-fitting collars and pulling in a manner
+that there occurs side draft with unusual strain on the muscles of one
+side of the neck and shoulder, seem to be the more frequent causes of
+this trouble. Blows such as are occasioned by kicks and falls frequently
+result in atrophy of shoulder muscles.
+
+Course.--In some cases a rapidly progressive atrophy characterizes the
+case and lameness and atrophy appear at about the same time. The
+affection in such instances does not recover spontaneously but
+constitutes a condition which requires prompt and rational treatment so
+that function may be fully restored to the parts involved.
+
+Occasionally one may observe cases where there is but slight atrophy;
+where the disease progresses slowly and atrophy is not extensive or
+marked. In vigorous young animals that are left to run at pasture when
+so mildly affected, spontaneous recovery occurs.
+
+Symptomatology.--Lameness is the first manifestation of shoulder
+atrophy, and in many cases where lameness is slight, the veterinarian
+may fail to discover the exact nature of the trouble if he is not very
+proficient as a diagnostician of lameness or if he is careless in taking
+into consideration obtainable history, age of the subject, etc. Because
+of the fact that the average layman believes that practically every case
+of fore-leg lameness wherein it is not obvious that the cause is
+elsewhere, is due to a shoulder affection of some kind, we may be too
+hasty in giving the client assurance that no "sweeny" exists. In some of
+these cases where a diagnosis of "shoulder lameness" has been made and
+the client has been assured that no sweeny exists, the patient is
+returned in about a week and there is then marked atrophy of one or both
+of the spinatus muscles.
+
+A mixed type of lameness characterizes this affection, and in the
+average case there exists little evidence of local pain. The salient
+points in recognizing the condition are a consideration of history if
+obtainable; age of the subject; finding slight local soreness, by
+carefully manipulating the muscles which are usually involved; noting
+the character of the lameness if any is present; and where atrophy is
+evident, of course, the true condition is obvious.
+
+Treatment.--Subcutaneous injections of equal parts of refined oil of
+turpentine and alcohol, with a suitable hypodermic syringe, is a
+practical and ordinarily effective treatment. From five to fifteen cubic
+centimeters (the quantity varies with the size of the animal), of this
+mixture is injected into the atrophied parts at different points, taking
+care to introduce only about one to two cubic centimeters at each point
+of injection. The syringe should be sterile and, needless to say, the
+site of injections must be surgically clean.
+
+Other agents, such as tincture of iodin, solutions of silver nitrate,
+saline solutions and various more or less irritating preparations have
+been employed; but in the use of these preparations one may either fail
+to stimulate sufficient inflammation to cause regeneration to take
+place, or infection is apt to occur. Where suppuration results, surgical
+evacuation of pus must be promptly effected else large suppurating
+cavities form.
+
+The employment of setons constitutes a dependable method of treatment of
+shoulder atrophy, but because of the attendant suppurative process which
+inevitably results, this method is not popular with modern surgeons and
+is a last resort procedure.
+
+After-care.--Regular exercise such as the horse usually takes when at
+pasture, is very helpful in treating atrophy, and in some cases it has
+been found that no reasonable amount of irritation would stimulate
+muscular regeneration; but by later allowing patients to exercise at
+will, recovery took place in a satisfactory manner. No special attention
+is ordinarily necessary.
+
+
+Paralysis of the Suprascapular Nerve.
+
+Anatomy.--The suprascapular (anterior scapular) nerve, a small branch
+of the brachial plexus, is given off from the anterior portion of this
+plexus. The nerve rounds the anterior border of the neck of the scapula,
+passing upward and backward under the supraspinatus (antea-spinatus)
+muscle and terminating in the infraspinatus (postea-spinatus) muscle.
+
+Etiology and Occurrence.--As the result of direct injury to this nerve
+by contusion such as may be received in runaway accidents, collar
+bruises, especially collar bruises in young horses that are not
+accustomed to pulling and that walk in a manner to cause side draft,
+injury to the nerve occurs, and partial or complete paralysis
+supervenes. Some writers state that it may be produced by confining an
+animal in recumbency, with the casting harness. The common cause of
+paralysis or paresis of this nerve in cases such as one observes in
+country practice, is bruises from the collar in colts that are put to
+heavy farm work or where ill fitting collars are used.
+
+Symptomatology.--With partial or complete suspension of function of
+the suprascapular nerve there results enervation of the supraspinatus
+and infraspinatus muscles. Since these muscles act as external lateral
+ligaments of the scapulohumeral joint, when they are incapacitated,
+there naturally follows more or less abduction of the shoulder when
+weight is borne.
+
+In extreme cases, as soon as the ailing animal is caused to support
+weight with the affected member, the joint is suddenly thrown outward in
+a manner that the average layman at once concludes that there must be
+scapulohumeral luxation, and the veterinarian receives a call to see a
+case wherein the "shoulder is out of place." There exists, however, no
+luxation in such cases.
+
+If serious injury is done the nerve so that it undergoes degenerative
+changes, there will result atrophy of the muscles that derive their
+nerve supply from the suprascapular nerve.
+
+[Illustration: Fig. 7--Paralysis of the suprascapular nerve of the left
+shoulder]
+
+Treatment.--During the first few days following injuries which result
+in this form of paralysis, it is well to keep the subject inactive, and
+if much inflammation of the injured structures contiguous to the nerve
+exists, the application of cold packs is beneficial. Later, as soon as
+acute inflammation has subsided, vesication of a liberal area around the
+anteroexternal part of the scapulohumeral joint and over the course of
+the suprascapular nerve, will stimulate recovery in favorable cases. As
+a rule, in mild cases, the subject is in a condition to return to work
+in two or three weeks.
+
+
+Radial Paralysis.
+
+Described under the titles of "Radial Paralysis" and "Brachial
+Paralysis," there is to be found in veterinary literature a discussion
+of conditions which vary in character from the almost insignificant form
+of paresis to the incurably affected conditions wherein the whole
+shoulder is completely paralyzed.
+
+When one considers the anatomy of the brachial nerve plexus and the
+distribution of its various branches, the location of this plexus and
+its proximity to the first rib, and the inevitable injury it must suffer
+in fracture of this bone, together with the inaccessibility of the
+plexus, it is not strange that a correct diagnosis of the various
+affections of the brachial plexus and the radial nerve is often
+impossible until several days or weeks have passed. And, in some
+instances, diagnosis is not established until an autopsy has been
+performed. Here, too, we fail to find cause for paralysis in some rare
+instances.
+
+Anatomy.--The radial nerve is a large branch of the brachial plexus
+and is chiefly derived from the first thoracic root of the plexus and is
+here situated posterior to the deep brachial artery. It is directed
+downward and backward under the subscapularis and teres major muscles,
+rounding the posterior part of the humerus, and passing to the anterior
+and distal end of the humerus, it finally terminates in the anterior
+carpal region. The radial nerve supplies branches to the three heads of
+the triceps brachii, to the common and lateral extensors of the digit
+and also to the skin covering the forearm.
+
+Etiology and Occurrence.--Nothing definite is known about the cause of
+some forms of radial paralysis. However, radial paralysis is encountered
+following injury to the nerve occasioned by its being stretched, as in
+cases where the triceps brachii is unduly extended in restraining
+subjects by means of a casting harness. Berns[10] states that in
+confining horses on an old operating table where it was necessary to
+draw the affected foot forward twenty-four to thirty-six inches in
+advance of its fellow, which was secured in a natural vertical
+position, radial paralysis of a mild form was of frequent occurrence.
+Country practitioners, in restraining colts by casting with harness or
+ropes, occasionally observe a form of paresis wherein the radial nerve
+suffers sufficient injury that there is caused a temporary loss of
+function of the triceps brachii. Such cases recover within three or four
+days and are not a true paralysis, but nevertheless constitute
+conditions wherein normal nerve function is temporarily suspended.
+
+[Illustration: Fig. 8--Radial paralysis.]
+
+Symptoms.--Immediately subsequent to injuries which involve the radial
+nerve, there is manifested more or less impairment of function.
+Remembering the structures supplied by the radial nerve and its
+branches, one can readily understand that there should occur as
+Cadiot[11] has stated:
+
+     In complete paralysis, the joints of the affected limb with the
+     exception of the shoulder are usually flexed when the horse is
+     resting. In consequence of loss of power in the triceps and
+     anterior brachial muscles, the arm is extended and straightened on
+     the shoulder, the scapulohumeral angle is open, and the elbow
+     depressed. The forearm is flexed on the arm by the contraction of
+     the coracoradialis (biceps brachii), while the metacarpus and
+     phalanges are bent by the action of the posterior antibrachial
+     muscles. The knee is carried in advance, level with, or in front
+     of, a vertical line dropped from the point of the shoulder. The
+     hoof is usually rested on the toe, but when advanced beyond the
+     above mentioned vertical line, it may be placed flat on the ground,
+     the joints then being less markedly bent. When the limb as a whole
+     is flexed, it may be brought into normal position by thrusting back
+     the knee with sufficient force to counteract the action of the
+     flexor muscles.
+
+[Illustration: Fig. 9--Merillat's method of fixing carpus in radial
+paralysis. Courtesy, Alex. Eger.]
+
+When made to walk, the animal being unable to exert muscular action with
+the paralyzed structures, limply carries the member as a whole, and
+there is shortening of the anterior portion of the stride. There being
+loss of function of the triceps brachii, it is impossible for the
+subject to straighten the leg in the normal position for supporting
+weight; therefore, any attempt to bear weight results in further
+flexion of the affected member and the animal will fall if the body is
+not suddenly caught up with the sound leg.
+
+Differential Diagnosis.--In making examination of these cases, one can
+exclude fracture by absence of crepitation and usually, also, swelling
+is absent in radial paralysis. In a typical case of radial paralysis,
+the affected leg can sustain its normal share of weight if placed in
+position, that is, if the carpal joint is extended in such manner that
+the leg is positioned as in its normal weight-bearing attitude. In
+brachial paralysis, whether due to fracture of the first rib or to other
+serious injury, it is impossible for the subject to support weight with
+the affected member even when it is passively placed in position.
+
+No difficulty is ordinarily experienced in differentiating radial
+paralysis from muscular injuries to the triceps; yet, in some cases of
+"dropped elbow," it is necessary to observe the progress of the case for
+ten days or two weeks before one can positively establish a diagnosis.
+
+     Quoting Merillat[12]: "When, after four weeks, there is no
+     amelioration of the paralysis, the muscles have atrophied, and the
+     patient has become emaciated from pain and discomfort, the
+     diagnosis of brachial paralysis with fracture of the first rib may
+     then be announced."
+
+Prognosis.--When no complete paralysis of the brachial plexus or no
+fracture of the first rib exists, the majority of cases recover
+completely in from ten days to six weeks. Some writers claim that
+recoveries occur in ninety per cent of cases when conditions are
+favorable.
+
+Treatment.--When incomplete radial paralysis exists, little needs be
+done except to allow the subject moderate exercise and to provide for
+its comfort. Local applications, stimulative in character, are
+beneficial, and the internal administration of strychnin is indicated.
+
+In the cases where weight is not supported without the affected leg
+being passively placed in position, it is necessary to provide for the
+subject's comfort in several ways.
+
+Mechanical appliances such as braces of some kind in order to keep the
+affected leg in a position of carpal extension, constitute the essential
+part of treatment. The leg is supported in such a manner that flexion of
+the carpus is impossible. Due regard is given to prevent chafing or
+pressure necrosis by contact of the skin with the braces--this may be
+done by bandaging with cotton. The supportive appliance is kept in
+position for ten days or two weeks. At the end of this time the brace
+may be removed and the subject given a chance to walk, and improvement,
+if any exists, will be evident. When there is manifested an amelioration
+of the condition, moderate daily exercise and massage of the affected
+parts are helpful.
+
+Should the subject be seriously inconvenienced by the application of a
+brace or other supportive appliances, it is necessary to employ slings.
+Further, if weight is supported entirely by the unaffected member,
+laminitis may supervene if a sling is not used.
+
+
+Thrombosis of the Brachial Artery.
+
+Thrombosis of the brachial artery or of its principal branches is of
+very rare occurrence in horses.
+
+Etiology.--Partial or complete obstruction of arteries (brachial or
+others) occurs as the result of direct injury to the vessel wall from
+compression and tension of muscles and resultant arteritis; lodging of
+emboli; and parasitic invasion of vessel walls causing internal
+arteritis.
+
+Symptomatology.--If sufficient collateral circulation exists to supply
+the parts with blood, no inconvenience is manifested while the subject
+is at rest. Where the lumen of the affected vessel is not completely
+occluded, there may be no manifestation of lameness when the ailing
+animal is moderately exercised. Consequently, the degree of lameness
+depends upon the extent of the obstruction to circulation; and,
+likewise, the course and prognosis depend upon the character and extent
+of such obstruction.
+
+In severe cases, lameness is markedly increased by causing the animal to
+travel at a fast pace for only a short distance. There are evinced
+symptoms of pain, muscular tremors and sudation, but the affected member
+remains dry and there is a marked difference of temperature between the
+normal areas and the cool anemic parts. When the subject is allowed to
+rest, circulation is not taxed, and there is a return to the original
+and apparently normal condition, only to recur again with exertion. This
+condition characterizes thrombosis.
+
+Treatment.--In these cases, little if any good directly results from
+any sort of treatment in the way of medication. Absolute rest is thought
+to be helpful. Potassium iodid, alkaline agents such as ammonium
+carbonate and potassium carbonate, have been administered. Circulatory
+stimulants also have been given, but it is doubtful if any good has come
+from medication.
+
+
+Fracture of Humerus.
+
+The shaft of the humerus, protected as it is by heavy muscles, is not
+frequently fractured; and fractures of its less protected parts, as for
+example, the head, are complicated in such manner that resultant
+arthritis soon constitutes the more serious condition.
+
+As a result of falls on frozen ground, kicks or any other form of heavy
+contusion, the humerus is occasionally broken. It is rarely fractured
+otherwise. Because of the force of contusions usually required to effect
+humeral fracture, the manner in which the bone is broken, with respect
+to direction, is variable. Often oblique fractures exist and
+occasionally there occurs multiple fracture. In addition to the
+ordinarily serious nature of the fracture itself, there is always much
+injury done the adjoining structures.
+
+Symptomatology.--Mixed lameness and manifestation of severe pain
+characterize this affection. Considerable swelling which increases, in
+some cases for a week or more, is to be observed. Crepitation is readily
+detected, if pain and swelling is not too great to prevent passive
+movement of the member. Where intense pain is not manifested, because of
+manipulation, one may abduct the extremity and thereby occasion distinct
+crepitation; but when it is possible to recognize crepitation by holding
+the hand in contact with the olecranon while the animal is made to walk,
+this method is to be preferred, if the subject can move without serious
+difficulty. The pathognomonic symptom here is recognition of
+crepitation, but this may be very difficult to recognize in fracture of
+condyles, and in such instances, a careful examination is necessary.
+Gentle manipulation in a manner that pain is not aggravated will tend to
+inspire confidence on the part of the subject and relaxation of muscles
+will enable the operator to detect crepitation.
+
+Course and Prognosis.--Because of the direction of the long axis of
+the humerus, with relation to the bony column of the extremity, it is
+obvious that any lateral movement of the leg tends to rotate the shaft
+of this bone. In fractures of the shaft of the humerus, then, it is
+apparent that immobilization is very difficult if at all possible.
+
+The proximity to the axillary lymph glands makes for easy dissemination
+of infection when the contused musculature becomes infected. The
+adjacent brachial nerve plexus is so very apt to become involved, if not
+actually injured at the time fracture occurs, that paralysis is a
+probable complication. Consequently, it is logical to reason that
+because of the many possible serious complications, such as shock,
+occasioned by the injury and the distress and pain which this accident
+produces, recovery must be the exception in fracture of the humerus.
+However, recoveries do take place and in addition to the reported
+recoveries by Liautard, Moller, Stockfleth, Lafosse, Frohner and others,
+we have instances cited by American practitioners where cases resulted
+in recovery. Thompson[13] reports a good recovery in a 1600-pound mare
+where there existed an oblique fracture of the humerus. This mare was
+kept in slings for eight weeks. Walters[14] reports complete recovery in
+humeral fracture in a foal three days old. The only treatment given was
+the application of a pitch plaster from the top of the scapula to the
+radius. The colt was kept in a comfortable box stall and in about four
+weeks regained use of the leg. Complete recovery eventually resulted. In
+the experience of the author, recovery has not occurred in humeral
+fractures.
+
+Treatment.--When animals are not aged and of sufficient value to
+justify treatment, they are best supported in a sling, if halter broken.
+If subjects are nervous, wild and unbroken, it is possible to employ the
+sling, if care is given to train the animal to this manner of restraint.
+The presence of an attendant for a day or two will reassure such
+subjects so that even in these cases it may be practicable to employ the
+sling.
+
+Braces and other mechanical appliances intended to immobilize the parts
+are not of practical benefit in the horse. Unlike the dog, the horse as
+yet has not been successfully subjected to tolerating rigid braces for
+the shoulder and hip.
+
+Everything possible must be done that will make for the patient's
+comfort. If the subject turns out to be a good self nurse, and the
+nature of the fracture is such that practical apposition of the broken
+ends of bone may be maintained, recovery will occur in some cases.
+
+
+Inflammation of the Elbow.
+(Arthritis.)
+
+Affections of this articulation other than those which are produced by
+traumatism are rare. This joint has wide articular surfaces, and
+securely joined as they are by the heavy medial and lateral ligaments
+(internal and external lateral ligaments), luxation is practically
+impossible. When luxation does occur, irreparable injury is usually
+done. Castagné as quoted by Liautard[15], reports a case of true
+luxation of the elbow joint in a horse where reduction was effected and
+complete recovery took place at the end of twenty-five days. This is an
+unusual case. The average practitioner does not meet with such
+instances.
+
+Anatomy.--The condyles of the humerus articulate with the glenoid
+cavities of the radius and a portion of the ulna. Two strong collateral
+ligaments pass from the distal end of the humerus to the head of the
+radius. The capsular ligament is a large, loose membrane which encloses
+the articular portion of the humerus with the radius and ulna and also
+the radioulnar articulation. It is attached anteriorly to the tendon of
+the biceps brachii (flexor brachii). The capsule extends downward
+beneath the origin of these digital flexors. This fact should be
+remembered in dealing with puncture wounds in the region, lest an error
+be made in estimating their extent and an open joint be overlooked at
+the initial examination.
+
+Etiology and Occurrence.--Exclusive of specific or metastatic
+arthritis, which is seldom observed except in young animals,
+inflammation of the elbow joint is usually caused by injury. This
+articulation is not subject to pathologic changes due to concussion or
+sprains as occasioned by ordinary service, but is frequently injured by
+contusion from falls, blows from the wagon-pole and kicks. Wounds which
+affect the elbow joint, then, may be thought of in most cases, as
+resultant from external violence. They may be contused wounds or
+penetrant wounds. Sharp shoe-calks afford a means of infliction of
+penetrant wounds which may occasion open joint and infectious arthritis.
+
+Classification.--A practical manner of classifying inflammation of the
+elbow is on an etiological basis. Eliminating the forms of elbow
+inflammation, such as are caused by metastatic infection and other
+conditions which properly belong to the domain of theory of practice, we
+may consider this affection under the classification of _contusive
+wounds_ and _penetrative wounds_.
+
+Symptomatology.--Any injury which is of sufficient violence to
+occasion inflammation of the elbow causes marked lameness and
+manifestation of pain. The degree of lameness and distress manifested by
+the subject, depends upon the nature and extent of the involvement. A
+contusion suffered as the result of a fall, which occasions a
+circumscribed inflammation of the structures covering this joint and
+where little inflammation of the articulating parts exists, marked
+evidence of pain and lameness might be absent. On the other hand, if a
+true arthritis is incited, there will be evident distress manifested,
+such as hurried respiration, accelerated pulse, inappetence, mixed
+lameness, local evidence of inflammation and particularly marked
+supersensitiveness of the affected parts. Considering these two extremes
+of manifested distress and injury, one may readily conclude that in the
+frequently seen case, wherein contusion has occasioned a moderate
+degree of injury, prognosis is favorable and recovery ordinarily
+follows in the course of a few weeks' treatment.
+
+In cases of arthritis due to penetrative wounds (because of the
+important function of this joint and its large capsule, which when
+inflamed discharges synovia in a manner that closure of such an open
+joint is seldom possible) a very grave condition results.
+
+Treatment.--Inflammation of the elbow, such as is frequently seen in
+general practice where horses are turned out together and exposed to
+kicks and other injuries, yields to treatment readily, if an open joint
+does not exist.
+
+Hot packs supported in contact with the elbow and kept around the
+inflamed articulation for a few days, materially decrease pain and tend
+to reduce inflammation. The subject must be kept quiet in a comfortable
+stall and, if necessary, a sling used. Where it is impossible for the
+animal to support much weight with the injured member the sling should
+be employed.
+
+As inflammation abates, which it does in the course of from one to three
+weeks in uncomplicated cases, the subject may be allowed the freedom of
+a comfortable box stall. Vesication of the parts is in order, and this
+may be repeated in the course of two weeks, if it is deemed necessary.
+
+Penetrative wounds resulting in open joint are not treated with success
+as a rule, and because of the handicap under which veterinarians labor,
+methods of handling such cases, where large, important articulations are
+affected, are not being rapidly improved. Prognosis is usually
+unfavorable, and for humane and economic reasons, animals so affected
+should be destroyed.
+
+Ordinary wounds of the region of the elbow are treated along general
+lines usually employed. They merit no special consideration, except that
+it may be mentioned that with such injuries concomitant contusion of the
+parts occasions injury that does not recover quickly.
+
+
+Fracture of the Ulna.
+
+Etiology and Occurrence.--Fractures of the ulna in the horse are not
+common in spite of the exposed position of the olecranon. This bone when
+broken, is usually fractured by heavy blows and any form of ulnar
+fracture is serious because of its function and position in relation to
+the joint capsule. Transverse fractures do not readily unite because of
+the tension of the triceps muscles, which prevent close approximation of
+the broken ends of the bone.
+
+Thompson[16], however, reports a case of transverse simple fracture of
+the ulna in a mare, the result of a kick, in which complete recovery
+took place. He kept the subject in a sling for six weeks and then
+allowed six months rest.
+
+Symptomatology.--The position assumed by a horse suffering from a
+transverse fracture of the ulna, is similar to that in radial paralysis.
+Crepitation may be detected by manipulating the parts, and in some
+instances of fracture of the olecranon, there occurs marked displacement
+of the broken portions of the bone. Lameness is intense and the parts
+are swollen and supersensitive. The capsular ligament of the elbow joint
+is usually involved in the injury because fracture of the ulna may
+directly extend within the capsular ligament. In such cases, there is
+synovitis, and later arthritis causes a fatal termination.
+
+Treatment.--The impossibility of applying a bandage in any way to
+practically immobilize these parts in fracture of the ulna, prevents our
+employing bandages and splints. Therefore, one can do little else than
+to put the patient in a sling and try to keep it quiet and as nearly
+comfortable as circumstances allow.
+
+
+Fracture of the Radius.
+
+Etiology and Occurrence.--From heavy blows received such as kicks,
+collision with trees or in falls in runaway accidents, the radius is
+occasionally fractured. In very young foals, fracture of the radius, as
+well as of the tibia and other bones, results from their being trampled
+upon by the mother.
+
+Symptomatology.--Excepting in some cases of radial fracture of foals
+where considerable swelling has taken place, there is no difficulty in
+readily recognizing this condition. The heavy brachial fascia materially
+contributes to the support of the radius, and in cases where swelling
+is marked, crepitation may not be readily detected. In fact, a
+sub-periosteal fracture may exist for several days or a week or more and
+then, with subsequent fracture of the periosteum, crepitation and
+abnormal mobility of the member are to be recognized. In such cases, the
+subject will bear some weight upon the affected member, but this causes
+much distress. In one instance the author observed a transverse fracture
+of the lower third of the radius which was not positively diagnosed
+until about ten days after injury was inflicted. In this case, without
+doubt, the subject originally suffered a sub-periosteal fracture of the
+bone and because the animal was a good self nurse, the brachial fascia
+supported the radius until the periosteum gave way and the leg dangled.
+In this instance infection took place and suppuration resulted. It was
+deemed advisable to destroy this animal.
+
+Prognosis.--In adult animals, radial fracture constitutes a grave
+condition; generally speaking, prognosis, in such cases, is unfavorable.
+Because of the leverage afforded by the extremity, immobilization of the
+radius is difficult. Any sort of mechanical appliance, which will
+immobilize these parts, is likely to produce pressure-necrosis of the
+soft structures so contacted. There is occasioned thereby much pain and
+the subject becomes restive, unmanageable and sometimes the splints are
+completely deranged because of the animal's struggles, and much
+additional injury to the leg is done. Occasionally, an otherwise
+favorable case is thus rendered hopelessly impossible to handle, and the
+subject must be destroyed several days after treatment has been
+instituted.
+
+Consequently, unless all conditions are good, and the affected animal a
+favorable subject, young, of good disposition, and the fracture a simple
+transverse one, complete recovery is not likely to result from any
+practical means of handling.
+
+Treatment.--Mature subjects ought to be put in slings and kept so
+restrained throughout the entire time of treatment. Immobilization of
+the broken parts of the bone is the object sought. This is attempted by
+practitioners who employ various methods, and each method has its
+advocates.
+
+Casts are used by some and serve very well in many cases; but because of
+their bulk and unyielding and rigid nature, they are not well adapted to
+use on fractures of bones proximal to the carpus and tarsus. This is in
+reference to plaster-of-paris casts or those of any similar material.
+
+Appliances which depend on glue or other adhesive substances combined
+with leather, wood or fiber for their support, are efficacious but not
+comfortable.
+
+The use of heavy leather when the member has been suitably padded with
+cotton and bandages, constitutes a very good manner of reducing fracture
+of the radius or of the tibia. Leather when cut to fit both the medial
+and lateral sides of a leg, and firmly held with bandages, will form a
+firm support that yields slightly to changes of position, thus making
+for comfort of the subject.
+
+Such a splint or support should extend from the fetlock region to the
+elbow, but the cotton and bandages are to reach to the foot. When one
+considers that, with the supportive appliance placed on each side of the
+affected member, rigidity is accomplished as much from tensile strain
+put upon the leather as from its own stiffness, it is seen that the
+leather need not be of the heaviest--sole leather is unnecessary.
+Because of the more comfortable immobilizing appliance, the subject is
+less restive, and chances for a successful outcome are materially
+increased thereby.
+
+In the mature subject, six or eight weeks' time is required for union of
+the parts to occur sufficiently so that splints may be dispensed with.
+Rearrangement of the supportive apparatus, however, is possible and
+usually necessary during the first few weeks of treatment. By employing
+care in handling the parts, the subject will be unlikely to do itself
+injury at the time readjustment of splints is being effected.
+
+In foals, it is best to give them the run of a box stall with the
+mother. Being agile, they get up and lie at will without doing injury to
+the fractured member. The splints (leather is preferable in these cases
+also) are looked after and readjusted as necessity demands.
+
+Three or four weeks time is all that is required for the average young
+colt to be kept in splints when suffering from simple transverse
+fracture of the radius.
+
+Compound fractures are necessarily more difficult to treat than are the
+simple variety, but even in such cases recovery results sometimes, and
+the practitioner is justified in attempting treatment after having
+explained the situation to his client.
+
+Oblique fractures, even when simple, do not completely recover. Muscular
+and tendinous contraction, together with the natural tendency for the
+beveled contacting parts of the broken bone to pass one another in
+oblique fracture, results in shortening of the leg and, if union
+results, a large callus usually forms. Where shortening of bones occur,
+necessarily, permanent lameness follows.
+
+
+Wounds of the Anterior Brachial Region.
+
+Etiology and Occurrence.--Contusions and lacerations of the forearm
+are of frequent occurrence in horses and are troublesome cases to
+handle; particularly is this noticeable where extensive laceration of
+the parts occurs. These injuries are caused by animals being kicked; by
+striking the forearm against bars in jumping; and in sections of the
+country where barbed wire is used to enclose pastures, extensive
+lacerated wounds are met with when horses jump into such fences.
+
+Symptomatology.--Any wound which causes inflammation of the structures
+of the anterior half of the forearm, is characterized by
+swinging-leg-lameness. Depending upon the nature and extent of the
+injury, manifestation varies. In cases where laceration has practically
+divided all of the substance of the extensor tendons, it is, of course,
+impossible for the subject to advance the leg; but where lacerated
+wounds involve only a part of the extensor apparatus of the foreleg, not
+so much inconvenience is evident, unless the wound is seriously infected
+and inflammation involves contiguous structures. Therefore, in many
+instances, lameness is more pronounced in contusions of the anterior
+brachial region than where tissues have been divided more or less
+keenly.
+
+In every instance diagnosis is easily established. The injury is quite
+evident, and the manner of locomotion is not in itself an essential
+feature to be considered in a discussion of symptoms. Where a contusion
+of the anterior brachial structures occurs, there is, in addition to
+lameness, swelling which is painful because of the pressure occasioned
+by the heavy non-yielding brachial fascia. And where suppuration occurs,
+there is then an intensely painful condition which is not relieved until
+pus has been evacuated. Rather frequently, drainage for wound secretions
+is a difficult problem, and approximation of the divided ends of muscles
+is always difficult to maintain.
+
+Treatment.--Contused wounds of the anterior brachial region are
+treated along usual lines; that is, attempt is made to stimulate prompt
+resolution. Hot or cold applications are employed throughout the acute
+stage of the affection. Complete rest is provided for until all pain has
+subsided. Later, stimulating liniments are beneficial.
+
+Where no injury is done the periosteum or bone, complete resorption of
+all products of inflammation usually occurs, though in many instances,
+this is tardy--six weeks or more are sometimes required for recovery to
+take place.
+
+If suppuration occurs, it is necessary to provide for drainage as soon
+as it is possible to distinguish the presence of pus. Due regard is
+given the manner of establishing drainage because of the usual existence
+of sub-fascial fistulae. In these cases, one avoids injecting solutions
+of aqueous antiseptics. By gently compressing the parts, pus is caused
+to drain out and in enforcing a moderate amount of exercise at a walk,
+when lameness is not intense, drainage is maintained. Cotton packs,
+moistened with hot antiseptic solutions, and kept around the forearm for
+several hours daily, are helpful because drainage is facilitated, and
+resolution is stimulated by the increase of blood thus attracted to the
+parts, and pain materially diminishes.
+
+In lacerated wounds of the anterior brachial region, after having
+controlled hemorrhage, an area around the wound margin is freed of hair
+by clipping or shaving. The wound is carefully examined, and the best
+site for drainage is selected and a suitable opening for wound discharge
+is provided for. Where the extensor carpiradialis (metacarpi magnus)
+with other structures, is divided and the distal portion is torn
+downward, as frequently is the case in barbed wire cuts, it is
+necessary to make careful provision for drainage. The wound is
+thoroughly cleansed by means of ablutions if necessary; but preferably
+by swabbing with pledgets of cotton or gauze which are moistened in
+antiseptic solutions. All shreds of macerated tissue are clipped with
+scissors and finally the whole wound surface is painted with tincture of
+iodin.
+
+If drainage is made by cutting through the tissues in the median portion
+of the structures that have been displaced, the opening should be packed
+with gauze so that it may remain patent after swelling has occurred.
+Such packing is left _in situ_ for twenty-four hours.
+
+The pendant muscular portions of tissues are sutured up by means of
+tapes and, while perfect apposition is not ordinarily possible, it is
+very essential to train the pendant tissues in their normal position
+even if they require resuturing within a week. This minimizes
+granulation of tissue, and there results less scar if the detached
+portions are kept near, even if not in contact with the proximal wound
+margins. The skin together with subcutaneous fascia is sutured on either
+side unless drainage is to be provided for on one side, and the
+lowermost part of that side is left unsutured.
+
+After-care.--Where extensive suturing of tissues has been necessary,
+subjects must be kept quiet. They are best confined in box stalls and
+not taken out for several weeks. Particularly is this true where
+transverse division of extensors has taken place. Sutures are removed at
+the end of from ten days to three weeks as cases permit. Drainage of
+wound secretions, which usually become infected, is necessary, because
+with obstructed drainage in an infected wound of this kind, there will
+result an early destruction of tissue at some point sutured. Daily
+irrigation done in a manner that practical asepsis is carried out, is
+necessary for about a week. All irrigation is done by way of the
+drainage opening, and this with warm aqueous solutions of suitable
+antiseptics. After a week or ten days' time, the wound should not be
+dressed more frequently than twice weekly.
+
+If it is necessary to leave a portion of the wound uncovered, as in
+cases where skin is destroyed, the frequent (three or four daily)
+application of a suitable antiseptic powder is necessary to check
+exuberant granulation. This may be directly effected by the use of an
+astringent or desiccant preparation, and such dressing serves as a
+mechanical protection as well.
+
+When such wounds are kept clean, where drainage is properly maintained,
+and the subject kept quiet, no particular attention other than the local
+application of an astringent lotion (such as the zinc and lead lotion)
+is necessary after the first three or four weeks. Usually, if the animal
+gnaws at the parts or otherwise manifests evidence of discomfort, it is
+an indication that new areas of infection are being established because
+of obstructed drainage or retained eschars. A thorough cleansing of the
+wound with a two per cent solution of Liquor Cresolis Compositus and
+this followed by moistening every part of the wound with tincture of
+iodin, will check all such disturbance if done promptly.
+
+Where practically all of the anterior surface of the radius has been
+denuded, recovery is tardy and there is in some cases imperfect
+extension of the leg for months after the wound has healed. But in such
+instances, animals gradually regain complete use of the affected member
+and in the course of a year function is fully restored.
+
+
+Inflammation and Contraction of the Carpal Flexors.
+
+Anatomy.--The structures which are usually considered as true flexors
+of the carpus are a group of three muscles, which have separate heads of
+origin and different points of tendinous insertion.
+
+The _flexor carpiradialis_ (flexor metacarpi internus) originates from
+the medial epicondyle of the humerus. It is inserted to the proximal end
+of the medial metacarpal (inner metacarpal or splint) bone. This muscle
+is the smaller of the three and is not usually divided in doing carpal
+tenotomy.
+
+The _flexor carpiulnaris_ (flexor metacarpi medius) has two heads of
+origin; one, the larger, originates from the epicondyle of the humerus
+and the other from the posterior surface of the olecranon. The two
+heads unite at the upper third of the radius and the muscle, becoming
+tendinous, as is the case with the other carpal flexors, is attached by
+one point of insertion to the accessory carpal bone (trapezum). The
+other blends with the posterior annular ligament of the carpus.
+
+The _ulnaris lateralis_ (flexor metacarpi externus) has its origin from
+the lateral epicondyle of the humerus and inserts to the proximal
+extremity of the fourth metacarpal (outer splint) bone and by another
+attachment to the accessory carpal bone (trapezium) with the tendon of
+the flexor carpiulnaris (flexor metacarpi medius).
+
+Acting together, these muscles flex the carpus or extend the elbow and
+this action is antagonized by the biceps brachii (flexor brachii) and
+extensors of the carpus and phalanges.
+
+Etiology and Occurrence.--Inflammation of the muscular or tendinous
+parts of the carpal flexors, does not occur as frequently as does
+inflammation of the flexors of the extremity. They are subject to injury
+such as is occasioned by hard work and concussion and contract as a
+result; but, more frequently a congenital malformation of the leg is
+responsible for undue strain upon these parts. Horses that are "knee
+sprung" or that have a congenital condition where in the anterior line,
+as formed by the radius, carpal and metacarpal bones, is bent forward at
+the carpus, are subject to inflammation and contraction of the carpal
+flexors. When these flexors are contracted, the condition is commonly
+known among horsemen as "buck knee." In itself, inflammation of the
+carpal flexors is not a condition which is likely to prove troublesome,
+but because of carpal involvement (which is often present) the cause of
+the trouble remains, and inflammation of the carpal flexors recurs or
+becomes chronic and contraction of tendons results.
+
+Symptomatology.--Inflammation of the carpal flexors, when acute and
+uncomplicated, is characterized by a painfully swollen condition of the
+affected tendons. No weight is borne upon the affected leg and the
+carpal joint is flexed. Mixed lameness is present. There is no
+difficulty encountered in arriving at a diagnosis because of the very
+noticeably inflamed parts.
+
+Many fully developed cases of contraction of the tendons of the carpal
+flexors are observed where the condition has become established
+gradually and no lameness has resulted from tendinitis or carpitis. In
+some of these cases, subjects are stumblers and when they are carelessly
+handled or kept at fast work over irregular or hard roads, chronic
+carpitis with hyperplasia of the structures of the anterior carpal
+region results, owing to frequent bruising from falls.
+
+[Illustration: Fig. 10--Contraction of carpal flexors, "knee sprung."]
+
+Where inflammation is caused by a puncture wound and subfascial
+infection occurs, there is evident manifestation of pain. No weight is
+supported by the affected member and because of the pressure, occasioned
+by the swollen muscles confined within the non-yielding brachial fascia,
+there exists marked supersensitiveness of the affected parts. Flexion of
+the elbow is avoided because contraction of the biceps brachii (flexor
+brachii) or the extensors, which are antagonists of the flexors of the
+carpus, tenses the carpal flexors and pain is thereby increased.
+
+However, in most instances, the practitioner's attention is not directed
+to typical and uncomplicated cases, but to subacute or chronic
+inflammations which are often attended with contraction of the tendinous
+parts of the carpal flexors, and in such cases carpitis is present.
+Animals so affected have lost the rigidity which characterizes the
+normal carpal joint when the leg is a weight bearing member, and because
+of its sprung condition, the leg trembles when supporting weight.
+
+Treatment.--Acute inflammation is treated by means of local
+application of cold or hot packs until the pain and acute stage of
+inflammation has subsided and later stimulating liniments are indicated.
+Absolute quiet must be enforced. Especially where the carpus is involved
+must the subject be kept quiet until all evidence of inflammation has
+subsided.
+
+The application of vesicants or line-firing is beneficial in subacute
+inflammation of the tendons of the carpal flexors. Where contraction of
+tendons exists and no osseous or ligamentous change prevents correction
+of the condition, tenotomy is necessary. The reader is referred to
+Merillat's "Veterinary Surgery"[17] for a good description of the
+technic of this operation.
+
+In all serious cases of inflammation of the carpal flexors, whether
+tenotomy has been performed or not, the subject needs a long period of
+rest subsequent to treatment. In fact, three or four months at pasture
+is necessary to permit of recovery and this where no congenital
+deformity has predisposed the subject to such affection of the flexors.
+Return to work must be gradual and the character of the work such as to
+enable the animal to become inured to service without a recurrence of
+the trouble if possible.
+
+It follows then, that tenotomy, here as in other cases, is not practical
+from an economic viewpoint, unless the animal be of sufficient value to
+justify the long period of rest for recovery. Tenotomy is not of
+practical benefit unless ample time is allowed for regeneration of
+divided tendinous tissue.
+
+
+Fracture and Luxation of the Carpal Bones.
+
+Etiology and Occurrence.--Fracture of the carpal bones is of
+infrequent occurrence in horses and, when it does occur, it is usually
+due to injuries, and because of their nature (resulting as they
+generally do from heavy falls or in being run over by street cars or
+wagons), a comminuted fracture of one or more bones exists. The
+accessory carpal bone (trapezium) is said to be fractured at times
+without being subjected to blows or like injuries, but this is
+exceptional.
+
+Luxations of the carpal joint are of rare occurrence, and very few cases
+of this kind are on record. Walters[18] reports a case of
+carpometacarpal luxation in a pony wherein reduction was spontaneous and
+an uneventful recovery followed. His reason for reporting the case, as
+he states, is its rarity.
+
+Symptomatology.--Fractures of the carpal bones as they usually take
+place are diagnosed without difficulty. Because of their usually being
+comminuted, abnormal movement of the joint is possible. Such movement is
+not restricted and flexion of the leg at the carpus in any direction is
+possible. Crepitation is readily detected and frequently these fractures
+are of the compound-comminuted variety.
+
+In fracture of the accessory carpal bone (trapezium) or in fracture of
+any other single bone when such exists, there is no increase in the
+movement of the joint. The accessory carpal bone may be readily
+manipulated and when fractured, its parts are more or less displaced.
+Recognition of fracture of any other single carpal bone must be done by
+detecting crepitation unless it be a compound fracture, whereupon
+probing is of aid in establishing a diagnosis.
+
+Carpal luxation when present is to be recognized by finding the apposing
+carpal bones joined in an abnormal manner--that is, out of position.
+There is restricted or suspended function of the joint, and in the cases
+recorded, no difficulty has been experienced in making a diagnosis. The
+carpometacarpal portion of the articulation is the part which is usually
+affected.
+
+Prognosis and Treatment.--There is no chance for complete recovery in
+the usual case of carpal fracture because of the fact that there results
+sufficient arthritis to destroy articular cartilage beyond repair. In
+the average instance, because of arthritis which persists for a
+considerable length of time, more or less ankylosis results. At best,
+one can only hope for partial recovery, that is to say, the member may
+regain its usefulness as a weight-supporting part, but because of
+restricted or abolished joint function, locomotion is more or less
+difficult. Exostoses, articular and periarticular, occur and the carpus
+usually becomes a large immobile articulation. There is danger of
+infection resulting in simple carpal fractures and, needless to say, in
+a compound-comminuted fracture of the carpus, infection usually occurs
+and a fatal outcome is probable.
+
+When treatment is instituted, antiseptic precautions are taken in
+handling the compound fractures, and in any case immobilization of the
+parts is sought. Here, as has been previously pointed out, it is best to
+employ leather splints, so that a maximum degree of rigidity with a
+minimum of distress and inconvenience to the patient will result. The
+leg must be bandaged from the hoof upward, making use of a sufficient
+amount of cotton to ensure against pressure-necrosis. The leather
+splints are placed mesially and laterally and, of course, need to extend
+as high as the proximal end of the radius. Subjects must be kept in
+slings until union of bones has become established, and as a rule there
+will then exist marked ankylosis.
+
+There is no particular difference in the handling of carpal luxation and
+dislocation of other bones. Where ligaments have not been destroyed to
+the extent that reduction is of no practical use, the parts are kept
+immobilized, if thought necessary. Later, vesication of the whole
+pericarpal region is done and the subject allowed exercise at will.
+
+
+Carpitis.
+
+Etiology and Occurrence.--Inflammation of the carpus is caused by
+contusions, such as are occasioned in falling, by kicks by striking the
+carpus against objects in jumping and sometimes by striking it against
+the manger in pawing. The condition is of rather frequent occurrence.
+
+Symptomatology.--Evident symptoms of inflammation in carpitis are
+always present--hyperthermia, supersensitiveness and swelling. Also,
+there exists lameness which is characterized by an apparent inability to
+flex the leg, and there is circumduction of the leg as it is advanced
+because in this way little if any flexion of the carpus (which increases
+pain) is necessary.
+
+Depending upon the nature of the cause, there occurs a marked difference
+in the character and amount of swelling.
+
+[Illustration: Fig. 11--Pericarpal inflammation and enlargement due to
+injury.]
+
+Naturally, when much extravasation of serum and blood takes place, there
+is occasioned a fluctuating swelling which is usually less painful to
+the subject upon manipulation than is a dense inflammatory change
+without marked extravasation.
+
+In acute carpitis, there is present, then, a very painful condition
+which involves the articulation, causing marked lameness, disturbance of
+appetite and some elevation of temperature.
+
+Chronic cases do not occasion serious pain or constitutional
+disturbances, but do interfere with locomotion in direct proportion to
+the existing articular inflammation and periarticular hypertrophy of
+ligamentous and tendinous structures.
+
+Treatment.--If possible, keep the subject absolutely quiet, employing
+the sling if necessary. During the first stages of inflammation, the
+application of ice packs to the affected parts, is of marked benefit.
+At the end of forty-eight hours, hot applications may be used and this
+treatment continued throughout several days. Anodyne liniments are of
+service and should be employed throughout the acute stage of
+inflammation during intervals between the hydrotherapeutic treatments.
+
+As inflammation subsides, a counterirritating application such as a
+suitable liniment and later blistering or line-firing is helpful in
+stimulating resolution.
+
+[Illustration: Fig. 12--Hygromatous condition of the right carpus, also
+distension of sheaths of extensor tendons of both fore legs.]
+
+
+Open Carpal Joint.
+
+Anatomy.--The carpal bones as they articulate with one another and
+with the radius and metacarpal bones, as classed by anatomists, form
+three distinct articular parts of the joint as a whole and are known as
+radiocarpal, intercarpal and carpometacarpal. These three pairs of
+articulating surfaces are all enclosed within one capsular ligament. On
+the anterior face of the bones, the capsular ligament is attached to the
+carpal bones in such manner that an imperfect partitioning of the three
+joint compartments is formed. Posteriorly, the capsule is very heavy and
+forms a sort of padding over the irregular surfaces of the bones, and
+also its reflexions constitute the sheaths of the flexor tendons. The
+anterior portion of the capsular ligament forms sheaths for the extensor
+tendons, and both portions of the joint have an attachment around the
+distal end of the radius and another at the proximal end of the
+metacarpal bones.
+
+[Illustration: Fig. 13--Carpal exostosis in aged horse.]
+
+Etiology and Occurrence.--Puncture wounds of any kind may serve to
+perforate the joint capsule and such traumatisms are occasioned by
+falls, kicks and in various ways in runaway accidents, and open carpal
+joint may follow.
+
+Symptomatology.--The pathognomonic symptoms of the existence of an
+open joint is the exposure to view of articular surfaces of bones or
+noting the escape of synovia from the joint capsule. As has been
+previously referred to, there always exists a peculiar suspension of
+carpal flexion in all cases of carpitis.
+
+Non-infective wounds which may cause open joint are not necessarily
+productive of an active carpitis--a synovitis may be the extent of the
+disturbance. Unlike synovitis, which may characterize a non-infectious
+penetrative wound of the capsular ligament, septic arthritis which may
+supervene is a very painful inflammatory disturbance. It is
+characterized by all of the symptoms which attend the case of open joint
+and synovitis plus the obvious manifestation of great pain. There is an
+elevation of temperature of from two to five degrees above normal;
+circulation is accelerated; the pulse is bounding; respiration is
+hurried; there is an expression of pain as indicated by the physiognomy;
+and because of rapid erosive changes of cartilages which take place,
+there is soon so much of the articulation destroyed that death is
+inevitable. Death is usually due to generalization of the arthritic
+infection.
+
+[Illustration: Fig. 14--Exostosis of carpus resultant from carpitis.]
+
+[Illustration: Fig. 15--Distal end of radius. Illustrating the effects
+of chronic carpitis.]
+
+In the meanwhile, if the character of the infectious material is not so
+virulent, the disease will take on a slower course and the subject may
+experience laminitis from supporting weight upon the sound member, or
+because of continued recumbency, decubital gangrene and emaciation
+sometimes cause death. If the subject does not soon succumb, it is
+compelled to undergo days or even weeks of unnecessary suffering, and
+too often in such cases, it is later deemed advisable to destroy the
+animal because of the cost of continuing treatment until the horse is
+serviceable. Therefore, it is evident that when such joints as the
+carpus or tarsus are open and infection exists, if they are not promptly
+treated and the infectious process checked, it is neither humane nor
+practical to prolong treatment.
+
+Distinction must be made between the different joints when infected as
+the condition is much more serious in some cases than in others. All
+things considered, perhaps open joints rank, with respect to being
+serious cases as follows: elbow, navicular, stifle, tarsus, carpus,
+fetlock and pastern. This, of course, is restricted to articulations of
+the locomotory apparatus.
+
+Treatment.--Preliminary care in the treatment of an open carpal joint,
+is the same as has been described in this condition as it affects the
+scapulohumeral articulation described on page 65. Likewise the further
+treatment of such cases is along the same lines except that where it is
+possible, the parts are kept covered with cotton and bandages. However,
+in some cases, animals have been successfully treated without bandaging
+and by keeping the patient in a standing position and on pillar reins
+until recovery resulted. Such cases were of the non-infectious type and
+recovery was possible within three or four weeks. Further, the condition
+is not sufficiently painful in such instances as to prevent the subjects
+bearing weight with the affected member; hence, no danger of resulting
+laminitis is incurred. And finally, where bandages are not employed, the
+frequent use of antiseptic dusting powders is substituted for cotton as
+a protector.
+
+When bandaged, such wounds need dressing more or less frequently, as
+individual instances demand. The purulent infective inflammation of a
+carpal joint will require daily dressing; whereas, in other cases
+(non-infective), semi-weekly change of bandages is sufficient. Equal
+parts of boric acid and exsiccated alum constitute a suitable
+combination for the treatment of these cases, and this powder should be
+liberally employed. Tincture of iodin may be injected into the joint
+capsule where there is provision for its ready evacuation, as
+conditions seem to require. Daily injections for three, four or five
+days, are not harmful and will control infection in many instances.
+
+
+Thecitis and Bursitis.
+
+Etiology and Occurrence.--The thecae and bursae of the leg are several
+in number. In the carpal region, the flexors of the phalanges are
+contained together in the carpal sheath, and this is the principal theca
+in the carpal region. Each of the tendons is provided with synovial
+sheaths which are subject to inflammation and occasionally synovitis and
+distension of these synovial sheaths occur.
+
+Because of faulty conformation, some animals are subject to inflammation
+of these sheaths, and all forms of strenuous work which taxes the
+tendons greatly is apt to result in synovitis. Direct injury such as
+blows may be the cause of synovial distension of thecae and the
+affection is to be seen in all horses that have done much fast work on
+hard road surfaces or pavements.
+
+The usual case as it occurs in practice is a non-infective synovitis,
+but where puncture wounds cause the trouble, an infectious inflammation
+obtains.
+
+Symptomatology.--No trouble is experienced in diagnosing distension of
+tendon sheaths, for the affection is very palpable. During acute
+inflammatory stages of this affection, some lameness is present--in
+infectious inflammation lameness is intense. Local heat and pain upon
+manipulation are readily discernible in all acute cases. And finally,
+where there is reason for doubt, an aseptic exploratory puncture of the
+wall of the fluctuating enlargement may be made with a suitable trocar,
+and the discharging synovia will be proof of the existence of synovial
+distension.
+
+After the affection becomes subacute or chronic, no lameness or
+inconvenience is manifested, and the condition is undesirable only
+because of its being a blemish.
+
+Treatment.--Acute non-infectious synovial distension of tendon sheaths
+is treated by aspirating as much synovia as possible from the affected
+theca (this is, of course, done under strict asepsis) and by means of
+bandages, a uniform degree of pressure is kept over the parts for ten
+days or two weeks. The patient is kept quiet and in the course of two
+weeks an active blistering agent is employed over the region affected.
+Usually, at the end of a month's time, complete recovery has taken place
+and the subject may be gradually returned to work.
+
+When synovial distensions are of long standing, it is necessary to take
+special precautions to check excessive secretion of synovial fluid, and,
+also because of the atonic condition of the tissues affected, resolution
+is tardy. In addition to aspirating synovia, the introduction of equal
+parts of alcohol and tincture of iodin into the theca is necessary. The
+quantity of this combination injected, depends upon the size of the
+sheath affected and the amount of synovia retained at the time injection
+is made. Experience is necessary to judge as to this part of the work,
+but one may consider that a quantity between three and ten cubic
+centimeters of equal parts of tincture of iodin and alcohol constitutes
+the proper amount to employ. Where much synovia is contained within the
+sheath at the time of injection, there occurs great dilution of the
+agent injected and consequently less irritation results.
+
+The object of such injections is to check synovial secretion, and this
+is sought by the local effect of iodin in contact with the secreting
+cells together with the reactionary swelling which occasions pressure.
+An increase in the local blood supply also follows. In all cases where
+it is possible to employ suitable bandages, this should be done. The
+ordinary derby bandages serve well and if their use is continued for a
+sufficient length of time, good results follow.
+
+There are other methods of treating these affections, and each has its
+advantages and disadvantages. Line-firing, instead of the vesicant is
+made use of by some, but the object desired is the same and results
+obtained are similar.
+
+Sheaths may be opened surgically by means of a knife, and the removal of
+a portion of the wall of distended and atonic tendon sheaths is
+possible. These operations belong to the realm of surgery and are not
+properly a part of this treatise. However, in passing, it may be said
+that if a perfect technic is possible in doing the last named
+operation, a permanent recovery is the outcome.
+
+
+Fracture of the Metacarpus.
+
+Etiology and Occurrence.--As the result of all sorts of violence, such
+as falls and injuries in accidents of various kinds wherein the
+metacarpals are subjected to contusions, fractures may result. In the
+horse it is unusual for fracture of one of the small metacarpal bones to
+take place without there being at the same time a fracture of the third
+(large) metacarpal bone.
+
+Classification.--Fractures of the metacarpal bones as they occur, are
+as likely to be compound as simple, and the multiple and comminuted
+varieties are occasionally observed. The manner in which the third
+(large) metacarpus is fractured, largely determines the outcome in any
+given case.
+
+Symptomatology.--Abnormal mobility of the broken parts of bone and
+crepitation mark fracture of the metacarpus, and the condition is easily
+diagnosed. In many instances, when compound fracture exists, broken ends
+of bone are protruding through the skin. No weight is borne upon the
+fractured member ordinarily, although during the excitement occasioned
+by runaways, horses are sometimes seen to support weight with a broken
+leg even when the protruding bone is sunk into the ground in so doing.
+
+Prognosis.--Generally speaking, fractures other than the
+simple-transverse in young animals, are considered unfavorable cases.
+With the metacarpus, however, there are instances where compound
+fracture occurs in colts that justify treatment. But in all cases of
+compound fracture, the element of infection in addition to the increased
+difficulty in maintaining immobility of the broken bone, creates almost
+insuperable difficulties in the average instance. And unless the
+practitioner distinctly explains to his client the various reasons which
+make treatment an economic impracticability, dissatisfaction is likely
+to follow if treatment is instituted without such an understanding.
+
+Treatment.--Perfect apposition of the broken ends of bone is easily
+effected and less difficulty is encountered in maintaining such
+relations in metacarpal fractures than in fractures of the radius.
+However, reduction and immobilization of this as in all fractures, must
+be done without delay. In simple fracture, the metacarpus is covered
+with enough cotton to pad the parts, and this is retained in position by
+bandages. Splints of heavy leather or of thin pieces of tough flexible
+wood are placed on each side of the leg and firmly held in position with
+bandages. Bandages may be put on in layers and a coating of glue applied
+over each layer if this is thought necessary. The advantage gained in
+using glue or other adhesive materials is that the cast thus formed is
+more rigid than where such material is not employed. On the other hand,
+all elasticity is lost as soon as the cast adapts itself to the contour
+of the extremity, and because of this rigidity, it is doubtful if
+anything is gained by the incorporation of glue, except in the way of
+added strength of the cast. Since the animal does not walk upon the
+broken leg, it is possible to employ splints of suitable materials which
+are retained in position without glue and frequent readjustment of a
+part of the immobilizing apparatus is possible. This is impossible with
+casts.
+
+In compound fractures, provision ought to be made for dressing the wound
+of the soft structures. This entails adjusting the splints in such
+manner that one splint may be retained and others removed for dressing
+the wound and readjusted as often as wound dressing is necessary.
+
+
+Splints.
+
+By this term is meant a condition where there exists an exostosis which
+involves usually the second (inner small) and third (large) metacarpal
+bones. While an exostosis involving any one of the splint bones, even
+when directly caused by an injury, is called a "splint," the term is
+employed here, in reference to exostoses not due to direct injury such
+as in contusions.
+
+Etiology and Occurrence.--This condition is one wherein there is
+osseous formation following a periostitis and the region of the upper
+portion of the second (inner small) metacarpal bone is the usual site of
+the exostosis. There is incited an inflammation of the periosteum at
+the site of the interosseous ligament which attaches the small to the
+large metacarpal bone. This ligament is involved in the inflammatory
+process, and according to Havemann, whose view is supported by Moller,
+this inflammation is the origin of the trouble.
+
+Various theories attempting an explanation of the frequent affection of
+this one certain part so regularly involved have been offered, but no
+proof of the correctness of any exists. It follows, however, that
+splints occur in young animals; that the affection seldom starts in
+subjects that are ten years of age or older, and that when the exostosis
+has formed, lameness usually subsides. Anything which will cause undue
+strain or irritation of the metacarpal bones in young animals, is quite
+apt to result in a splint being formed. Concussion such as is caused by
+fast work on hard roads, or work on rough or irregular road surfaces
+which cause unequal distribution of weight, will cause splint lameness
+and exostosis follows.
+
+[Illustration: Fig. 16--Posterior view of radius (right) illustrative of
+effects of splint. Note the extent of exostosis.]
+
+Course.--Because of the peculiar manner in which the second and third
+metacarpal bones articulate in young animals, until the bones become
+ossified and permanently joined, the inflammation which attends the
+acute stage of this affection, causes lameness. Later, unless an
+unusually large exostosis is formed, which may cause a constant
+irritation due to its size and juxtaposition to the carpus, lameness is
+discontinued.
+
+Symptomatology.--Lameness is usually the first manifestation of this
+disorder, and the thing which characterizes splint lameness is its
+peculiar intermittence. There is a mixed form of lameness which may not
+be in evidence when an affected animal is started on a drive, but which
+is marked after the subject has gone some distance. The animal may,
+however, go lame throughout the whole of a drive and continue to be lame
+for several days or weeks in some cases. It is noticeable that lameness
+is augmented or produced when the subject travels on rough road surfaces
+and that little or no difficulty is encountered when roads are smooth.
+
+The heavy brachial fascia is inserted in part to the head of the second
+metacarpal (inner small) bone together with the oblique digital extensor
+(extensor metacarpi obliquus) and this explains the reason for pain
+being manifested during extension of the member.
+
+Before there is a visible exostosis, supersensitiveness is readily
+recognized upon palpation of the parts, if careful comparison is made
+between the sound and unsound members. However, frequently splints occur
+on both forelegs at the same time and in some instances exostoses are
+several in number upon each member affected. In some instances, the
+affection involves the outer splint bone and no evident involvement of
+the inner one exists.
+
+Treatment.--At the onset complete rest should be provided and the
+local application of some good cataplasm is in order. A stimulating
+liniment is beneficial when employed several times daily and massage is
+also quite helpful. Later, the application of a blistering ointment is
+good treatment. The use of the actual cautery stimulates prompt
+resolution, but there is seldom any resorption of products of
+inflammation following firing. Whereas, in cases where other treatment
+is begun early, there usually follows considerable diminution in the
+size of the exostosis. A rest of four or five weeks is necessary and
+very young animals should not be put to work too soon, if the character
+of the work is such as to induce a recurrence of the trouble.
+
+Many cases are treated successfully in draft types of animals (where the
+subjects are not kept at work that occasions serious irritation to the
+affected parts) by blistering the exostosis repeatedly and allowing the
+animals to continue in service. In such cases, it is unreasonable to
+expect to check the size of the exostosis and, of course, such methods
+are not employed where lameness causes distress to the subject.
+
+Firing usually causes prompt recovery from lameness and is a dependable
+manner of treating such cases but there remains more blemish following
+cauterization than where vesication is done.
+
+
+OPEN FETLOCK JOINT.
+
+This condition, because of the frequency with which it occurs may be
+taken as typal, from the standpoint of treatment and results obtained
+therefrom. While it serves to constitute a basis from which other
+joints, when open, are to be considered, due allowance must be made for
+the fact that, as has been previously mentioned, some articulations when
+open constitute cause for grave consequences; while with others an open
+capsule, even when infected, does not cause disturbance enough to be
+classed as difficult to handle. Moreover, the fetlock joint is admirably
+suited, anatomically, to bandaging; and when wounded, is easily kept
+protected by means of surgical dressings. This fact is of great
+importance in influencing the course and termination in any given case
+of open fetlock joint and should not be forgotten.
+
+There is no logical reason for comparing the pedal joint with the
+pastern on the basis that it may also be completely and securely
+bandaged. Open navicular joint does not occur, as a rule, except by way
+of the solar surface of the foot, and the introduction of active and
+virulent contagium is certain to happen; consequently, an acute
+synovitis quickly resulting in an intensely septic and progressively
+destructive arthritis soon follows in perforation of the capsule of the
+distal interphalangeal articulation.
+
+Etiology and Occurrence.--Wounds of the fetlock region resulting in
+perforation or destruction of a part of the capsular ligament are caused
+by all sorts of accidents, such as wire cuts, incised wounds occasioned
+by plowshares, disc harrows, stalk cutters and other farming implements.
+In runaways the joint capsule is sometimes punctured by sharp pieces of
+wood or other objects. In horses driven on unpaved country roads the
+fetlock is occasionally wounded by being struck against the sharp end of
+some object, the other end of which is firmly embedded in the ground. In
+one instance the author treated a case wherein the fetlock joint was
+perforated by the sickle-guard of a self-binder. In this case there
+occurred complete perforation causing two openings through the
+_cul-de-sac_ of the joint. Such wounds are produced by implements which
+are, to say the least, non-sterile, and this perforation of the
+uncleansed skin conveys infectious material into the joint capsule. Yet
+in many instances, especially in country practice, no infectious
+arthritis results where cases are promptly cared for.
+
+Symptomatology.--A difference in the character of symptoms is
+evidenced when dissimilar causes exist. Small penetrant wounds which
+infect the synovial membranes cause infectious arthritis in some cases,
+whereas a wound of sufficient size to produce evacuation of all synovia
+will, in many instances, cause no serious distress to the subject, even
+when not treated for several days. If it is not evident that an open
+joint exists and the articular cavity is not exposed to view a positive
+diagnosis may be early established by carefully probing the wound. In
+some cases where a small wound has perforated the joint capsule,
+swelling and slight change of relation of the overlying tissues may
+preclude all successful exploratory probing. In such instances it is
+necessary to await development of symptoms. Twenty-four hours after
+injury has been inflicted, there is noticeable discharge of synovia
+which coagulates about the margin of the orifice, where synovial
+discharge is possible. Particularly evident is this accumulation of
+coagulated synovia where wounds have been bandaged--there is no
+mistaking the characteristic straw-colored coagulum which, in such
+cases, is somewhat tenacious.
+
+No difference exists between other symptoms in infectious arthritis
+caused by punctures, and non-infectious arthritis, excepting the
+intensity of the pain occasioned, the rise in temperature, circulatory
+disturbances, etc.; all of which have been previously mentioned.
+
+Treatment.--Just as has been stated in discussions on the subject of
+open joint, probing or other instrumentation is to be avoided until the
+exterior of the wound and a liberal area surrounding has been thoroughly
+cleansed--too much importance can not be placed on this preliminary
+measure. In cases of open joint where ragged wound margins exist and the
+interior of the joint capsule is contaminated, much time is required to
+thoroughly cleanse all soiled parts. In some instances an hour's time is
+required for this cleansing process after the subject has been
+restrained and prepared. In order to thoroughly cleanse these delicate
+structures without doing them serious injury, one ought to be skillful
+and careful in all manipulations of the exposed parts of the joint
+capsule.
+
+The general plan of treatment, after preliminary cleansing has been
+accomplished, has been outlined on page 66 in the consideration of
+scapulohumeral joint affections. The injection of undiluted tincture of
+iodin in ounce quantities, it must be remembered, is not to be done
+unless there is provision for its free exit. Where good drainage from
+the joint cavity exists all infected wounds should be thus treated, and
+this treatment may be repeated as conditions seem to require--until
+infection is checked.
+
+If daily injections are necessary, dilution of the tincture of iodin
+with an equal amount of alcohol is advisable in order to avoid doing
+irreparable damage to the articular cartilages and synovial membranes.
+
+An antiseptic powder composed of equal parts of boric acid and
+exsiccated alum is employed to protect the wound surfaces and the
+margins, and the parts are then bandaged. In bandaging wounds of this
+kind a liberal amount of cotton should be employed, and after a large
+surface surrounding the wound has been thoroughly cleansed, it must be
+so kept thereafter. This is impossible, if one uses a small amount of
+cotton, particularly if such meager quantity of dressing material is
+carelessly wrapped in position with an insufficient amount of bandage
+material. Mention, without description of the elemental problem of
+applying cotton and bandages to a wound, would be sufficient, were it
+not that this is a very important part of the handling of such cases,
+and many practitioners are not only thoughtless in this part of their
+work, but also apparently careless. What does it profit to prepare a
+part and cleanse a wound with painstaking care and then neglect to take
+every possible precaution to prevent its subsequent contamination?
+
+In the handling of open joint capsules where the perforation of the
+capsular ligament is small and discharge of synovia does not immediately
+follow, there is presented a problem which is difficult to decide upon
+and that is the manner in which such wounds are to be handled. One
+hesitates to enlarge such openings to drain or irrigate the capsule when
+there is no proof that serious trouble will follow because of infectious
+material which has probably been introduced at the time the wound was
+inflicted. It is especially difficult to decide upon the manner of
+handling such cases where the tarsal joint is wounded, although one
+hesitates to invade any joint to the extent of incising its capsule,
+unless there is urgent need of so doing.
+
+Frost[19] offers the following suggestion in such instances:
+
+     The treatment recommended by us for open joints, in which we wish
+     to prevent ankylosis, is, first, to shave all hair from the area
+     surrounding the wound, following with a thorough cleansing of the
+     skin and disinfection of the wound, and then to inject a twenty per
+     cent Lugol's solution in glycerin into the wound. This should be
+     repeated two or three times a day, each time enough of the solution
+     being injected to fill the joint capsule, thereby securing the
+     flushing effect. As this solution does not cause irritation to the
+     tissue and yet is a strong antiseptic, it serves to shorten the
+     period of congestion and inflammation and to overcome the infection
+     without causing a destruction of the secreting membrane until the
+     external wound has had time to heal. The injection of this solution
+     seems to retard the excessive secretion of synovia. The larger the
+     joint capsule and the smaller the external wound, the longer our
+     antiseptic will remain in contact with the inflamed tissues as the
+     glycerin, being thick, does not flow through a small opening.
+
+After-care.--Following the initial cleansing and treatment of open
+joint, subsequent dressing is necessary as frequently as conditions
+demand. If the parts are badly infected and profuse discharge of pus
+exists a daily change of dressings is necessary. In the average
+instance, however, semi-weekly treatments are sufficient. And in many
+instances where one is obliged to travel a considerable distance to
+handle the affected animal one weekly dressing of the wound will suffice
+after the second treatment.
+
+The same general plan of treatment concerning the subject's comfort that
+has been previously mentioned in arthritis, is carried out here. A
+further and detailed consideration of the subject of handling of open
+joints follows.[20]
+
+     * * * Such wounds may be classified in two general groups as
+     follows: First, wounds in which the trauma has exposed the
+     articulation to view, and second, those the result of punctures, in
+     which the external wound is small and free drainage is lacking.
+
+     Wounds in which the articulation is exposed to view have drainage
+     either all ready provided for, or it is established without
+     hesitancy surgically. With free drainage thus established there is
+     little or no chance for the adjacent tissues to become infiltrated
+     with infected wound discharge. This prevents an extension of the
+     injury and the establishment of a good field for the growth of
+     anaerobic bacteria.
+
+     Open joints caused by punctures, unless the puncture is aseptic,
+     produce a swelling which is more painful than is the open wound
+     which exposes the joint to view. Especially is this true if the
+     puncture is of small diameter, allowing the tissues to partially
+     close the opening immediately after the wound has been made. Where
+     drainage is lacking there follows an exudation which congests the
+     tissues surrounding the injury and all factors favoring germ growth
+     are present. It is perhaps advisable to establish good drainage in
+     such cases as soon as a diagnosis is made.
+
+     It is not always an easy matter to recognize an open-joint, when
+     first made, but twelve to twenty-four hours later there is no cause
+     for doubt. The condition is then a very painful one; lameness is
+     excessive; there is rise in temperature; acceleration of the pulse
+     and manipulation or palpation of the region affected, occasions
+     great pain.
+
+     The treatment of open joints must be varied to suit the disposition
+     of the animal, the nature and location of the injury, the length of
+     time intervening between the infliction of the wound and the first
+     attention given, and the surroundings in which the patient is kept.
+
+     In each and every case in which there exists an open wound the
+     surface surrounding the wound is cleansed thoroughly, the hair is
+     shaved if possible, and the margin of the wound is curretted and
+     cleansed thoroughly with antiseptic solutions.
+
+     If there is evidence that the articulation contains infective
+     material, it is washed out with copious quantities of peroxide of
+     hydrogen--usually as much as six or eight ounces. This is followed
+     by injection of an ounce or two of tincture of iodin. Even though
+     the joint appears to be clean some tincture of iodin is used, as it
+     checks the secretion of synovia and is, in every way, beneficial.
+     Care is taken to apply the iodin also to the surface immediately
+     surrounding the wound. The entire wound is then covered with a
+     dusting powder composed of zinc oxide, boric acid, exsiccated alum,
+     phenol and camphor.
+
+     This powder is used in abundance and the wound is then covered with
+     a heavy layer of absorbent cotton and well bandaged. This bandage
+     is not disturbed for at least three days and may be left in place
+     for a week. In cases in which it is necessary to keep the dressing
+     on for a week, or in cases where the patient is, through necessity,
+     kept in quarters that are wet or unclean, the first bandage is
+     covered with a layer of oakum which has been saturated in oil of
+     tar and this in turn is held in place by means of several layers of
+     bandages. The bandages are also saturated with oil of tar.
+
+     In from one to two months wounds so treated, unless they are
+     foot-wounds, will be ready to dress without being bandaged. It is
+     ordinarily unnecessary to dress foot-wounds oftener than every
+     second week after the discharge of synovia has ceased. When the
+     wound has filled with granulation, a protective dressing is applied
+     which is rendered water proof by the use of bandages covered with
+     oil of tar. The patient can now be turned out for a month or six
+     weeks without disturbing the dressing. After the removal of the
+     bandages, the only treatment necessary is an occasional application
+     of some mildly antiseptic ointment.
+
+     Except in nail pricks of the foot, occasioned by punctures, a five
+     per cent tincture of iodin is injected into open joints, if the
+     wound remains sufficiently open, and this treatment is continued so
+     long as there is a discharge of synovia. Surgical drainage is
+     established if it is considered practicable and the remainder of
+     the treatment is about the same as for wounds which are open.
+
+     Open joints occur in horses at pasture and are sometimes not
+     discovered until several days or a week after the injury, and in
+     some instances the wounds are filled with maggots. The only
+     difference in the treatment of these cases is that more time and
+     care is taken in cleansing the wound, more curetting is necessary,
+     and after cleansing the wound with peroxide of hydrogen, the joint
+     is thoroughly washed out with equal parts of tincture of iodin and
+     chloroform. This is followed by the injection of a quantity of
+     seventy-five percent alcohol and the wound is dressed and bandaged
+     as already described. At each subsequent dressing of infected
+     wounds so treated less suppuration is noticed and the synovial
+     discharge usually ceases in from one to two months.
+
+     About _ninety percent of all cases of open joint make complete
+     recoveries_, about four per cent partially recover and six per cent
+     are fatal. Among the fatal cases are the open joints with
+     complications as severed tendons, those occasioned by calk wounds
+     in horses that are stabled, and nail punctures of the feet. The
+     following report of twelve favorable cases is taken from a record
+     of sixty-two cases. The favorable ones are reported, chiefly
+     because there are now enough reports on record of such cases which
+     have terminated fatally.
+
+     Case 1.--A gray gelding used as a saddle pony received a
+     horizontal wire cut laying completely bare the scapulohumeral
+     articulation. The margins of the wound were cleansed as heretofore
+     described, a drainage was provided surgically, tincture of iodin
+     was injected and the wound was covered with equal parts of boric
+     acid and exsiccated alum. The horse was kept tied and a diluted
+     tincture of iodin was injected into the wound once daily and the
+     powder applied often enough to keep the wound covered. The case
+     made a complete recovery and the pony was again in service within
+     sixty days.
+
+     Case 2.--A twelve-hundred-pound bay mare with an open carpal
+     joint. The wound was an open one about two and one-half inches in
+     length, and made transversely and when the member was flexed the
+     articular surface of the carpal bones were presented to view. An
+     ounce of tincture of iodin was injected into this joint after
+     having cleansed the margin of the wound and the mare was cross-tied
+     in a single stall to keep her from lying down. The owner was
+     instructed to keep the outside of the wound powdered with air
+     slaked lime and a very unfavorable prognosis was given.
+
+     I heard nothing further from this case until fifty-nine days from
+     the date of the injury, when I met the owner driving this mare to a
+     buggy. The wound had healed by first intention and at that time so
+     little cicatrix remained that it was difficult to find it.
+
+     Case 3.--A brown mare with an open fetlock joint due to a
+     spike-nail puncture. Lameness was excessive, and joint greatly
+     swollen. Tincture of iodin was injected into the wound and towels
+     dipped in hot antiseptic solutions were applied for several hours
+     daily until the acute stage had passed. Later the mare was turned
+     out to pasture and a vesicant was applied once or twice a month
+     until recovery was complete which was in about six months.
+
+     Case 4.--A four-year-old bay mare having a wire-cut which opened
+     the tarsus joint was treated as heretofore described. The wound was
+     kept bandaged for about two weeks and later it was dressed without
+     being bandaged. In ninety days she had completely recovered.
+
+     Case 5.--A twelve-year-old mare with an open fetlock joint due to
+     a puncture wound. The margins of the wound were cleansed and the
+     external wound enlarged to facilitate drainage. Tincture of iodin
+     was injected; the wound was bandaged and dressed for a month in the
+     manner heretofore described, when all discharge had stopped. A
+     vesicant was applied; the mare was put to pasture and within sixty
+     days from the date of the injury she was being driven on short
+     trips.
+
+     Case 6.--A two-year-old brown gelding with a wire-cut on the left
+     front foot. The wound extended down through the sole and opened the
+     navicular joint. This colt was very wild and it was necessary to
+     tie it down each time the wound was dressed. The wound was dressed
+     weekly for a month and less frequently thereafter. It was handled
+     eight times; the last dressing was left in place until worn out.
+     Six months later the colt was practically well, a very little
+     lameness being shown when walking on frozen ground.
+
+     Case 7.--A seven-year-old saddle-horse weighing eleven hundred
+     and fifty pounds received a wound of the tarsus, laying bare the
+     articular surfaces of a part of the joint. It was impossible to
+     keep this wound bandaged because of the restless disposition of the
+     subject. Injections of a dilute tincture of iodin were employed
+     every second or third day for a month and the wound was kept
+     covered with the antiseptic dusting powder referred to heretofore.
+     In five months complete recovery had taken place, with the
+     exception of a stubborn skin disturbance which was successfully
+     treated six months after the wound was inflicted. The horse is
+     still in use and is absolutely free from lameness.
+
+     Case 8.--A two-year-old brown gelding with a wire-wound opening
+     the scapulohumeral joint. This wound was large enough to expose to
+     view the articular portion of the humerus. The same treatment as
+     that given case No. one was instituted and in ninety days the colt
+     was practically well.
+
+     Case 9.--A three-year-old bay filly was found at pasture with one
+     fore foot badly injured. The owner intended to destroy her, but a
+     neighbor prevailed upon him to have her treated. Apparently the
+     wound was of about a week's standing and in a very bad condition,
+     filled with maggots and dirt. Both the navicular and coronary
+     articulations were open. This wound was cleansed in the usual
+     manner and the owner cared for the case the balance of the time
+     because the distance from my office was too great to give her
+     personal attention. She made an almost complete recovery in five
+     months.
+
+     Case 10.--At two-year-old mule with an open navicular joint due
+     to a barbed wire wound. Usual care was given this case and in five
+     months recovery was complete and little scar is to be seen. This
+     case received seven treatments.
+
+     Case 11.--An eighteen-months-old colt at pasture was found down
+     and unable to rise without help. In addition to several wounds of
+     lesser importance there was a large wound on the inner side of the
+     elbow, the joint was open and the entire leg was greatly swollen
+     and in a state of acute infectious inflammation. The colt could not
+     walk, its temperature was 105°, pulse was rapid and respiration was
+     a little hurried. After advising the owner to put the poor animal
+     out of its misery I left the place. Four days later the owner came
+     to my office and asked if he could borrow some old shears to "trim
+     off some loose hide from that colt." He left the colt in the
+     pasture and all the care it received was the regular application of
+     a proprietary dusting powder. It made a complete recovery.
+
+     Case 12.--A family mare, heavy in foal, received a vertical wound
+     of the fetlock joint inflicted by a disc-harrow. The _cul-de-sac_
+     of the ligament of this joint was opened freely. The wound was
+     dressed in the usual manner and again three days later when no
+     suppuration had taken place. Four days later the patient gave birth
+     to a colt and suckled it right along through her convalescence.
+     This wound healed by first intention and seventy-nine days from the
+     date of the injury the mare was driven to town, two and one-half
+     miles distant, and showed but little lameness.
+
+
+Phalangeal Exostosis (Ringbone)
+
+This term is applied to exostoses involving the first and second
+phalanges (suffraginis and corona), regardless of their size, extent or
+location. It is a misnomer, in a sense, and the veterinarian is
+frequently obliged to spend considerable time with his clients in order
+to convince them that a spherodial exostosis of the proximal phalanx, in
+certain cases, is in reality "ringbone," even though there exists no
+exostosis which completely encircles the affected bone.
+
+Etiology and Occurrence.--Exostosis of the first and second phalanges
+is usually due to some form of injury, whether it be a contusion, a
+lacerated wound which damages the periosteum, or periostititis and
+osteitis incited by concussions of locomotion, or ligamentous strain.
+Practically the only exception is in the rachitic form of ringbone which
+affects young animals.
+
+There are predisposing causes that merit consideration, chief among
+which is the normal conformation of the coronet joint. This proclivity
+is constant; the normal interphalangeal articulation is an incomplete
+ginglymoid joint and while its dorso-volar diameter is great, this in no
+wise compensates for its disproportionately narrow transverse diameter.
+The pivotal strain which is sometimes thrown upon this articulation when
+an animal turns on one foot, as well as the tension which is put on the
+collateral ligaments when the inner or the outer quarter of the foot
+rests in a depression of the road surface, tends to detach the insertion
+of these ligaments or to cause fibrillary fractures of their substance.
+
+Short, upright, pasterns receive greater concussion during fast travel
+on hard roads than do the longer more sloping and well formed
+extremities. Those who are advocates of the theory that this type of
+osteitis with its complications has its origin in the articular portion
+of the joint, claim that the upright pastern constitutes an important
+tendency toward ringbone. Howbeit, ringbone is an active, serious and
+frequent cause of lameness and it affects animals of all ages and occurs
+under various conditions. Horses having good conformation and kept at
+work wherein no great amount of strain is put upon these parts, are
+occasionally victims of this affection.
+
+Classification.--The arrangement employed by Moller[21] is intensely
+practical and logical. He considers ringbone as _articular_,
+_periarticular_, _rachitic_ and _traumatic_. A mode of classification
+that is common and in a practical way, good, is, high and low ringbone.
+When prognosis is considered, for instance, it is very convenient to
+state that the chances for recovery are much better in high ringbone
+than in low ringbone. The classification of Möller will be followed
+here.
+
+[Illustration: Fig. 17--Phalangeal exostoses.]
+
+Symptomatology.--In all forms of incipient ringbone except rachitic,
+the first manifestation of its existence, or of injury to the ligaments
+in the region of the pastern joint which causes periostitis, or
+affections of the articular portions of the proximal inter-phalangeal
+joint, is lameness. Lameness which typifies ringbone is of the
+supporting-leg variety and by compelling the subject to step from side
+to side, marked flinching is observed, especially in periarticular
+ringbone; causing the affected animal to turn abruptly on the diseased
+member, using it as a pivot, likewise accentuates the manifestation. In
+fact, many subjects that exhibit no evidence of locomotory impediment
+while walking or trotting in a straight line on a smooth road surface,
+will manifest the characteristic form of lameness from ringbone when the
+aforementioned side to side movement is performed.
+
+When the manner in which pain is occasioned is considered, it will be
+understood why lameness is intermittent in the early stages of this
+affection and may even be unnoticed by the driver. An animal may travel
+on a smooth road without giving evidence of any inconvenience, but as
+soon as a rough and irregular pavement or road surface is reached, will
+limp. As the subject is driven farther on level streets the lameness may
+disappear. This intermittent type of lameness may continue until there
+is developed a large exostosis, or until articular involvement causes so
+much distress during locomotion that lameness is constant. On the other
+hand, resolution may occur during the stage of periosteal inflammation,
+or, an exostosis forms which causes no interference with function.
+
+[Illustration: Fig. 18--Rarefying osteitis in chronic ringbone and
+ossification of lateral cartilages.]
+
+Before there is evidence of an exostosis, diagnosis of ringbone is not
+easy, for it is then a problem of detecting the presence of a
+ligamentous sprain, periostitis, or osteitis. The diagnostician should
+take note of local manifestations of hypersensitiveness, or heat if such
+exist, and, in addition, other conditions must be excluded before
+definite conclusions are possible.
+
+In _articular_ ringbone as soon as there is developed an exostosis, it
+occupies a position on the dorsal (anterior) part of the articulation
+and extends around the sides of the joint.
+
+_Periarticular_ ringbone is characterized by exostoses which are
+situated on the sides of the phalanges and not extending around to the
+anterior part of the joint. This type of ringbone as well as the
+articular may occur "high" or "low."
+
+[Illustration: Fig. 19--Phalangeal exostoses in chronic ringbone. Museum
+specimen of the Kansas City Veterinary College.]
+
+With the _traumatic_ form of ringbone, all consequences, as to the size
+and form the exostosis is to assume, depend upon the nature and extent
+of the injury.
+
+_Rachitic_ ringbone is frequently observed in some sections of the
+country and does not ordinarily cause much if any lameness. It is a
+disease of colts and may affect one or all of the phalanges at the same
+time. As the subject advances in age there is more or less diminution in
+the size of the enlargements.
+
+Treatment.--Rest is essential in the treatment of ringbone. If
+diagnosed during its incipiency, remedial measures such as are usually
+employed to treat sprains, are indicated and later the parts should be
+blistered. When an exostosis has developed puncture firing is the remedy
+_par excellence_. Not that this method of treatment is infallible, for
+to any thinking one who takes into consideration the pathological
+anatomy of this condition, it is evident that no manner of treatment is
+beneficial in some cases. If the exostosis is so situated that it does
+not mechanically interfere with function, and is not so large that it
+may inhibit flexion and extension, and where the articular portions of
+the joint are not eroded, good results attend the use of the actual
+cautery.
+
+In firing, after having anesthetized the extremity, and prepared the
+surgical area, the cautery is deeply inserted in numerous places, taking
+care, however, not to open the joint. The parts are immediately covered
+with aseptic absorbent cotton and this dressing is left in position for
+forty-eight hours and if perchance there is evidence of synovial
+discharge, the parts are again aseptically dressed in order to prevent
+infection of the articulation. If, as is the case usually, no
+perforation of the joint capsule exists, the openings made by the
+cautery have been closed by the coagulation of serum and there is then
+little chance of infection causing trouble, even though the member is
+left unbandaged.
+
+In several instances, the author has treated ringbone by this method
+where the periarticular type existed and lameness was marked, and in
+three weeks the subjects were in service and not lame--this, in one
+instance in a valuable polo pony where the subject continued in service
+for more than a year without any evidence of recurrence of the lameness.
+The production of a deep-seated and acute inflammation with the actual
+cautery is preferable to any sort of counter-irritation which may be
+produced by vesicants.
+
+There is no occasion for any difference in the treatment of either of
+the first three classes of ringbone, but in the rachitic type where
+treatment is given, the application of a vesicant is all that is
+required. In most instances treatment is not necessary.
+
+The affected animals require a month to three months' time for recovery
+to take place in the average favorable cases of ringbone.
+
+Median neurectomy is of service in many instances where lameness is not
+completely relieved by the use of the actual cautery and no bad results
+attend the performance of this operation even though no benefit is
+derived thereby. Plantar neurectomy is contraindicated in all cases
+where there exists much lameness. If lameness is due to acute
+inflammation bad results such as sloughing and loss of the hoof may
+follow; and if large exostoses mechanically interfere with function of
+the joint, or where articular erosions exist, no possible good can come
+from neurectomy. Careful discrimination should be employed in selecting
+cases for neurectomy for this operation; otherwise, it is very likely to
+prove disappointing.
+
+
+Open Sheath of the Flexors of the Phalanges.
+
+This condition does not differ from a like affection involving other
+tendons except that the function of these tendons is such that large
+synovial sheaths are necessary, and when synovitis exists, the condition
+then becomes more serious.
+
+Infectious synovitis involving these tendons in the fetlock region is of
+more frequent occurrence than a like affection of carpal or tarsal
+sheaths. With the exception of the extent of the involvement and
+distress occasioned thereby, synovitis the result of open tendon
+sheaths, is similar wherever it occurs.
+
+Etiology.--The same conditions which are responsible for open fetlock
+joint and other wounds of the pastern region, cause open tendon sheaths
+of the flexor tendons.
+
+Symptomatology.--Because of the size and extent of this sheath and the
+different manner in which it is opened, there is manifested dissimilar
+symptoms in different cases. A nail puncture which perforates the sheath
+in the pastern region and at the same time produces an infectious
+synovitis, will cause a markedly different manifestation than will a
+wound which freely opens the sheath above the fetlock. In the first
+instance, the condition is much more painful; swelling is intense in
+some cases; and if the subject does not possess sufficient resistance so
+that spontaneous resolution promptly occurs, surgical evacuation of pus
+is usually necessary. When these tendon sheaths are opened, there
+follows a reaction which is quite analogous to that which exists in
+arthritic synovitis, but instead of ankylosis, adhesions with thecal
+obliteration occur. Rarely there result cartilaginous and osseous
+formations.
+
+The constitutional disturbances which characterize this condition vary
+with the degree of distress occasioned. As the infection is virulent and
+causes serious destruction of the affected parts, so does evidence of
+malaise and finally distress appear. Detailed discussions of
+symptomatology in similar conditions have heretofore been given, and
+further repetition is unnecessary.
+
+Treatment.--The same general plan of treatment which is employed for
+handling open joint is put in practice in these cases. Following the
+preoperative cleansing of the external wound and adjacent surfaces,
+where liberal drainage exists, tincture of iodin is injected into the
+sheath, the parts covered with a suitable dressing powder, and the
+entire member is carefully dressed with cotton and bandages.
+
+Subsequent treatment is the same as has been outlined in the discussion
+of open fetlock joint on page 112. The same general plan of after-care
+is necessary. Recovery, however, does not require so much time
+ordinarily, yet punctures of the sheath occasioned by nails or other
+small implements make for long drawn out cases of infective synovitis.
+
+
+Luxation of the Fetlock Joint.
+
+Etiology and Occurrence.--The manner of construction of the fetlock
+joint is such that disarticulation without irreparable injury resulting,
+is practically impossible. Logically, this joint in the fore legs (not
+so in the pelvic limbs) should disarticulate in such manner that either
+all of the inhibitory apparatus (flexor tendons and suspensory ligament)
+must rupture or a lateral luxation is necessary. Lateral disarticulation
+must necessarily sever the attachment of one of the common collateral
+ligaments. Because of the width (transverse diameter) of the
+articulating surfaces of this joint, lateral luxation requires a great
+strain; and a force that is sufficient to occasion this trauma usually
+causes serious additional injury. Therefore, the condition is considered
+one wherein prognosis is always unfavorable in so far as practical
+methods of treatment are concerned.
+
+Mr. A. Barbier[22] reports a case of bilateral luxation of the fetlock
+joints of the hind legs in a horse. This was done in jumping, and the
+extensor tendon of each leg was ruptured and the anterior portion of the
+metatarsus was protruding through the skin. Profuse hemorrhage had taken
+place due to tearing of the blood vessels.
+
+Symptomatology.--Entire luxation of this joint when present is so
+evident that one cannot fail to recognize the condition. Complete
+disarrangement of normal relation occurs and there is either a breaking
+down of the inhibitory apparatus, or if a lateral disarticulation
+exists, the normally straight line formed by the bones of the front leg,
+as viewed from the front or rear, is broken at the fetlock.
+
+Often fracture of bones are concomitant and then, of course, mobility is
+increased and not decreased as is the case in uncomplicated luxation.
+
+Such violence occurs at times, when this joint is disarticulated, that
+the joint capsule is also completely ruptured and the articular portion
+of the bones is exposed to view.
+
+Treatment.--The condition being practically a hopeless one,
+destruction of the subject is the thing which should be promptly done.
+In valuable breeding animals, owners may prefer that treatment be
+attempted when a lateral luxation and detachment of but one common
+ligament have permitted luxation without complete disarticulation and
+rupture of the joint capsule. In such cases, by immobilizing the
+affected parts as in fracture, and confining the subject in a sling for
+about sixty days, partial recovery may occur in some instances.
+
+Experience has shown that where luxation with detachment of a
+collateral ligament occurs, recovery is slow and incomplete--there
+always results considerable exostosis at the site of injury.
+
+
+Sesamoiditis.
+
+Etiology and Occurrence.--Inflammation of the proximal sesamoid bones
+is caused by any kind of irritation which may involve this part of the
+inhibitory apparatus. Positioned as they are, between the bifurcations
+of the suspensory ligament and the pastern joint, they serve as fulcra
+and effectively assist in minimizing concussion which is received by the
+suspensory ligament. The flexor tendons also, in contracting, exert
+strain upon the inter-sesamoidean ligament, which has a similar effect
+upon the sesamoid bones as that which is produced by the suspensory
+ligament.
+
+The condition occurs quite frequently, and because of the important
+function performed by these bones, active inflammation of the sesamoids
+constitutes a serious affection. Because of the fact that these bones
+have proportionately large articular surfaces, when they are inflamed to
+the extent that degenerative changes affect the articular cartilage,
+complete recovery seldom results.
+
+The same pathological changes occur here that are to be seen in any case
+of arthritis. No special pathological condition characterizes
+sesamoiditis but this condition causes incurable lameness when the
+sesamoid bones are much inflamed.
+
+Symptomatology.--In acute inflammation, there exist all the symptoms
+which portray any arthritic inflammation of like character. The parts
+are readily palpable and are found to be hot, supersensitive, and more
+or less infiltration of the tissues contiguous to the joint causes
+swelling. There is volar flexion of the phalanges when the subject is at
+rest. Lameness is intense; in some acute inflammatory disturbances the
+subject is unable to bear weight on the affected member.
+
+In chronic sesamoiditis, constant lameness is the one salient feature
+which marks the condition. While it is possible for one sesamoid bone to
+become involved without its fellow being affected, this is not usual.
+Considerable organization of tissue surrounding the joint is present and
+no particular evidence of supersensitiveness exists. However,
+supporting weight brings sufficient pressure to bear upon the inflamed
+and more or less eroded bones so that pain is occasioned and lameness
+results.
+
+Treatment.--During acute inflammation, absolute quiet is, of course,
+of first consideration. Cold packs are to be kept in contact with the
+parts until acute inflammatory symptoms subside. The fetlock region is
+then enveloped with a poultice or an iodin and glycerin combination
+(iodin one part to seven parts of glycerin) is applied and a dressing of
+cotton is kept in contact with the inflamed region. Following this, a
+vesicant is employed and the subject is allowed a month's rest.
+
+In sub-acute cases, the entire region surrounding the pastern is
+blistered or the actual cautery is used. Line-firing is preferable. The
+subject is given a month or six weeks rest and one may be guided by the
+presence or absence of lameness as to whether improvement or recovery is
+taking place.
+
+Old chronic cases, and particularly those where there are considerable
+induration and fibrous organization of tissue surrounding the joint, are
+not to be benefited by treatment.
+
+The chief consideration in handling sesamoiditis is checking
+inflammation as early as possible and preventing, if this can be done,
+the erosion of articular surfaces. If destruction of any part of the
+articular surfaces can be prevented and the patient allowed ample time
+for complete resolution of the affected parts to occur, permanent relief
+is possible.
+
+
+Fracture of the Proximal Sesamoids.
+
+Etiology and Occurrence.--Fracture of the proximal sesamoid bones is
+caused by violent strain when there exists _fragilitas osseum_, or by
+contusions. The author treated a case where fracture of one sesamoid was
+occasioned by a horse receiving a puncture wound wherein the sharp end
+of a steel bar was protruding from the ground where it was firmly
+embedded. The subject in this case was injured while being driven along
+a country road. Frost[23] reports simultaneous fracture of all of the
+proximal sesamoids occurring in a sixteen-year-old pony. The condition
+is of rather common occurrence in some countries because of the fragile
+condition of horses' bones.
+
+Symptomatology.--If the parts can be examined before extravasation of
+blood and swelling mask the condition, crepitation may be detected. In
+other instances, it is possible to note a displacement of parts of the
+sesamoid bones--this in horizontal fracture. There occurs more or less
+descent of the fetlock which must not be attributed to rupture of the
+superficial flexor tendon (perforatus). By outlining the course of this
+tendon with the fingers, when it is passively tensed sufficiently to
+follow its course, one may exclude rupture of the superficial flexor.
+Finding the suspensory ligament intact from its origin to the sesamoid
+attachments, one may also eliminate rupture of this structure as a cause
+of the trouble. Needless to say, marked lameness and swelling of the
+fetlock soon take place. The condition is painful, and ordinarily,
+recovery is impossible.
+
+Treatment.--Where treatment is attempted, immobilization as in
+luxation is in order. The patient's comfort is sought, and if the
+fractured parts can be kept in close proximity, their union may occur in
+time. However, chances for partial recovery (which is the best to be
+hoped for) are so remote that early destruction of the subject is the
+humane and economical thing to do.
+
+Where treatment is instituted, it is found that there is required a long
+time for union of the fractured bones to occur (where union does take
+place) and the cost of treatment together with the uncertainty of even
+partial recovery, makes for an unfavorable outcome. When the best
+possible results succeed treatment, a large callosity is formed and
+movement of the pastern joint is restricted. Lameness, though not
+intense, in the case referred to, where one bone was broken, was
+permanent and the subject was out of service for nearly a year.
+
+
+Inflammation of the Posterior Ligaments of the Pastern (Proximal
+Interphalangeal) Joint.
+
+Anatomy.--The ligaments here involved are the four volar ligaments
+described by Sisson[24] as follows: "The _volar ligaments_ (Ligg
+Volaria) consist of a central pair and a lateral and medial bands which
+are attached below to the posterior margin of the proximal end of the
+second phalanx and its complementary fibro-cartilage. The lateral and
+medial ligaments are attached above to the middle of the borders of the
+first phalanx, the central pair lower down and on the margin of the
+triangular rough area."
+
+This portion of the inhibitory apparatus is described by Strangeways'
+Anatomy as two posterior ligaments which run each from three points on
+the sides of the os suffraginis to a piece of fibro cartilage, described
+as the glenoid cartilage, and attached to the postero-superior edge of
+the os coronae; between them is the insertion of the inferior
+sesamoidean ligament.
+
+Etiology and Occurrence.--Everything tending to increase strain upon
+these ligaments is contributory to possible fibrillary fracture of these
+structures. Excessive leverage as furnished by long toes, long toe-calks
+and low heels increases the normal tension on the posterior ligaments of
+the pastern joint. Faulty conformation, which throws an abnormal strain
+on these ligaments, is a predisposing cause of inflammation of these
+structures. Hard pulling upon slippery and rough or frozen roads is a
+common exciting cause of this injury. The condition is of comparatively
+frequent occurrence and is seen affecting draft horses frequently, in
+the hind legs.
+
+Symptomatology.--Lameness is the first manifestation of this affection
+and weight bearing is painful in direct proportion to the extent of
+injury present. Volar flexion of the phalanges relieves tension on the
+parts; therefore, this position is assumed while the subject is at rest.
+When considerable tissue has been ruptured, and the condition is very
+painful, the foot is held off the ground as in all painful affections of
+the extremity.
+
+By palpation evidence of pain is discernible, though very little
+swelling occurs. Pain is increased by manual tension of the parts which
+is done by grasping the toe of the foot and exerting traction on the
+flexor apparatus. Care must be taken in executing such manipulations,
+and it is only by comparison of the affected member with the sound one
+and noting the difference in the manifestations of discomfort that we
+may arrive at the proper conclusion.
+
+Some hyperthermia is to be recognized in acute inflammation, by
+comparing the extremities. In the fore legs, navicular disease is
+differentiated by noting absence of contraction at the heel. By use of
+the hoof testers one may recognize evidence of inflammation of the
+navicular apparatus. In inflammation of the posterior ligaments of the
+pastern joint, there is also absence of the characteristic stumbling
+which is seen in navicular disease.
+
+Treatment.--Rest is the first requisite, and in addition every
+mechanical means possible to change the center of gravity in the
+phalangeal region, is to be employed. This is best accomplished by
+shortening the toe and paring the sole at the toe as much as conditions
+will permit. The heel is raised by means of a shoe with moderately high
+heel calks.
+
+The iodin-glycerin combination heretofore mentioned may be applied and
+the parts covered with cotton and bandage. Subjects require from three
+weeks to several months' rest and must be returned to work carefully,
+lest the incompletely regenerated tissues suffer injury.
+
+Regeneration of tissue in such cases, as has been pointed out, is slow
+and sufficient time for complete recovery must be allowed or relapses
+will occur.
+
+
+Fracture of the First and Second Phalanges.
+
+Etiology and Occurrence.--Fractures of the first phalanx (suffraginis)
+occur with respect to frequency, second to pelvic fractures. Often,
+almost insignificant injuries cause phalangeal fractures. On city
+streets, horses shod with shoes having long calks get caught in frogs of
+street railways or by slipping on rails, and phalangeal bones are often
+broken. The author observed a case of comminuted fracture of both the
+first and second phalanges (suffraginis and corona) in a polo pony
+caused by making a sudden turn while in action in a contest on the turf.
+
+Symptomatology.--Fracture of the phalanges is nearly always signalized
+by lameness, and this is marked during the period of weight bearing.
+Lameness is usually intense and where the pathognomonic symptom
+(crepitation) is not recognized, the intensity of the claudication, when
+other causes are absent, is indicative of fracture. The subject does not
+bear weight upon the affected member and where pain is intense, the foot
+is held in an elevated position and swung back and forth. In hind legs
+the member is often flexed in abduction and held in this position for
+several minutes, being rested on the ground only during short intervals.
+When compelled to walk, if pain is excruciating, the animal hops with
+the sound leg, no weight being supported by the fractured member.
+
+When an examination of the subject is possible before the extremity is
+swollen, crepitation is usually found without great difficulty, except
+in a subperiosteal break or in some cases of vertical or oblique
+fracture. Great care is necessary in handling the injured extremity in
+these cases, and particularly in nervous subjects or in excited animals
+that have been recently injured in runaways, is it necessary to be
+gentle in manipulating the extremity, if definite deductions are to be
+made. As has been mentioned in the chapter on diagnostic principles, if
+the condition is so painful that the subject does not relax the parts
+and crepitation is masked, local anesthesia is necessary. An anesthetic
+solution of cocain or novocain may be applied to the metacarpal or
+metatarsal nerves and an entirely satisfactory examination is then
+possible.
+
+Passive movement of the phalanges in all directions is practised in
+order to produce crepitation. When rotation of the parts does not
+occasion crepitation, gentle flexion and extension may do so. And in
+many instances, considerable manipulation of the phalanges is necessary
+before the pathognomonic symptom is to be recognized.
+
+In cases where crepitation is not found and lameness is pronounced, out
+of proportion with other possible existing causes, one may by exclusion
+of other causes establish a diagnosis of fracture in the course of
+forty-eight hours. In the meanwhile, support is given the affected
+member by applying an effective leather splint, so that pain may be
+diminished. To combat inflammation, a suitable cataplasm may be applied
+directly to the skin, the extremity bandaged, and the temporary
+immobilizing appliance may be secured over all. In this manner one may
+make repeated examinations of the subject, and if slings are used and
+every other necessary precaution taken to promote comfort for the
+subject, no harm will result in delaying for several days the
+application of permanent immobilization--bandages and splints or casts.
+In fact, where much swelling exists at the time one is called to treat
+such cases, it is advisable to delay the application of a permanent
+dressing or cast until inflammation has somewhat subsided.
+
+Course and Prognosis.--Where conditions are favorable, the nature of
+the fracture one that will yield to treatment, the subject not aged, and
+facilities for giving good attention to the affected animal are ample,
+fractures of the first and second phalanges recover completely in from
+six weeks to four months. Only simple fractures are considered curable
+from a practical and economical point of view, excepting in foals, where
+compound, and even comminuted, fractures may be so handled that animals
+may eventually become serviceable though blemished.
+
+Age retards the process of osseous regeneration, but in one instance at
+the Kansas City Veterinary College, a very aged mare suffering from a
+multiple fracture of the first phalanx was treated and at the end of
+sixty days was able to walk into an ambulance. Large exostoses had
+developed and the subject remained lame, but union of the broken bone
+took place in a surprisingly prompt and effective manner, when age of
+the subject and nature of the fracture are considered.
+
+As a rule, one is loath to recommend treatment, even in a simple
+transverse fracture of the first phalanx, in animals ten years of age or
+older. The conditions which exist in any given locality that regulate
+the expense of caring for an animal during the period of treatment,
+especially influence the course to be pursued in treating fractures.
+
+Treatment.--For permanent immobilization of the phalanges in fracture,
+materials which might adapt themselves to the irregular contour of the
+member and at the same time contribute sufficient rigidity to the parts
+without doing injury to the soft structures, would constitute ideal
+means of treatment; but no such materials have yet been devised, and
+opinions are various as to the most efficient and practical method to
+employ.
+
+After the fetlock has been shorn of hair and the ergot trimmed, the skin
+is thoroughly cleansed and allowed to dry. Several thin layers of long
+fiber cotton are then wrapped around the extremity--enough to pad well
+the member--and this is retained in position with a wide bandage. Gauze
+bandages are preferable to heavier bandages of cotton fabric because
+they are somewhat more elastic and yield to the irregular contour of the
+parts to a better advantage. Layers of three inch gauze bandages, which
+are soaked with a cold starch paste are wound about the extremity.
+Strips of leather that are flexible and not more than an inch in width
+are placed in a vertical position around the leg and these are also
+covered with the starch and securely held in position with the bandages.
+In this way, one is able to provide a sufficient degree of rigidity and
+at the same time, where the cast is carefully applied, little if any
+injury is done the skin. Such a cast is not difficult to remove and is
+so inexpensive that it may be removed and reapplied at any time it
+should be thought preferable to do so. Of course, this does not
+constitute an effective means of support if the parts are to be
+frequently and thoroughly soaked with water, but animals undergoing this
+sort of treatment are usually kept sheltered.
+
+The same after-care is necessary in such cases as is given in fractures
+of other bones. Two months after the injury has been done, the
+application of a blistering ointment to the entire region is of benefit.
+
+Results.--Much depends on the nature of fractures as to the success
+one may attain in approximating the parts of a broken bone, and in some
+cases of oblique fracture for instance, complete recovery is impossible,
+despite the most skillful and painstaking attention given. On the other
+hand, cases of simple transverse fractures make perfect recoveries in
+some instances. All fractures are serious, and in every instance the
+practitioner would best be careful to impress his client with the many
+difficulties which usually attend the treatment of fracture in horses.
+
+
+Tendinitis.
+
+Inflammation of the Flexor Tendons.
+
+One of the most common causes of lameness in light harness and saddle
+horses is tendinitis, and because of the character of the structure of
+tendons and because of their function, an active inflammation of these
+parts is always serious.
+
+Being almost inelastic and not well supplied with blood, tendinous
+tissue is slowly regenerated, and so much time is required for complete
+recovery to take place in tendinitis, that affected animals seldom fully
+recover before they are in service or vigorously exercising at will. As
+a result, complete recovery is delayed or prevented.
+
+The extensor tendons, because of the nature of their function, are very
+seldom strained; they are often bruised and occasionally divided, but
+unlike this condition in the flexors, tendinitis of the extensors is of
+rare occurrence.
+
+For a concise discussion of this subject the most practical
+classification is one made on a chronological basis and we may then
+consider tendinitis as _acute_ and _chronic_.
+
+
+ACUTE TENDINITIS.
+
+Etiology and Occurrence.--Causes of tendinitis, as in almost all
+diseases, may be considered under the heads of predisposing and
+exciting. Among the predisposing causes of tendinitis may be mentioned,
+faulty conformation. Everything which has to do with increasing the
+strain upon tendons adds to the probability of their being over-taxed.
+Long, sloping, pastern bones; disproportionate development of parts,
+such as a heavy body and small, weak tendons and long hoofs, are the
+principal factors which usually predispose to tendinous sprains.
+Degenerative changes which take place in tendons following
+constitutional diseases such as influenza may also be classed as a
+predisposing cause.
+
+Excessive strain when put upon tendons in any possible manner, such as
+is occasioned in running and jumping; making missteps and catching up
+the weight of the body with one foot, when the force thus thrown upon
+the supporting structure is great because of momentum gained at a rapid
+pace, are exciting causes of tendinitis.
+
+Symptomatology.--In all cases of acute tendinitis there is presented a
+characteristic attitude by the subject. Volar flexion in a sufficient
+degree to relax the inflamed structures is always evident. The foot may
+be rested on the toe or placed slightly in advance of the one supporting
+weight, but the fetlock is always thrown forward. More or less swelling
+of the inflamed tendons is present. Where the deep flexor (perforans) is
+involved swelling is marked and with swelling there is present the other
+symptoms of inflammation--heat and supersensitiveness.
+
+In manipulating tendons for the purpose of detecting supersensitiveness,
+care must be taken so that no false conclusion be drawn, because of the
+aversion many horses have to submitting to palpation of the tendons even
+when they are in a normal condition.
+
+Supporting-leg-lameness is present and varies in degree with the
+intensity of the pain caused by weight bearing. In many instances, as
+soon as the subject has traveled a considerable distance, lameness
+diminishes or discontinues. As soon as the affected animal is permitted
+to stand long enough to "cool out" there is a return of the lameness,
+which is then marked.
+
+No difficulty is encountered in making a practical diagnosis in
+tendinitis; that is, one may fail to readily recognize the extent of the
+involvement as it affects the superficial flexor tendon, for instance,
+but this has no practical bearing on the prognosis and treatment, when
+existing inflammation of the deep flexor is recognized.
+
+The course of each tendon is readily outlined by palpation; all parts
+are easily manipulated; and with experience one may readily recognize
+the extent and degree of the inflammation.
+
+Treatment.--In some cases of acute tendinitis, pain is intense and the
+application of cold packs during this stage is very beneficial in that
+pain is controlled and inflammation subsides. The extremity may be
+bandaged with a liberal quantity of absorbent cotton or with woolen
+material. Ice water is then poured around the bandaged member every
+fifteen minutes and this should be continued for about forty-eight
+hours. In some cases this treatment is not necessary for more than
+twelve hours; at the end of this length of time, pain has subsided and
+the acute stage of inflammation has passed or its intensity has been
+diminished.
+
+Following the application of cold packs, the use of a poultice such as
+some of the sterile, medicated muds, is of marked benefit. The author
+has made use of tincture of iodin and glycerin in the proportion of one
+part of iodin to seven parts glycerin, with very satisfactory results.
+This combination is hygroscopic, anodyne and antiseptic and is easily
+applied. A liberal quantity is directly applied all around the affected
+tendons and the leg covered with a heavy layer of cotton, and this is
+snugly held in position with bandages. The application may be used once
+or twice daily, or if it is thought necessary, an attendant may pour a
+quantity of the iodized-glycerin around the leg and under the bandage
+once daily without removing the cotton and bandage. Needless to say,
+absolute rest is imperative.
+
+When all evidence of acute inflammation has subsided vesication is
+indicated. At this stage walking exercise is beneficial and the subject
+may be allowed the freedom of a paddock.
+
+Some practitioners are partial to the use of the actual cautery in these
+cases, but it is doubtful if it is necessary to produce such a great
+degree of counter-irritation in cases where the subject is suffering the
+first attack of tendinitis.
+
+As has been indicated, ample time should be allowed for recovery and
+depending upon conditions, it takes from three weeks to six months for
+complete recovery to become established.
+
+
+Chronic Tendinitis and Contraction of the Flexor Tendons.
+
+Etiology and Occurrence.--Acute inflammation of the flexor tendons may
+result in chronic tendinitis. Recurrent attacks in cases where
+insufficient time is allowed for complete recovery to result, is
+followed by chronic inflammation and hypertrophy of the tendons. Again,
+in subjects where conformation is faulty, no amount of care will be
+sufficient to prevent a recurrence of the inflammation and the condition
+must become chronic.
+
+Symptomatology.--On visual examination of the subject at rest, one may
+note the hypertrophied condition of the affected tendons. Their
+transverse diameter is usually perceptibly increased and in many cases,
+there is an increase in the antero-posterior diameter. The latter
+condition causes a bulging of the tendon that is so noticeable, because
+of the convexity thus formed, it is commonly known as "bowed tendon."
+
+[Illustration: Fig. 20--Contraction of the superficial digital flexor
+tendon (perforatus) of the right hind leg, due to tendinitis.]
+
+In chronic tendinitis there occurs repeated attacks of inflammation
+wherein lameness is pronounced and there exists in reality, at such
+times, acute inflammation of a hypertrophic structure, where at no time
+does inflammation completely subside. Therefore, in chronic tendinitis
+there is to be found at times the same conditions which characterize
+acute inflammation, except that there is usually a variance of symptoms
+because of the difference in the degree of inflammation and pain.
+
+The diagnosis of contraction of tendons is an easy matter because of the
+fact that relations between the phalanges are constantly changed with
+tendinous contraction. If one bears in mind the attachments and function
+of the digital flexors, no difficulty is encountered in recognizing
+contraction of either tendon.
+
+Contraction of the superficial digital flexor (perforatus), when
+uncomplicated, is characterized by volar flexion of the pastern joint.
+The foot is flat on the ground and the heel is not raised because the
+superficial flexor tendon does not have its insertion to the distal
+phalanx (os pedis) and therefore can not affect the position of the
+foot.
+
+By causing the subject to stand on the affected member, one may outline
+the course of the flexor tendons by palpation, and in this way recognize
+any lack of tenseness or contraction of tendons or of the suspensory
+ligament.
+
+[Illustration: Fig. 21--Contraction of the deep flexor tendon
+(perforans) of the right hind leg, due to tendinitis.]
+
+Contraction of the suspensory ligament would cause the pastern joint to
+assume the same position as is occasioned by contraction of the
+superficial digital flexor (perforatus) tendon, but when the subject is
+bearing weight on the affected member, it is easy to determine that no
+contraction of the suspensory ligament exists, by noting an absence of
+abnormal tenseness of this structure. And finally, contraction of the
+suspensory ligament is of rare occurrence.
+
+Contraction of the deep flexor tendon (perforans) causes an elevation of
+the heel. The foot can not set flat because the insertion of the deep
+flexor tendon to the solar surface of the distal phalanx (os pedis)
+causes when the tendon is contracted--a rotation of the distal phalanx
+on its transverse axis--hence the raised heel. No other tendon has this
+same effect on the distal phalanx and the condition is correctly
+diagnosed without difficulty.
+
+[Illustration: Fig. 22--A chronic case of contraction of both flexor
+tendons of the phalanges. In this case (presented at a clinic of the
+Kansas City Veterinary College) because of long continued contraction of
+the flexors, which prevented weight being supported with any degree of
+comfort, there resulted a partial paralysis of the extensors, and
+consequently the extremity was dragged on the ground.]
+
+Course and Complications.--This condition may exist for years without
+causing the subject any serious inconvenience, if the affected animal is
+kept at suitable work. In other instances recurrent attacks of lameness
+are of such frequent occurrence that the subject is not fit for service.
+Many affected animals that are kept in service in spite of lameness (and
+in some instances where no lameness is present), soon become
+unserviceable because of contraction of the inflamed tendon. This, in
+fact, is the condition which eventually becomes established in most
+instances.
+
+Treatment.--Where conformation is not too faulty so that recovery may
+be expected, good results are obtained by line-firing the tendons and
+allowing the subject a few months' rest. In some cases median neurectomy
+is advisable. This is recommended by Breton[25] as being productive of
+good results even where contraction of tendons exists and tenotomy is
+done.
+
+[Illustration: Fig. 23--Contraction of the superficial and deep flexor
+tendons (perforatus and perforans) of the left fore leg.]
+
+By shoeing with high heel-calks considerable strain is taken from the
+inflamed tendons because of the changed position of the foot which
+alters the distribution of weight on different parts of the leg. Rubber
+pads materially diminish concussion and should be made use of when the
+subject is returned to work, if the character of the work is such as to
+occasion much concussion.
+
+It is to be remembered, however, that in sprains there occurs fibrillary
+fracture of soft structures and time is required for regeneration of
+tissue which has been injured or destroyed. Absolute rest is necessary
+where inflammation is acute and in sub-acute or chronic tendinitis
+avoidance of all work which causes irritation to the affected tendons is
+imperative.
+
+[Illustration: Fig. 24--Contraction of superficial digital flexor and
+slight contraction of deep flexor tendon.]
+
+Where contraction of tendons exists surgical treatment is necessary. No
+good comes from appliances which are calculated to stretch the affected
+tendons; in fact, they aggravate the inflamed condition and hasten
+complete loss of function of the affected member. Where there exists no
+articular or ligamentous diseases which would defeat the purpose,
+tenotomy is the only remedy for contracted tendons.
+
+
+Contracted Tendons of Foals.
+
+Etiology and Occurrence.--This condition is occasionally observed and
+no positive explanation of the reason for its existence can be given.
+That mal-position _en utero_ causes the metacarpal bones to develop in
+length so rapidly that the tendons are too short, is an explanation that
+is offered. Be that as it may, in breeding sections of the country the
+general practitioner is obliged to handle these cases and successful
+methods of treatment are essential even though cause is not removable.
+
+Symptomatology.--The superficial flexor tendon (perforatus) alone, is
+the one usually contracted, and while both flexors are at times
+involved, this rarely occurs. The condition is usually bilateral.
+
+The degree of contraction varies greatly in different cases. In some,
+contraction exists to such extent that it is impossible for the colt to
+stand, and because of continual decubitus where no relief is given, the
+subject is lost because of gangrenous infection occasioned by bed sores.
+Otherwise the same symptoms are to be observed in this condition, that
+exist in contraction of tendons of the mature animal.
+
+Treatment.--Wherever contraction is not too marked and weight is borne
+with the affected members, and where the feet can be kept on the ground
+in a nearly normal position, it is possible to correct the condition
+without doing tenotomy. That is, in cases where the subject is simply
+"cock-ankled", where volar flexion of the pastern joint exists but the
+foot is kept flat on the ground, correction is possible without
+tenotomy.
+
+In such instances the foal must be treated early--before the skin on the
+anterior pastern region has been badly damaged by knuckling over. It is
+possible in many cases to stretch the flexor tendons by grasping the
+colt's foot with one hand, and with the other hand one may push the
+pastern in the direction of dorsal flexion. This may be tried and when a
+reasonable amount of force is employed, no harm is done, even though no
+material benefit results. Some veterinarians claim good results from
+this treatment alone and direct their clients to repeat the stretching
+process several times daily.
+
+Whether the tendons are manually stretched or not, splints should be
+adjusted to the affected members. The legs are padded with cotton and
+bandages and a suitable splint is applied on either side of the members
+and securely fixed in position by bandaging.
+
+The splints are kept in position for four or five days and then removed
+for inspection of the affected parts. If necessary, they are reapplied
+and left in position for a week; however, this is unnecessary in the
+average case that is treated in this manner.
+
+Where contraction exists to the extent that the subject can not stand
+and where no weight is borne by the feet, it is necessary to divide the
+affected tendons surgically. The same technic is put into practice that
+is employed in the mature subject but there is much greater chance for a
+favorable outcome in the foal. Further, if necessary, one may divide
+with impunity, both tendons on each leg, at the same time. In all cases
+this operation is done by observing strict aseptic precautions and the
+legs are, of course, bandaged. If both tendons are divided, splints
+should be employed and kept in position for ten days or two weeks.
+Primary union of the small surgical wound of the skin and fascia occurs
+in forty-eight hours.
+
+The reader is referred to William's "Veterinary Surgical and Obstetrical
+Operations," for a complete description of this operation.
+
+     In veterinary literature there is occasionally described a
+     condition which affects young foals wherein symptoms similar to
+     those of contraction of the flexors are manifested, but upon
+     examination it is found that rupture of the extensor of the digit
+     (extensor pedis) exists. This affection is briefly described by
+     Cadiot but no complete treatise on this condition has been
+     published.
+
+     In parts of Canada foals of from one to three days of age are found
+     affected in such manner that more or less interference with the
+     gait is to be seen in those moderately affected. There is, in some
+     subjects, only a slight impediment in locomotion which is
+     occasioned by inability to properly extend the digit. In other
+     subjects, while able to stand and walk, great difficulty is
+     experienced because of volar flexion of the phalanges. The more
+     seriously affected animals are unable to stand and, in most
+     instances, perish because of the effects of prolonged decubitus.
+
+     A local enlargement occurs at the anterior carpal region and the
+     mass is somewhat fluctuating, extravasated fluids becoming infected
+     in many instances, and necrosis of the skin and fascia provide
+     means for spontaneous discharge of the contents of the enlargement
+     if it is not opened. The infection when it becomes generalized
+     causes a fatal termination in most cases that are not treated.
+
+[Illustration: Fig. 25--"Fish knees."--Photo by Thos. Millar,
+M.R.C.V.S.]
+
+     Native stock owners of some parts of Canada know this condition as
+     "fish knees" because of the presence of the ruptured end of the
+     extensor tendon which is found coiled in the cavity of the
+     enlargements caused by the ruptured tendon.
+
+     Local practitioners have treated the condition by incising the
+     swollen mass and removing the part of tendon contained within such
+     cavities. Treatment has not proved entirely satisfactory in the
+     majority of instances, perhaps because of tardy interference.
+
+     In a colt's leg sent the author by Mr. Thomas Millar, M.R.C.V.S.,
+     of Asquith, Saskatchewan, a careful dissection of the carpal region
+     revealed the fact that in this case the ruptured extensor tendon
+     was due to injury. The colt may have been trampled upon by its dam
+     in such manner that the tendon was divided. No noticeable evidence
+     of injury to the skin was to be seen on its outer surface, but on
+     the fascial side a cyanotic congested area, which was situated
+     immediately over the site of the ruptured tendon, was very
+     evident.
+
+     With the execution of a good surgical technic, the ruptured tendon
+     might be sutured; the wound of the tendon sheath as well as that of
+     the skin carefully united by means of gut sutures, the leg bandaged
+     and immobilized with leather splints and recovery follow in a
+     reasonable percentage of cases so treated. These cases afford an
+     opportunity for the perfection of practical means of treatment by
+     those who frequently meet with this affection.
+
+
+Rupture of the Flexor Tendons and Suspensory Ligament.
+
+Etiology and Occurrence.--Rupture of the flexor tendons or of the
+suspensory ligament is of rare occurrence. Frequently, these structures
+are divided as the result of wounds; but rupture, due to strain, is not
+frequent.
+
+[Illustration: Fig. 26--Extreme dorsal flexion said to have resulted
+from an attack of distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No.
+4.]
+
+In some cases in running horses, or in animals that are put to strenuous
+performances, such as are jumpers, rupture of tendons or of the
+suspensory ligament takes place. However, more frequently this follows
+certain debilitating diseases such as influenza or local infectious
+inflammation of the parts which results in degenerative changes and
+rupture follows.
+
+The non-elastic suspensory ligament receives some heavy strains during
+certain attitudes which are taken by horses in hurdle jumping as is
+explained in detail by Montané and Bourdelle[26] under the description
+of this ligament. But in spite of the frequent and unusually heavy
+strains, which these structures receive, complete rupture is not
+frequently seen.
+
+Symptomatology.--When the anatomy and function of the flexor tendons
+and suspensory ligament is thoroughly understood, recognition of rupture
+of either of these structures is easily recognized. When one considers
+that in rupture, a position directly opposite to that which is seen in
+contraction in either one of these structures, is assumed, a detailed
+description of each separate condition is needless repetition.
+
+However, it is pertinent to suggest that rupture of the deep flexor
+tendon (perforans) allows a turning up of the toe. Whether it be torn
+loose from its point of attachment or ruptured at some point proximal
+thereto, the position is the same--heel flat on the ground, toe slightly
+raised and this raising of the toe varies in degree as the subject moves
+about.
+
+When the superficial flexor (perforatus) is ruptured there is no change
+in the position of the foot but the fetlock joint is slightly lowered.
+The pathognomonic symptom is the lax tendon during weight bearing, which
+may be felt by palpation of the tendon along its course in the
+metacarpal region.
+
+With complete rupture of the suspensory ligament there occurs a marked
+dropping of the fetlock joint and an abnormal amount of weight is then
+thrown upon the superficial flexor tendon (perforatus), causing it to be
+markedly tensed. This is readily recognized by palpation. By palpating
+the suspensory ligament from its proximal portion down to and beyond its
+bifurcation, while the affected member is supporting weight, it is
+possible to diagnose rupture of one of its branches.
+
+Prognosis and Treatment.--In rupture of the superficial flexor tendon
+(perforatus) because of its comparatively less important function,
+prognosis is favorable and recovery takes place when proper treatment is
+put into practice.
+
+With rupture of the deep flexor tendon (perforans), especially when it
+occurs at or near its point of insertion and sometimes following
+disease, prognosis is unfavorable.
+
+Rupture of the suspensory ligament constitutes a condition which is, as
+a rule, hopeless, because of the impracticability of treating such
+cases.
+
+The salient feature which characterizes any practical attempt at
+treatment of ruptured tendons or other portions of the inhibitory
+apparatus of the fetlock region, is to retain the phalanges in their
+normal position for a sufficient length of time that the approximated
+ends of ruptured tendons or ligaments may unite. The length of time
+required for this to occur, together with the difficulties encountered
+in confining the affected extremities in suitable braces or supportive
+appliances, precludes all possibility of this condition's being
+practically amenable to treatment when the deep flexor tendon
+(perforans) and suspensory ligament are simultaneously ruptured. It does
+not follow, even so, that recovery does not succeed treatment in some of
+these unfavorable cases.
+
+[Illustration: Fig. 27--A good style of shoe for bracing the fetlock
+where tenotomy has been performed, or in case of traumatic division of
+the flexor tendons. An invention of Dr. G.H. Roberts.]
+
+Affected subjects are kept in slings as long as it seems
+necessary--until they learn to get up without deranging the braces worn.
+
+Several styles of braces are in use and each has its objections;
+nevertheless some sort of support to the affected member is necessary
+and steel braces which are connected with shoes are usually employed.
+
+The principal difficulty which attends the use of braces is
+pressure-necrosis of the skin which is caused by the constant and firm
+contact of the metal support. The practitioner's ingenuity is taxed in
+every case to contrive practical means of padding the exposed parts in
+order to prevent or minimize necrosis from pressure. This is
+attempted--with more or less success--by frequent changing of bandages
+and the local application of such agents as alcohol or witch hazel.
+Needless to say, the skin must be kept perfectly clean and the dressings
+free from all irritating substances.
+
+[Illustration: Fig. 28--Showing the Roberts brace in operation.]
+
+The fact that tendons or ligaments which are ruptured, do not regenerate
+as readily as in cases where traumatic or surgical division occurs, must
+not be lost sight of, and prognosis is given in accordance.
+
+
+Thecitis and Bursitis in the Fetlock Region.
+
+Etiology and Occurrence.--Synovial distension of tendon sheaths and
+bursae in the region of the fetlock are caused by the same active
+agencies which produce this condition in other parts. The fetlock region
+is exposed to more frequent injury than is the carpus and as a
+consequence is more often affected. The same proportionate amount of
+irritation affects this part of the leg, owing to strains, as affect the
+carpus from a similar cause; and synovitis from this cause, is as
+frequent in one case as in the other. Therefore, it is a natural
+sequence that the tendon sheaths of the metacarpophalangeal region are
+frequently distended because of chronic synovitis and thecitis. These
+inflammations are usually non-infective in character.
+
+The _cul-de-sac_ of the capsular ligament of the fetlock joint which
+extends upward between the bifurcation of the suspensory ligament is the
+most frequently affected structure in this region. When distended, two
+spheroidal masses bulge laterally and anterior to the flexor tendons in
+a characteristic manner. This condition is known among horsemen as
+"wind-gall" or "fetlock-gall."
+
+The sheath of the flexor tendons, which begins about the middle portion
+of the lower third of the metacarpus, and continues downward below the
+pastern joint is often distended.
+
+Excepting in cases of acute inflammation attending synovitis of these
+parts, no lameness marks its existence and in chronic cases of synovial
+distension the service of affected animals is not interfered with. These
+distensions constitute unsightly blemishes and they are treated chiefly
+for this reason.
+
+No difficulty is encountered in recognizing these conditions even where
+considerable organization of tissue overlying distended thecae occurs.
+In such cases there may be only slight fluctuation of the enlargement,
+but if necessary, an aseptic exploratory puncture may be made with a
+suitable needle or trocar.
+
+Treatment.--Complete rest and the local application of cold packs are
+in order in acute synovitis when there is distension of tendon sheaths.
+In the fetlock region, because of the ease with which pressure may be
+employed, the parts should be kept snugly wrapped with cotton, and derby
+bandages are used to exert the desired amount of pressure over the
+affected region. The pressure-bandages should be employed as soon as all
+acute and painful inflammation has subsided; and then they should be
+continued, day and night, for ten days or two weeks. The bandages should
+be removed morning and night. After the skin of the leg has thoroughly
+dried off, an infriction of alcohol or distilled extract of hamamelis is
+given the parts and the cotton and bandages are readjusted. A good, even
+and firm pressure in such cases is productive of satisfactory results.
+
+[Illustration: Fig. 29--Distension of theca of the extensor of the digit
+(extensor pedis).]
+
+In chronic distensions of tendon sheaths synovia may be aspirated and
+about five cubic centimeters of equal parts of tincture of iodin and
+alcohol is injected into the cavity. This is not done, however, without
+usual aseptic precautions. If no marked swelling results within
+forty-eight hours the entire fetlock region is thoroughly vesicated and,
+as soon as the skin has recovered from the effects of the vesicant,
+pressure bandages may be employed. In these cases, subjects may be put
+into service after all swelling which the injection or the vesicant has
+produced has subsided. The pressure bandages are used at night or during
+the time that the horse is in its stall and they are not worn by the
+subject while at work.
+
+Where no marked swelling occurs within ten days, as the result of the
+injection of iodin, the injection may be repeated and, if thought
+necessary, the quantity may be materially increased. If swelling does
+not occur it is indicative that no particular irritation has been
+caused.
+
+Some swelling is desirable and much swelling sometimes results and
+persists for weeks. This is not in any way likely to cause permanent
+trouble; and if the technic of injection is skilfully executed no
+infection will follow.
+
+By persistent and careful use of suitable elastic bandages, the support
+thus given the parts, together with the absorption of products of
+inflammation which constant pressure occasions, some chronic cases of
+synovial distension of tendon sheaths recover in two or three months and
+this without other treatment. Such good results are not to be expected
+in aged subjects, nor in horses having at the same time, chronic
+lymphangitis.
+
+Where bandages of pure rubber are employed great care is necessary, if
+one is not experienced in their use, lest necrosis result. Where
+bandages are uncomfortably tight the subject will manifest discomfort,
+and an attendant should observe the animal at intervals for a few hours
+(where there may be some doubt as to the degree of pressure which is
+exerted by elastic bandages) and readjustment made before any harm is
+done.
+
+
+Arthritis of the Fetlock Joint.
+
+Anatomy.--The anatomy of the metacarpophalangeal articulation is
+briefly reviewed on page 58 under the heading of "Anatomo-Physiological
+Review of Parts of the Foreleg."
+
+Etiology and Occurrence.--The chief causes of non-infective arthritis
+of the fetlock joint are irritations from concussion and contusions due
+to interfering. The condition occurs in young animals that are
+over-driven in livery service or other similar exhausting work, where
+they become so weary that serious injury is done these parts by striking
+the pasterns with the feet--interfering. In these "leg-weary" animals,
+that are always kept shod with fairly heavy shoes, much direct injury is
+done at times by concussion due to self-inflicted blows. In older
+animals, where there exists similar conditions, with respect to their
+being worn from fatigue and, in addition, periarticular inflammatory
+organizations, arthritis is not of uncommon occurrence.
+
+[Illustration: Fig. 30--Rarefying osteitis wherein articular cartilage
+was destroyed in a case of arthritis of fetlock joint.]
+
+Symptomatology.--In true arthritis there exists a very painful
+affection which is characterized by manifestations of distress. The
+subject may keep the extremity moving about--where pain is
+great--suspended and swinging. There is swelling which is more or less
+hot to the touch and compression of the parts with the fingers increases
+pain. Lameness is always pronounced and no weight is supported with the
+affected member in very acute and generalized arthritic inflammations.
+There occurs the usual facial manifestations of pain--the tense
+condition of the facial muscles and the fixed eye and nostril are in
+evidence.
+
+In cases where there exists a synovitis or where a very limited portion
+of the articulation is involved, a somewhat different clinical picture
+is presented. Then, the disturbance causes less distress; local swelling
+and evidence of supersensitiveness are not so pronounced and lameness is
+not intense, though weight-bearing is painful.
+
+Prognosis.--There is a constant difference in the degree of pain
+manifested, as well as the other symptoms of inflammation, between true
+arthritis, which involves much of the joint, and synovitis; or synovitis
+plus a small circumscribed area of joint involvement. This difference is
+present in all joint affections of the extremities and, in passing, it
+is well to say that infection usually increases every manifestation of
+pain. Infection occasions more pronounced local symptoms of inflammation
+and, because of the rapid progress of necrotic destruction of cartilage,
+the course of the affection is usually rapid; ankylosis is a frequent
+result and loss of the subject is often inevitable. However, in
+non-infective arthritis of the fetlock joint, prognosis is favorable.
+
+Treatment.--The same general principles which are employed in
+arthritis of other joints are used here. Rest and comfort for the
+patient is sought in every available manner. If the subject remains
+standing too long, the sling should be used and a well-bedded box-stall
+will contribute much to the comfort of the patient.
+
+Pain and acute inflammation is diminished or controlled, if possible, by
+using ice-cold packs. In nervous, well-bred animals analgesic agents may
+be employed; or small doses of morphin sulphate--one to two
+grains--given at intervals of three hours during the first stages of the
+affection is very beneficial. This is especially indicated in infectious
+arthritis.
+
+As inflammation subsides, hot applications are used and finally counter
+irritants are employed. Their selection is a matter of choice with the
+practitioner. The object sought is the same with every practitioner and
+while methods employed vary, results are not markedly different except
+in so far as the degree of counter irritation which is produced varies
+in given cases. Where a great degree of counter irritation is thought
+necessary, line-firing with the actual cautery is the remedy _par
+excellence_.
+
+After-care.--In the course of three or four weeks subjects may be
+allowed the run of a paddock and, after a complete rest of six weeks at
+pasture, they may be returned to work with care, if the work is not of a
+nature to occasion concussion or other manner of irritation to the
+articulation.
+
+Neurectomy is not indicated even though there is a recurrence of
+lameness, unless the lameness is not pronounced and inflammation is
+periarticular and no osseous enlargements mechanically interfere with
+function of the joint. There are few cases then, where neurectomy is
+materially helpful.
+
+
+Ossification of the Cartilages of the Third Phalanx.
+(Ossification of the Lateral Cartilages.)
+
+Anatomy and Function of the Cartilages.--Surmounting each wing of the
+distal phalanx (os pedis) is the irregularly-quadrangular cartilage. The
+superior border of this cartilage is thin, generally convex, and
+perforated for vessels to pass to the frog; the inferior border is
+attached to the wing of the third phalanx and posteriorly, it is
+reflected inward and is continuous with the inferior surface of the
+sensitive frog. The anterior border which is directed obliquely downward
+and backward becomes blended with the anterior lateral ligament of the
+coffin joint. The fibrous expansion of the anterior digital extensor
+(extensor pedis) is united to the anterior borders of the lateral
+cartilages.
+
+     According to Smith[27]: These structures form an elastic wall to
+     the sensitive foot, and attachment to the vascular laminae; they
+     also admit of increase in width occurring at the posterior part of
+     the foot without destroying the union of the two set of leaves.
+     Further, by their connection with the vascular system of the foot,
+     their elastic movements materially assist the circulation. The
+     primary use of the lateral cartilages is to render the internal
+     foot elastic, and admit of its change in shape which occurs under
+     the influence of the weight of the body. The alteration in the
+     shape of the foot is brought about by pressure on the pad, which
+     widens and in consequence presses on the bars. The pressure
+     received by the pad is also transmitted to the plantar cushion,
+     which likewise flattens and spreads under pressure. Both of these
+     factors force the cartilages slightly outwards. When the posterior
+     wall recoils the cartilages are carried back to their original
+     position. Should the elastic cartilage under pathological
+     conditions become converted into bone, its functions are destroyed,
+     and lameness may occur.
+
+Etiology and Occurrence.--The causes of ossification of these
+cartilages are several. No doubt there exists a predisposition to this
+condition for it is of such frequent occurrence in heavy draft types of
+horses. Concussion plays an important rôle and, according to
+Möller's[28] theory, which is sound, high heel calks prevent the frog
+from contacting the ground, and as weight is placed upon the foot "the
+lateral cartilages are subjected to a continuous inward and downward
+dragging strain."
+
+[Illustration: Fig. 31--Ringbone and sidebone.]
+
+The condition affects the cartilages of the fore feet more frequently
+than those of the hind and the outer cartilage is more often ossified
+than is the inner. This fact may be accounted for by its more exposed
+position; it is also frequently injured by being trampled upon and
+otherwise contused or cut, as in lacerated wounds of the quarter.
+
+Symptomatology.--Ossification of the cartilages is known by grasping
+the free borders with the fingers and attempting their flexion; the
+rigid inflexible ossified cartilage is thus easily recognized.
+
+Lameness during weight-bearing occurs in the majority of cases at some
+time. Much depends on the conformation of the foot and whether the
+involvement affects one or both cartilages as to the degree and duration
+of lameness which marks this affection. In narrow and contracted heels
+it is reasonable to expect more lameness than in well formed feet. Where
+only one cartilage is ossified, the other being flexible, there is less
+inconvenience experienced by the subject during weight-bearing, because
+of the expansion of the heel which the one normal cartilage allows.
+
+Treatment.--There is little if anything to be done in case the
+cartilage has become ossified except to shoe without high calks but
+preferably with rubber pads. The hoof should be kept moist; the wall at
+the quarter may be rasped thin and kept anointed. Firing is of no
+practical benefit in these cases, and it is doubtful if vesication is
+helpful excepting where only a part of the cartilage is ossified.
+
+Subjects which continue somewhat lame, because of complete ossification
+of both cartilages, are best put to slow work on soft ground and not
+driven on pavements.
+
+
+Navicular Disease.
+
+This more or less ambiguous term has been applied to various diseases
+affecting the structures which make up the coffin joint. We consider
+this name to be applicable to inflammatory involvement of the third
+sesamoid (navicular bone), the deep flexor tendon (perforans) and the
+bursa podotrochlearis or navicular bursa.
+
+Etiology and Occurrence.--In 1864 Thomas Greaves[29] wrote on the
+subject of navicular disease as follows: "The opinion I entertain upon
+the subject of navicular disease is, that in by far the greater majority
+(if not all) of these cases there exists in the animal affected a
+congenital tendency or predisposition, that, generally speaking, it is
+the high stepper, the good goer, that becomes the victim to this
+disease; and it is a fact well attested, that it as frequently develops
+itself in the feet with wide frogs, bulbous heels, shallow heels, spread
+flattish feet, as in the narrow upright feet.... I have known foals,
+born from defective parents, in which this condition was so strongly
+developed, that all men would at once pronounce them affected with
+navicular disease, and such lameness was permanent."
+
+Often both fore feet are affected and this would point toward its being
+a disease wherein either conformation or congenital tendencies exists.
+It is rare that hind feet are involved.
+
+There are many theories regarding the possible exciting causes of
+navicular disease and, when one has carefully considered the
+explanations as offered by Peters, Möller, Branell, Schrader and others,
+he may conclude that navicular disease is a non-infectuous inflammatory
+affection of the third sesamoid (navicular) bone, deep flexor tendon
+(perforans) and adjoining structures. Whether it originates in the
+flexor tendon or whether the bone is the original part affected, the
+disease is frequently met, and of all possible causes, jars and
+irritation incident to concussion of travel, are probably the principal
+causative agents.
+
+Symptomatology.--Lameness is the primary indicator and a constant
+symptom which attends navicular disease wherever much structural change
+affects the infirm parts. As the degree of intensity or extent varies,
+so is there a dissimilarity in the character of the impediment.
+Incipient cases of bilateral involvement are more difficult to diagnose
+than are unilateral affections, particularly when lameness is not
+marked. There is manifested a supporting-leg-lameness which varies as to
+degree in the same subject at different times. This may be noticed
+during the same trip in an animal that is being driven. There is a
+tendency for the subject to stumble and, of course, where the affection
+is bilateral, there is a stilted gait owing to shortened strides.
+
+At rest the lame animal usually points with the affected member. Because
+of the fact that the distance is lessened between the origin and
+insertion of the deep flexor tendon (perforans) by this attitude, one
+may readily understand the reason for the position assumed by the
+subject. Pressure on the navicular bone is diminished and tension on the
+flexor tendon is relieved by even slight volar flexion.
+
+In acute inflammatory affections abnormal heat may be detected in the
+region of the heel. By exerting tension on the flexor tendon, by means
+of passive dorsal flexion of the member, evidence of hyperesthesia may
+be detected. With the hoof testers one may determine supersensitivenss
+in most instances. There occurs more or less contraction of the hoof in
+navicular disease, but this is not to be taken as a cause of the
+affection, but rather a sequence.
+
+[Illustration: Fig. 32--"Pointing"--the position assumed by horse having
+unilateral navicular disease.]
+
+In some cases of unilateral navicular disease there is a marked contrast
+in size between the sound and unsound foot. However, one must not be
+misguided in this particular, for in some pairs of sound feet there
+exists considerable difference in size. Finally, by a change from the
+normal position of the foot to one in which the heel is somewhat
+elevated (as may be obtained by shoeing with high heel calks), relief is
+evident, and in the opposite position, the condition is aggravated.
+This experiment may be used for diagnostic purposes.
+
+Treatment.--When the anatomy of the diseased parts is taken into
+consideration, and an analysis of the lesions which occur in cases where
+considerable structural change is occasioned by this affection, it is
+obvious that recovery is impossible. Only in cases where the
+inflammation is promptly checked before damage has been done the
+navicular bone or the flexor tendon, is permanent recovery possible. The
+disease is not frequently treated during this stage, however, and in the
+majority of instances the condition becomes chronic.
+
+As soon as a diagnosis is made the shoes must be removed, the toe
+shortened with the hoof pincers and rasp and the subject is put in a
+well bedded box-stall. If the animal is very lame and the inflammation
+is acute, ice-cold packs should be applied to the feet. As soon as acute
+inflammation has subsided the foot may be so pared that all excess of
+sole and frog is removed without lowering the heels, and the animal may
+be blistered about the coronet region. The subject may be shod later,
+with heel calks that raise the heel moderately and a protracted period
+of rest should be enforced.
+
+In cases where no acute inflammatory condition exists, neurectomy is
+beneficial. One must discriminate, however, between favorable and
+unfavorable subjects. This is not a last resort expedient to be employed
+in cases where extensive lesions of the navicular structures exists.
+With proper shoeing, and by putting the subject at suitable work, where
+concussion of fast travel on hard roads is not necessary, the best
+results are obtainable.
+
+
+Laminitis.
+
+This disease is primarily a non-infective inflammation of the sensitive
+laminae which very frequently affects the front feet. Often all four
+feet are affected, less frequently one foot (when its fellow is unable
+to sustain weight) and rarely the hind feet alone.
+
+Occurrence.--Probably a greater number of cases of laminitis occur in
+localities where horses that are worked on heavy transfer wagons are,
+when in a state of perspiration, allowed to stand exposed to sudden
+lowering of temperature and to stand in a cool or cold shower of rain
+such as occurs near the coast of the Great Lakes or the ocean in some
+parts of this country.
+
+This disease occurs in connection with digestive disorders of various
+kinds and, because of the frequent association of the two conditions,
+the common term "founder" has long been employed to designate laminitis.
+In cases of "over-loading," particularly when a large quantity of wheat
+has been eaten by animals that are unaccustomed to this diet, laminitis
+almost constantly results.
+
+Large draughts of cold water, when drunk by animals that are overheated
+is often followed by laminitis. Concussion, such as attends hard
+driving, especially in unshod horses or on rough and hard roads, is
+often succeeded by this affection. Likewise, as has been stated, injury
+such as is occasioned by long continued standing on the same foot is
+followed by laminitis. Some horses that are frequently shod, suffer from
+this affection a few hours after shoes have been reset. Dr. Chas. R.
+Treadway of Kansas City reports the rather frequent occurrence of such
+conditions in horses that are in the fire department service in his
+city.
+
+Age in no way influences the occurrence of laminitis and the general
+condition of an animal with regard to its vigor or state of flesh has no
+apparent influence toward predisposing horses to this ailment.
+
+Etiology and Classification.--As it is with some other diseases, one
+may unprofitably theorize on cause and readily enumerate many conditions
+which are apparently contributory toward producing the affection. Causes
+may well be grouped, however, and a more definite understanding of
+laminitis is possible as a result. Such collocation would include
+conditions which directly or indirectly affect the digestion, such as
+puerperal laminitis, drinking of large quantities of cold water and
+exposure to cold and rain when the body is warm. All of these various
+conditions might be said to affect the vaso-constrictor nerves in such
+manner that the natural tendency (because of the peculiar structure of
+the sensitive laminae and their mode of attachment to the non-sensitive
+wall) which solipeds have for this affection is indirectly due to this
+one cause--vaso-constriction. According to Dr. D.M. Campbell, the effect
+of toxic materials, which may be absorbed from the digestive tract or
+the uterus in parturient females, upon the vaso-constrictor nerves, is
+such that a passive congestion of the sensitive laminae occurs and
+laminitis is the result. He believes that even the chilling of the
+surface of the body when very warm, by a cold rain, constitutes a
+condition wherein the effect upon the vaso-constrictors is the same.
+
+This grouping does not include the effect of direct injuries of any and
+all kinds to which the feet are subjected such as: Concussion in fast
+road work, injuries occasioned by tight or ill fitting shoes, contusions
+of any kind resulting in non-infectious inflammation of the sensitive
+laminae, as well as the causes which produce laminitis where weight is
+borne by one foot when its fellow is out of function.
+
+A classification which is practical is that of _acute_ and _chronic_
+laminitis. To the practicing veterinarian it is this manner of
+consideration that is essential in the handling of these cases.
+
+Symptomatology.--In the acute attack the condition is so well
+described by Dr. R.C. Moore[30] that we quote him in part as follows:
+
+     The acute form is generally ushered in very suddenly. Often a horse
+     that is perfectly free from symptoms of the disease is found a few
+     hours later so stiff and sore that he will scarcely move. They
+     stand like they were riveted to the ground. If forced to move the
+     evidence of pain subsides to some extent after they have gone a
+     short distance, to return more severe than ever after they have
+     been allowed to stand for a short time. If the disease is confined
+     to the two front feet, the hind feet are placed well under the
+     center of the body to support the weight and the front ones are
+     advanced in front of a perpendicular line so as to lessen the
+     weight they must bear. If they are made to move, the same position
+     of the feet is maintained. If made to turn in a small circle, they
+     do so by using the hind feet as a pivot, bringing the front parts
+     around by placing as little weight on them as possible.
+
+     Placing the hind feet so far under the body, arches the back and
+     often leads to errors in diagnosis, the condition sometimes being
+     taken for diseases of the loins or kidneys.
+
+     If all four feet are involved, the animal stands in the usual
+     position assumed in health, but if urged to move, the least effort
+     to do so usually brings on chronic spasms of the entire body. In
+     very severe cases, a slight touch of the hand will develop the
+     spasms. At times they are so severe, and have such short
+     intermissions, that the disease has been mistaken for tetanus.
+     However, the clonic nature of the spasm should prevent such an
+     error. If they are lying down, it is difficult to get them to
+     arise, and if they do so, they show marked symptoms of pain for
+     some time after rising.
+
+     If the disease is confined to the hind feet, they are placed well
+     forward to relieve the strain on the toe caused by the downward
+     pull of the perforans (deep flexor) tendon, but in place of the
+     front feet being kept in front of a perpendicular line, as they are
+     when the disease is confined to the front ones, they are placed far
+     back under the body, so they will carry the maximum share of the
+     body weight of which they are capable. The position of the feet is
+     of great importance and offers symptoms that should not be
+     overlooked.
+
+When the subject is caused to walk, symptoms of excruciating pain are
+manifested in all acute cases of laminitis. In some cases where all four
+feet are affected, no reasonable amount of persuasion will cause the
+suffering animal to move from its tracks.
+
+There is acceleration of the rate of heart action; the pulse is full and
+in some cases, bounding. As the affection progresses the pulse becomes
+rather weak and irregular. The character of the pulse in the region of
+the extremity is a reliable indicator; but one has to learn to make
+necessary discrimination because of the condition of the parts, as in
+some cases of lymphangitis or where the skin is abnormally thick. The
+characteristic throbbing pulse is, however, easily recognized in most
+cases. Temperature is variable, though usually elevated from one to four
+degrees above normal. This symptom varies with the type and stage of the
+affection. In a subject that has been down, unable to rise for several
+days, where there is a suppurative and sloughing condition of the
+laminae, the temperature is high. Whereas, in some other and less
+destructive cases there may be little thermic disturbance after the
+first few hours have lapsed.
+
+A constant symptom in bilateral affections of acute laminitis is the
+difficulty with which the subject supports weight with one foot. It is
+this which causes the victim to stand as if "rooted to the ground" when
+all four feet are involved. If one attempts to take up one foot, thus
+causing the subject to stand on the other, there is much resistance and
+in many cases the animal refuses to give the foot.
+
+When we consider that the sensitive parts of the foot are encased by a
+horny, unyielding box and that, when the laminae are congested, a great
+pressure is brought to bear upon the sensitive structures, it is easy to
+understand why the condition is so painful.
+
+_Chronic laminitis_ is a sequel of acute inflammation of the sensitive
+laminae. It varies as to intensity and the exact manner of its
+manifestation depends upon preëxisting disturbances.
+
+In some mild cases of laminitis there are recurrent attacks wherein no
+particular structural change exists, and diagnosis is established
+chiefly by noting the character of the pulse at the bifurcation of the
+large metacarpal (or metatarsal) artery just above the fetlock. The same
+manifestation of pain is present when weight is supported by one foot,
+though in a lesser degree. There is less local heat to be detected by
+palpation than in the acute cases.
+
+Chronic laminitis as it occurs following acute attacks which have
+resulted in structural changes of the foot, present the same symptoms
+just described and, in addition, the peculiar alterations in structure
+exist. When, owing to acute inflammation of the sensitive laminae, there
+has resulted necrosis of this sensitive tissue together with
+infiltration between the anterior surface of the distal phalanx (os
+pedis) and the contacting hoof, the lower portion of the distal phalanx
+is turned downward and backward (rotated upon its transverse axis).
+Because of the traction which is exerted by the deep flexor tendon
+(perforans), as it attaches to the solar surface of the distal phalanx,
+this rotation is facilitated. With hyperplasia of lamina, at the
+anterior portion of the distal phalanx, there results a thick "white
+line." Rotation of the distal phalanx necessitates a descent of its
+apical portion and there occurs a "dropped sole."
+
+In time, partly because of excessive wear of hoof at the heel, owing to
+an altered condition in the normal antagonistic relation between the
+flexor and extensor tendons, the toe makes an excessive growth, and the
+concavity of the anterior line is accentuated owing to this abnormal
+length of hoof. The hoof, because of recurrent inflammatory attacks, is
+corrugated--elevations of horn in parallel rings are usually present.
+
+[Illustration: Fig. 33--The hoof in chronic laminitis. Note the
+concavity. This animal was serviceable for any work that could be
+performed at a walk.]
+
+Animals that are so affected in traveling strike the heel first and the
+toe is later contacted with the ground surface. Rotation of the distal
+phalanx upon its transverse axis produces a condition, with respect to
+this peculiar impediment, that is equivalent to added and excessive
+length of the deep flexor tendon.
+
+Where there occurs suppuration, by careful inspection of the coronary
+region, one may early recognize detachment of hoof. In such cases
+animals remain recumbent and, while the condition is not so painful at
+this stage, the practitioner must not overlook the real state of
+affairs. History, if obtainable, will be a helpful guide in such cases.
+Separation of hoof occurs as a rule in from four to ten days after the
+initial attack of acute laminitis. Needless to say these cases are
+hopeless, when the economic phase of handling subjects is considered.
+
+[Illustration: Fig. 34--Showing the effects of laminitis. By permission,
+from Merillat's "Veterinary Surgical Operations."]
+
+Treatment.--Much depends upon the concomitant disturbances (or causes
+if one is justified in referring to them as such) as to the manner in
+which laminitis is to be treated. In all cases where digestive
+disturbances exist, the prompt unloading of the contents of the
+alimentary canal is certainly indicated. D.M. Campbell[31] in a
+discussion of laminitis has the following to say regarding the treatment
+of such cases:
+
+     Because superpurgation may be followed by laminitis, the
+     advisability of using the active hypodermic cathartics is
+     questioned. Neither arecolin nor eserin can cause superpurgation.
+     The action of the former does not continue longer than an hour
+     after administration and of the latter not more than eight hours.
+     The action of either is mild after the first few minutes.
+
+     I do not think that anyone has recommended either arecolin or
+     eserin where there is severe purgation. Where the intestinal canal
+     is fairly well emptied and its contents fluid, I should be inclined
+     to rely upon intestinal antiseptics to hold in check harmful
+     bacterial growth.
+
+     The use of alum in the treatment of laminitis is held to be without
+     reason other than the empirical one that it is beneficial. If
+     laminitis is due chiefly to an autointoxication, good and
+     sufficient reason for the administration of alum can be shown based
+     upon its known physiological action. It is the most powerful
+     intestinal astringent that I know of and has the fewest
+     disadvantages. I have not noted constipation following its use nor
+     diarrhea, nor a stopping of peristalsis, nor indigestion, and in
+     any case its action lasts at most only a few hours, and if it did
+     all these, it could not much matter. Quitman says, that it
+     constricts the capillaries. If this is true, a thing of which I am
+     not certain, is it not reasonable to suppose that as with other
+     vaso-constrictors, e.g., digitalis, there is a selective action on
+     the part of the capillaries (not of the drug) and those that need
+     it most, i.e., those of the affected feet in laminitis, are
+     constricted most? All body cells exert this selective action in the
+     assimilation of food, the tissue needing most any particular kind
+     of food circulating in the blood, gets it.
+
+     Our first consideration in laminitis should be to remove the
+     cause--to stop the absorption of the toxin in the intestinal tract
+     that is producing the condition. This we accomplish by partially
+     unloading it by the use of the active hypodermic cathartics and
+     stopping absorption by the surest and most harmless of intestinal
+     astringents. Whether the astonishingly prompt and certain action of
+     alum in this case is due wholly to its astringent action or whether
+     alum combines with the harmful bacterial products chemically and
+     forms an innocuous combination, I can only surmise, and it is
+     unimportant. At any rate, when alum is administered, the onslaught
+     of the disease is promptly stopped. Irreparable damage may already
+     have been done if the case is a neglected one, but whether
+     administered early or late in acute attacks, the progress of the
+     disease is stopped immediately.
+
+The same authority may be profitably quoted in the matter of handling
+all cases wherein the revulsive effect of agents which diminish vascular
+tension are chiefly indicated or necessary as adjuvants. In this
+connection, Campbell says:
+
+     The early and vigorous administration of aconitin in laminitis to
+     its full physiological effect, is more logical. Assuming that
+     laminitis is due to absorption of harmful products from the
+     intestinal tract permitted through the deranged functioning of the
+     organs of digestion, or assuming that it is due to an extension of
+     the inflammation from the mucosa to the sensitive lamina, or that
+     it is a reflex from a sudden chilling of the skin, we have in any
+     of these conditions a disturbed circulation, and aconitin is the
+     first and foremost of circulation "equalizers." Furthermore, in
+     laminitis there is an elevation of the temperature, an almost
+     invariable indication for aconitin. A speedy return of the
+     temperature to normal, a very marked diminution of the pain and
+     improved conditions generally, appear coincident with the symptoms
+     of full physiological effect of aconitin when given in cases of
+     laminitis, which constitutes assuredly an important part of its
+     treatment.
+
+[Illustration: Fig. 35--Inferior (convex) surface of Cochran shoe.]
+
+Where lameness is not great as in cases wherein no marked structural
+change of the foot has occurred, proper shoeing is very beneficial. By
+keeping the heels as low as possible and shoeing without heel calks a
+more comfortable position is made possible. Thin rubber pads which do
+not elevate the heel are of service in diminishing concussion.
+
+Dr. David W. Cochran of New York City has attained unusual success in
+cases of chronic laminitis with dropped sole by the use of a specially
+designed shoe.
+
+[Illustration: Fig. 36--Superior surface, showing concavity or bowl, as
+formed by the toe and branches of the shoe, as designed by Dr. David W.
+Cochran.]
+
+Cochran claims that, not only are horses with dropped soles that would
+otherwise have to be put off the streets enabled to do a fair amount of
+work by means of this shoe, but that continually wearing it, meanwhile
+keeping the convexity of the front of the hoof rasped thin, in time
+brings about a marked improvement, and that after some months or years
+of use the animals are able to work with ordinary rubber-pad shoes,
+provided they are arranged to facilitate breaking over.
+
+From having been successfully used on some race horses of high value,
+the Cochran shoe has attained considerable notoriety and is being used
+by a number of practitioners. A disadvantage, however, arises from the
+fact that few horseshoers other than Doctor Cochran seem able to make
+the shoe, the peculiar shape of which offers considerable difficulty in
+forging. Concerning the application of the shoe Cochran[32] says:
+
+     "The most important primary procedure is the preparation of the
+     foot to receive the shoe. All excess of growth must be removed from
+     the anterior face of the hoof. The outer face must be reduced at
+     the toe (not shortened), but rasped down thin for the lighter the
+     top of the foot is, the more chance the sole and coffin bone will
+     have of resuming their former normal position. The pressure of the
+     wall at the toe upon the exudate between wall and coffin bone,
+     tends to force the coffin bone and sole out of their normal
+     position. Leave the sole alone. You can lower the excess of growth
+     at the heels.
+
+     "There are many designs of shoes to relieve this condition. A great
+     deal depends on the judgment of the shoer to meet the conditions
+     presented, depending on the degree of the convexity and strength of
+     the sole. In some cases we use a shoe that admits of a large amount
+     of sole room. Again, we shoe with a shoe of wide cover. In other
+     cases a shoe with even pressure over the whole sole. In some cases
+     a high, narrow shoe, resting only on the wall, or the ordinary
+     plain shoe with side calks welded close to the outside edge and the
+     shoe dished well from these as a foundation. Then we have the air
+     cushion pad designed after the model of the bowl shoe."
+
+In cases when slight and persistent lameness interferes sufficiently to
+prevent using an animal at any sort of work on hard roads, median
+neurectomy will relieve all lameness in most instances. This is a safe
+operation, moreover, in that no bad after effects are to be feared, even
+though lameness were to continue.
+
+
+Calk Wounds. (Paronychia.)
+
+Etiology and Occurrence.--Injuries of various kinds are inflicted upon
+the coronary region but usually they are due to the foot being trampled
+upon. When the foot that inflicts the injury happens to be unshod, a
+contusion of the injured member is occasioned, but in the majority of
+instances, wounds that demand attention are the result of shoe calks
+which have penetrated the tissues in the region of the coronary band.
+Often calk wounds are self-inflicted. When animals are excited and in
+turning crowd one another, they often perform dancing movements which
+frequently result in deep calk wounds of the coronet. Some horses have a
+habit of resting the heel of one hind foot upon the anterior coronary
+region of the other. While sleeping in this position, if they are
+suddenly awakened, the weight is abruptly shifted to the uppermost foot
+and the one underneath is (because of the pain attending its being
+wounded) quickly drawn out from under its fellow. In this way deep cuts
+may divide the coronary band and inflict extensive injury to the
+sensitive lamina as well.
+
+An infectious type of coronary inflammation occurs in some localities
+during the winter months, wherein the condition is enzootic.
+
+Symptomatology.--Depending upon the manner in which the injury has
+been produced, the appearance of the wound varies and likewise lameness
+is more or less pronounced. If the tissues are not divided and the wound
+is chiefly of the subsurface structures, there will not immediately
+occur pronounced local evidence of the existence of injury; but as soon
+as the lame animal is made to move, the peculiar character of the
+impediment (supporting-leg lameness with the affected foot kept well in
+advance of its normal position) directs attention to the extremity and
+all of the symptoms of acute inflammation are discovered.
+
+Where a wound is inflicted which divides, in some manner, the surface
+structures (skin, coronary band, or the hoof wall) one's attention is at
+once called to the existence of the wound.
+
+Because of the fact that there is every facility for the production of a
+sub-coronary and podophylous infection, these wounds should receive
+prompt attention. In some instances, the pastern joint is opened by calk
+wounds and then, of course, an infectious arthritis succeeds the injury.
+
+Treatment.--In all contused wounds of the coronary region the parts
+need thorough cleansing; the hair, if long is clipped and a cataplasm is
+applied. Or preferably, an iodin-glycerin combination of one part of
+iodin to four parts of glycerin is poured on a layer of cotton, and
+this is confined in contact with the inflamed parts by means of a
+bandage.
+
+Where normal resistance to infection obtains, the subject usually
+suffers no suppurative disturbance when the surface structures are not
+broken; and daily applications of the antiseptic lotion above referred
+to stimulates complete resolution. This may be expected in from four to
+ten days depending upon the extent of the injury.
+
+If a calk wound has been inflicted, the adjoining surface structures are
+freed of hair and the parts cleansed in the usual manner, (which in
+wounds recently inflicted, should be done without employing quantities
+of water) and after painting the wound surface with tincture of iodin
+and saturating its depths with the same agent, the wound is cleansed, if
+it contains filth, by means of a small curette. By using a small and
+sharp curette, one is enabled to cleanse the average wound quickly and
+almost painlessly.
+
+In such cases, equal parts of tincture of iodin and glycerin are
+employed. The wound is filled with this preparation and a quantity of it
+is poured upon a suitable piece of aseptic gauze or cotton and this is
+contacted with the wound. The extremity is carefully bandaged and this
+dressing is left in position for forty-eight hours unless there occurs,
+in the meanwhile, evidence of profuse suppuration--which is unusual.
+
+One is to be guided as to the progress made by the degree of lameness
+present. If little or no lameness develops, it is reasonable to expect
+that infection has been checked; that the wound is dry and redressing
+every second day is sufficiently frequent.
+
+Where cases progress favorably, recovery (unless infectious arthritis
+results) should occur in from ten days to three weeks. Where extensive
+sub-coronary fistulae result, either from lack of prompt or proper
+attention, the condition is then one requiring a radical operation to
+establish drainage and to disinfect if possible, the suppurating
+tissues.
+
+
+Corns.
+
+Etiology and Occurrence.--In horses, because of a tendency toward
+contraction of the heel in some subjects, together with work on hard
+roads and pavements, where the feet become dry and brittle, and because
+of neglect of the matter of shoeing, this affection is of frequent
+occurrence. Unshod horses are rarely affected. If conformation is faulty
+and too much weight is borne on the inner or the outer quarter, and the
+hoof wall at the quarter tends to turn inward, corns are usually
+present. They occur more frequently on the inner quarters of the front
+feet, though the outer quarters are occasionally also affected and in
+rare instances corns are found at the toes. They do not often affect the
+hind feet.
+
+As soon as injury by pressure, such as is supposed to cause the
+formation of corns, is brought to bear on the sensitive sole, an
+extravasation of blood occurs. In time when the cause remains active,
+this discoloration is evident in the substance of the insensitive sole
+and consists in a red or yellowish spot which varies in size--this is
+ordinarily termed dry corn.
+
+In some cases where infection of this extravasation of blood and serum
+occurs, instead of desiccation and discoloration of the insensitive
+parts, there is, in time, manifested a circumscribed area of destruction
+of the insensitive sole and the abscess may, where no provision for
+drainage exists, burrow between sensitive and insensitive laminae and
+perforate the tissues at the coronet. If the suppurative material
+discharges readily by way of the sole, no disturbance of the heel or
+quarters occurs above the hoof.
+
+Symptomatology.--A supporting-leg-lameness characterizes this
+condition; and this lameness in most instances varies in degree with the
+amount of distress which is occasioned by pressure upon the inflamed
+parts. By an examination of the sole after having removed all dirt, and
+exposed the horny sole to view, no difficulty is encountered in locating
+the cause of the trouble.
+
+Treatment.--Before suppuration has taken place and in the cases where
+suppuration does not occur, the horse-shoer's method of paring out the
+diseased tissue affords a means of temporary relief; but unless
+frequently done, in many cases, lameness results within about three
+weeks after such treatment has been given. In other instances temporary
+relief is not to be gotten in this manner for any great length of time
+or until a more rational mode of treatment becomes necessary so that the
+subject may experience a cessation of the inconvenience or distress.
+
+The general plan which meets with the approval of most practitioners
+consists in careful leveling of the foot and removing enough of the wall
+and sole at the quarters to make possible frog pressure by means of a
+bar shoe. With frog pressure, expansion of the heel follows in time, and
+permanent relief is obtainable in this manner. Thinning the wall of the
+quarter is advocated by many practitioners and is undoubtedly beneficial
+in chronic cases where marked contraction has taken place. The wall must
+be thinned with a rasp until it is readily flexible by compressing with
+the thumbs.
+
+There are instances, however, where corns and contraction of the heel
+have existed so long that they do not yield to treatment. Such cases are
+found in old light-harness or saddle-horses that have been more or less
+lame for years and where there exists marked contraction of the heels,
+rough hoof walls, and hard and atrophied frogs.
+
+Suppurating corns require surgical attention in the way of removal of
+the purulent necrotic mass and making provision for drainage. Dry
+dressings, such as equal parts of zinc sulphate and boric acid, may be
+employed to pack the cavity. After the infectious condition has been
+controlled, and the wound is dry, the same plan of treatment is
+indicated that is employed in the non-suppurating corn. Ample time is
+allowed, however, for the surgically invaded tissues to granulate and,
+if the subject is to be put in service, a leather pad, under which there
+has been packed oakum and tar, affords good protection.
+
+
+Quittor.
+
+This name is employed to designate an infectious inflammation of the
+lateral cartilage and adjoining structures. The disease is characterized
+by a slowly progressive necrosis and by a destruction of more or less of
+the cartilage and by the presence of fistulous tracts.
+
+Etiology and Occurrence.--The disease is due to the introduction of
+pus producing organisms into the subcoronary region of the foot under
+conditions which favor the retention of such contagium and extension of
+infection into contiguous tissues.
+
+Morbific material is introduced into the region of the lateral cartilage
+by means of calk wounds and other penetrant injuries of the foot. A
+sub-coronary abscess which, because of lack of proper care or because of
+virulency of the contagium or low vitality of the subject, is quite apt
+to result in cartilaginous affection and its perforation by necrosis
+follows.
+
+Symptomatology.--Quittor is readily diagnosed on sight in many
+instances. Where there is dependable history or other evidence of the
+chronicity of an infectious inflammation of the kind, quittor is easily
+identified. If no positive evidence of the disease exists, by means of
+careful exploration of sinuses with the probe, one may distinguish
+between true cartilaginous quittor and superficial abscess formation
+that is often accompanied by hyperplasia.
+
+Lameness depends upon the extent of the involvement as it affects the
+structures contiguous to the cartilage. A variable degree of lameness is
+manifested in different cases.
+
+Treatment.--Two general plans of handling this disease are in vogue.
+One, the more popular method, consists in the injection of caustic
+solutions of various kinds into the fistulous openings with the object
+of causing sloughing of necrotic tissue and the stimulation of healthy
+granulation of such wounds. The other mode consists in either complete
+surgical removal of the cartilage or its remaining portions, or removal
+of the diseased parts of curettage.
+
+When quittor has not extensively damaged the foot and the lateral
+cartilage is not partly ossified as it is in some old chronic cases, the
+complete removal of the lateral cartilage by means of the Bayer
+operation or a modification thereof is indicated. A complete description
+of the Bayer operation as well as Merillat's operation for this disease
+(the latter consisting in part, in the removal of diseased cartilage
+with the curette) are given in Volume three of Merillat's "Veterinary
+Surgical Operations."
+
+Treatment by injection of caustic solutions has many advocates and
+because of the fact that, in many instances the condition is such that
+they are not desirable surgical cases and also because some animals may
+be put in service before treatment is completed, the injection method is
+popular.
+
+The mode of treatment advocated by Joseph Hughes, M.R.C.V.S.,
+constitutes a very successful manner of handling quittor and we can do
+no better than quote Dr. J.T. Seeley[33] on his manner of using this
+particular treatment.
+
+[Illustration: Fig. 37--Hyperplasia of right fore foot, due to chronic
+quittor.]
+
+     Preparation.--First remove the shoe, have the foot pared very
+     thin and balanced as nicely as possible. Moreover, all loose
+     fragments of horn must be detached and all crevices cleaned
+     thoroughly.
+
+     Next, have the leg brushed and hair clipped from the knee or hock
+     to the foot and scrubbed with ethereal soap and warm water, after
+     which the foot must be scrubbed in like manner. The foot is then
+     placed in a bichlorid bath several hours daily, for from two to
+     five days, depending upon whether or not soreness is shown. The
+     bichlorid solution is 1 to 1,000 strength.
+
+     On removing the horse from the bath a liberal layer of gauze is
+     soaked in 1 to 1,000 bichlorid solution and placed so as to cover
+     the entire foot. On discontinuing the bath, cover the foot with
+     gauze saturated with a 1 to 1,000 bichlorid solution. This is to be
+     covered with absorbent cotton and a gauze bandage, and over all is
+     placed an oil cloth or silk covering. This pack is kept moist with
+     bichloride solution for forty-eight hours. The foot is then ready
+     for injection.
+
+[Illustration: Fig. 38--Chronic quittor, left hind foot. Showing
+position assumed because of painfulness of the affection.]
+
+     Preparation of the Injection Fluids.--Have on hand a pint of a
+     one per cent aqueous solution of formaldehyd made under cleanly
+     conditions, even to a clean bottle and cork, and a clean container
+     when ready to use the liquid. Prepare also a bichlorid of mercury
+     solution as follows: Hydrarg. Chlor. Corros. 3IV; Acid Hydrochlor.
+     3Iss.; Aqua Bulliens, Oij. This should be thoroughly triturated,
+     and then filtered into a clean bottle, when it is ready for use.
+
+     Injection.--The patient should be laid on a table, if one is
+     available, or cast, and the foot securely fixed. Then, with an
+     ordinary one-ounce hard rubber syringe, with a good plunger (tried
+     first to note whether or not any fluid works around between the
+     barrel and the plunger), introduce one syringe full of the
+     formaldehyd solution, then thoroughly probe the quittor to
+     determine the number of sinuses. This done, inject each sinus. If
+     two sinuses open on the surface, close one with cotton while
+     filling the other so that if there is a connection the solution
+     will come in contact with all tissues involved. Irrigate with the
+     full pint of formaldehyd solution first, then follow with six or
+     eight ounces of the bichlorid solution. Never probe the foot nor
+     allow it to be tampered with except in the manner prescribed.
+
+     After-Treatment.--Put on a pack saturated with a solution of
+     bichlorid of mercury 1 to 1,000 and let it remain two days. Remove
+     pack, and once daily afterwards wipe off with cotton the secretion
+     which accumulates on the outside, and apply a dry dressing or
+     healing oil composed of phenol, camphor gum and olive oil.
+
+     When Dangerous to Inject.--Never inject a quittor in the acute
+     stage. Never inject a quittor if considerable lameness is present.
+     On injecting a solution of formalin, hold cotton tightly around the
+     nozzle of the syringe, when the plunger is down, then withdraw the
+     syringe gently and note particularly if the fluid returns through
+     the opening; if none returns cease operations at once, as it is
+     dangerous to proceed farther, it indicates that the sinus is not
+     well defined and the fluid retained will cause much trouble and
+     often the death of the patient.
+
+Experience has taught that, if extensive destructive changes of the foot
+exist, the Bayer operation is not indicated. In the country, where
+quittors are not so frequently met as in urban practice, the Merillat
+operation is preferable in all cases. However, the cost of the
+protracted period of idleness, which convalescent surgical patients
+require, renders the Hughes method more satisfactory in the hands of the
+general practitioner, especially in the city.
+
+
+Nail Punctures.
+
+Nail punctures, as herein considered, embrace all penetrant wounds of
+the solar surface of the horse's foot due to trampling upon street
+nails. This does not include accidental nail pricks occasioned in
+shoeing. In city practice, in some stables, these cases are of frequent
+occurrence; and, generally speaking, nail punctures are observed more
+frequently in urban horses than in animals that are kept in the country.
+
+Occurrence and Method of Examination.--This condition, then, is a
+rather common cause of lameness and in no case, where cause of the
+claudication is not obvious, is the practitioner warranted in concluding
+his examination without careful search for the possible existence of
+nail puncture of the solar surface of the foot.
+
+[Illustration: Fig. 39--Skiagraph of foot. The X-ray offers very limited
+possibilities in the diagnosis of lameness. The location of a "gravel"
+or a nail that had worked its way some distance from the surface, or of
+an abscess of some proportion, deep in the tissues, might be facilitated
+under some circumstances by the aid of the X-ray. Its use in the
+detention of fractures is very limited, owing to the difficulty
+encountered in getting a view from the right position--many trials being
+necessary in most cases. The case shown above was diagnosed clinically
+as incipient ringbone. The X-ray revealed no lesions. (Photo by L.
+Griessmann.)]
+
+In occasional instances there co-exists an obvious cause for
+supporting-leg-lameness and an occult cause--a nail puncture. Where such
+complications are met, the practitioner is not necessarily guilty of
+neglect or carelessness when the nail puncture is not discovered at
+once, nevertheless, an examination is not complete until practically
+every possible cause of lameness has been located or excluded in any
+given case.
+
+In a search for nail puncture it is necessary to expose to view every
+portion of the sole and frog in such manner that the existence of the
+smallest possible wound will be revealed. This necessitates removal of
+the shoe, if, after a preliminary examination, a puncture is not found,
+when there is good reason to suspect its presence. However, where it is
+readily possible to locate and care for a wound without removal of the
+shoe, allowing the shoe to remain materially facilitates retaining
+dressings in position and relieves the solar surface of contact with the
+ground. If extensive injury or infection exists, it is of course
+necessary to remove the shoe and leave it off. By removing a superficial
+portion of all of the sole and frog, thus carefully and completely
+exposing to view all parts of the solar surface of the foot, and with
+the aid of hoof-testers one is enabled to positively determine the
+existence of nail punctures. Because of the tendency of puncture wounds
+of the foot to close, and since the superficial portion of the solar
+structures are usually soiled, it is absolutely necessary to conduct
+examinations of this kind in a thorough manner.
+
+Symtomatology.--Not all cases of nail puncture cause lameness during
+the course of the disturbance and in many instances no lameness is
+manifested for some time after the injury has been inflicted--not until
+infection has been the means of causing considerable inflammation of
+sensitive structures. Nevertheless, this lack of manifestation occurs
+only in cases where serious injury has not taken place and the degree of
+lameness is a constant and reliable indicator of the character and
+extent of nail punctures within twenty-four hours after injury has been
+inflicted.
+
+The position assumed by the affected animal inconstantly varies with the
+location and nature of the injury and is not of particular importance in
+establishing a diagnosis. The subject may support some weight with the
+affected member and stand "base-wide" or "base-narrow," or no weight may
+be borne with the foot or the animal may point or keep the extremity in
+a state of volar flexion. In cases where extensive injury has been
+inflicted, and great pain exists, the foot is kept off the ground much
+of the time and it may be swung back and forth as in all painful
+affections of the extremity.
+
+Nail punctures cause typical supporting-leg-lameness and in some cases
+certain peculiarities of locomotory impediment are worthy of notice.
+Punctures of the region of the heel, which directly affect or involve
+the deep tendon sheath, cause a type of lameness wherein pain is
+augmented, when dorsal flexion of the extremity occurs as well as when
+weight is borne. Wounds in the region of the toe of the hind feet
+sometimes cause the subject to carry the extremity considerably in
+advance of the point where it is planted and, just before placing the
+foot on the ground, it is carried backward a little way--ten or twelve
+inches.
+
+However, diagnosis of nail puncture is based on the finding of the
+characteristic wound or resultant local changes.
+
+Course and Prognosis.--The nature of the progress and the manner of
+termination of these cases are variable. If the coffin joint has been
+invaded, and a septic arthritis exists, the condition is at once grave.
+An open and infected tendon sheath, while not so serious, constitutes a
+condition which is distressing, and recovery is slow even under the most
+favorable conditions. Where a heavy, rigid and sharp nail enters the
+foot, in such manner that fracture of the third phalanx (os pedis)
+occurs, this complication makes for a protraction of the condition.
+Experience teaches that the natural course and termination in these
+cases are modified by the location and depth of the injury, virulency of
+the contagium and resistance of the subject to such infection.
+
+Prevention.--In all horses which are kept at such work that exposure
+to nail punctures is frequent, a practical means of prevention of such
+injuries consists in the employment of heavy sole leather or suitable
+sheet metal to cover the sole of the foot and, at the same time, confine
+oakum and tar in contact with the solar surface to prevent the
+introduction of foreign material between the foot and such protecting
+appliances. Further, if drivers and owners could be impressed with the
+serious complications which so frequently attend wounds of this kind,
+undoubtedly many cases which are now lost, because of ignorance or
+neglect on the part of the teamsters or proprietors of horses, would be
+saved by prompt and rational treatment.
+
+Treatment.--The treatment of this condition falls so largely within
+the dominion of surgery that we can give little more than an outline
+here.
+
+In cases where there exists no evidence of open joint or open tendon
+sheath as judged by the site of the puncture and degree of lameness
+present (after having thoroughly cleansed the solar surface of the foot
+and enlarged the opening in the nonsensitive sole) a little phenol is
+introduced into the wound. In such cases, where it is possible for the
+antiseptic to contact every part of wound surface to the extreme depths
+of the puncture, infection is prevented when such treatment is promptly
+administered. This may be considered as first aid, or emergency care,
+and is indicated in all wounds of the foot whether the injury be serious
+or almost insignificant.
+
+Subsequently one of two general courses may be pursued in the treatment
+of cases of nail puncture. One, by the employment of means to keep the
+wound patent and injection of suitable antiseptics, or agents that are
+more or less caustic in conjunction with strict observance of asepsis
+and wound protection. The other method consists in prompt establishment
+of drainage by surgical means and includes exploration and curettage.
+
+The first method is better adapted to the use of the average general
+practitioner and he would do well to keep the opening in the
+nonsensitive structures patent. By introducing equal parts of tincture
+of iodin and glycerin daily, good results will follow in most instances.
+The wound is protected in unshod horses, either by completely bandaging
+the foot and retaining, in contact with the wound, cotton that is
+saturated with iodin and glycerin, or, if a minor injury exists, the
+moderately enlarged opening in the nonsensitive sole or frog, which has
+been moistened with the antiseptic, is packed with a very small quantity
+of cotton. A little practice in this mode of closing benign puncture
+wounds will enable the practitioner to successfully protect the
+sensitive parts in the treatment of such cases in unshod country
+horses.
+
+When the condition progresses favorably the wound may be dressed every
+second day or twice weekly, and in the course of from two to six weeks
+recovery should be complete.
+
+If the practitioner is somewhat proficient as a surgeon, and has at his
+command facilities for doing surgery, the second method is preferable in
+many cases. By using a local anesthetic on the plantar nerves and
+confining the subject on an operating table, restraint should be
+perfect. The solar surface of the foot is first thoroughly cleansed, the
+puncture wound is enlarged in the nonsensitive structures and the parts
+are then moistened with phenol or other suitable antiseptics. By means
+of a small probe the puncture is explored and, depending on the
+character of the wound and the structures involved, surgical
+intervention is varied to suit the case. If necessary, all of the
+insensitive frog is removed, and in wounds affecting the region of the
+heel the tissues may be incised from the puncture outward dividing all
+of the tissues outward and backward to the surface. A suitable surgical
+dressing is then applied.
+
+If, on the other hand, the puncture extends into the navicular bursa,
+the radical operation is perhaps indicated, though not until one is sure
+that infection of the bursa and serious consequences are to follow if
+this operation is not performed. Detailed description of the technic of
+this operation belongs to the realm of surgery and a good discussion of
+it is to be found in William's work on veterinary surgical and
+obstetrical operations.
+
+One may summarize the discussion of treatment of nail puncture by saying
+that emergency care as herein described is of first consideration. In
+every case an immunizing dose of anti-tetanic serum should be given.
+Subsequently, the method employed must suit the character of the wound,
+existing facilities for handling the subject and the skill and aptitude
+of the practitioner.
+
+FOOTNOTES:
+
+[Footnote 5: Manual of Veterinary Physiology, by Major-General F. Smith,
+page 590.]
+
+[Footnote 6: Manual of Veterinary Physiology by Major-General F. Smith,
+page 589.]
+
+[Footnote 7: Regional Veterinary Surgery and Operative Technique, Jno.
+A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 765.]
+
+[Footnote 8: Dr. Roscoe R. Bell in the Proceedings, N.Y. State
+Veterinary Medical Society, 1899.]
+
+[Footnote 9: American Veterinary Review, Vol. 35, P. 456.]
+
+[Footnote 10: "Radial Paralysis and Its Treatment by Mechanical Fixation
+of Knee and Ankle," Geo. H. Berns, D.V.S. Proceedings of the American
+Veterinary Medical Association, 1912, p. 219.]
+
+[Footnote 11: As quoted by Berns, in Radial Paralysis, etc., Proceedings
+of the A.V.M.A., 1912.]
+
+[Footnote 12: Veterinary Surgical Operations, by L.A. Merillat, V.S., p.
+507.]
+
+[Footnote 13: A paper presented before the Illinois Veterinary Medical
+Assn. by Dr. H. Thompson of Paxton, Ill., American Veterinary Review,
+Vol. 15, p. 134.]
+
+[Footnote 14: "Fractures in Foals," by Dr. Wilfred Walters, M.R.C.V.S.,
+American Journal of Veterinary Medicine, Vol. 8, p. 669.]
+
+[Footnote 15: American Veterinary Review, Vol. 26, p. 1068.]
+
+[Footnote 16: Fractures, by H. Thompson, Paxton, Ill., American
+Veterinary Review, Vol. 15, p. 134.]
+
+[Footnote 17: Veterinary Surgical Operations, by L.A. Merillat, Vol. 3,
+p. 198.]
+
+[Footnote 18: Wilfred Walters, American Journal of Veterinary Medicine,
+Vol. 8, p. 606.]
+
+[Footnote 19: J.N. Frost, assistant professor of Surgery, Veterinary
+Dept., Cornell University, in "Wound Treatment," page 159.]
+
+[Footnote 20: Open Joints and Their Treatment in my practice, by J.V.
+Lacroix, American Journal of Veterinary Medicine, Vol. 5, page 203.]
+
+[Footnote 21: Regional Veterinary Surgery Möller--Dollar, page 605.]
+
+[Footnote 22: Extract from Receuil de Médecine Vétérinaire in Ameircan
+Veterinary Review, Vol. 23, p. 893.]
+
+[Footnote 23: Fracture of All the Sesamoid Bones, by R.F. Frost,
+M.R.C.V.S., A.V.D., Rangoon, Burmah, in American Veterinary Review, Vol.
+5, p. 362.]
+
+[Footnote 24: The Anatomy of the Domestic Animal, by Septimus Sisson,
+S.B., V.S.]
+
+[Footnote 25: Traité De Thérapeutique Chirurgicale Des Animaux
+Domestique, par P.J. Cadiot et J. Almy, Tome Second, page 547.]
+
+[Footnote 26: Anatomie Regionale Des Animaux Domestique, page 695.]
+
+[Footnote 27: Manual of Veterinary Physiology, by Major-General F.
+Smith, C.B., C.M.G., page 678.]
+
+[Footnote 28: Möller's Regional Veterinary Surgery, by Dollar, page
+630.]
+
+[Footnote 29: Edinburgh Veterinary Review, Vol. VI, page 616.]
+
+[Footnote 30: Equine Laminitis or Pododermatitis, by R.C. Moore, D.V.S.,
+American Journal of Veterinary Medicine, Vol. XI, page 284.]
+
+[Footnote 31: American Journal of Veterinary Medicine, Vol. XI, page
+318.]
+
+[Footnote 32: The Shoeing of a Dropped Sole Foot by Dr. David W.
+Cochran, New York City, The Horse Shoers Journal, March, 1915.]
+
+[Footnote 33: Quittor and Its Treatment by the Hughes Method, J.T.
+Seeley, M.D.C., Seattle, Washington, Chicago Veterinary College
+Quarterly Bulletin, Vol. 9, page 27.]
+
+
+
+
+SECTION IV.
+
+LAMENESS IN THE HIND LEG.
+
+
+Anatomo-Physiological Consideration of the Pelvic Limbs.
+
+The pelvic bones as a whole constitute the analogue of the scapulae with
+respect to their function as a part of the mechanism of locomotive and
+supportive apparatus of the horse. The manner of attachment or
+connection between the ilia and the trunk is materially different from
+that of the scapulae, however, and the angles as formed by the long axes
+of the ilia in relation to the spinal column are maintained by two
+functionally antagonistic structures--the sacrosciatic ligaments, and
+the abdominal muscles by means of the prepubian tendon. The sacro-iliac
+articulations are such that a very limited amount of movement is
+possible; free movement, however, is unnecessary because of the
+enarthrodial (ball and socket) femeropelvic joint.
+
+The various muscles which exert their effect upon the pelvis in changing
+their relationship between the long axes of the ilia and spinal column,
+are concerned but little more in propulsion and weight bearing than are
+the pectoral muscles. A general treatise on the subject of lameness does
+not properly include such structures any more than it does the various
+affections of the dorsal, lumbar and sacral vertebrae or inflammation of
+the abdominal parietes. Involvement of such parts cause manifestations
+of lameness but the matter of establishing a diagnosis is difficult in
+many instances and in some cases impossible.
+
+The femeropelvic articulation is formed by the hemispherical head of the
+femur and the acetabulum; the latter constituting a cotyloid cavity
+which is deepened by the cotyloid ligament.
+
+The round ligament (ligamentum teres) is the principal binding structure
+of the hip joint and it arises in a notch in the head of the femur and
+is attached in the subpubic groove close to the acetabular notch.
+Another ligament, peculiar to Equidae--the accessory (pubiofemoral)--is
+attached to the head of the femur near the round ligament and passes
+through the cotyloid notch and along the under side of the pubis. It
+is inserted or blends with the prepubic tendon. This ligament prevents
+extreme abduction of the leg. The joint capsule encompasses the
+articulation and is attached to the brim of the acetabulum and the edge
+of the head of the femur.
+
+[Illustration: Fig. 40--Sagital section of right hock. The section
+passes through the middle of the groove of the trochlea of the tibial
+tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick
+part of joint capsule over which deep flexor tendon plays. 4. Fibular
+tarsal bone (sustentaculum). A large vein crosses the upper part of the
+joint capsule (in front of 1). (From Sisson's "Anatomy of the Domestic
+Animals.")]
+
+[Illustration: Fig. 41--Muscles of right leg; front view. The greater
+part of the long extensor has been removed. 1, 2, 3. Stumps of patellar
+ligaments. 4. Tuberosity of tibia. (From Sisson's "Anatomy of the
+Domestic Animals.")]
+
+The stifle joint is analagous to the knee joint of man and is to be
+considered an atypical ginglymus (hinge) articulation formed by the
+femur, tibia and patella. The ligaments are femerotibial, femeropatellar
+and capsular.
+
+In addition to the usual provision for articulation of bones there are
+situated cartilaginous _menisci_ between the condyles of the femur and
+the head of the tibia. These discs surround the tibial spine and are
+otherwise shaped to fit perfectly between the articular portions of the
+femur and tibia.
+
+Collateral ligaments (internal and external lateral) pass from the
+distal end of the femur to the proximal portion of the tibia. The mesial
+(internal) arises from the internal condyle of the femur and is attached
+to a rough area below the margin of the medial (internal) condyle of the
+tibia. The lateral (external), shorter and thicker, arises from the
+depression on the lateral epicondyle and inserts to the head of the
+fibula.
+
+The crucial or interosseus, anterior and posterior, are situated between
+the femur and tibia, and according to Smith,[34] the crucial ligaments
+are necessary to properly join the two bones, because of the character
+of the structure of the articular ends of the femur and tibia.
+
+The femeropatella ligaments are two thin bands which reinforce the
+capsular ligament. They arise from the lateral aspects of the femur,
+just above the condyles and are inserted to the corresponding surfaces
+of the patella.
+
+The patellar ligaments are three strong bands which arise from the
+antero-inferior surface of the patella, and are inserted to the anterior
+aspect of the tuberosity of the tibia.
+
+Taken as a whole, the tarsal bones, interarticulating and articulating
+with the tibia and metatarsal bones form the hock joint and this
+articulation is analagous to the carpus. As with the carpus, there is
+less movement in the inferior portion of the joint than in the
+superior part of the articulation. The chief articulating parts are the
+tibia with the tibial tarsal bone (astragulus).
+
+[Illustration: Fig. 42--Muscles of lower part of thigh, leg and foot;
+lateral view, o', Fascia lata; q, q', q", biceps femoris; r,
+semitendinosus; 21', lateral condyle of tibia. The extensor brevis is
+visible in the angle between the long and lateral extensor tendons.
+(After Ellenberger-Baum, Anat. für Künstler.) (From Sisson's "Anatomy of
+the Domestic Animals.")]
+
+The capsular ligament is attached around the margin of the articular
+surfaces of the tibia, to the tarsal bones, the collateral ligaments
+(internal and external lateral) and to the metatarsus.
+
+[Illustration: Fig. 43--Right stifle joint; lateral view. The
+femoro-patellar capsule was filled with plaster-of-Paris and then
+removed after the cast was set. The femoro-tibial capsule and most of
+the lateral patellar ligament are removed. M. Lateral meniscus. (From
+Sisson's "Anatomy of the Domestic Animals.")]
+
+The common ligaments of the tarsal joint are the collateral, the plantar
+(calcaneo-metatarsal and c. cuboid) and dorsal ligaments (oblique).
+
+The medial (internal lateral) ligament serves to join the medial
+(internal) tibial malleolus with tibial tarsal (astragalus) and other
+tarsal bones.
+
+The lateral (external lateral) ligament is inserted to the lateral
+(external) tibial malleolus and its distal portions are attached to the
+tibial tarsal (astragalus), fibular tarsal (calcaneum) bone, fourth
+tarsal (cuboid) and metatarsus bones.
+
+[Illustration: Fig. 44--Left stifle joint; medial view. The capsules are
+removed. (From Sisson's "Anatomy of the Domestic Animals.")]
+
+The plantar ligament (calcaneo-cuboid) is a strong flat band which is
+attached to the plantar surface of the fibular and fourth tarsal bones
+(calcaneum and cuboid) and the head of the lateral metatarsal (external
+small) bone.
+
+The dorsal (oblique) ligament is attached above to the distal tuberosity
+on the inner side of the tibia. It is inserted below to the central
+(cuneiform magnum) and third (c. medium) tarsal bones, to the proximal
+ends of the large and outer small metatarsal bones.
+
+The tarsus is a true hinge joint and because of the great strain which
+it sustains, is subject to frequent injury. About seventy-five percent
+of cases of lameness affecting the hind leg may be said to arise from
+disease of the hock.
+
+As members of locomotion the legs receive strains of two kinds: those of
+concussion and weight-bearing and strains of propulsion; the latter are
+the greater. In the horse as a work animal, the hind legs are probably
+subjected to greater strains than are the front but the manner of
+construction of the various parts of the pelvic limbs with the possible
+exception (according to some authorities) of the tibial tarsal joint,
+offsets this condition.
+
+The femur may be considered analagous to the humerus in that it bears a
+similar relationship to the ilium, that exist between the humerus and
+scapula. Further flexion during repose is prevented chiefly by the
+glutens medius (maximus) muscle and its tendons. The larger tendon
+inserts to the summit of the trochanter major of the femur and
+corresponds to the biceps brachii in the action of the latter on the
+scapulohumeral joint, except that the gluteus medius, in attaching to
+the femoral trochanter, exerts its effect as a lever of the first class.
+Because of the relationship between the long axes of the femur and iliac
+shaft it is evident that the angle formed by these two bones is
+maintained chiefly by the gluteus muscles during weight bearing.
+Contraction of muscular fibers of the gluteus medius causes extension of
+the femur and muscular strain is prevented to a great degree by the
+inelastic portion of this muscle. The chief physiological antagonistics
+of the glutei are the quadriceps femoris and tensor fascia lata.
+
+While the leg is supporting weight the stifle joint is fixed in position
+mainly by the quadriceps femoris group of muscles which are attached to
+the patella. Tendinous fibres intersect this muscular mass and relieve
+muscular strain during weight bearing. Because of the manner in which
+the patella functionates with the trochlea of the femur, comparatively
+little energy is required to prevent further flexion of the stifle
+joint. The patella, according to Strangeways, may be considered a
+sesamoid bone.
+
+[Illustration: Fig. 45--Left stifle joint; front view. The capsules are
+removed. 1. Middle patellar ligament. 2. Stump of fascia lata. 3. Stump
+of common tendon of extensor longus and peroneus tertius. (From Sisson's
+"Anatomy of Domestic Animals.")]
+
+The quadriceps group of muscles is assisted by the anterior digital
+extensor (extensor pedis) peroneus tertius and tibialis anticus (flexor
+metatarsi) muscles. The latter pair (flexor metatarsi, muscular and
+tendinous portions, because of their attachment to the external condyle
+of the femur and to the metatarsal bone) are enabled to automatically
+flex the tarsal joint when the stifle is flexed.
+
+The hock is kept fixed in position by the gastrocnemius and the
+superficial digital flexor (perforatus). The latter structure, which is
+chiefly tendinous, originates in the supracondyloid fossa of the femur
+and has an insertion to the summit of the fibular tarsal (calcis) bone.
+It relieves the gastrocnemius of muscular strain during weight bearing.
+
+Smith[35] styles the function of the stifle and hock joints a
+reciprocating action, and we quote from this authority the following:
+
+     From what has been said, it is evident that flexion and extension
+     of stifle and hock are identical in their action. When the stifle
+     is extended, the hock is automatically extended, nor can it under
+     any circumstances flex without the previous flexion of the stifle.
+     There is no parallel to this in the body. The two joints, though
+     far apart, act as one, and they are locked by the drawing up of the
+     patella, and in no other way. The so-called dislocation of the
+     stifle in the horse is a misnomer. That the patella is capable of
+     being dislocated is beyond doubt, but the ordinary condition
+     described under that term, when the stifle and hock are rigid while
+     the foot is turned back with its wall on the ground, is nothing
+     more than spasm of the muscles which keeps the patella drawn up.
+     The moment they relax the previously immovable limb and useless
+     foot have their function restored as if by magic, but are
+     immediately thrown out of gear in the course of a few minutes as a
+     recurrence of the tetanus of the petallar muscle takes place. The
+     fascia of the thigh, like that of the arm, is a most potent factor
+     in giving assistance to the constant strain imposed on the muscles
+     of the limbs during standing.
+
+     Below the hock the hind limb is arranged like that of the fore, the
+     deep flexor (perforans) receiving its additional support from the
+     "check ligament," as in the fore leg.
+
+     The natural attitude of standing adopted by the horse is to rest on
+     three legs--one hind and two fore. If he is alert, he stands on all
+     four limbs; but if standing in the ordinary manner, he always rests
+     on one hind leg. He does not remain long in this position without
+     changing to the other. Hour by hour he stands, shifting his weight
+     at intervals from one to the other hind leg, and resting its fellow
+     by flexing the hock and standing on the toe. He never spares his
+     fore-limbs in this manner in a state of health, but always stands
+     squarely on them.
+
+
+Hip Lameness.
+
+Fortunately, because of the heavy musculature which goes to form a part
+of the locomotive apparatus of the rear extremity, hip lameness is
+comparatively rare. While the term is in itself ambiguous and signifies
+nothing more definite than does "shoulder lameness," yet diagnosis of
+almost any condition that may be classed under the head of "hip
+lameness" is not easy except in cases where the cause is obvious, as in
+wounds of the musculature and certain fractures. To the complexity which
+the gait of the quadruped contributes, because of its being four-legged,
+there is added the complicated manner of articulation of the bones of
+the hind leg. This involves the hip in the manner of diagnostic problems
+and because of the inaccessibility of certain parts, owing to the bulk
+of the musculature of these parts, diagnosis of some hip ailments
+becomes an intricate problem. Consequently, in some instances, before
+one may arrive at definite and enlightening conclusions, repeated
+examinations are necessary as well as a knowledge of reliable history
+and recorded observations of the subject over a considerable period.
+
+Rheumatic affections, when present, usually cause recurrent attacks of
+lameness; myalgia, due to subsurface injury occasioned by contusion,
+generally produces an ephemeral disturbance; and while these are
+examples of cases where occult causes are active, they are by no means
+unprecedented. In cases where the cause of lameness is not definitely
+located, and when by the process of exclusion one is enabled to decide
+that the seat of trouble is in the hip, a tentative diagnosis of hip
+lameness is always appropriate.
+
+In one instance a Shetland pony evinced a peculiar form of intermittent
+lameness which affected the left hip, and repeated examinations did not
+disclose the cause of the trouble. After about a year there was
+established spontaneously an opening through the integument overlying
+the region of the attachment of the psoas major (magnus), through which
+pus discharged. With the occurrence of this fistula, lameness almost
+entirely disappeared, but the emission of a small amount of pus
+persisted for more than a year. The subject was not observed thereafter
+and the outcome in this case is not a matter of record. Whether there
+existed a psoic phlegmon due to metastatic infection or necrosis of a
+part of a lumber or dorsal vertebra is a matter for speculation. Thus
+the presence of some anomalous conditions which affect the pelvic region
+and cause lameness may be discovered, yet both in hip and shoulder
+regions causes may not be definitely located by means of practical
+methods of examination.
+
+Injuries of all kinds are the more frequent causes of hip lameness. In
+such cases, lameness may result directly and resolution be prompt, or
+the claudication become aggravated in time, due to muscular atrophy or
+degenerative changes affecting the hip joint or nerves. Rheumatism or
+metastatic infection may be the cause of hip lameness as well as
+affections of the pelvic bones, lumbar and sacral vertebrae. Hip
+lameness may also be provoked by melanotic or other tumors.
+
+In the diagnosis of hip lameness, one is guided in a general way by the
+character of the impediment manifested. Swinging-leg lameness is often
+present and the impediment is more accentuated when the animal is caused
+to step backward. In many cases lameness is mixed, being about equally
+noticeable during weight bearing and while the member is being swung. By
+exclusion of causes which might affect other parts; one may definitely
+locate the cause of the trouble or determine that a certain region is
+affected.
+
+The sudden manifestation of lameness is indicative of injury; thermic
+disturbances may signalize metastatic infection; history, if dependable,
+is always helpful. Repeated observations, taking into account the course
+which the affection assumes during a period of a few days, often serve
+to afford a means of establishing a diagnosis in baffling cases.
+
+
+Fractures of the Pelvic Bones.
+
+The os innominatum may be so fractured that the pelvic girdle is broken,
+as in fracture of the iliac shaft, or in a manner that the girdling
+continuity of the innominate bones is not interrupted. It naturally
+follows that greater injury is done when the pelvic girdle is broken
+than when it is not, except in cases where the acetabulum is involved
+and its brim not completely divided.
+
+Etiology and Occurrence.--Pelvic fractures are usually caused by falls
+or other manner of contusion. Cases are reported where it would seem
+that fracture of the iliac angle resulted from muscular contraction, but
+it is certain that most fractures of this kind are due to collisions
+with door jambs or similar injuries. In old horses especially, fracture
+of pelvic bones occurs frequently. This form of injury is of more
+frequent occurrence in animals of all ages that work on paved streets.
+The country horse is not subjected to the uncertain footing of the
+slippery pavement, nor to injuries which compare with those caused by
+contusions sustained in falling upon asphalt or cobble-stones.
+
+Symptomatology.--While in many cases of pelvic fracture lameness or
+abnormal decumbency are the salient manifestations, yet the pathognomic
+symptoms are crepitation or palpable evidence which may be obtained by
+rectal or vaginal examination. In fractures of the angle of the ilium
+and the ischial tuberosity, perceptible evidence always exists.
+
+In cases where fracture of some portion of the pelvic girdle is
+suspected and the subject is able to walk, crepitation is sought by
+placing one hand on an external angle of the ilium and the other on the
+ischial tuberosity and the animal is then made to walk. Or, by placing
+the hands as just directed, an assistant may grasp the horse's tail and
+by alternately exerting traction on the tail and pushing against the hip
+in such manner that weight is shifted from one leg to the other,
+crepitation may be detected.
+
+Fracture of the pubis near its symphysis constitutes a grave injury, as
+there is danger of the bladder becoming caught in the fissure and
+perforation of its wall may result. Such a case is reported by
+Bauman[36] wherein a three-year-old gelding bore the history of having
+been lame for ten days. Upon rectal examination the bladder was found to
+be hard and tumor-like and about the size of a baseball. The body of the
+ischium in this case was fractured and a rent in the bladder was caused
+by a sharp projecting piece of bone. Autopsy revealed, in addition to
+the fracture and rent of the bladder wall, a large quantity of urine in
+the peritoneal cavity.
+
+In other instances hemorrhage caused death and not infrequently
+infection was responsible for a fatal issue. Moller,[37] quoting Nocard,
+describes a case where fracture occurred through the region of the
+foramen ovale and paralysis of the obturator nerve followed.
+
+Fractures which include the acetabular bones cause great pain. This is
+manifested by marked lameness, both during weight bearing and when the
+member is swung. Such cases terminate unfavorably--complete recovery is
+impossible.
+
+Where small portions of the angle of the ilium are broken, and the skin
+is left intact, there exists the least troublesome class of pelvic
+fracture. If large portions of the ilium are fractured, considerable
+disturbance results. There eventually occurs more or less displacement
+in such cases, if such displacement does not take place at the time of
+injury. The same may be said of fracture of the tuber ischii, but when
+these bones are fractured a more serious condition results.
+
+Treatment.--When a case is found to be uncomplicated, that is, if the
+fracture is such that recovery seems possible and after having
+determined that treatment may be practicable, the first consideration is
+that of confining the subject in suitable slings. In many cases of
+pelvic fracture, the affected animal will need to be kept in slings from
+six weeks to three months, and it becomes a difficult problem to
+minimize the distress during this long period of confinement in the
+peculiar manner required for favorable outcome.
+
+The pattern of sling employed should be the best that is obtainable and
+the matter of its adjustment is quite important lest unnecessary chafing
+or even necrosis of skin result. Frequent readjustment may be necessary,
+and time is well spent in this manner since this contributes materially
+toward a favorable termination by encouraging the subject to remain
+quiet so that coaptation of the broken bones may be maintained. Aside
+from slings, mechanical appliances that are helpful in the treatment of
+these cases are not yet in use.
+
+A regimen that is nutritive and at the same time laxative is essential
+and in some cases cathartics and enemata are necessary. Also, during the
+first few days, if there is retention of urine, catheterization is
+imperative. In a word, the handling of such cases consists largely in
+keeping the subject inactive, as comfortable as possible, and giving
+attention to suitable diet.
+
+Simple fracture of the external iliac angle needs no particular
+attention, except that the subject is kept quiet until lameness
+subsides. In all cases where much of the bone is broken, the animal is
+blemished, but interference with function does not follow. If infection
+results because of a compound fracture, loose pieces of bone must be
+removed surgically and drainage provided for.
+
+In fracture of the ischial tuberosity, infection is more apt to result
+than in like injury of the ilium, and greater displacement of bone
+occurs. This displacement, due to contraction of the attached muscles,
+is in some instances a contributing cause to the infection which often
+follows in these cases. In females where the body of the ischium is
+fractured, lacerations of the vagina may be present, and this
+constitutes a serious complication which usually terminates fatally.
+
+After-care in fracture of the pelvic girdle consists principally in
+allowing a protracted period of rest before subjects are put to work.
+
+
+Fractures of the Femur.
+
+Etiology and Occurrence.--This is a comparatively rare injury in the
+horse because of the protection afforded the femur by the heavy
+musculature. Fragilitas of the bone probably exists in many cases when
+fracture of its diaphysis occurs. It is generally conceded that the neck
+of the femur is rarely broken because of a lack of constriction in this
+part, but fracture of the trochanters has been recorded rather
+frequently. However, Lienaux and Zwanenpoete[38] state that fracture of
+the neck of the femur is of frequent occurrence in Belgian colts.
+Tapley[39] reports in the Veterinary Journal (English) fracture of the
+head and internal trochanter of the femur and patellar luxation
+occurring simultaneously affecting a mule. In this case the mule was
+found decumbent on a concrete floor. After three weeks, the subject was
+destroyed and autopsy revealed rupture of the left pubiofemoral
+ligament, tearing with it a portion of the articular surface of the
+femur. The internal trochanter was also fractured in four small pieces.
+In this case it is fair to suppose that the mule in trying to regain
+footing on a slippery floor violently abducted the legs and fracture
+resulted. It is possible also that a temporary luxation of the patella
+took place first and caused the animal to struggle in such manner that
+fracture followed.
+
+[Illustration: Fig. 46--Oblique fracture of the femur of a 1,500
+six-year-old draft horse. Showing shortening of bone, owing to a lateral
+approximation of the diaphysis because of muscular contraction. Photo by
+Dr. Edward Merillat.]
+
+Symptomatology.--According to Cadiot and Almy,[40] "regardless of the
+location of femoral fractures, the subject is usually intensely lame,
+the animal frequently walking on three legs--fractures of the diaphysis
+are characterized by an abnormal mobility."
+
+As a rule, crepitation is to be recognized in fractures of the shaft of
+the bone, by passively moving the leg to and from the medial plane
+(adduction and abduction).
+
+Fracture of the trochanter major is signalized by local swelling and
+evidence of pain; the forward stride is shortened because this movement
+tenses the tendon of the gluteus major (maximus) which is attached
+principally to the trochanter.
+
+[Illustration: Fig. 47--Same bone as in Fig. 46 after about six months'
+treatment. In this case Dr. Merillat employed a weight to counteract
+muscular contraction. It is noticeable that very little provisional
+callus has formed in this case, and in spite of unusual ingenuity and
+good facilities for caring for the subject, union of bone did not
+occur.]
+
+Treatment.--Reduction of femoral fracture in the horse is practically
+impossible, and retaining the broken bones in coaptation is not possible
+by means of mechanical appliances. Consequently, prognosis is
+unfavorable in fracture of the body of the femur. When union of bone
+occurs, there results shortening of the leg and animals are rendered
+permanently lame. If the immediate region of the head of the bone is
+involved as well as in case of fracture of the condyles, an incurable
+arthritis ensues.
+
+Where the trochanters are broken, chronic lameness and muscular atrophy
+is the result. Therefore, it is evident that, because of the manner of
+function of the femur, the leverage afforded by its great trochanter and
+its heavy muscular attachments, fractures of this bone in the horse do
+not terminate favorably.
+
+
+Luxation of the Femur.
+
+Etiology and Occurrence.--Uncomplicated femoral luxation is of less
+frequent occurrence in the horse than in the other domestic animals.
+The deep cotyloid cavity renders disarticulation difficult and luxation
+does not often take place. Complications that usually occur are rupture
+of the round (coxofemoral) ligament or fracture of the neck of the
+femur. Falls or violent strains are necessary to produce this luxation.
+Goubaux is quoted by Cadiot and Almy[41] as having observed the head of
+the femur in an instance wherein luxation had long existed. In this case
+autopsy revealed the fact that the inner portion (two-thirds) of the
+head of the femur had completely disappeared.
+
+Luxation of the femur is observed in old emaciated animals that are
+worked on slippery pavements. Occasionally, evidence of chronic luxation
+of the femur is observed in the anatomical laboratory. The chronicity of
+the condition is obvious when one notes the well formed articulation
+which Nature provides for the head of the femur, where fracture or other
+serious complications are not present.
+
+Symptomatology.--In every case there must exist either restriction of
+movement or an evident abnormal position of the leg, or both conditions
+may exist at once. Also, the leg may be markedly shortened.
+Manifestation of this affection varies, depending upon the character of
+the luxation (position of the head of the humerus with relation to the
+acetabulum). Lusk[42] cites a case of a mule which had suffered femoral
+luxation. The animal was destroyed and on autopsy the head of the femur
+found to be contained within a false articular cavity situated about
+four inches above the acetabulum. In Dr. Lusk's case as he states it,
+the following symptoms were presented: "Limb shortened and fixed in a
+position of adduction. While standing the affected limb hung directly
+across and in front of the opposite one; upper trochanter very
+prominent; skin over hip joint very tense. The mobility of the limb was
+very limited, especially in the forward direction."
+
+Being very prominent when there is an upward luxation and less
+perceptible in downward displacement, the location of the trochanter
+major is an indicator of the character of the luxation with respect to
+the position of the head of the femur. This variation of position
+causes abnormal tenseness or looseness of the skin over the region of
+the trochanter major. Rectal examination is of aid in locating the head
+of the humerus.
+
+Treatment.--When it is evident that a subject should be given
+treatment and not destroyed, the animal must be cast and completely
+anesthetized. With complete relaxation thus secured by rotation of the
+limb, using the hip joint region as a pivot, reduction may be effected.
+Traction is exerted in the same direction from the acetabulum that the
+head of the femur is situated and by pressing over the joint, the
+displaced bone may be returned in position. If luxation is downward,
+traction on the extremity will tend to dislodge the head of the femur
+from the inferior acetabular margin making reduction possible.
+
+The same general plan which is ordinarily employed in correcting
+luxation is indicated here, but because of the heavy musculature of the
+hip, complete anesthesia is imperative in all such manipulations.
+
+
+Gluteal Tendo-Synovitis.
+
+The glutens medius (g. maximus) muscle is inserted chiefly by means of
+two tendons; one to the summit of the trochanter major of the femur and
+the other passing over the anterior part of the convexity of the
+trochanter, and being attached to the crest below it. The trochanter is
+covered with cartilage, and a bursa (the trochanteric) is interposed
+between the tendon and the cartilage.
+
+Etiology and Occurrence.--This affection is probably caused in most
+instances by direct injury to the parts, such as may be occasioned by
+being kicked, falling on pavement, or being struck by the body of a
+heavy wagon. Strains in pulling or in slipping are undoubtedly causative
+factors and in draft horses such strains may result in involvement of
+this synovial apparatus.
+
+Symptomatology.--If pain be severe and inflammation acute, weight may
+not be borne with the affected member. There is some local manifestation
+of the condition in acute cases. Swelling of the tissues contiguous to
+the bursa is present and pain is evinced upon manipulation of the
+parts. A characteristic gait marks inflammation of the trochanteric
+bursa, and as Gunther has put it, the subject generally moves or trots
+as does the dog--the sound member being carried in advance of the
+affected one and the forward stride of the diseased leg is shortened. In
+some chronic cases crepitation is discernible by holding the hand on the
+trochanter while the subject walks.
+
+Treatment.--In the first stages of an acute affection absolute quiet
+must be enforced; local antiphlogistic applications are beneficial.
+Later, vesication of a liberal area surrounding the trochanter major is
+indicated. Where the condition has become chronic in horses that are to
+be kept at heavy draft work there is little chance for complete
+recovery. And, naturally, one is not to expect resolution in cases where
+there exist erosion and ossification of cartilage--where crepitation is
+discernible.
+
+
+Paralysis of the Hind Leg.
+
+Aside from paraplegic conditions due to disease of the cord or the
+lumbosacral plexus, and monoplegic affections resultant from
+disturbances of this plexus, paralysis of certain nerves are
+occasionally encountered.
+
+Anatomy.--The lumbosacral plexus results substantially from the union
+of the ventral branches of the last three lumbar and the first two
+sacral nerves, but it derives a small root from the third lumbar nerve
+also. The anterior part of the plexus lies in front of the internal
+iliac artery, between the lumbar transverse processes and the psoas
+minor. It supplies branches to the iliopsoas[43] (designated by Girard,
+the iliacomuscular nerves). The posterior part lies partly upon and
+partly in the texture of the sacrosciatic ligament. From the plexus are
+derived the nerves of the pelvic limb (Sisson).
+
+
+Paralysis of the Femoral (Crural) Nerve.
+
+Anatomy.--The femoral nerve (crural) is derived chiefly from the
+fourth and fifth lumbar nerves. It runs ventrally and backward, at
+first between the psoas major and minor, then crosses the deep face of
+the tendon of the latter and descends under cover of the sartorious over
+the terminal part of the iliopsoas. It innervates the psoas major
+(magnus), psoas minor (parvus), sartorious, rectus femoris, vastus
+lateralis (interims). Branches supply the stifle and the adductor and
+pectineus muscles.
+
+Etiology and Occurrence.--While paralysis of the femoral nerve, also
+known as "dropped stifle" occurs as a result of local injuries and
+melanotic tumors in gray horses, most cases are due to azoturia.
+So-called crural paralysis or "hip swinney" is occasionally observed but
+this is not a condition wherein the nerve is affected in the manner that
+characterizes the marked atrophy of quadriceps femoris (crural) muscles
+in some cases of hemaglobinuria. This form of paralysis according to
+Hutyra and Marek is due primarily to diffuse degeneration of the
+muscles.
+
+Symptomatology.--When muscular atrophy is not extensive no particular
+evidence of this condition may be manifested while the subject is at
+rest, but where muscular waste has occurred, the nature of the ailment
+is at once recognized. Since the femoral nerve supplies the quadriceps
+femoris muscles, it follows that when the psoic portion of this nerve
+becomes diseased, the stifle loses its support, and in a unilateral
+involvement when the subject attempts to walk on the affected member,
+the stifle sinks down for want of support and the leg collapses unless
+weight is caught up with the other leg. Often, following azoturia, a
+bilateral affection is to be observed.
+
+Treatment.--Horses may be restrained in the standing position, and in
+the average instance, a twitch and hood are all the restraining
+appliances necessary.
+
+In cases where the disease is unilateral and atrophy is not of too long
+standing, recovery is possible in vigorous subjects. All affections,
+however, wherein degenerative changes involve the nerve trunk, whether
+due to diffuse myositis or pressure from malignant tumors, will not
+yield to treatment.
+
+The same general plan of treatment is indicated that is described on
+page 74 in the consideration of atrophy of the scapular muscles. It is
+especially important to provide for the subject to be exercised when
+there is atrophy of the quadriceps muscles following azoturia.
+
+In addition to the foregoing, good results have attended the use of
+intramuscular injections of oxygen. The technic of the operation
+consists in preparing the area of skin which covers the atrophied
+muscles as for any operation. The hair is clipped over five or six or
+more circular areas of about an inch in diameter; the skin is cleansed
+and then painted with tincture of iodin.
+
+A long heavy sterile needle, which is connected with an oxygen tank by
+means of six feet of rubber tubing, is thrust into the depths of the
+affected muscles and the gas is gently introduced into the tissues. One
+needs exercise extreme care that the gas enter slowly because great pain
+is produced by the sudden injection of the oxygen. Likewise too much of
+the gas must not be introduced at one place. When the oxygen is slowly
+introduced it may be allowed to enter the tissues until the subject
+gives evidence of experiencing considerable pain, or if the parts are
+not particularly sensitive, a reasonable amount (enough to cause a mild
+degree of diffuse inflammation) is introduced at each one of five or six
+points. In large animals more points of injection may be used.
+
+No infection or other bad results will follow the execution of a good
+technic and the treatment may be repeated every three or four weeks
+until either marked regeneration of tissue is evident or the case is
+obviously proved hopeless.
+
+
+Paralysis of the Obturator Nerve.
+
+Anatomy.--The obturator nerve, situated at first under the peritoneum,
+accompanies the obturator artery through the obturator foramen and
+gaining the muscles on the internal face of the thigh, terminates in the
+obturator externus, adductors, pectineus and gracilis, also giving twigs
+to the obturator internus (Strangeways).
+
+Etiology and Occurrence.--This condition occurs upon rare occasions as
+the result of injury such as falls which cause extreme abduction of the
+legs, or in pelvic fracture where the nerve is directly injured, or
+when melanotic tumors or other new growths compress the nerve in such
+manner that its function is suspended. Paralysis of the obturator nerve
+or nerves is met with rather frequently, notwithstanding, in mares,
+following dystocia. The nerves (one or both) may become bruised at the
+brim of the obturator foramen by being caught between the pelvis and the
+body of the fetus in some cases of protracted labor.
+
+Symptomatology.--In a unilateral affection there may be little
+evidence of the trouble while the subject is standing; or there is to be
+seen some abduction; or the affected member may present abduction of the
+stifle and stand "toe outward." If the animal is walked there will be
+manifested more or less abduction and the character of the impediment
+varies according to the nature of the involvement.
+
+Following protracted cases of labor in some instances where only a
+unilateral paralysis exists, walking is performed with difficulty; the
+subject may be unable to support weight with the affected member and is
+obliged to hop on the one sound hind leg. In bilateral affections, they
+are unable to rise. If the condition is severe the sling is required to
+keep the subject standing, and with this care, recovery will follow.
+
+Treatment.--If new growths or callosities or similar conditions affect
+the nerve, little, if any, hope for recovery exists. In young and
+vigorous subjects where cause is not definitely known, a course of
+strychnin may be given. Good nursing, providing for the subject's
+comfort and allowing moderate exercise, constitute rational treatment.
+Stimulating embrocations on the abductor muscles resorted to in cases
+during the incipient stage may prove helpful.
+
+When paralysis of the obturator nerve occurs as a post-partum
+complication, and other conditions are favorable, the subject should be
+raised to its feet without unnecessary delay. If the mare is unable to
+assist in regaining her feet, a sling is required. Usually little else
+is necessary and after a few days in the sling the subject can get about
+unassisted. In the meanwhile the well-being of the affected animal is to
+be considered just as in any other case where the patient is so
+confined. The foal in such instances constitutes a source of some
+trouble, but the average mare offers no serious resistance to the
+confinement occasioned by the sling.
+
+Good hygienic care, a suitable diet and full physiological doses of
+strychnin are indicated. Cadiot and Almy recommend vaginal douches of
+cold water and counterirritation of the region of the inner thigh in
+these cases.
+
+
+Paralysis of the Sciatic Nerve.
+
+Anatomy.--The great sciatic nerve leaves the pelvis in company with
+the gluteal nerves, through the great sciatic foramen (notch), passing
+downward along the posterior face of the femur. Near the stifle it
+passes between the two heads of the gastrocnemius muscle and continues
+as the tibial. Branches supply the following muscles--obturator,
+semimembranosus (adductor magnus), biceps femoris (triceps abductor
+femoris), semitendinosus (biceps rotator tibialis), lateral extensor
+(peroneus) and the tibial nerve, its continuation, innervates the
+digital flexors.
+
+Etiology and Occurrence.--Paralysis of the great sciatic nerve may be
+caused by central disorders, injury in falling, fractures and new
+growths. Because of its protected position, this nerve does not often
+suffer injury, and paralysis of the sciatic nerve is recorded in a few
+instances owing to its rarity.
+
+Symptomatology.--When consideration is given the number of muscles
+that are supplied by the sciatic nerve and the function of these
+muscular structures, it is obvious that the leg cannot be used in
+sciatic paralysis. However, the limb is capable of sustaining weight
+when it is fixed in position, but this is done without exertion of
+muscular fibers which are supplied by the great sciatic nerve. Trotting
+is impossible and flexion of the affected member is also likewise
+precluded. The foot is dragged when the subject is caused to advance.
+
+Under the heading "sciatica," Scott[44] has described a case of acute
+sciatic affection wherein a pacing horse manifested evidence of great
+pain of a nervous character. There were muscular twitchings and the leg
+was held off the floor and moved about convulsively. Breathing was very
+much accelerated, pulse 85 per minute, the temperature was 103° and
+manipulation of the hips augmented the pain.
+
+This was not a paralytic condition and recovery resulted, yet
+undoubtedly this was a case which, if not properly cared for, might have
+terminated unfavorably.
+
+Treatment.--Prognosis is decidedly unfavorable in paralysis of the
+great sciatic nerve. If treatment is attempted, it is to be conducted
+along the same general lines as in femoral paralysis. Particular
+attention should be given to conditions which will make for the
+patient's comfort, and as soon as it is evident that the affection is
+not progressing favorably, the subject should be humanely destroyed.
+
+
+Iliac Thrombosis.
+
+This condition is undoubtedly of more frequent occurrence than we are
+wont to grant when one considers the comparatively small number of cases
+that are actually recognized in practice. It does not follow, however,
+that iliac thrombosis rarely exists. Probably in the majority of
+instances there is insufficient obstruction of the lumina of vessels to
+provoke noticeable inconvenience. Or, if circulation is hampered to the
+extent that function is impaired and manifestations are observed by the
+driver, the subject may be permitted to rest a few days and partial
+resolution occurs, so that further trouble is not noticeable.
+
+As judged by lesions of the aorta and iliac arteries in dissecting
+subjects, the conclusion that arteritis and resultant disorders are of
+rather frequent occurrence, is logical.
+
+Etiology.--Inflammation of the vessel walls and resultant
+prolifieration of tissue together with the accumulation of clotted blood
+becoming organized, serve to obstruct the lumen of the affected artery.
+The cause of arteritis is unknown in many instances, but parasitic
+invasion and contiguous involvement of vessels in some inflammatory
+injuries are etiological factors.
+
+Symptomatology.--A characteristic type of lameness signalizes iliac
+thrombosis and the following brief abstract from a contribution on this
+subject by Drs. Merillat[45], clearly portrays the chief symptoms:
+
+[Illustration: Fig. 48--Exposure of aorta and its branches, showing
+location of thrombi in numerous places. In this case (same as Fig. 49)
+Dr. L.A. and Dr. Edward Merillat found the cause of the condition to be
+due to sclerastomiasis.]
+
+     The seizures are accompanied with profuse sudation, tremors,
+     dilated nostrils, accelerated respirations and other symptoms of
+     pain and distress, all of which, together with the lameness,
+     disappear as rapidly as they had developed, leaving the animal in
+     an apparently perfect state of health, ready to fall with another
+     attack of precisely the same kind, as soon as enough exercise is
+     forced upon it. The rectal explorations may reveal a pulseless
+     state of one or more of the iliac arteries and a hardness and
+     enlargement of the aortic quadrifurcation, but sometimes this
+     palpation fails to disclose any _perceptible_ diminution of the
+     blood current of these vessels. The obturation being incomplete, it
+     may be impossible by palpation to decide that thrombosis really
+     exists. In this event and, in fact, in all eases, the clinical
+     symptoms are sufficiently characteristic to make a diagnosis
+     without reservation. It cannot be mistaken for any other disease,
+     once properly investigated. Any given seizure may easily be
+     mistaken for azoturia, at first, but a better examination soon
+     excludes that disease.
+
+[Illustration: Fig. 49--Illustrative of thrombosis of the aorta, iliacs
+and branches. Photo by Dr. L.A. Merillat.]
+
+     Prognosis and Treatment.--In the majority of instances, when
+     there is occasioned serious inconvenience, the outcome is not
+     likely to be favorable, according to Möller. Detachment of a
+     portion of the thrombus, according to Hoare, may result in the
+     lodgment of an embolus in the brain or kidneys. The latter
+     authority also states that muscular atrophy may occur owing to lack
+     of blood supply in some of these cases. Möller states that
+     moderate exercise or work stimulates the establishment of
+     collateral circulation. Massage per rectum is condemned as
+     dangerous by Cadiot.
+
+
+Fracture of the Patella.
+
+Etiology and Occurrence.--Patellar fractures are rarely met with in
+the horse but may be caused by falls and heavy contusions. Violent
+muscular contraction, it is said, may also bring about the same
+condition.
+
+Symptomatology.--Fracture may be transverse or vertical, and depending
+on the manner in which the bone is broken, prognosis is either at once
+rendered favorable or unfavorable. The patella performs a function which
+is in a way similar to that of the sesamoids and when fractured,
+complete recovery is improbable in the average instance. When complete,
+transverse fractures permit of separation of the parts of bone. Tension
+on the straight ligaments below and contraction of the quadriceps above
+usually cause insuperable difficulty in the handling of this type of
+fracture in the horse.
+
+Compound fractures as well as multiple or comminuted fractures
+occasionally occur and these constitute injuries which are generally
+considered fatal, although Andrien, according to Cadiot and Almy,
+succeeded in obtaining complete recovery in a case of compound fracture
+of the patella and the horse was in service and almost free from
+lameness two months after treatment was begun.
+
+No difficulty is encountered in recognizing the fracture of the patella
+because of the exposed position of the bone. Crepitation, and in some
+cases fissures, may be easily detected.
+
+Treatment.--In simple fracture, when treatment is thought advisable,
+the subject is put in a sling and kept as nearly comfortable as
+possible. If little inflammation exists, the application of a vesicant
+two or three weeks after the injury has been inflicted will be helpful
+and serve to hasten repair.
+
+Bandages or mechanical appliances are of no practical use in the
+handling of these cases.
+
+
+Luxation of the Patella.
+
+Etiology and Occurrence.--This, the most common luxation met with in
+the equine subject, has been described by writers as existing in many
+forms. Patellar disarticulation may be more practically considered as
+_momentary_ and _fixed_, regardless of the position taken by the
+patella. Described under the title of false luxation are recorded cases
+wherein the quadriceps (crural) muscles become contracted in such manner
+that a condition simulating true disarticulation of the patella obtains.
+Also, some practictioners report cases of patellar luxation and refer to
+pseudo-luxations, without clearly defining the conditions which
+constitute pseudo-luxation. This has contributed to the extant cause of
+misconception as to actual differences between luxation and conditions
+simulating dislocation.
+
+Luxation of the patella is a condition wherein the articular portions of
+the femur and patella assume abnormal relations whether such
+displacement of the patella be momentary and capable of spontaneous
+reduction, or fixed and requiring corrective manipulation. Spasmodic
+contraction of the crural muscles which sometimes retains the patella in
+such position that the leg is rigidly extended, does not in itself
+constitute luxation of the patella; and unless this bone becomes lodged
+on the upper portion of a femoral condyle or laterally displaced out of
+its femoral groove, luxation cannot be said to exist in the horse. These
+are sub-luxations.
+
+Occasionally one may observe in suckling colts outward luxation of the
+patella wherein there is history of navel infection and no marked
+evidence of rachitis is present. Some of these cases recover. In a
+unilateral involvement of this kind in a three-month-old mule colt, the
+author observed a case wherein an unfavorable prognosis was given and
+destruction of the subject advised, because of the extreme dislocation
+of the patella. This colt, however, was not destroyed and in three weeks
+had apparently recovered. No treatment was given in this instance; the
+colt was allowed the run of a small pasture with its dam and in time it
+matured, becoming a sound and serviceable animal.
+
+Classification.--Two forms of true patellar luxation in the horse may
+be considered; one which is due to the patella becoming fixed upon the
+internal trochlear rim of the femur and the other when the patella slips
+over the outer rim of the trochlea.
+
+The first form is known as _upward_ luxation and is made possible by
+rupture of the mesial (internal) femeropatellar ligament. According to
+Cadiot and Almy, it is only by the rupture of this ligament--the
+femeropatellar--that upward luxation may occur. This type of luxation is
+rarely observed and is usually due to violent strain and abnormal
+extension of the stifle joint.
+
+The second class, _outward_ luxation, occurs in colts and is, in many
+instances, congenital. This form of luxation is also the one usually
+seen following debilitating diseases such as influenza and pneumonia.
+
+_Upward luxation of the patella_ is characterized by the stiff-extended
+position of the leg. When the patella is situated upon the inner
+trochlear rim, the tibia must be extended because of the traction
+exerted by the straight ligaments. Since the stifle and hock joints
+extend and flex in unison, there is presented also an extension of the
+tarsus. Extension of the stifle joint would increase the distance
+between the femoral origin of the gastrocnemius and its insertion to the
+summit of fibular tarsal bone (calcis) were it not for the gastrocnemius
+and superficial flexor (perforatus). Extension of the hock in upward
+luxation of the patella, permits of flexion of the phalanges. In upward
+luxation, then, the leg is extended as if too long, but the phalanges
+may be in a state of moderate flexion. If the foot rests on the ground
+when the extremity is not flexed, it is almost impossible for the
+subject to step backward. Because of immobilization of the stifle and
+hock joints in upward luxation, the subject can walk only by hopping on
+the sound leg and then the extremity is flexed, allowing the anterior
+portion of the fetlock to drag on the ground.
+
+In some cases practitioners are called to attend young animals that are
+reported to be "stifled" (often in young mules that have made a rapid
+growth) and upon arrival the only noticeable symptom of preëxisting
+luxation is the soiled condition of the anterior fetlock
+region--evidence of its having been dragged. Such cases may be styled
+momentary luxation, whether they are due to a weakened condition of the
+patellar ligaments or spasmodic contraction of the crural muscles.
+
+In upward luxation, reduction is effected by attempting further
+extension of the stifle joint and at the same time the patella is pulled
+outward, off the internal rim of the trochlea. This is attempted by
+securing the subject in a standing position; the sound side is kept
+against a wall if possible and a rope is tied to the extremity of the
+affected leg. Traction is exerted upon the rope and at the same time
+force is directed against the stifle joint to produce further extension
+if possible, so that the straight patellar ligaments may relax
+sufficiently to allow the patella to be dislodged from its position upon
+the inner trochlear lip. Failing in this manner of procedure, the
+affected animal is to be cast and anesthetized with chloroform. The
+relaxation which attends surgical anesthesia will permit of reduction of
+the dislocated bone and manipulations such as have just been outlined
+may be employed.
+
+Following reduction in the average case it is essential that the subject
+be given vigorous exercise for a few minutes. Reduction having been
+affected, the application of a vesicant over the whole patellar region
+is customary.
+
+In cases of habitual luxation, unless the ligaments are so lax that the
+patella may be displaced laterally over the inner as well as the outer
+trochler rims, division of the inner straight patellar ligament will
+correct the condition. This desmotomy has been advocated by Bassi, and
+good results in appropriate cases have been reported by Cadiot, Merillat
+and Schumacher. This operation has been found a corrective in cases of
+outward luxation as well as those of upward dislocation of the patella
+when resorted to before the trochleae are worn from frequent luxation.
+
+_Outward luxation of the patella_ is occasioned by a lax condition of
+the internal femeropatellar ligament or a rupture of the same so that
+the patella slips over the outer femoral trochlear rim and permits of an
+abnormal flexion of the stifle joint. The outer trochlear rim being the
+smaller of the two, inward luxation does not occur in the horse. With
+the patella disarticulated in this manner, the action of the quapriceps
+femoral group of muscles has no effect on the stifle joint and,
+therefore, flexion of this articulation occurs as soon as the subject
+attempts to sustain weight and the leg collapses unless weight is at
+once taken up by the other member if sound.
+
+As a rule, the reduction of this form of luxation is not difficult. The
+patella may be pushed inward and into position without manipulation of
+the leg. Retention of the patella in position is a difficult problem.
+Bandaging is considered impractical and is not ordinarily done in this
+country. Benard, according to Cadiot and Almy, recommends bandaging with
+a heavy piece of cloth in which an opening is made through which the
+patella is allowed to protrude, and by turning such a bandage snugly
+about the stifle several times, the patella is held in position. This
+bandage should be kept in place for about ten days.
+
+In young and rachitic animals outdoor exercise and a good nutritive
+ration for the subject are indicated. Hypophosphites in assimilable form
+may be beneficial, and vesication of the patellar region contributes to
+recovery.
+
+Where extreme luxation is present in both stifles, the prognosis is
+unfavorable. In such cases, degenerative changes may exist and in some
+instances the ligaments are so diseased and elongated that regeneration
+is impossible. Williams[46] reports a case where bilateral "floating"
+(outward) luxation was present and extensive degeneration changes
+affected the articulation.
+
+In subjects suffering frequent dislocation of the patella (habitual
+luxation) it is possible in some cases, to prevent its occurrence or at
+least to minimize the distress occasioned by momentary luxation, by
+keeping the animals in wide stalls so that "backing" is unnecessary. In
+some nervous subjects that seem to be suffering from cramp of the crural
+muscles, the difficulty and pain of their being backed out of narrow
+stalls, accentuates the nervousness. Sudation and restlessness are
+manifested and the subject presents a clinical picture of distress and
+fear of a painful ordeal. In some cases of this kind, complete recovery
+takes place by the time animals are five or six years of age. One should
+avoid keeping such subjects in narrow stalls. Preferably patellar
+desmotomy should be performed that relief may be obtained at once.
+
+Luxations attending some cases of influenza recover promptly when
+subjects are kept comfortably confined in roomy box-stalls. The
+administration of stimulative medicaments such as nux vomica and the
+application of an active blistering agent to the patella serve to hasten
+recovery. Dislocations in such cases are often bilateral and they are
+usually momentary. Reduction occurs spontaneously, as a rule, and the
+subjects are not occasioned much distress if they are kept quiet for a
+few days.
+
+
+Chronic Gonitis.
+
+Etiology and Occurrence.--Chronic inflammation of the stifle joint is
+met with following acute synovitis due to strains and concussion. It is
+an ailment which affects heavy horses and particularly animals that are
+kept at work on paved streets, but this does not explain its existence
+in animals that are not subjected to work likely to cause concussion.
+Berns[47] considers rheumatism a probable cause of gonitis and, as he
+states, the dropsical form of affection of this joint is not ordinarily
+attended with manifestations of inconvenience to the subject. Gonitis is
+often bilateral and its onset is insidious in many instances.
+
+Symptomatology.--In unilateral gonitis weight is not borne by the
+affected member. There is noticeable distension of the joint capsule--a
+characteristic pendant pouching protrusion. When both stifles are
+affected the subject frequently shifts the weight from one limb to the
+other. Lameness comes on gradually and during the incipient stages may
+be intermittent but it progressively increases so that in time affected
+animals become useless. In bilateral affections animals drag the toes
+because of the pain incident to flexing the stifles. This is
+particularly evident when the subject is made to trot. As the disease
+progresses, atrophy of the quadriceps femoris muscles becomes pronounced
+and as destructive changes involving the articular cartilages take
+place. The subject becomes more lame and eventually is rendered
+incapable of service.
+
+Upon manipulation of the patellar region, one is impressed with the fact
+that hyperesthesia does not exist in proportion to the pain manifested
+during locomotion. In some cases a gelatinous swelling is present and
+may be detected by palpating between the straight ligaments of the
+patella. Williams, Hughes, Merillat, Hadley and others have directed
+attention to the existence of floating masses (_corpora oryzoidea_) in
+the synovial capsule of this joint in gonitis, and as with all cases of
+arthritis, irreparable damage is often done the articular cartilages
+during the course of the ailment.
+
+[Illustration: Fig. 50--Chronic gonitis. The knuckling which results
+from long continued inactivity of the crural muscles in chronic cases is
+marked in this instance. Photo by Dr. L.A. Merillat.]
+
+Treatment.--No effective method is as yet known which will control
+this condition during its incipiency. The disease progresses, and more
+or less damage is done the affected parts in the course of months or
+even years in some cases before subjects are rendered hopelessly
+crippled. When recognized early (before chronic gonitis exists)
+aspiration of the synovia and the injection of diluted tincture of iodin
+might prove beneficial in cases of synovial distension. Chronic gonitis
+is considered an incurable affection and as soon as subjects manifest
+evidence of distress from this condition they should by all means be
+taken from work. Firing and vesication have not been productive of
+beneficial results.
+
+[Illustration: Fig. 51--Gonitis. Showing position assumed in such cases
+because of pain occasioned. Photo by Dr. C.A. McKillip.]
+
+
+Open Stifle Joint.
+
+Anatomy of the Joint Capsule.--This joint capsule is thin and very
+capacious. On the patella it is attached around the margin of the
+articular surface, but on the femur the line of attachment is at a
+varying distance from the articular surface. On the medial side it is an
+inch or more from the articular cartilage; on the lateral side and
+above, about half an inch. It pouches upward under the quadriceps
+femoris for a distance of two or three inches, a pad of fat separating
+the capsule from the muscle. Below the patella it is separated from the
+patellar ligaments by a thick pad of fat, but inferiorly it is in
+contact with the femerotibial capsules. The joint cavity is the most
+extensive in the body. It usually communicates with the medial sac of
+the femerotibial joint cavity by a slit-like opening situated at the
+lowest part of the medial ridge of the trochlea. A similar, usually
+smaller, communication with the lateral sac of the femerotibial capsule
+is often found at the lowest part of the lateral ridge. (Sisson's
+Anatomy.)
+
+Thus it is seen that because of its frequent communication with the
+other parts of this large synovial membrane, a wound which opens the
+external portion of the femerotibial capsule may be the cause of
+contamination and resultant infectious arthritis of the whole stifle
+joint. Because of the distance between the most dependent part of the
+femerotibial articulation and the summit of the patella, one may
+misjudge the exact location of the lowermost part of this portion of the
+capsular ligament of the stifle joint and thereby fail at once to
+appreciate the seriousness of calk wounds in this region.
+
+Etiology and Occurrence.--Wounds to the patellar region are of rather
+frequent occurrence, and because of the comparatively unprotected
+position of these structures, the capsular ligaments of the stifle joint
+may be perforated as a result of violence in some form. Calk wounds
+which penetrate the tissues in the immediate region of the lower portion
+of the external part of the femerotibial capsule sometimes result in
+open joint because of tissue necrosis resulting from the introduction of
+infection. Contused wounds sometimes destroy the skin and fascia over
+large areas on the lateral patellar region and because of subsequent
+sloughing of tissue due to infection as well as to the manner in which
+such wounds are inflicted, septic arthritis subsequently occurs.
+Penetrant wounds, such as may be caused by a fork tine may not result in
+infection; if infectious material is introduced an infectious arthritis
+does not necessarily follow, though such cases should be considered as
+serious from the outset.
+
+Symptomatology.--The pathognomonic symptom of open stifle joint is the
+profuse escape of synovia, indicating perforation of the synovial
+capsule; by means of a probe the wound may be explored in a way that
+will clearly reveal the nature of the injury.
+
+After a few days have elapsed in cases where considerable infection has
+taken place, there is manifestation of pain as in all cases of infective
+arthritis. Hughes[48] gives an excellent description of the clinical
+aspect of arthritis which applies here:
+
+     Acute arthritis begins like an ordinary attack of synovitis. In
+     joints other than the pedal and pastern, there is sudden and
+     extensive swelling, which at first is intra-articular, succeeded by
+     extra-articular tumefaction, and accompanied by violent lameness.
+     The pain soon becomes intense and agonizing. There is severe
+     constitutional disturbance, the temperature ranging from 104 to 106
+     degrees and the pulse from 60 to 72. Painful convulsions of the
+     limb occur, shown by involuntary spasmodic elevations due to reflex
+     irritation of the muscles. There is loss of appetite, rapid
+     emaciation, the flank is tucked up and the back arched. In from
+     three to six days, the tumefaction around the joint tends to soften
+     at a particular place, and bursts, and a discharge that is
+     sometimes of a sanious character, mixed with synovia, escapes.
+     Great exhaustion at times supervenes, and if the joint is an
+     important one, the horse lies or falls and is unable to rise.
+
+Treatment.--In small puncture wounds the immediate application of a
+vesicating ointment has given good results, but when infection has taken
+place to such extent that the animal manifests evidence of intense pain,
+and lameness is marked and local swelling and hyperesthesia are great,
+vesication is contraindicated. In such instances the exterior of the
+wound and its margins should be prepared as in similar affections of
+other joints. A quantity of synovia is then aspirated by means of a
+small trocar and care should be taken to observe all due aseptic
+precautions. Subsequently the injection of from four to six ounces of a
+mixture of tincture of iodin, one part to ten parts of glycerin, and
+gentle massage of the joint immediately after the injection has been
+made, serves to check the infective process in some cases.
+
+The subject should be cared for as has been previously suggested in
+arthritis proper provisions for comfort being made. Good nursing is
+always essential to a successful issue. However, the author cannot view
+cases of open stifle joint with the same optimism concerning their
+course and outcome that is expressed by a number of writers on this
+subject. It is a grave condition wherein the prognosis should be given
+advisedly.
+
+
+Fracture of the Tibia.
+
+Etiology and Occurrence.--Because of its exposed position to kicks,
+and its lack of protection by heavy musculature (especially on its inner
+surface), there is afforded ample opportunity for frequent injury to the
+tibia. Fractures are complete and varying as to nature, or incomplete.
+The heavy tibial fascia affords sufficient protection so that fissures
+without entire solution of continuity of the bone may occur from
+violence to which this part is often subjected. Möller classes tibial
+fracture as ranking second in frequency--pelvic fracture being more
+often met with in horses. This does not apply in our country as
+phalangeal and metacarpal and even metatarsal fractures are observed in
+more instances than are such injuries to the tibia. The tibia is
+occasionally broken at its middle and lower thirds, but malleolar
+fractures are not common.
+
+Symptomatology.--When fracture is complete and all support is removed,
+the leg dangles, and the nature of the injury is so obvious that there
+is no mistaking its identity. However, in case of incomplete fracture
+one needs to base all conclusions upon the history of the case, evidence
+of injury, or other knowledge of the character of violence to which
+this bone has been exposed. For without the presence of crepitation
+(even by excluding other possible causes for the pronounced lameness
+which characterizes some of these cases) we can only resort to the
+knowledge which experience has taught that fracture may be deemed
+probable in many injuries to the tibial region. Consequently, we are to
+look upon all injuries that affect the tibia as being fractures of some
+sort when there is either local evidence of the infliction of violence
+or whenever marked lameness attends such injuries, unless there is
+positive indication that no fractures exist.
+
+A careful examination of parts of the tibia, i.e., noting the amount and
+painfulness of swellings, exploration with the probe, and observations
+of the course taken in any given case, will determine the exact nature
+of injuries. Such examination needs to extend over a period of a week or
+in some instances two or three weeks may pass before the true state of
+affairs is apparent. In the meanwhile, cases are to be handled as though
+tibial fracture certainly existed.
+
+Prognosis.--Prediction of the outcome in tibial fracture is somewhat
+presumptuous, but in the majority of cases in mature subjects fatality
+results. Cadiot[49], however, views this condition with more optimism
+than have American practitioners. While he considers the condition
+grave, in citing case reports of successful treatment by d'Arboval,
+Duchemin, Leblanc, and others, his conclusion is that many practitioners
+erroneously consider fractures of the tibia as incurable.
+
+The method of handling these cases by Leblanc is as follows: The subject
+is placed in a sling; a pit is excavated below the affected member so
+that a heavy weight may be attached to the extremity; splints are
+applied to each side of the leg, which is padded with oakum, and this is
+kept in position by means of bandages covered with pitch. The outer
+splint extends from the hoof to the stifle and the inner one from the
+hoof to the upper third of the leg. This method in the hands of Leblanc
+has been successful in several instances, according to Cadiot.
+
+In a foal the author has in one instance succeeded in obtaining complete
+recovery in a simple fracture of the lower third of the tibia where the
+only support given the broken bone was a four-inch plaster-of-paris
+bandage which was adjusted above the hock. Below the tarsus a cotton and
+gauze bandage was applied to prevent swelling of the extremity. In this
+instance (an emergency case in which materials that are not to be
+recommended were necessarily employed) recovery took place within thirty
+days.
+
+As has been mentioned in the consideration of radial fractures, heavy
+leather is better suited for immobilization of these parts than a cast
+or other rigid splint materials. Mature animals may be expected to
+resist the immobilization of the hind legs because of the normal manner
+of flexion of the tarsal and stifle joints in unison. Therefore, the
+application of rigid splints to the leg and including the hock is
+productive of disastrous results in some cases.
+
+The application of cotton and bandages to pad the member and the
+adjusting of heavy leather splints on either side of the leg, and
+retaining them in position with four-inch gauze bandages will prove more
+nearly satisfactory than some other methods employed. Prognosis is
+unfavorable, however, in most cases of compound fracture and recovery is
+improbable when the upper portion of the tibia is broken.
+
+
+Rupture and Wounds of the Tendo Achillis.
+
+Etiology and Occurrence.--Cases are recorded by Uhlrich in which
+rupture has followed degenerative changes affecting the tendo Achillis.
+Not infrequently, the result of a trauma, division of the tendo Achillis
+occurs. Möller states that rupture of this tendon may be due to jumping,
+in riding horses and in draught horses, in their efforts to avoid
+slipping. In runaways, it sometimes occurs where sharp-edged implements
+are bounced against the legs in such fashion that division of the tendon
+results.
+
+Symptomatology.--With division of the tendo Achillis or of the
+musculature of the gastroenemii and the superficial flexor
+(perforatus), there remains nothing to inhibit tarsal flexion except the
+deep flexor tendon (perforans) and this does not support the leg. When
+attempt is made to sustain weight with the affected member, abnormal
+flexion of the tarsus takes place and the hock sinks almost to the
+ground. The symptoms are so characteristic that recognition is always
+easy even in case no wound of the skin exists.
+
+Prognosis.--Spontaneous recoveries occur and such cases are reported
+by Bouley who is quoted by Cadiot as having observed division of the
+tendo Achillis due to a sword wound wherein at the end of four months
+recovery was complete. Division of this tendon in brood mares has been
+practiced by the early settlers of parts of the United States for the
+purpose of preventing their straying too far from home. In such
+instances one leg only was so mutilated and in most instances, it is
+reported that spontaneous recovery took place.
+
+In unilateral involvement without complications, the prognosis is not
+unfavorable if provisions for giving necessary attention are available.
+
+Treatment.--The subject is to be confined in a sling and the member
+bandaged and supported by means of leather splints. Immobilization as
+for fracture is not necessary but, nevertheless, movement is to be
+restricted as much as possible. In case of open wounds, the exposed
+tissues are cared for along general surgical lines. Where the divided
+parts of the tendon are maintained in fairly close and constant
+relation, granulation of tissue, sufficient to sustain weight takes
+place in from six weeks to three months.
+
+
+Spring-Halt. (String-Halt.)
+
+Occurrence.--This condition is a myoclonic affection of the hind leg
+which is discussed in works on theory and practice under the head of
+neuroses, but the cause or causes have not been established. Theories
+that heredity is responsible have their supporters and advocates of
+hypotheses attributing it to disease of the sciatic nerve, patellar
+subluxation, fascial contraction of various muscles, "dry spavin"
+(tarsal arthritis), iliac exostoses, disease of the foot and contraction
+of the hoof, are on record in veterinary literature. This ailment
+affects old horses more frequently than it does young and is seen in all
+breeds of animals including mules.
+
+[Illustration: Fig. 52--Spring-halt.]
+
+Symptomatology.--This disease develops slowly, and progressively
+increases in severity as a rule, but does not ordinarily constitute
+cause for rendering an animal unserviceable. While the affection is
+sometimes bilateral (occasionally affections of the forelegs are
+reported) and the extreme flexion of the legs in the spasmodic manner
+which characterizes spring-halt, cause great waste of energy during
+locomotion, yet such cases are rare. Usually the ailment is markedly
+evinced when subjects are first taken from the stable, but as they are
+exercised the manifestation diminishes, and in many instances it
+completely subsides. The condition is generally more noticeable when the
+subject is made to step backward. In some animals there is marked
+abduction at the time flexion occurs and in singular instances the
+spasmodic contraction is so violent that the subject falls to the ground
+as a result of the peculiar flexion of the leg.
+
+In severe cases of "scratches" or chemical irritation of the extremity,
+the legs are abnormally flexed in a manner which simulates spring-halt,
+but because of the evident injury of the parts this is not likely to
+confuse. Since all facts concerning etiological agencies are surrounded
+with so much obscurity, classification does not lend any particular
+assistance in the consideration of this ailment.
+
+Prognosis.--One cannot intelligently give a prognosis in these cases
+if forecast is expected to state the exact course following treatment.
+However, in a general way, cases of recent affection are thought more
+favorable than are those of long standing or in old animals where
+myositis and other muscular and fascial affections exist owing to years
+of hard service.
+
+Treatment.--No known line of medicinal treatment is of service, nor is
+any particular surgical operation to be considered dependable for
+obtaining relief. Operations of almost every conceivable nature have
+been tried with the hope of securing recovery in spring-halt but under
+no condition can the practitioner as yet be reasonably certain of
+effecting permanent relief in any case. Treatment is, therefore,
+entirely empirical.
+
+Neurectomies have been performed and recoveries following were
+attributed thereto; fascial divisions in the crural region have been
+done with good results and this manner of treatment has its favorers.
+Advocates of tenotomies, likewise, are to be found. Consequently, one
+may summarize thus: Spring-halt is a disease of unknown origin--the
+exact cause has not been determined; therefore, all treatment is, in a
+way, experimental. The recommendation of any given procedure in handling
+cases must then be a matter of opinion based either upon practical
+experience or knowledge of the experiences of others. Divisions of the
+lateral digital extensor (peroneus) below the tarsus near its point of
+insertion to the extensor of the digit is recommended here because it is
+followed by a percentage of recoveries that is as large as in any other
+method of treatment and the operation is not difficult to perform nor
+is its performance fraught with any dangerous complications. In selected
+subjects about fifty per cent of cases recover in from two to six weeks
+following this operation.
+
+[Illustration: Fig. 53--Lateral (external) view of tarsus showing
+effects of generalized tarsitis.]
+
+
+Open Tarsal Joint.
+
+Like the tibia the hock is exposed to frequent injuries and in some
+cases wounds perforate the joint capsule. When due to calk wounds where
+horses are kicked, the injury is often on the side of the tarsus (medial
+or lateral) and such wounds not infrequently result in infectious
+arthritis. Horses sometimes jump over wire fences and wounds are
+inflicted which constitute extensive laceration of the joint capsule. In
+firing for bone spavin, where a deep puncture is made very near the
+tibial tarsal (tibioastragular) joint if infection gains entrance,
+serious and generalized infection of the open joint cavity supervenes in
+some cases.
+
+Symptomatology.--There is no marked difference in the constitutional
+disturbances which are occasioned in this condition and those
+encountered in other cases of septic arthritis (previously considered
+herein) except that there is a difference in the degree of resultant
+derangement and local tissue changes. Chiefly, because of the difficulty
+encountered in keeping the hock joint in an aseptic condition or
+securely bandaged, open tarsal joint constitutes a more serious
+condition than a similar affection of the fetlock. Otherwise, a very
+similar condition obtains and the same diagnostic principles serve here
+that have been described on page 110 in considering open fetlock joint.
+
+Treatment.--The same plan that is described in detail for treatment of
+similar conditions affecting the fetlock joint is indicated in this
+affection. Exceeding care must be exercised in bandaging the hock,
+however, lest the animal be so irritated that in the extreme flexion of
+the tarsus which is often caused by bandaging, the wound dressings may
+be completely deranged. A wide gauze bandage material is most
+satisfactory; cotton of long fiber is separated in thin layers and wound
+about the hock, extending from the site of injury to a point about six
+inches proximal to the summit of the os calcis. By using an abundance
+of cotton in this way, it will not be found necessary to apply the
+bandages very snugly; with a four-inch gauze bandage material, which is
+supported above the cap of the hock and brought across the anterior face
+of the tarsus in a diagonal manner, a comfortable and very serviceable
+protective dressing is provided for. Animals so treated will not
+ordinarily resist because of pressure from the bandages. Pressure is
+unavoidable in the use of adhesive dressings or where careful attention
+is not given the manner of applying cotton to the parts. Such methods
+are sure to result disastrously. But if subjects are kept quiet after
+the parts have been properly bandaged, no difficulty is encountered in
+maintaining asepsis in an uninfected wound. Recovery takes place in
+favorable cases in from three weeks to three months, depending on the
+nature and extent of injuries inflicted.
+
+
+Fracture of the Fibular Tarsal Bone (Calcaneum.)
+
+Etiology and Occurrence.--This condition though rarely met with in the
+horse, is the result of violent strain upon the os calcis by the
+gastrocnemius and superficial flexor tendons in efforts put forth by
+animals in attempts to regain a footing when the hind feet slip forward
+under the body, or in jumping and in falls or direct contusion by heavy
+bodies. Hoare[50] reports a case of a mare that had produced fracture in
+jumping.
+
+Fracture of the other tarsal bones are very seldom observed but may be
+occasioned by contusions wherein multiple or comminuted fractures are
+produced, such as are to be seen in small animals. Fracture of the
+tibial tarsal bone (astragalus) is to be observed as a complication in
+luxations of the tarsal joint and, according to Cadiot, the other tarsal
+bones may likewise suffer fracture in luxations of the hock.
+
+Symptomatology.--Great pain attends this accident according to the
+observations given in recorded cases. In the case cited by Hoare the
+animal evinced great pain and uneasiness; the hock was unduly flexed;
+the calcaneum was displaced forward; and marked crepitation was present.
+A portion of the body of the calcaneum was protruding through the
+perforated skin. The animal was destroyed and the bone was found broken
+in three pieces.
+
+[Illustration: Fig. 54--Right hock joint. Viewed from the front and
+slightly laterally after removal of joint capsule and long collateral
+ligaments. T.t., Tibial tarsal bone (distal tuberosity). T.c., central
+tarsal bone. T.3. Ridge of third tarsal bone. T.f. Fibular tarsal bone
+(distal end). T.4. Fourth tarsal bone. Mt. III, Mt. IV. Metatarsal
+bones. Arrow points to vascular canal. (From Sisson's "Anatomy of the
+Domestic Animals.")]
+
+Since the support for the tendo Achillis is removed in such fracture and
+no leverage on the metatarsus obtains, it naturally follows that any
+attempt to sustain weight must result in extreme flexion of the hock and
+descent of this part in a manner similar to cases of rupture or division
+of the Achilles' tendon. The two conditions should not be confused,
+however, as the parts may be definitely outlined by palpation and the
+slack condition of the tendon and displaced summit of the calcaneum,
+which characterize fracture of the fibular tarsal bone, are easily
+recognized.
+
+Treatment.--Prognosis is unfavorable in the majority of cases, but
+should attempts at treatment be undertaken in young and quiet mares
+which might prove valuable for breeding purposes in case of imperfect
+recovery, they should be put in slings and the member is to be
+immobilized as in tibial fracture. Authorities are agreed that prognosis
+is entirely unfavorable in mature animals, when the case is viewed from
+an economic standpoint.
+
+
+Tarsal Sprains.
+
+Etiology and Occurrence.--The hock joint is often subjected to great
+strain because of the structural nature of this part and its relation to
+the hip as well as the manner in which the tarsus functionates during
+locomotion. That ligamentous injuries owing to sprain frequently occur
+and attendant periarticular inflammations with subsequent hypertrophic
+changes follow, is a logical inference. Fibrillary fracture of the
+collateral ligaments may take place in falls or when animals make
+violent efforts to maintain their footing on slippery streets. In
+expressing opinions concerning the frequency with which the hock is
+found to be the seat of trouble in lameness of the pelvic members,
+different writers place the percentage of hock lameness at from
+seventy-five to ninety per cent. And when one considers the possibility
+that a goodly proportion of cases of tarsal exostis are the outcome of
+sprains, the occurrence of tarsal sprains may be more generally
+admitted.
+
+Symptomatology.--A mixed type of lameness is present and the nature of
+the impediment varies, depending upon the location of the injury.
+Sprains of the mesial tarsal ligaments cause lameness somewhat similar
+to that of spavin. However, in establishing a diagnosis, local evidence
+in these cases is of greater significance than the manner of locomotion.
+During the acute stage of inflammation there is to be detected local
+hyperthermia, some hyperesthesia and a little swelling. Later, when
+resolution is not prompt, considerable swelling (or perhaps correctly
+speaking, an indurated enlargement) variable in size is developed. In
+some cases the entire tarsal region becomes greatly enlarged and this
+swelling is very slowly absorbed in part or completely. Such sub-acute
+cases are observed during the winter season and particularly where
+subjects are kept in tie stalls without exercise for weeks at a time.
+
+Treatment.--Attention should be directed toward relief for the animal
+in all acute inflammations. Local applications of heat are helpful and,
+of course, rest is essential. Towels that are wrung out of hot water and
+held in position by means of a few turns of a loose bandage and this
+covered with an impervious rubber sheet, will serve as a practical means
+of application of hydrotherapy. Following this when conditions improve,
+as in the handling of all similar cases, counterirritation is indicated.
+
+When proper care is given at the onset and where injury does not involve
+too much ligamentous tissue, recovery takes place in a few weeks but in
+some cases which occur during the winter season in farm horses, complete
+recovery does not result until several months have passed.
+
+
+Curb.
+
+The hock is said to be curbed when the normal appearance, viewed from
+the side, is that of bulging posteriorly at any point between the summit
+of the calcaneum and the upper third of the metatarsus. Among some
+horsemen a hock is said to be "curby" whenever there exists an
+enlargement of any kind on the posterior face of the tarsus whether it
+be due to sprain, exostosis or proliferation of tissue as a result of
+contusion.
+
+French veterinarians consider under the title of "courbe," an exostosis
+situated on the mesial side of the distal end of the tibia. Cadiot and
+Almy state that this condition (courbe) is of rare occurrence. Percivall
+defines curb as "a prominence upon the back of the hind leg, a little
+below the hock, of a curvilinear shape, running in a direct line
+downwards and consisting of infusion into, or thickening of, the sheath
+of the flexor tendons." Möller's version of true curb is a thickening of
+the plantar ligament (calcaneocuboid or calcaneometatarsal). Hughes and
+Merillat consider curb as a synovitis having for its seat the synovial
+bursa which is situated between the superficial flexor tendon
+(perforatus) and the plantar ligament.
+
+Occurrence.--Certain predisposing factors seem to favor the occurrence
+of curb. A malformation of the inferior part of the tarsus so that its
+antero-posterior diameter is considerably less than normal is a
+contributing cause. Such hocks are known as "tied-in." Another fault in
+conformation is the existence of a weak hock that is set low down on a
+crooked leg, especially when such a member is heavily muscled at the
+hip. Given such conformation in an excitable horse, and curb is usually
+produced before the subject is old enough for service. It is certain
+that in cases where conformation is bad, greater strain is put upon the
+plantar ligament. This structure serves to bind the tibial tarsal
+(calcis) bone to the metatarsus; traction exerted upon its summit by the
+tendo Achillis is great when animals run, jump or rear and also at heavy
+pulling. In animals having curby hocks, sprain is likely to result and
+curb supervenes.
+
+Symptomatology.--The characteristic swelling which marks curb may
+develop quickly and lameness occur suddenly or the enlargement comes on
+gradually and slowly, causing little lameness. Lameness is not
+proportionate to the size of the swelling and in all cases whether
+subacute or chronic, the condition improves with rest, but lameness is
+again manifested upon exertion. A horse which "throws a curb" will go
+lame until the acute inflammatory condition subsides and depending upon
+treatment received and conformation of the hock, this requires from
+three days to two or three weeks.
+
+The character of the swelling varies; in some cases it is not large but
+rather dense and lacking in evidence of heat and hyperesthesia; in other
+cases there is considerable swelling, which is hot and doughy, somewhat
+painful to the touch but not necessarily productive of much lameness. In
+any event, whether the swelling or enlargement is big or little, its
+location makes it conspicuous when viewed in profile.
+
+In most cases after the acute inflammatory period has passed, lameness
+is slight, if at all present, and in time no interference with the
+subject's usefulness is occasioned because of the curb, but the animals
+often remain blemished--complete resorption of inflammatory products
+being unusual when much disturbance has existed.
+
+Treatment.--The handling of curb during the acute inflammatory stage
+is along the same lines as in sprain--local applications of cold and
+heat. Subjects must be kept quiet until all inflammation has subsided,
+for there are no cases wherein a little brisk exercise is more likely to
+cause a recurrence of lameness before recovery is complete than in curb.
+Vesication is in order in a week or ten days after the affection has set
+in; in old stubborn cases that have resisted ordinary treatment for a
+few months, the use of the actual cautery (line firing) is to be
+recommended.
+
+[Illustration: Fig. 55--Spavin.]
+
+
+Spavin. (Bone Spavin.)
+
+This term is applied to an affection of the tarsus which is usually
+characterized by the existence of an exostosis on the mesial and
+inferior portion of the hock. There is also included under this name,
+articular inflammation wherein no external evidence is shown. Spavin
+lameness has long been recognized and much has been written upon this
+subject. Since authorities are agreed that most cases of lameness in the
+hind leg are due to hock affection, and because the majority of cases of
+lameness which have the tarsal region as the seat of trouble are
+instances of spavin lameness, this disease merits all the attention it
+has received.
+
+Etiology and Occurrence.--Causes may well be classified as
+predisposing and exciting, for there are many etiologic factors to be
+reckoned with in spavin, some of which are widely different in nature.
+
+Considered as predisposing causes, hereditary influences play an
+important rôle and may, owing to faulty conformation, subject an animal
+to affections of this kind because of disproportionate development of
+parts (weak and small joints and heavy muscular hips); or as a
+consequence of inherited traits, a subject may manifest susceptibility
+to degenerative bone changes which are signalized by the formation of
+exostoses of different parts on one or more of the legs. Hereditary
+predispositions make for the presence of spavin in a large percentage of
+the progeny of sires so affected. This fact has been repeatedly
+demonstrated in this country as well as elsewhere according to Quitman,
+Dalrymple and Merillat.[51] A number of states have passed stallion
+inspection laws stipulating that animals having such exostoses as spavin
+and ringbone cannot be registered except as "unsound."
+
+Asymmetrical conformation, particularly where the hock is obviously
+small and weak as compared with other parts of the leg, constitutes a
+noteworthy predisposing cause.
+
+Peters' theory is plausible that the screw-like joint between the tibia
+and the tibial tarsal (astragulus) bones causes these structures to
+functionate in a manner not in harmony with the provisions allowed by
+the collateral ligaments of the tarsus, permitting movement only in a
+direction parallel with the long axis of the body.
+
+Because of the quality of their temperaments, nervous animals possessing
+no particular congenital structural defects of the hock and having no
+history of spavined progenitors, are subject to spavin when kept at work
+likely to produce tarsal sprain. Spavin usually develops early in such
+subjects and examples of this kind may be frequently observed in
+agricultural sections of the country. Where spavin develops in unshod
+colts at three and four years of age, shoeing is not an influencing
+agency when animals are not worked on pavements.
+
+Exciting causes of spavin are sprain and concussion. Various hypotheses
+are recorded as to how sprains are influenced and among others may be
+mentioned that of McDonough[52], which is that the foot is robbed of its
+normal manner of support by the ordinary three-calked shoe. With such a
+shoe, little support is given the sides of the foot; hence, undue strain
+is put upon the collateral ligaments of the tarsus. Moreover, the shoe
+with its calks increases the length of the leg and adds to the leverage
+on the hock, by virtue of such added length. This makes for greater
+strain upon the mesial or lateral tarsal ligaments whenever the foot
+bears upon a sloping ground surface, so that one side (inner or outer)
+is higher or lower than the other. But according to McDonough's theory
+(a good one concerning horses that work on pavements), the chief error
+in shoeing lies in that the foot is deprived of its normal base or
+support on the sides--the three-calked shoe being an unstable
+support--and that this manner of shoeing city horses working on
+pavements is an "inhumane" practice, a "diabolical method."
+
+Whether spavin has its point of origin within the articulation as a
+rarefying ostitis of the cancellated structure of the lower tarsal bones
+as suggested by Eberlein; or, as Diekerhoff asserts, that the cunean
+bursa may be the initial point of affection, is unsettled; but it is
+reasonable to consider occult spavin as having its origin within the
+articulation, and that cases readily yielding to cunean tenotomy are
+primarily due to affection of the cunean bursa.
+
+Symptomatology.--Where a visible exostosis exists, the presence of
+spavin is easily detected, yet exostoses that extend over large areas
+may constitute cause for serious trouble and still be difficult of
+detection. By observing the internal surface of the hock from various
+suitable angles, such as from between the forelegs or directly behind
+the subject, one may note the presence of any ordinary exostosis.
+
+The position assumed by the spavined horse is often characteristic. More
+or less knuckling is usually present (Liautard, McDonald). There is
+abduction of the stifle in some cases, or the toe may be worn in unshod
+horses so that it presents a straight line at the surface. This is
+manifested to a great degree in some animals and in others the foot is
+not dragged and there is no wearing of the hoof at the toe.
+
+Spavin lameness is so distinctive that one trained and experienced in
+the examination of horses that are spavined, should correctly diagnose
+the condition in practically every instance without recourse to other
+means than noting the peculiar character of the gait of the subject.
+Lameness develops gradually in the majority of instances, and an
+important feature in spavin lameness is that it disappears after the
+subject has gone a little way, to return again as soon as the animal has
+rested for a variable length of time--from a half hour to several hours.
+This "warming out" is marked during the incipient stage, but less
+pronounced in most chronic cases. A complete disappearance of lameness
+is observed in some instances, while in others only partial subsidence
+is evident. Because of the fact that pain is occasioned both during
+weight bearing and while the leg is being flexed and advanced, there is
+manifested the characteristic mixed lameness and exaggerated hip action
+which typifies spavin. By throwing the hips upward with the sound member
+it is possible to advance the affected leg with less flexion, hence less
+pain is experienced in this manner of locomotion. When made to step
+aside in the stall, a spavined horse will flex the affected member
+abruptly and when weight is taken on the diseased leg, symptoms are
+evinced of pain, and weight is immediately shifted to the sound limb.
+This is marked during the incipient stages of spavin. Lameness usually
+precedes the formation of exostosis, though cases are observed wherein
+an exostosis is present and no lameness is manifested and no history of
+the previous existence of lameness is available.
+
+The "spavin test" is of value as a diagnostic measure when it is
+employed with other means of examination, though reaction to this test
+is seen in some cases in old "crampy" horses that have experienced hard
+service. The test consists in flexing the affected leg (elevating the
+foot from the ground twelve to twenty-four inches) and holding the
+member in this position for a minute, whereupon the animal is made to
+step away immediately at a trot. During the first few steps taken
+directly thereafter, the subject shows pronounced lameness and this
+constitutes a reaction to the spavin test.
+
+Where no exostosis is present it becomes necessary to exclude other
+causes for lameness but the characteristic spavin lameness is to be
+relied upon to a greater extent in such cases than are other means of
+examination. Such cases are known as occult spavin and may be present
+for months before any external changes in structure are observable. In
+some instances no extoses form even during the course of years. The
+spavin test is of aid in establishing a diagnosis here but the marked
+"warming out" peculiar to spavin is not so pronounced in such cases.
+
+Prognosis.--An animal having hereditary predisposition to spavin is
+not likely to recover completely whether this predisposition be due to
+faulty conformation or susceptibility to bone changes. In predicting the
+outcome, the temperament of the subject is to be taken into account, as
+well as the character of service the animal is expected to perform. And
+finally, a very important feature to be noted, is the location of the
+exostosis. If situated rather high and extending anterior to the hock,
+there is less likelihood of recovery resulting than where an exostosis
+is confined to the lower row of tarsal bones. When situated anterior to
+the tarsus a large exostosis may by mechanical interference to function,
+cause lameness when all other causes are absent. In making examinations
+one must not be deceived by the inconspicuous and seemingly
+insignificant exostosis which has a broad base. In some cases of this
+kind, dealers style the condition as "rough in the hock" when as a
+matter of fact, in some instances, incurable spavin lameness develops.
+
+Treatment.--Many incipient cases of spavin yield to vesication and a
+protracted period of rest. Results depend primarily upon the nature of
+the affection. However, in every instance if there is involvement of the
+tibial tarsal (astragalus) bone, complete recovery is highly improbable.
+When the disease is confined to the lower tarsal bones, lameness
+subsides as soon as the degenerative changes are checked and ankylosis
+occurs.
+
+The use of the actual cautery when properly employed constitutes an
+excellent method of treatment. The "auto-cautery" when equipped with a
+point of about one-eighth of an inch in diameter and about three-fourths
+of an inch in length is well suited for this particular operation.
+Before deciding to cauterize, it is necessary to ascertain the extent of
+area affected. The nearness of the exostosis to the tibiotarsal
+articulation can be definitely determined by palpation. The hair over
+the entire surgical field is clipped and the cautery at white heat is
+pushed through the overlying soft tissues and into the central part of
+the exostosis. Care is taken to keep the cautery-point away from the
+articular margin of the tibial tarsal bone about three-fourths of an
+inch. No danger will result from cauterizing to a depth of three-fourths
+of an inch in the average case. Two or three (and not more) centrally
+located points for penetration with the cautery are sufficient.
+Experience has shown that several (five or six or more) punctures are
+not productive of good results. When considerable cicatricial tissue is
+present, due to the action of depilating vesicants or other chemicals,
+sloughing of tissue is very apt to follow deep cauterization, if one is
+not careful to keep the punctures at least one-half inch apart when
+three are made. It is best, in such cases, to make but two deep
+penetrations with the cautery but additional superficial punctures may
+be made if kept about three-fourths of an inch distant and not nearer
+than this to one another. Sloughing of tissue is not necessarily
+productive of bad results but there is occasioned an open wound which
+usually becomes infected and necrosis of tissue may extend into the
+articulation. No benefit results from sloughing and it should be
+avoided. In small horses, one deep point of cauterization is sufficient
+if the osseous tissues are penetrated to a proper depth so that an
+active inflammation is induced. The cautery may, if necessary, be
+reintroduced several times. When the field of operation has been
+properly prepared and it is thought advisable (as where subjects are
+kept in the hospital for a time), the hock may be covered with cotton
+and bandaged and no chance for infection will occur.
+
+After cauterization the subject should be kept quiet in a comfortable
+stall for three weeks; thereafter, if the animal is not too playful, the
+run of a paddock may be allowed for about ten days and a protracted rest
+of a month or more at pasture is best. It is unwise in the average case
+to put an animal in service earlier than two months after having been
+"fired."
+
+Where cases progress favorably, lameness subsides in about three weeks
+after cauterization and little if any recurrence of the impediment is
+manifested thereafter. However, because of violent exercise taken in
+some instances when subjects are put out after being confined in the
+stall, a return of lameness occurs and it may remain for several days or
+in some cases become permanent. No good comes from the use of blistering
+ointments immediately after cauterization. The actual cautery is a means
+of producing all necessary inflammation and it should be so employed
+that sufficient reactionary inflammation succeeds such firing. The use
+of a vesicating ointment subsequent to cauterization invites infection
+because of the dust that is retained in contact with the wound. The
+employment of irritating chemicals in a liquid form following firing is
+needless and cruel.
+
+In many instances lameness is not relieved and subjects show no
+improvement at the end of six weeks time and it then becomes a question
+of whether or not recovery is to be expected even with continued rest
+and treatment. As a rule, such cases are unfavorable. In one instance
+the author employed the actual cautery three times during the course of
+six months and lameness gradually diminished for a year. In this case
+the spavin was of nearly one year's standing when treatment was
+instituted. The subject was a nervous and restless but well-formed
+seven-year-old gelding. Recovery was not complete; recurrent intervals
+of lameness marked this case, but the horse limped so slightly that the
+average observer could not detect its existence after the animal had
+been driven a little way.
+
+Cunean tenotomy has been advocated and practiced by Abildgaard, Lafosse,
+Peters, Herring, Zuill and others and good results have followed in many
+cases so treated.
+
+Considering results, the employment of chemicals of various kinds for
+the purpose of relieving spavin lameness does not compare favorably with
+firing. Moreover, so many animals have been tortured and needlessly
+blemished in the attempted cure of spavin that agents which are not of
+known value, the use of which are likely to result in extensive injury
+to the tissues, are only to be condemned.
+
+When spavin is bilateral and lameness is likewise affecting both
+members, prognosis is at once unfavorable. Such cases are often
+benefited by cauterization but only one leg at a time should be treated.
+
+Bossi's double tarsal neurectomy (division of the anterior and posterior
+tibial nerves) has undoubtedly been of decided benefit in many cases,
+but is not at present a popular method of treatment in this country.
+This operation has its indications, however, and may be recommended in
+chronic lameness where no extensive exostosis exists which may
+mechanically interfere with function.
+
+
+Distension of the Tarsal Joint Capsule. (Bog Spavin.)
+
+Distension of the capsular ligament of the tibial tarsal
+(tibioastragular) joint with synovia is commonly known as bog spavin.
+This condition is separate and distinct from that of distension of the
+sheath of the deep flexor tendon (perforans) though not infrequently the
+two affections coexist.
+
+Etiology and Occurrence.--Following strains from work in the harness
+or under the saddle, horses develop an acute synovitis of the hock
+joint, which often results in chronic synovial distension. Debilitating
+diseases favor the production of this affection in some animals. It is
+also frequently observed in young horses and in draught colts of twelve
+to eighteen months of age. This condition occurs while the subjects are
+at pasture and often spontaneous recovery results by the time the
+animals are two years of age.
+
+[Illustration: Fig. 56--Bog spavin. Showing point of view which may be
+most advantageously taken by the diagnostician in examining for
+distension of the capsular ligament of the tarsal joint.]
+
+Symptomatology.--Bog spavin is recognized by the distended condition
+of the joint capsule which is prominent just below the internal tibial
+malleolus and this affection is characterized by a fluctuating swelling
+which varies considerably in size in different subjects. Except in cases
+of acute synovitis, lameness is not present and in chronic distension of
+the capsule of the tarsal joint, no interference with the subject's
+usefulness occurs. In the majority of instances, the disfigurement which
+attends bog spavin is the principal objectionable feature. The condition
+is bilateral in many instances, and in such cases the subjects have a
+predisposition to this condition or it follows attacks of strangles or
+other debilitating ailments. Because of a rapid and unusual growth,
+bilateral affections are of frequent occurrence in some animals.
+
+Treatment.--The most practical method of handling bog spavin consists
+in aspiration of synovia and injection of tincture of iodin. Discretion
+should be employed in selecting subjects for treatment, regardless of
+the manner in which such cases are to be handled. Where there exists
+chronic distension of the joint capsule of several years' standing in
+old or weak subjects, needless to say, recovery is not likely to result.
+When animals are vigorous and two or three months' time is available,
+treatment may be begun with reasonable hope for success.
+
+The average subject is handled standing and can be restrained with a
+twitch, sideline and hood. Aspirating needles and all necessary
+equipment must be in readiness (sterile and wrapped in aseptic cotton or
+gauze) so that no delay will occur from this cause when the operation
+has been started. The central or most prominent part of the distended
+portion of the capsule is chosen for perforation and an area of an inch
+and a half in diameter is shaved. The skin is cleansed and then painted
+with tincture of iodin. The sterile aspirating needle is pushed through
+the tissues and into the capsule with a sudden thrust. With a large and
+sharp needle (fourteen gauge), synovia can be drawn from the cavity in
+most instances and the subject usually offers no resistance. By
+compressing the distended capsule and surrounding structures with the
+fingers, considerable synovia may be evacuated. In singular instances,
+no synovia is to be aspirated with the needle, and in such cases the
+amount of iodin injected needs be increased, possibly twenty-five per
+cent., as experience will indicate. From two to five cubic centimeters
+of U.S.P. tincture of iodin is injected through the aspirating needle
+into the synovial cavity of the joint, and the exterior of the parts are
+vigorously massaged immediately after injection to stimulate
+distribution of the iodin throughout the synovial cavity. Where a
+bilateral affection exists, two or three weeks' time should intervene
+between the treatments of each leg. A sterile metal syringe equipped
+with a slip joint for the needle is well adapted to this operation.
+Lubrication of the plunger with heavy sterile vaseline or glycerin will
+prevent the syringe from being ruined by the iodin.
+
+Following the injection, the subject is kept in a stall or in a suitable
+paddock, so that conditions may be observed for four or five days. The
+object sought by the introduction of iodin is not only for a local
+effect upon the synovial membranes in checking secretions, but the
+production of an active inflammation and great swelling, which will
+remain from four weeks to three months subsequent to the injection. This
+periarticular swelling should produce and maintain a constant pressure
+over the entire affected parts for a sufficient length of time until
+normal tone is re-established.
+
+In some cases, swelling does not develop as the result of a single
+injection of iodin. When marked swelling has not taken place within five
+days, none will occur and a repetition of the injection may be made
+within ten days after the first treatment has been given. One may safely
+increase the amount of iodin at the second injection in such cases by
+one-fourth to one-third.
+
+In Europe this method of treating bog spavin has been employed by
+Leblanc, Abadie, Dupont and others according to Cadiot; but Bouley, Rey,
+Lafosse and Varrier used it with bad results. Where a perfect technic is
+executed (and no other is excusable in this operation), no infection
+will occur if a reasonable amount of iodin is injected. The dilution of
+iodin with an equal amount of alcohol has been practised by the author
+in many cases, but later this was found unnecessary.
+
+Other methods of treatment have been used with success. Perhaps the most
+heroic consists in opening the joint capsule with a bistoury or with
+the actual cautery. Such practice is too hazardous for general use and
+is not to be recommended, although good results should follow the
+employment of such methods if infectious arthritis does not occur.
+
+Line firing over the distended capsule is a practical method of
+treatment. This is attended with good results in young animals in many
+cases, but considerable blemish is caused when sufficient irritation is
+produced to stimulate resolution.
+
+Vesication also is successfully employed in some instances. However,
+only cases of recent origin in young animals--colts of two years or
+younger--yield to blistering, and in some affected colts no doubt
+recovery would have been spontaneous had no treatment been instituted.
+
+Ligation of the saphenous vein at two points, one above and the other
+below the distended ligamentous capsule, is an old operation, which has
+undoubtedly given good results in some cases, although it does not seem
+to be a rational procedure.
+
+After-Care.--After swelling has fully developed--which occurs within a
+week--the subject is turned to pasture and no attention is necessary
+thereafter. A gradual subsidence of the swelling occurs and in the
+average instance, this completely resolves within six or eight weeks.
+
+Complete recovery succeeds the aspiration-and-injection-treatment in
+about seventy-five per cent of cases as the result of one operation, and
+subjects may be gradually and carefully returned to work in about sixty
+days after treatment has been given.
+
+
+Distension of the Tarsal Sheath of the Deep Digital Flexor.
+(Thoroughpin.)
+
+The terms "thoroughpin" or "throughpin" are translations from the French
+_vessignon chevillé_ and have the same significance. They are so named
+because of the diametrically opposed distensions of the sheath of the
+deep flexor tendon in such manner that the distensions appear to be due
+to a supporting peg.
+
+Anatomy.--The theca through which the deep digital flexor (perforans)
+plays in the tarsal region, begins about three inches above the inner
+tibial malleolus and extends about one-fourth of the way down the
+metatarsus. The posterior part of the capsular ligament of the hock
+joint is very thick in its most dependent portions and is in part
+cartilaginous, forming a suitable groove for the passage of the deep
+flexor tendon.
+
+[Illustration: Fig. 57--Thoroughpin. Showing distension of the sheath of
+the deep flexor tendon as it protrudes antero-externally to the fibular
+tarsal bone (calcaneum).]
+
+Etiology and Occurrence.--Strains and sequellae to debilitating
+diseases constitute the usual causes of this affection. As a result of
+acute synovitis a chronic synovial distension of the tarsal sheath
+occurs. Bog spavin is often present in case of thoroughpin but the two
+conditions are separate and distinct excepting in that both may occur
+simultaneously and as the result of the same cause. Some animals are
+undoubtedly predisposed to disease of synovial structures. The average
+horse that has been subjected to hard service on pavements or hard roads
+at fast work suffers synovial distension of bursae, thecae or of joint
+capsules. Some of the well bred types such as the thoroughbred horses
+may be subjected to years of hard service and still remain "clean
+limbed" and free from all blemishes. Thus it seems that subjects of
+rather faulty conformation, animals having lymphatic temperaments and
+the coarse-bred types, are prone to synovial disturbances such as
+thoroughpin, bog spavin, etc., sometimes having both legs affected.
+
+[Illustration: Fig. 58--Fibrosity of tarsus as a complication in chronic
+thoroughpin.]
+
+Symptomatology.--Thoroughpin is characterized by a distended condition
+of the tarsal sheath which is manifested by protrusions anterior to the
+tendo Achillis. However, where but moderate distension of the sheath
+exists, there is little, if any, bulging on the mesial side of the hock
+and but a small hemispherical enlargement is presented on the outer side
+of the tarsus, anterior to the summit of the os calcis. In some
+instances the protruding parts assume large proportions, but always,
+because of the relationship between the fibular tarsal bone (calcaneum)
+and the tendon sheath, the larger protrusion is situated mesially.
+
+During the acute inflammatory stage there is marked lameness present but
+this soon subsides when local antiphlogistic agents are applied to the
+parts. In fact, spontaneous relief from lameness usually results in the
+course of ten days' time following the appearance of thoroughpin. No
+lameness marks the advent of this affection when it develops as the
+result of continuous strain and concussion occasioned by hard service,
+and local changes tend to remain in _status quo_.
+
+[Illustration: Fig. 59--Another view of same case as illustrated in Fig.
+58.]
+
+Treatment.--Rest and the local application of heat or cold will suffice
+to promote resolution of acute inflammation and lameness when present
+will subside within two weeks. In chronic affections, however, the matter
+and manner of effecting a correction of the condition--distended tarsal
+sheath--merit careful consideration. While drainage of distended thecae
+and bursae by means of openings made with hot irons was practiced by the
+Arabs, centuries ago, and good results have attended such heroic
+corrective measures, nevertheless the occasional serious complications
+which result from infection likely to be introduced in following such
+procedures, cause the prudent and skilful practitioner to employ safer
+methods of treatment.
+
+The application of blistering agents is of no value in stimulating
+resorption of an excessive amount of synovia in chronic cases and the
+actual cautery when employed without perforation of the synovial
+structure, is of little benefit. Trusses or mechanical appliances for
+the purpose of maintaining pressure upon the distended parts are of no
+practical value because of the great difficulty of keeping such
+contrivances in position. They usually cause so much discomfort to the
+subject that they are not tolerated.
+
+A very practical and fairly successful method of treatment consists in
+the aspiration of a quantity of synovia and injecting tincture of iodin.
+Cadiot recommends the drainage of synovia with a suitable trocar and
+cannula and injecting a mixture consisting of tincture of iodin, one
+part, to two parts of sterile water, to which is added a small quantity
+of potassium iodid. The latter agent is added to prevent precipitation
+of the iodin. This authority (Cadiot) further advocates the removal of
+practically all of the synovia that will run out through the cannula and
+the immediate introduction of as much as one hundred cubic centimeters
+of the above mentioned iodin solution. This solution is allowed to
+remain in the synovial cavity a few minutes and by compressing the
+tissues surrounding the tendon sheath, the evacuation of as much of the
+contents of the synovial cavity as is practicable, is effected.
+Subsequently the subject is allowed absolute rest and more or less
+inflammatory reaction follows. In some cases there occur marked lameness
+and some febrile disturbance, but where a good technic is carried out,
+no bad results follow. At the end of four weeks' time, horses so treated
+may be returned to service, but the full beneficial effect of such
+treatment is not experienced until several months' time have elapsed.
+
+Where good facilities for executing a careful technic in every detail
+are at hand, incision of the tarsal sheath, evacuation of its contents
+and uniting its walls again by means of sutures and providing for
+drainage with a suitable drainage tube, may be practiced. This manner of
+treatment has been satisfactory in the hands of a number of surgeons.
+
+
+Capped Hock.
+
+Enlargements which occur upon the summit of the os calcis, whether
+hypertrophy of the skin and subcuticular fascia, the result of injury or
+repeated vesication, distension of the subcutaneous bursa or injury to
+the superficial flexor tendon (perforatus) or its sheath, are generally
+known as capped hock. However, the term should be restricted to use in
+reference to distensions of synovial structures of that region.
+
+Etiology and Occurrence.--Usually there occurs a hygromatous
+involvement of the subcutaneous bursa due to contusion. As in bog
+spavin, following certain infectious diseases (influenza, purpura
+hemorrhagica, etc.) there remains a distended condition of the
+subcutaneous bursa, after swelling of the member has subsided. In
+feeding pens where numbers of young mules are kept in crowded quarters
+many cases may be observed. In some instances where violent contusions
+result from kicking cross-bars of wagon shafts (by nymphomaniacs or in
+habitual kickers where there is opportunity for doing such injury) the
+superficial flexor tendon and its synovial apparatus are injured and a
+more serious condition may result.
+
+Symptomatology.--In acute and extensive inflammation of the parts,
+lameness is present, but in the average case no inconvenience to the
+subject results. The prominent site of the affection is cause for an
+unsightly blemish. This is undesirable, particularly in light-harness or
+saddle horses. These affections are characterized by a fluctuating mass
+which has a thin wall and in all cases of long standing the condition is
+painless.
+
+By careful palpation one may readily distinguish between a hygromatous
+condition of the superficial bursa and involvement of the underlying
+structures. Affection of the expanded portion of the flexor tendon and
+contiguous structures makes for an organized mass of tissue which is
+somewhat dense and in some instances painful to the subject when
+manipulated. This is particularly noticeable in cases where the parts
+are regularly and repeatedly injured as in habitual kickers.
+
+[Illustration: Fig. 60--"Capped hock." Distension of the bursa over the
+summit of the os calcis.]
+
+Treatment.--In acute inflammation, antiphlogistic applications are
+indicated and the subject must be kept quiet. The matter of bandaging
+the hock is a difficult problem in some cases and needs be done with
+care. As has been previously stated in this volume, the tarsus needs to
+be well padded with cotton before the bandages are applied and only a
+moderate degree of tension is employed in applying the bandages lest
+anemic-necrosis result from pressure. In distension of the superficial
+bursa, after clipping the hair over a liberal area and preparing the
+skin by thoroughly cleansing and painting with tincture of iodin, the
+capsule is incised with a bistoury. An incision about an inch in length,
+situated low enough to provide drainage, is made through the tissues and
+the contents are evacuated. Tincture of iodin is injected into the
+cavity and the parts are covered with cotton and bandaged. No after-care
+is necessary except to retain the dressing in position, which is not
+difficult in the average case if the subject is kept tied. If much
+resistance is exhibited, such as extreme flexion of the bandaged hock,
+the animal may be put in a sling and little if any objection to the
+bandage will be offered thereafter. The wound may be dressed at the end
+of forty-eight hours and no redressing will be necessary in the average
+instance if infection is not present. But slight local disturbance and
+little distress to the subject result in cases so treated even when
+infection occurs, but a good technic is possible of execution in most
+instances and no infection should take place.
+
+The surgical wound heals in two or three weeks and inflammation
+gradually subsides. Bandages are retained one or two weeks, as the case
+may require, and subsequently a good wound lotion may be employed
+several times daily. A good lotion for such cases as well as in many
+others has long been employed with success by Dr. A. Trickett of Kansas
+City. It consists of approximately equal parts of glycerin, alcohol and
+distilled extract of witch hazel, to which is added liquor cresolis
+compositus, two percent, and coloring matter q.s.
+
+Complete resolution does not occur in the average case. There remains
+some hyperplastic tissue and even where the enlargement is slight, the
+prominent situation of the affection precludes its being unnoticed.
+
+In disease of the flexor tendon and its bursa where contiguous
+inflammation of tissue is present, the parts are blistered or fired.
+Line firing is beneficial in such instances but in all cases the cause
+is to be removed if possible.
+
+
+Rupture and Division of the Long Digital Extensor
+(Extensor Pedis).
+
+Etiology and Occurrence.--Because of the fact that the long digital
+extensor is the only extensor of the phalanges of the pelvic limb, its
+rupture or division constitutes a troublesome condition, which in some
+cases does not readily respond to treatment.
+
+Rupture of this tendon may occur during work on rough and uneven roads,
+particularly in range horses that are ridden over ground that is
+burrowed by gophers or prairie dogs; in such cases, horses are apt to
+suddenly and violently turn the foot in position of volar flexion,
+thereby causing undue strain to the digital extensor and its rupture
+sometimes follows. In foals of one or two days of age, this tendon is
+sometimes found parted or ruptured and the condition may be bilateral.
+
+As the result of accidents, the digital extensor may be divided and when
+the wound becomes contaminated, as it does because of the marked volar
+flexion (knuckling) which occurs during the course of this affection,
+regeneration of tissue is checked and recovery is tardy.
+
+Symptomatology.--There is no interference with ability to sustain
+weight in such cases, when the foot is placed in normal position; but
+immediately upon attempting to walk, the toe is dragged, and if weight
+is borne with the affected member, it comes upon the anterior face of
+the fetlock. The flexors are not antagonized and if there be an open
+wound the parts soon become contaminated; or, in rupture, if animals
+travel about very much, there soon occurs necrosis of the tissues of the
+anterior fetlock region and the condition is rendered incurable. Cases
+are reported of animals that have suffered rupture of the long digital
+extensor and the subjects learned to throw the member forward during
+extension, substituting for the extensor tendon the pendulum-like
+momentum which the foot affords when so employed; and a walking and even
+a trotting pace was possible without doing injury to the fetlock region.
+
+Where a subcutaneous division exists as in rupture, the divided ends of
+the tendon may be definitely recognized by palpation.
+
+Treatment.--Subjects are best put in slings and kept so confined until
+regeneration of tendinous structures has been completed. This requires
+from six weeks to two months' time. In addition, the extremity is kept
+in a state of extension by means of suitable splints and shoes,--a shoe
+equipped with an extension at the toe and perforated so that a steel
+brace may be hooked into the perforation and the brace fashioned to be
+buckled to the upper metatarsal region. When braces are placed in front
+of the foot, great care is necessary in properly padding the member with
+cotton lest sloughing from pressure occurs at the coronet; but this does
+not apply in rupture of extensors so much as where flexors are ruptured.
+
+Open wounds are treated along general surgical lines, dressed as
+frequently as occasion demands, and recovery will be complete in a few
+months' time unless much of the tendon has been destroyed. In one
+instance, the author had occasion to observe such a condition, which,
+because of the extensive destruction of tendon and lack of facilities
+for giving proper attention to the subject, results were so unfavorable
+that it was deemed necessary to destroy the animal.
+
+
+Wounds From Interfering.
+
+When, during locomotion, injury is inflicted upon the mesial side of an
+extremity by the swinging foot of the other member, the condition is
+termed interfering.
+
+Etiology and Occurrence.--Faulty conformation, bad shoeing and
+over-work are the principal causes of interfering. Horses that are "base
+narrow" or that have crooked legs are quite apt to interfere. Shoes that
+are put on a foot that is not level or applied in a twisted position, or
+shoes wide at the heel will often cause interfering and injury. Animals
+that are driven at fast work until they become nearly exhausted may be
+expected to interfere. Such cases are frequently observed in young
+horses that are driven over rough roads, particularly when so nearly
+exhausted or weakened from disease or inanition that the feet are
+dragged forward rather than picked up and advanced in the normal manner.
+
+Symptomatology.--Wounds inflicted by striking the extremities in this
+manner present various appearances and occasion dissimilar
+manifestations. The hind legs are almost as frequently affected as the
+front and the fetlock region is most often injured, though wounds may be
+inflicted to the coronet. In front, the carpus is sometimes the site of
+injury.
+
+When only an abrasion is caused, little if any lameness occurs, but
+where interfering is continued and nerves are involved or subfascial
+infection and extensive inflammation succeed such abrasions, marked
+lameness and evidence of great pain are manifested. Frequently, in
+chronic cases affecting the hind leg, the fetlock assumes large
+proportions, and at times during the course of every drive the subject
+strikes the inflamed part, immediately flexing and abducting the injured
+member, and the victim hops on the other leg until pain has somewhat
+subsided.
+
+Interfering is much more serious in animals that are used at fast work
+than in draft horses. In light-harness or saddle horses, it may render
+the subject practically valueless or unserviceable if the condition
+cannot be corrected.
+
+Treatment.--Wherever possible, cause is to be removed and if animals
+are properly used, ordinary interfering wounds will yield to treatment.
+If the shoeing is faulty, this should be corrected, the foot properly
+prepared and leveled before being shod and suitable shoes applied. In
+young animals that become "leg-weary" from constant overwork, rest and
+recuperation are necessary to enhance recovery. In such cases it will be
+found that very light shoes, frequently reset, will tend to prevent
+injury to the fetlock region such as characterizes these injuries of
+hind legs.
+
+Palliative measures of various kinds are employed where cause is not to
+be removed and a degree of success attends such effort. In draft horses
+or animals that are used at a slow pace, shields of various kinds are
+strapped to the extremity and protection is thus afforded. Or, large
+encircling pads of leather, variously constructed, serve to cause the
+subject to walk with the extremities apart.
+
+Interfering shoes of different types are of material benefit in many
+instances. Often the principle upon which corrective shoeing is based is
+that the mesial (inner) side of the foot is too low; the foot is
+consequently leveled and the inner branch of the shoe is made thicker
+than the outer, altering the position of the foot in this way. This is
+productive of desirable results. However, much depends upon the manner
+in which the foot in motion strikes the weight-bearing member as to the
+corrective measures that are indicated. This belongs to the domain of
+pathological shoeing and the reader is referred to works on this subject
+for further study of this phase of lameness.
+
+
+Lymphangitis.
+
+Excluding glanders, in the majority of instances, lymphangitis in the
+horse, such as frequently affects the hind legs, is due to the local
+introduction of infectious material into the tissues as a result of
+wounds. However, one may observe in some instances an acute lymphangitis
+which affects the pelvic limbs of horses and no evidence of infection
+exists. Consequently, lymphangitis may be considered as _infectious_ and
+_non-infectious_.
+
+
+INFECTIOUS LYMPHANGITIS.
+
+Etiology and Occurrence.--Traumatisms of the legs frequently result in
+infection and when such injuries are near lymph glands, even though the
+degree of infection be slight, more or less disturbance of function of
+the muscles in the vicinity of such glands occurs and lameness follows.
+
+The prescapular, axillary and cubital lymph glands when in a state of
+inflammation, cause lameness of the front leg, and the superficial
+inguinal and deep inguinal lymph glands not infrequently become involved
+also. Because of the location of these lymph glands, they are subject to
+comparatively frequent injury and inflammation, causing lameness more
+often than other lymph-gland-affections.
+
+Small puncture wounds in the region of the elbow are often met with.
+These may be inflicted when horses lie down upon sharp stumps of
+vegetation or shoe-calk injuries may be the means of introducing
+contagium, and an infectious inflammation results. Abscess formation,
+the result of strangles or other infection in the prescapular glands,
+may be observed at times. Following castration, the inguinal lymph
+glands may become involved in an infectious inflammation and locomotion
+is impeded to a marked degree. Horses running at pasture sometimes
+become injured by trampling upon pieces of wood, causing one end of
+these or of various implements to become embedded in the soft earth and
+the other end to enter at the inguinal region and even penetrate the
+tissues to and through the skin and fascia just below the perineal
+region.
+
+Nail punctures resulting in infection frequently cause an infectious
+lymphangitis and a marked and painful swelling of the legs supervenes.
+
+[Illustration: Fig. 61--Chronic lymphangitis. Showing hypertrophy of the
+left hind leg, due to repeated inflammation.]
+
+Symptomatology.--Lameness, mixed or swinging-leg, signalizes the
+presence of acute lymphangitis. There is always more or less swelling
+present and manipulation of the affected parts gives pain to the
+subject. Depending upon the character of the infection and its extent,
+there is presented a varying degree of constitutional disturbance. There
+may be a rise in temperature of from two to five degrees, and in such
+instances there is an accelerated pulse. Where much intoxication is
+present, anorexia and dipsosis are to be noticed.
+
+Swelling may increase gradually and in time discharge of pus may take
+place spontaneously without drainage being provided for, if the
+character of the infection does not cause early death. In these cases
+lameness is pronounced and the cause of the disturbance is to be sought,
+particularly if the condition be due to a nail puncture.
+
+[Illustration: Fig. 62--Elephantiasis.]
+
+Treatment.--Location of the site of injury is advisable in all cases
+and in some instances provision for drainage, as in puncture wounds, is
+helpful. Locally, curettage and the application of suitable antiseptics
+are indicated. Hot fomentations are beneficial and should be continued
+for several days if necessary, to stimulate resolution. A brisk purge
+should be admintered at the onset and strychnin, because of its indirect
+stimulative effect upon the circulation together with its tonic effect
+upon the musculature, is beneficial.
+
+In all such cases rational treatment, good hygiene and careful nursing
+are the principal factors which stimulate recovery. Individual
+resistance or lowered vitality has a marked influence on the course of
+this affection.
+
+
+NON-INFECTIOUS LYMPHANGITIS.
+
+This type of lymphangitis is associated with, or the result of, a
+derangement of digestion. It affects heavy draft horses, rarely other
+types of animals, and involves one or both hind legs.
+
+Occurrence.--In healthy and well nourished horses irregularly used,
+this affection may suddenly manifest itself. It occurs in singular
+instances in mares that are in advanced pregnancy even when such animals
+are at pasture. Usually, however, this malady is found in heavy draft
+horses that have been kept stabled from one to three days.
+
+Symptomatology.--At the outset in severe cases, there is elevation of
+temperature, labored breathing, accelerated pulse, anorexia and more or
+less swelling of the affected members. Swelling is very painful and when
+the affected legs are palpated, pain is manifested by flinching. The
+inguinal lymph glands are often swollen but in some cases they are not
+affected in any perceptible degree. In the average case suppuration does
+not occur and when conditions are favorable, resolution is complete
+within ten days. The extent of the involvement and the intensity of the
+affection vary materially in different cases and a chronic lymphangitis
+may succeed the acute attacks and finally in some instances,
+elephantiasis results.
+
+Treatment.--An active purgative should be given at once and in the
+ordinary case, stimulants are indicated. If marked distress is present,
+morphin is given and where there is much rise of temperature, cold
+drinking water is offered in abundance and catharsis is enhanced by
+enemata. Locally, hot applications are of benefit. Hot towels or cotton
+held in position by bandages and kept soaked with warm water will
+relieve pain and stimulate resolution. Diuretics may be of benefit and
+anodyne applications are to be employed with profit in some cases.
+Walking exercise, if not indulged in to excess, is helpful as soon as
+acute inflammation has subsided. By giving careful attention to the
+regimen and providing regular exercise for susceptible subjects, this
+type of lymphangitis is often forestalled.
+
+FOOTNOTES:
+
+[Footnote 34: Manual of Veterinary Physiology. Page 610.]
+
+[Footnote 35: Manual of Veterinary Physiology, page 601.]
+
+[Footnote 36: Case report at meeting of the Iowa State Veterinary
+Medical Association, Jan., 1904, by Dr. S.H. Bauman, Birmingham, Ia.]
+
+[Footnote 37: Regional Veterinary Surgery and Operative Technique, by
+John A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 733.]
+
+[Footnote 38: As quoted by A. Liautard, M.D., V.M., American Veterinary
+Review, Vol. 37, page 667.]
+
+[Footnote 39: Quoted by Prof. Liautard, American Veterinary Review, Vol.
+33, page 190.]
+
+[Footnote 40: Traite de Thérapeutique Chirurgical des Animaux Domestique
+par P.J. Cadiot et J. Almy, Tome second, page 460.]
+
+[Footnote 41: Traite de Thérapeutique Chirurgical, Tome second, page
+465.]
+
+[Footnote 42: Luxation of the Femur, by Wm. V. Lusk, Veterinary Surgeon,
+U.S. Cavalry, American Veterinary Review, Vol. 21, page 254.]
+
+[Footnote 43: Because of the intimacy of the psoas major (p. magnus) and
+the iliacus they are sometimes called iliopsoas.]
+
+[Footnote 44: Dr. John Scott, Peoria, Ill., in The American Veterinary
+Review, Vol. 16, page 16.]
+
+[Footnote 45: Annotation on Surgical Items, by Drs. L.A. and Edward
+Merillat, American Veterinary Review, Vol. 31, page 358.]
+
+[Footnote 46: W.L. Williams in American Veterinary Review, Vol. 21, page
+452.]
+
+[Footnote 47: Geo. H. Berns, D.V.S., report, American Veterinary Medical
+Association, 1912, page 238.]
+
+[Footnote 48: Joseph Hughes, M.R.C.V.S., in the Chicago Veterinary
+College Quarterly Bulletin, Vol. 10, page 15.]
+
+[Footnote 49: Traite de Therap. Chir. Cadiot et Almy, Tome second, page
+480.]
+
+[Footnote 50: E. Wallis Hoare, F.R.C.V.S., American Veterinary Review,
+Vol. 27, page 1189.]
+
+[Footnote 51: Discussions on paper entitled "The Spavin Group of
+Lamenesses," by W.L. Williams, Carl W. Fisher and D.H. Udall,
+Proceedings of American Veterinary Medical Association, 1905.]
+
+[Footnote 52: "Hock-Joint Lameness," by Dr. James McDonough, Proceedings
+of the A.V.M.A., 1913, page 545.]
+
+
+
+
+INDEX
+
+
+A
+
+Acetabulum, 185
+
+Acute arthritis, 65
+
+Acute laminitis, 162
+
+Acute tendinitis, 135
+
+Affections of blood vessels, 31
+
+Affections of bursae and thecae, 27
+
+Affections of the feet, 34
+
+Affections of ligaments, 20
+
+Affections of lymph vessels and glands, 32
+
+Affections of muscles and tendons, 28
+
+Affections of nerves, 30
+
+Anamnesis, 38
+
+Anatomo-physiological review of parts of fore leg, 55
+
+Anatomo-physiological consideration of the pelvic limbs, 185
+
+Anatomy of the joint capsule, 220
+
+Annular ligament, 58
+
+Antea-spinatus muscle, 65
+
+Anterior brachial region, wounds of, 90
+
+Anterior digital extensor muscle, 193
+
+Arteritis, 209
+
+Artery (brachial), thrombosis of the, 81
+
+Arthritis, 22, 84
+
+Arthritis, acute, 65
+
+Arthritis, chronic, 65
+
+Arthritis, infectious, 66
+
+Arthritis, metastatic, 25
+
+Arthritis of the fetlock joint, 152
+
+Arthritis, rheumatic, 26
+
+Arthritis, scapulohumeral, 65
+
+Arthritis, tarsal, 225
+
+Arthritis, traumatic, 22
+
+Articular ringbone, 121
+
+Articulation, femeropelvic, 185
+
+Articulation, metacarpophalangeal, 58
+
+Articulation, scapulohumeral, 55
+
+Aspiration-and-injection treatment of bog spavin, 244
+
+Aspiration-and-injection treatment of capped hock, 252
+
+Aspiration-and-injection treatment of thoroughpin, 250
+
+Astragalus, 190
+
+Astragalus, fracture of the, 230
+
+Attitude of the subject, 41
+
+Atrophy of the quadriceps muscles, 205
+
+Atrophy, shoulder, 73
+
+
+B
+
+Biceps brachii, 58, 65, 68, 69
+
+Bicipital bursa, inflammation of, 68
+
+Blood vessels, affections of, 31
+
+Bog spavin, 242
+
+Bog spavin, aspiration-and-injection treatment of, 244
+
+Bog spavin, line firing for, 246
+
+Bog spavin, vesication for, 246
+
+Bone spavin, 235
+
+Bones, degenerative changes in, 16
+
+Bones, tarsal, 190
+
+Bossi's double tarsal neurectomy, 242
+
+Brachial artery, thrombosis of the, 81
+
+Brachial paralysis, 77
+
+Bursa intertubercularis, 62, 69
+
+Bursa podotrochlearis, inflammation of the, 157
+
+Bursae, affections of, 27
+
+Bursitis, 27, 104
+
+Bursitis, infectious, 28
+
+Bursitis in the fetlock region, 150
+
+Bursitis intertubercularis, 68
+
+Bursitis, noninfectious, 28
+
+
+C
+
+Calcaneo-cuboid ligaments, 190
+
+Calcaneo-metatarsal ligaments, 190
+
+Calcaneum, fracture of the, 230
+
+Calk wounds, 170
+
+Capped hock, 251
+
+Capped hock, aspiration-and-injection treatment of, 252
+
+Capsular ligament, 190
+
+Caput muscles, 71
+
+Carpal bones, fracture of the, 96
+
+Carpal bones, luxation of the, 96
+
+Carpal flexors, contraction of the, 93
+
+Carpal flexors, inflammation of the, 93
+
+Carpal joint, 58
+
+Carpal joint, open, 100
+
+Carpitis, 98
+
+Carpus, inflammation of the, 98
+
+Cartilage, lateral, inflammation of, 174
+
+Cartilages of the third phalanx, ossification of the, 155
+
+Chronic arthritis, 65
+
+Chronic gonitis, 217
+
+Chronic laminitis, 164
+
+Chronic tendinitis, 137
+
+Cochran shoe for dropped soles, 169
+
+Collateral ligaments, 190
+
+Comminuted fractures, 17
+
+Compound fractures, 17
+
+Contracted tendons of foals, 143
+
+Contraction of the carpal flexors, 93
+
+Contraction of the flexor tendons, 137
+
+Contusions of the triceps brachii, 71
+
+Contusive wounds, 85
+
+Coracoradialis, 58
+
+Corns, 172
+
+Coronary region, wounds of the, 170
+
+Corpora oryzoidea, 218
+
+Cotyloid ligament, 185
+
+Courbe, 233
+
+Crepitation, false, 48
+
+Crepitation, true, 47
+
+Crucial ligaments, 188
+
+Crural nerve, paralysis of the, 204
+
+Cunean bursa, 237
+
+Cunean tenotomy, 242
+
+Cuneiform magnum, 191
+
+Cuneiform medium, 191
+
+Curb, 233
+
+
+D
+
+Deep digital flexor, distension of the tarsal sheath of, 246
+
+Deep flexor tendon (perforans), 60
+
+Degenerative changes in bones, 16
+
+Diagnosis by exclusion, 53
+
+Diagnosis by use of the X-ray, 179
+
+Diagnostic principles, 37
+
+Disease, navicular, 157
+
+Dislocations, 21
+
+Distension of the tarsal joint capsule, 242
+
+Distension of the tarsal sheath of the deep digital flexor, 246
+
+Division of long digital extensor, 253
+
+Dorsal ligaments, 190
+
+Dropped elbow, 71, 80
+
+Dropped soles, shoe for, 169
+
+Dropped stifle, 205
+
+Dry spavin, 225
+
+
+E
+
+Elbow, dropped, 71, 80
+
+Elbow, inflammation of the, 84
+
+Elbow joint, 58
+
+Elephantiasis, 34
+
+Etiology, general discussion of, 15
+
+Examination by palpation, 43
+
+Examination, special methods of, 53
+
+Examination, visual, 39
+
+Exclusion, diagnosis by, 53
+
+Exostosis of splint bones, 107
+
+Exostosis, phalangeal, 118
+
+Extensor (long digital) rupture and division of, 253
+
+Extensor of the digit, rupture of, 145
+
+Extensor pedis, 60
+
+Extensor pedis, rupture of, 145
+
+Extensor pedis, rupture and division of, 253
+
+
+F
+
+False crepitation, 48
+
+Feet, affection of the, 34
+
+Femoral nerve, paralysis of the, 204
+
+Femeropatella ligaments, 188
+
+Femeropelvic articulation, 185
+
+Femur, 185, 192
+
+Femur, fracture of the, 199
+
+Femur, luxation of the, 201
+
+Fetlock joint, 58
+
+Fetlock joint, arthritis of the, 152
+
+Fetlock joint, luxation of the, 125
+
+Fetlock joint, open, 110
+
+Fetlock region, thecitis and bursitis in, 148
+
+Fetlock, shoe for bracing the, 181
+
+Fibular tarsal bone, fracture of the, 230
+
+Firing, treatment of ringbone by, 123
+
+First phalanx, 59
+
+"Fish knees", 145
+
+Fixed luxations, 21
+
+Fixed patellar disarticulation, 213
+
+Flexor brachii, 58, 68, 69
+
+Flexor carpiradialis, 93
+
+Flexor carpiulnaris, 93
+
+Flexor metacarpi externus, 94
+
+Flexor metacarpi internus, 93
+
+Flexor metacarpi medius, 93
+
+Flexor metatarsi, 193
+
+Flexor, superficial digital, 194
+
+Flexor tendons, contraction of the, 137
+
+Flexor tendons, inflammation of the, 135
+
+Flexor tendons, rupture of, 146
+
+Flexors of phalanges, open sheath of, 124
+
+Foals, contracted tendons of, 143
+
+Forearm, wounds of, 90
+
+Fore leg, lameness in the, 55
+
+Fracture of the carpal bones, 96
+
+Fracture of the femur, 199
+
+Fracture of the fibular tarsal bone, 230
+
+Fracture of first and second phalanges, 131
+
+Fracture of humerus, 82
+
+Fracture of the ilium, 198
+
+Fracture of the ischial tuberosity, 199
+
+Fracture of the metacarpus, 106
+
+Fracture of the patella, 212
+
+Fractures of the pelvic bones, 196
+
+Fracture of the proximal sesamoids, 128
+
+Fracture of the pubis, 197
+
+Fracture of the radius, 87
+
+Fracture of the scapula, 62
+
+Fracture of the tibia, 222
+
+Fracture of the tibial tarsal bone, 230
+
+Fracture of the ulna, 86
+
+Fractures, 16
+
+Fractures, comminuted, 17
+
+Fractures, compound, 17
+
+Fractures, green stick, 18
+
+Fractures, impacted, 19
+
+Fractures, longitudinal, 18
+
+Fractures, multiple, 18
+
+Fractures, multiple longitudinal, 19
+
+Fractures, oblique, 18
+
+Fractures, simple, 17
+
+Fractures, simple transverse, 18
+
+Fractures, transverse, 18
+
+Fragilitas, 199
+
+Fragilitas osseum, 128
+
+
+G
+
+Gait, observing character of, 48
+
+Gastrocnemius, 194
+
+Gluteal tendo-synovitis, 203
+
+Gluteus medius muscle, 192, 203
+
+Gonitis, chronic, 217
+
+Green stick fractures, 18
+
+
+H
+
+Hind leg, lameness in the, 185
+
+Hind leg, paralysis of the, 204
+
+Hip lameness, 195
+
+Hip swinney, 205
+
+Hock, capped, 251
+
+Hock joint, 188
+
+Hoof testers, 53
+
+Humeroradioulnar joint, 58
+
+Humerus, fracture of, 82
+
+
+I
+
+Iliac thrombosis, 209
+
+Iliopsoas, 204
+
+Ilium, fracture of the, 198
+
+Impacted fractures, 19
+
+Infectious arthritis, 66
+
+Infectious bursitis, 28
+
+Infectious inflammation of the lateral cartilage, 173
+
+Infectious lymphangitis, 257
+
+Infectious synovitis, 124
+
+Inflammation of the bicipital bursa, 68
+
+Inflammation of the bursa podotrochlearis, 157
+
+Inflammation of the carpal flexors, 93
+
+Inflammation of the carpus, 98
+
+Inflammation of the elbow, 84
+
+Inflammation of the flexor tendons, 135
+
+Inflammation of posterior ligaments of pastern, 129
+
+Inflammation of proximal sesamoid bones, 127
+
+Inflammation of third sesamoid and deep flexor tendon, 157
+
+Inflammation of the trochanteric bursa, 204
+
+Infraspinatus muscle, 65
+
+Injection of fluids for quittor, 177
+
+Injuries to scapulohumeral joint, 66
+
+Interfering, shoeing for, 256
+
+Interfering, wounds from, 255
+
+Ischial tuberosity, fracture of the, 199
+
+
+J
+
+Joint capsule, anatomy of the, 220
+
+Joint, carpal, 58
+
+Joint, elbow, 58
+
+Joint, fetlock, 58
+
+Joint capsule, tarsal, distension of the, 242
+
+Joint, fetlock, arthritis of the, 152
+
+Joint, fetlock, luxation of, 125
+
+Joint, hock, 188
+
+Joint, humeroradioulnar, 58
+
+Joint, open, 67
+
+Joint, open carpal, 100
+
+Joint, open fetlock, 110
+
+Joint, pastern proximal interphalangeal, 129
+
+Joint, shoulder, 55
+
+Joint, stifle, open, 220
+
+Joint, tarsal, open, 229
+
+
+L
+
+Lameness, hip, 195
+
+Lameness, mixed, 49
+
+Lameness in the fore leg, 55
+
+Lameness in the hind leg, 185
+
+Lameness, shoulder, 61
+
+Lameness, supporting-leg, 49
+
+Lameness, swinging-leg, 49
+
+Laminitis, 160
+
+Laminitis, acute, 162
+
+Laminitis, chronic, 164
+
+Lateral cartilage, infectious inflammation of the, 174
+
+Lateral cartilages, ossification of, 155
+
+Ligaments, affections of, 20
+
+Ligament, capsular, 190
+
+Ligaments, collateral, 190
+
+Ligament, cotyloid, 185
+
+Ligaments, crucial, 188
+
+Ligaments, dorsal, 190
+
+Ligaments, femeropatella, 188
+
+Ligament, medial, 190
+
+Ligaments, mesial tarsal, sprains of the, 232
+
+Ligaments of pastern proximal interphalangeal joint, inflammation of, 129
+
+Ligaments, patellar, 188
+
+Ligaments, plantar, 190
+
+Ligament, pubiofemoral, 185
+
+Ligament, superior check, 58
+
+Ligament, suspensory, rupture of, 146
+
+Ligaments, volar, 129
+
+Ligament, volar-carpal or annular, 58
+
+Ligation of the saphenous vein, 246
+
+Line firing for bog spavin, 246
+
+Longitudinal fractures, 18
+
+Lumbosacral plexus, 204
+
+Luxation of the carpal bones, 96
+
+Luxation of the femur, 201
+
+Luxation of fetlock joint, 125
+
+Luxation of the patella, 213
+
+Luxation of the patella, outward, 215
+
+Luxation of the patella, upward, 214
+
+Luxation of scapulohumeral joint, 67
+
+Luxations, 21
+
+Luxations, fixed, 21
+
+Luxations, temporary, 21
+
+Lymph vessels and glands, affections of, 32
+
+Lymphangitis, 32
+
+Lymphangitis, infectious, 257
+
+Lymphangitis, non-infectious, 260
+
+
+M
+
+Medial ligament, 190
+
+Median neurectomy, 124
+
+Mesial tarsal ligaments, sprains of the, 232
+
+Metacarpophalangeal articulation, 58
+
+Metacarpus, fracture of the, 106
+
+Metastatic arthritis, 25
+
+Mixed lameness, 49
+
+Momentary patellar disarticulation, 213
+
+Movements, passive, 47
+
+Multiple fractures, 18
+
+Multiple longitudinal fractures, 19
+
+Muscles, affections of, 28
+
+Muscle, antea-spinatus, 65
+
+Muscle, anterior digital extensor, 193
+
+Muscle, biceps brachii, 58
+
+Muscle, caput, 71
+
+Muscle, gluteus medium, 192, 203
+
+Muscle, infraspinatus, 65
+
+Muscle, peroneus tertius, 193
+
+Muscle, postea-spinatus, 65
+
+Muscles, quadriceps, 193
+
+Muscles, quadriceps, atrophy of the, 205
+
+Muscle, subscapularis, 65
+
+Muscle, supraspinatus, 65
+
+Muscle, tibialis anticus, 193
+
+Muscle, triceps brachii, 58
+
+Myalgia, 195
+
+
+N
+
+Nail punctures, 178
+
+Navicular disease, 157
+
+Nerves, affections of, 30
+
+Nerve, femoral, paralysis of the, 204
+
+Nerve, obturator, paralysis of the, 206
+
+Nerve, sciatic, paralysis of the, 208
+
+Nerve, (suprascapular) paralysis of the, 75
+
+Non-infectious lymphangitis, 260
+
+Non-infectious bursitis, 28
+
+Neurectomy, Bossi's double tarsal, 242
+
+Neurectomy, median, 124
+
+Neurectomy, plantar, 124
+
+
+O
+
+Oblique fractures, 18
+
+Observing character of gait, 48
+
+Obturator nerve, paralysis of the, 206
+
+Occurrence, general discussion of, 15
+
+Omphalophlebitis, 25
+
+Open carpal joint, 100
+
+Open fetlock joint, 110
+
+Open joint, 67
+
+Open sheath of flexors of phalanges, 124
+
+Open stifle joint, 220
+
+Open tarsal joint, 229
+
+Os corona, 60
+
+Ossification of cartilages of the third phalanx, 155
+
+Ossification of the lateral cartilages, 155
+
+Os innominatum, 196
+
+Os suffraginis, 59
+
+Osteitis, rarefying, 16
+
+Outward luxation of the patella, 215
+
+
+P
+
+Palpation, examination by, 43
+
+Paralysis, brachial, 77
+
+Paralysis of the femoral nerve, 204
+
+Paralysis of the hind leg, 204
+
+Paralysis of the obturator nerve, 206
+
+Paralysis of the sciatic nerve, 208
+
+Paralysis of the suprascapular nerve, 75
+
+Paralysis, radial, 77
+
+Paronychia, 170
+
+Passive movements, 47
+
+Pastern proximal interphalangeal joint, inflammation of ligaments of, 129
+
+Patella, 188
+
+Patella, fracture of the, 212
+
+Patella, luxation of the, 213
+
+Patella, outward luxation of the, 215
+
+Patella, upward luxation of the, 214
+
+Patellar disarticulation, fixed, 213
+
+Patellar disarticulation, momentary, 213
+
+Patellar ligaments, 188
+
+Pelvic bones, fractures of the, 196
+
+Pelvic limbs, anatomo-physiological consideration of the, 185
+
+Penetrative wounds, 85
+
+Periarticular ringbone, 122
+
+Peroneus tertius muscle, 193
+
+Phalangeal exostosis, 118
+
+Phalanges, fracture of first and second, 131
+
+Phalanges, open sheath of flexors of, 124
+
+Phalanx, first, 59
+
+Phalanx, second, 60
+
+Phalanx, third, ossification of cartilages of, 155
+
+Plantar ligaments, 190
+
+Plantar neurectomy, 124
+
+Polyarthritis, 25
+
+Postea-spinatus muscle, 65
+
+Principles, diagnostic, 37
+
+Proximal sesamoid bones, inflammation of, 127
+
+Proximal sesamoids, fracture of, 128
+
+Pubiofemoral ligament, 185
+
+Pubis, fracture of the, 197
+
+Punctures, nail, 178
+
+
+Q
+
+Quadriceps muscles, 193
+
+Quadriceps muscles, atrophy of the, 205
+
+Quittor, 174
+
+Quittor, injection of fluids for, 177
+
+
+R
+
+Rachitic ringbone, 122
+
+Radial paralysis, 77
+
+Radius, fracture of the, 87
+
+Rarefying osteitis, 16
+
+Rheumatic arthritis, 26
+
+Rheumatism, 196
+
+Ringbone, 118
+
+Ringbone, articular, 121
+
+Ringbone, periarticular, 122
+
+Ringbone, rachitic, 122
+
+Ringbone, traumatic, 122
+
+Ringbone treated by firing, 123
+
+Roberts shoe for bracing the fetlock, 181
+
+Rupture of the extensor pedis, 145
+
+Rupture of flexor tendons and suspensory ligament, 146
+
+Rupture of long digital extensor, 253
+
+Rupture of the tendo archillis, 224
+
+
+S
+
+Saphenous vein, ligation of the, 246
+
+Scapula, fracture of the, 62
+
+Scapulohumeral articulation, 55
+
+Scapulohumeral joint, injuries to, 66
+
+Scapulohumeral joint, luxation of, 67
+
+Scapulohumeral joint, wounds of, 67
+
+Scapulohumeral arthritis, 65
+
+Sciatica, 208
+
+Sciatic nerve, paralysis of the, 208
+
+Second phalanx, 60
+
+Sesamoid bones, 59
+
+Sesamoid, third, inflammation of the, 157
+
+Sesamoids, proximal, fracture of, 128
+
+Sesamoiditis, 127
+
+Setons, 75
+
+Sheath of flexors of phalanges, open, 124
+
+Sheath (tarsal) of the deep digital flexor, distension of the, 246
+
+Shoe for dropped soles, 169
+
+Shoeing for interfering, 256
+
+Shoulder atrophy, 73
+
+Shoulder joint, 55
+
+Shoulder lameness, 61
+
+Simple fractures, 17
+
+Simple transverse fractures, 18
+
+Soles, dropped, shoe for, 169
+
+Spavin, bog, 242
+
+Spavin, bone, 235
+
+Spavin, dry, 225
+
+Spavin test, 239
+
+Special methods of examination, 53
+
+Sprains of the mesial tarsal ligaments, 232
+
+Sprains, tarsal, 232
+
+Splints, 107
+
+Spring-halt, 225
+
+Stifle, dropped, 205
+
+Stifle joint, open, 220
+
+Strangles, 25
+
+Streptococcus equi, 25
+
+String-halt, 225
+
+Subject, attitude of the, 41
+
+Subscapularis muscle, 65
+
+Supporting-leg-lameness, 49
+
+Suprascapular nerve, paralysis of the, 75
+
+Supraspinatus muscle, 65
+
+Superficial digital flexor, 194
+
+Superior check ligament, 58
+
+Suspensory ligament, rupture of, 146
+
+Sweeny, 73
+
+Swinging-leg-lameness, 49
+
+Swinney, 73
+
+Swinney, hip, 205
+
+Synovial distension of tendon sheaths, 104
+
+Synovitis, 25
+
+Synovitis, infectious, 124
+
+
+T
+
+Tarsal arthritis, 225
+
+Tarsal bones, 190
+
+Tarsal joint capsule, distension of the, 242
+
+Tarsal joint, open, 229
+
+Tarsal sheath of the deep digital flexor, distension of the, 246
+
+Tarsal sprains, 232
+
+Tarsus, 192
+
+Temporary luxations, 21
+
+Tendinitis, 135
+
+Tendinitis, acute, 135
+
+Tendinitis, chronic, 137
+
+Tendo achillis, rupture and wounds of the, 224
+
+Tendon, deep flexor, inflammation of the, 157
+
+Tendon, deep flexor (perforans), 60
+
+Tendon, extensor, rupture of, 145
+
+Tendon, flexor, rupture of, 146
+
+Tendons of foals, contracted, 143
+
+Tendon sheaths, synovial distension of, 104
+
+Tendons, affections of, 28
+
+Tendons, flexor, contraction of the, 137
+
+Tendons, flexor, inflammation of the, 135
+
+Tendo-synovitis, gluteal, 203
+
+Tenotomy, cunean, 242
+
+Tensor fascia lata, 192
+
+Test, spavin, 239
+
+Testers, hoof, 53
+
+Thecae, affections of, 27
+
+Thecitis, 27, 104
+
+Thecitis in the fetlock region, 150
+
+Thoroughpin, 246
+
+Thoroughpin, aspiration-and-injection treatment of, 250
+
+Thrombosis, iliac, 209
+
+Thrombosis of the brachial artery, 81
+
+Tibia, 188
+
+Tibia, fracture of the, 222
+
+Tibial tarsal bone, fracture of the, 230
+
+Tibialis anticus muscle, 193
+
+Tibioastragular joint, distension of the, 242
+
+Transverse fractures, 18
+
+Traumatic arthritis, 22
+
+Traumatic ringbone, 122
+
+Treatment of bog spavin by aspiration and injection, 244
+
+Treatment of capped hock by aspiration and injection, 252
+
+Treatment of ringbone by firing, 123
+
+Treatment of thoroughpin by aspiration and injection, 250
+
+Triceps brachii, 58
+
+Triceps brachii, contusions of, 71
+
+Triceps extensor brachii, 71
+
+Trochanteric bursa, inflammation of the, 204
+
+True crepitation, 47
+
+
+U
+
+Ulna, fracture of the, 86
+
+Ulnaris lateralis, 94
+
+Upward luxation of the patella, 214
+
+
+V
+
+Vein, saphenous, ligation of the, 246
+
+Vesication for bog spavin, 246
+
+Vessignon chevillé, 246
+
+Visual examination, 39
+
+Volar-carpal ligament, 58
+
+Volar ligaments, 129
+
+
+W
+
+Wounds, calk, 170
+
+Wounds, contusive, 85
+
+Wounds from interfering, 255
+
+Wounds of anterior brachial region, 90
+
+Wounds of coronary region, 170
+
+Wounds of scapulohumeral joint, 67
+
+Wounds of tendo achillis, 224
+
+Wounds, penetrative, 85
+
+
+X
+
+X-ray diagnosis, 179
+
+
+
+
+
+AUTHORITIES CITED
+
+
+Almy, J., 141, 200, 202, 208, 212, 216, 214, 233
+
+Bassi, 215
+Bauman, S.H., 197
+Bell, Roscoe R., 69
+Benard, 216
+Berns, Geo. H., 77, 218
+Bouley, 225
+Bourdelle, 147
+
+Cadiot, P.J., 78, 141, 200, 202, 208, 212, 214, 216, 223, 225, 233, 245,
+    250
+Campbell, D.M., 162, 166, 167
+Castagné, 84
+Cochran, David W., 169, 170
+
+Diekerhoff, 237
+Dollar, Jno. A.W., 68, 198
+
+Eberlein, 237
+
+Fisher, Carl W., 236
+Frost, J.N., 113
+Frost, R.F., 128
+
+Greaves, Thomas, 157
+
+Hoare, E. Wallis, 25, 211, 230
+Hughes, Joseph, 176, 221
+Hutyra and Marek, 205
+
+Law, James, 33
+Leblanc, 223
+Liautard, A., 84, 199, 238
+Lusk, Wm. V., 203
+
+McDonough, James, 237
+Merillat, Edward, 210
+Merillat, L.A., 80, 96, 175, 210
+Millar, Thomas, 145
+Möller, H., 119, 156, 211, 222
+Montane, 147
+Moore, R.C., 162
+
+Roberts, G.H., 181
+
+Schumacher, 215
+Scott, John, 208
+Seeley, J.T., 176
+Sisson, Septimus, 129, 204, 220
+Smith, F., Major General, 56, 60, 155, 188, 194
+Strangeways, 193
+
+Taylor, Henry, 71
+Thompson, H., 83, 87
+Trickett, A., 253
+
+Udall, D.H., 236
+Uhlrich, 224
+
+Walters, Wilfred, 83, 97
+Williams, W.L., 217, 236
+
+
+Transcriber's notes:
+
+   Accented words: The following spelling differences have been
+   maintained:
+
+      Moller / Möller
+      Montane / Montané
+      Traite / Traité.
+
+   Hyphenation: The following hyphenation differences have been
+   maintained:
+
+      bilateral / bi-lateral
+      calcaneocuboid / calcaneo-cuboid
+      calcaneometatarsal / calcaneo-metatarsal
+      counterirritation / counter-irritation
+      counterirritating / counter-irritating
+      foreleg / fore-leg
+      interphalangeal / inter-phalangeal
+      noninfectious / non-infectious
+      nonsensitive / non-sensitive
+      overwork / over-work
+      posteaspinatus / postea-spinatus
+      ringbone / ring-bone
+      subacute / sub-acute
+      subcoronary / sub-coronary
+      subfascial / sub-fascial
+      subperiosteal / sub-periosteal
+
+   Typographical errors:
+
+      sub-facial         for  sub-fascial
+      "At two-year-old"  for  "A two-year-old"
+      Ameircan           for  American
+      Symtomatology      for  Symptomatology
+      extoses            for  exostoses
+      admintered         for  administered
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK LAMENESS OF THE HORSE***
+
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diff --git a/16370-8.zip b/16370-8.zip
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+<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1" />
+<title>The Project Gutenberg eBook of Lameness of the Horse, by John Victor Lacroix</title>
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+<h1>The Project Gutenberg eBook, Lameness of the Horse, by John Victor Lacroix</h1>
+<pre>
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at <a href = "https://www.gutenberg.org">www.gutenberg.org</a></pre>
+<p>Title: Lameness of the Horse</p>
+<p>       Veterinary Practitioners' Series, No. 1</p>
+<p>Author: John Victor Lacroix</p>
+<p>Release Date: July 27, 2005  [eBook #16370]</p>
+<p>Language: English</p>
+<p>Character set encoding: ISO-8859-1</p>
+<p>***START OF THE PROJECT GUTENBERG EBOOK LAMENESS OF THE HORSE***</p>
+<p>&nbsp;</p>
+<h3>E-text prepared by Juliet Sutherland, Julia Miller,<br />
+    and the Project Gutenberg Online Distributed Proofreading Team<br />
+    (https://www.pgdp.net)</h3>
+<p>&nbsp;</p>
+<table border="0" cellpadding="10">
+<tr>
+<td valign="top">Transcriber's Notes:</td>
+<td>The original text was inconsistent in the use of accents and
+hyphenation. These variants and a small number of typographical errors
+were maintained in this transcription. A complete list of the variant
+spellings is found at the end of the book along with the list of
+typographical errors.<br />
+<br />
+The Table of Contents lists the Authorities Cited section as preceding
+the Index but it was printed following the Index. This order has been
+maintained in this transcription and the links from the Table of Contents
+go to the appropriate section rather than the page number.</td>
+</tr>
+</table>
+<p>&nbsp;</p>
+<hr class="full" />
+<p>&nbsp;</p>
+
+
+<h3><a name="Page_-1" id="Page_-1"></a>VETERINARY PRACTITIONERS' SERIES<br />
+NO. 1</h3>
+
+
+<hr style='width: 45%;' />
+
+<h1>LAMENESS of the HORSE</h1>
+
+<h3>BY</h3>
+
+<h2>J.V. Lacroix, D.V.S.</h2>
+
+<p class="center">Professor of Surgery, The Kansas City Veterinary College<br />
+Author of "Animal Castration"</p>
+
+<hr class="tptop" />
+<p class="center">Illustrated</p>
+<hr class="tpbot" />
+
+<p class="center">Chicago</p>
+
+<p class="center">AMERICAN JOURNAL OF VETERINARY MEDICINE</p>
+
+<p class="center">1916</p>
+
+<hr style="width: 65%;" />
+<h2><a name="Page_1" id="Page_1"></a><a name="PREFACE" id="PREFACE"></a>PREFACE</h2>
+
+
+<p>All that can be known on the subject of lameness, is founded on a
+knowledge of anatomy and of the physiology of locomotion. Without such
+knowledge, no one can master the principles of the diagnosis of
+lameness. However, it must be assumed that the readers are informed on
+these subjects, as it is impossible to include this fundamental
+instruction in a work so brief as this one.</p>
+
+<p>The technic of certain operative or corrective procedures, has been
+described at length only where such methods are not generally employed.
+Where there is no departure from the usual methods, treatment that is
+essentially within the domain of surgery or practice is not given in
+specific detail.</p>
+
+<p>Realizing the need for a treatise in the English language dealing with
+diagnosis and treatment of lameness, the author undertook the
+preparation of this manuscript. That the difficulties of depicting by
+means of word-pictures, the symptoms evinced in baffling cases of
+lameness, presented themselves in due course of writing, it is needless
+to say.</p>
+
+<p>It is hoped that this volume will serve its readers to the end that the
+handling of cases of lameness will become a more satisfactory and
+successful part of their work; that both the practitioner and his
+clients may profit thereby; and last but by no means least, that the
+horse, which has given such incalculable service to mankind and is
+deserving of a more concrete reward, will be benefited by the
+application of the principles herein outlined.</p>
+
+<p>In addition to the consultation of standard works bearing on various
+phases of the subject of lameness, the author wishes to thankfully
+acknowledge helpful advice and assistance received from the publisher,
+Dr. D.M. Campbell; to appreciatively credit Drs. L.A. Merillat, A.
+Trickett and F.F. Brown for valuable suggestions given from time to
+time. Particular acknowledgment is made to Dr. Septimus Sisson, author,
+and W.B. Saunders &amp; Co., publishers of The Anatomy of Domestic Animals,
+for permission to use a number of illustrations from that work.</p>
+
+<p class="right">J.V.L.</p>
+
+<p>Chicago, Illinois, October, 1916.</p>
+
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_2" id="Page_2"></a></p>
+
+<div class="blockquot">
+<p><i>Justice shows a triumphant face at the works of humane practitioners,
+who give serious thought and expend honest effort, for the alleviation
+of animal suffering</i>.</p>
+</div>
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_3" id="Page_3"></a></p>
+
+<h2><a name="TABLE_OF_CONTENTS" id="TABLE_OF_CONTENTS"></a>TABLE OF CONTENTS</h2>
+
+<ul class="TOC">
+<li>&nbsp;<span class="ralign">Page</span></li>
+<li><a href="#Page_7">Illustrations</a> <span class="ralign">7</span></li>
+<li><a href="#Page_11">Introduction</a> <span class="ralign">11</span></li>
+</ul>
+
+<p class="center"><a href="#SECTION_I">SECTION I</a></p>
+
+<ul class="TOC">
+<li><a href="#SECTION_I">Etiology and Occurrence</a> <span class="ralign">15</span></li>
+<li><a href="#AFFECTIONS_OF_BONES">Affections of Bones</a> <span class="ralign">15</span></li>
+<li><a href="#Rarefying_Osteitis">Rarefying Osteitis, or Degenerative Changes</a> <span class="ralign">16</span></li>
+<li><a href="#Fractures">Fractures</a> <span class="ralign">16</span></li>
+<li><a href="#AFFECTIONS_OF_LIGAMENTS">Affections of Ligaments</a> <span class="ralign">20</span></li>
+<li><a href="#Luxations_Dislocations">Luxations&mdash;Dislocations</a> <span class="ralign">21</span></li>
+<li><a href="#Arthritis">Arthritis</a> <span class="ralign">22</span></li>
+<li><a href="#AFFECTIONS_OF_BURSAE_AND_THECAE">Affections of Bursae and Thecae</a> <span class="ralign">27</span></li>
+<li><a href="#AFFECTIONS_OF_MUSCLES_AND_TENDONS">Affections of Muscles and Tendons</a> <span class="ralign">28</span></li>
+<li><a href="#AFFECTIONS_OF_NERVES">Affections of Nerves</a> <span class="ralign">30</span></li>
+<li><a href="#AFFECTIONS_OF_BLOOD_VESSELS">Affections of Blood Vessels</a> <span class="ralign">31</span></li>
+<li><a href="#AFFECTIONS_OF_LYMPH_VESSELS_AND_GLANDS">Affections of Lymph Vessels and Glands</a> <span class="ralign">32</span></li>
+<li><a href="#AFFECTIONS_OF_THE_FEET">Affections of the Feet</a> <span class="ralign">34</span></li>
+</ul>
+
+<p class="center"><a href="#SECTION_II">SECTION II</a></p>
+
+<ul class="TOC">
+<li><a href="#SECTION_II">Diagnostic Principles</a> <span class="ralign">37</span></li>
+<li><a href="#Anamnesis">Anamnesis</a> <span class="ralign">38</span></li>
+<li><a href="#Visual_Examination">Visual Examination</a> <span class="ralign">39</span></li>
+<li><a href="#Attitude_of_the_Subject">Attitude of the Subject</a> <span class="ralign">41</span></li>
+<li><a href="#Examination_by_Palpation">Examination by Palpation</a> <span class="ralign">43</span></li>
+<li><a href="#Passive_Movements">Passive Movements</a> <span class="ralign">47</span></li>
+<li><a href="#Observing_the_Character_of_the_Gait">Observing the Character of the Gait</a> <span class="ralign">48</span></li>
+<li><a href="#Special_Methods_of_Examination">Special Methods of Examination</a> <span class="ralign">53</span></li>
+</ul>
+
+<p class="center"><a href="#SECTION_III">SECTION III<br />
+Lameness in the Fore Leg</a></p>
+
+<ul class="TOC">
+<li><a href="#Anatomo-Physiological_Review_of_parts_of_the_Fore_Leg">Anatomo-Physiological Review of Parts of the Fore Leg</a> <span class="ralign">55</span></li>
+<li><a href="#Shoulder_Lameness">Shoulder Lameness</a> <span class="ralign">61</span></li>
+<li><a href="#Fracture_of_the_Scapula">Fracture of the Scapula</a> <span class="ralign">62</span></li>
+<li><a name="Page_4" id="Page_4"></a>
+    <a href="#Scapulohumeral_Arthritis">Scapulohumeral Arthritis</a> <span class="ralign">65</span></li>
+<li><a href="#Infectious_Arthritis">Infectious Arthritis</a> <span class="ralign">66</span></li>
+<li><a href="#Injuries">Injuries</a> <span class="ralign">66</span></li>
+<li><a href="#Wounds">Wounds</a> <span class="ralign">67</span></li>
+<li><a href="#Luxation_of_the_Scapulohumeral_Joint">Luxation of the Scapulohumeral Joint</a> <span class="ralign">67</span></li>
+<li><a href="#Inflammation_of_the_Bicipital_Bursa">Inflammation of the Bicipital Bursa</a> <span class="ralign">68</span></li>
+<li><a href="#Contusions_of_the_Triceps_Brachii">Contusions of the Triceps Brachii</a> <span class="ralign">71</span></li>
+<li><a href="#Shoulder_Atrophy">Shoulder Atrophy (Sweeny)</a> <span class="ralign">73</span></li>
+<li><a href="#Paralysis_of_the_Suprascapular_Nerve">Paralysis of the Suprascapular Nerve</a> <span class="ralign">75</span></li>
+<li><a href="#Radial_Paralysis">Radial Paralysis</a> <span class="ralign">77</span></li>
+<li><a href="#Thrombosis_of_the_Brachial_Artery">Thrombosis of the Brachial Artery</a> <span class="ralign">81</span></li>
+<li><a href="#Fracture_of_Humerus">Fracture of the Humerus</a> <span class="ralign">82</span></li>
+<li><a href="#Inflammation_of_the_Elbow">Inflammation of the Elbow</a> <span class="ralign">84</span></li>
+<li><a href="#Fracture_of_the_Ulna">Fracture of the Ulna</a> <span class="ralign">86</span></li>
+<li><a href="#Fracture_of_the_Radius">Fracture of the Radius</a> <span class="ralign">87</span></li>
+<li><a href="#Wounds_of_the_Anterior_Brachial_Region">Wounds of the Anterior Brachial Region</a> <span class="ralign">90</span></li>
+<li><a href="#Inflammation_and_Contraction_of_the_Carpal_Flexors">Inflammation and Contraction of the Carpal Flexors</a> <span class="ralign">93</span></li>
+<li><a href="#Fracture_and_Luxation_of_the_Carpal_Bones">Fracture and Luxation of the Carpal Bones</a> <span class="ralign">96</span></li>
+<li><a href="#Carpitis">Carpitis</a> <span class="ralign">98</span></li>
+<li><a href="#Open_Carpal_Joint">Open Carpal Joint</a> <span class="ralign">100</span></li>
+<li><a href="#Thecitis_and_Bursitis">Thecitis and Bursitis</a> <span class="ralign">104</span></li>
+<li><a href="#Fracture_of_the_Metacarpus">Fracture of the Metacarpus</a> <span class="ralign">106</span></li>
+<li><a href="#Splints">Splints</a> <span class="ralign">107</span></li>
+<li><a href="#OPEN_FETLOCK_JOINT">Open Fetlock Joint</a> <span class="ralign">110</span></li>
+<li><a href="#Phalangeal_Exostosis_Ringbone">Phalangeal Exostosis (Ringbone)</a> <span class="ralign">118</span></li>
+<li><a href="#Open_Sheath_of_the_Flexors_of_the_Phalanges">Open Sheath of the Flexors of the Phalanges</a> <span class="ralign">124</span></li>
+<li><a href="#Luxation_of_the_Fetlock_Joint">Luxation of the Fetlock Joint</a> <span class="ralign">125</span></li>
+<li><a href="#Sesamoiditis">Sesamoiditis</a> <span class="ralign">127</span></li>
+<li><a href="#Fracture_of_the_Proximal_Sesamoids">Fracture of the Proximal Sesamoids</a> <span class="ralign">128</span></li>
+<li><a href="#Inflammation_of_the_Posterior_Ligaments_of_the_Pastern_Proximal">Inflammation of the Posterior Ligaments of the Pastern Proximal Interphalangeal Joint</a> <span class="ralign">129</span></li>
+<li><a href="#Fracture_of_the_First_and_Second_Phalanges">Fracture of the First and Second Phalanges</a> <span class="ralign">131</span></li>
+<li><a href="#Tendinitis">Tendinitis (Inflammation of the Flexor Tendons)</a> <span class="ralign">135</span></li>
+<li><a href="#Chronic_Tendinitis_and_Contraction_of_the_Flexor_Tendons">Chronic Tendinitis and Contraction of the Flexor Tendons</a> <span class="ralign">137</span></li>
+<li><a href="#Contracted_Tendons_of_Foals">Contracted Tendons of Foals</a> <span class="ralign">143</span></li>
+<li><a href="#Rupture_of_the_Flexor_Tendons_and_Suspensory_Ligament">Rupture of the Flexor Tendons and Suspensory Ligament</a> <span class="ralign">146</span></li>
+<li><a href="#Thecitis_and_Bursitis_in_the_Fetlock_Region">Thecitis and Bursitis in the Fetlock Region</a> <span class="ralign">150</span></li>
+<li><a name="Page_5" id="Page_5"></a>
+    <a href="#Arthritis_of_the_Fetlock_Joint">Arthritis of the Fetlock Joint</a> <span class="ralign">152</span></li>
+<li><a href="#Ossification_of_the_Cartilages_of_the_Third_Phalanx">Ossification of the Cartilages of the Third Phalanx</a> <span class="ralign">155</span></li>
+<li><a href="#Navicular_Disease">Navicular Disease</a> <span class="ralign">157</span></li>
+<li><a href="#Laminitis">Laminitis</a> <span class="ralign">160</span></li>
+<li><a href="#Calk_Wounds_Paronychia">Calk Wounds (Paronychia)</a> <span class="ralign">170</span></li>
+<li><a href="#Corns">Corns</a> <span class="ralign">172</span></li>
+<li><a href="#Quittor">Quittor</a> <span class="ralign">174</span></li>
+<li><a href="#Nail_Punctures">Nail Punctures</a> <span class="ralign">178</span></li>
+</ul>
+
+<p class="center"><a href="#SECTION_IV">SECTION IV<br />
+Lameness in the Hind Leg</a></p>
+
+<ul class="TOC">
+<li><a href="#Anatomo-Physiological_Consideration_of_the_Pelvic_Limbs">Anatomo-Physiological Consideration of the Pelvic Limbs</a> <span class="ralign">185</span></li>
+<li><a href="#Hip_Lameness">Hip Lameness</a> <span class="ralign">195</span></li>
+<li><a href="#Fractures_of_the_Pelvic_Bones">Fractures of the Pelvic Bones</a> <span class="ralign">196</span></li>
+<li><a href="#Fractures_of_the_Femur">Fractures of the Femur</a> <span class="ralign">199</span></li>
+<li><a href="#Luxation_of_the_Femur">Luxation of the Femur</a> <span class="ralign">201</span></li>
+<li><a href="#Gluteal_Tendo-Synovitis">Gluteal Tendo-Synovitis</a> <span class="ralign">203</span></li>
+<li><a href="#Paralysis_of_the_Hind_Leg">Paralysis of the Hind Leg</a> <span class="ralign">204</span></li>
+<li><a href="#Paralysis_of_the_Femoral_Crural_Nerve">Paralysis of the Femoral (Crural) Nerve</a> <span class="ralign">204</span></li>
+<li><a href="#Paralysis_of_the_Obturator_Nerve">Paralysis of the Obturator Nerve</a> <span class="ralign">206</span></li>
+<li><a href="#Paralysis_of_the_Sciatic_Nerve">Paralysis of the Sciatic Nerve</a> <span class="ralign">208</span></li>
+<li><a href="#Iliac_Thrombosis">Iliac Thrombosis</a> <span class="ralign">209</span></li>
+<li><a href="#Fracture_of_the_Patella">Fracture of the Patella</a> <span class="ralign">212</span></li>
+<li><a href="#Luxation_of_the_Patella">Luxation of the Patella</a> <span class="ralign">213</span></li>
+<li><a href="#Chronic_Gonitis">Chronic Gonitis</a> <span class="ralign">217</span></li>
+<li><a href="#Open_Stifle_Joint">Open Stifle Joint</a> <span class="ralign">220</span></li>
+<li><a href="#Fracture_of_the_Tibia">Fracture of the Tibia</a> <span class="ralign">222</span></li>
+<li><a href="#Rupture_and_Wounds_of_the_Tendo_Achillis">Rupture and Wounds of the Tendo Achillis</a> <span class="ralign">224</span></li>
+<li><a href="#Spring-Halt_String-Halt">Spring-Halt (String-Halt)</a> <span class="ralign">225</span></li>
+<li><a href="#Open_Tarsal_Joint">Open Tarsal Joint</a> <span class="ralign">229</span></li>
+<li><a href="#Fracture_of_the_Fibular_Tarsal_Bone_Calcaneum">Fracture of the Fibular Tarsal Bone (Calcaneum)</a> <span class="ralign">230</span></li>
+<li><a href="#Tarsal_Sprains">Tarsal Sprains</a> <span class="ralign">232</span></li>
+<li><a href="#Curb">Curb</a> <span class="ralign">233</span></li>
+<li><a href="#Spavin_Bone_Spavin">Spavin (Bone Spavin)</a> <span class="ralign">235</span></li>
+<li><a href="#Distension_of_the_Tarsal_Joint_Capsule_Bog_Spavin">Distension of the Tarsal Joint Capsule (Bog Spavin)</a> <span class="ralign">242</span></li>
+<li><a href="#Distension_of_the_Tarsal_Sheath_of_the_Deep_Digital_Flexor">Distension of the Tarsal Sheath of the Deep Digital Flexor (Thoroughpin)</a> <span class="ralign">246</span></li>
+<li><a name="Page_6" id="Page_6"></a>
+    <a href="#Capped_Hock">Capped Hock</a> <span class="ralign">251</span></li>
+<li><a href="#Rupture_and_Division_of_the_Long_Digital_Extensor">Rupture and Division of the Long Digital Extensor (Extensor Pedis)</a> <span class="ralign">253</span></li>
+<li><a href="#Wounds_From_Interfering">Wounds from Interfering</a> <span class="ralign">255</span></li>
+<li><a href="#Lymphangitis">Lymphangitis</a> <span class="ralign">257</span></li>
+<li><a href="#AUTHORITIES_CITED">Authorities Cited</a> <span class="ralign">265</span></li>
+<li><a href="#INDEX">Index</a> <span class="ralign">267</span></li>
+</ul>
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_7" id="Page_7"></a></p>
+
+<h2><a name="ILLUSTRATIONS" id="ILLUSTRATIONS"></a>ILLUSTRATIONS</h2>
+
+<ul class="TOC">
+<li>&nbsp;<span class="ralign">Page</span></li>
+<li>Fig.&nbsp;&nbsp; 1&mdash;<a href="#image01">Hoof Testers</a> <span class="ralign">53</span></li>
+<li>Fig.&nbsp;&nbsp; 2&mdash;<a href="#image02">Muscles of Left Thoracic Limb, Lateral View</a> <span class="ralign">56</span></li>
+<li>Fig.&nbsp;&nbsp; 3&mdash;<a href="#image03">Muscles of Left Thoracic Limb, Medial View</a> <span class="ralign">57</span></li>
+<li>Fig.&nbsp;&nbsp; 4&mdash;<a href="#image04">Sagital Section of Digit and Distal Part of Metacarpus</a> <span class="ralign">59</span></li>
+<li>Fig.&nbsp;&nbsp; 5&mdash;<a href="#image05">Ordinary Type of Heavy Sling</a> <span class="ralign">62</span></li>
+<li>Fig.&nbsp;&nbsp; 6&mdash;<a href="#image06">A Sling Made in Two Parts</a> <span class="ralign">63</span></li>
+<li>Fig.&nbsp;&nbsp; 7&mdash;<a href="#image07">Paralysis of the Suprascapular Nerve of Left Shoulder</a> <span class="ralign">76</span></li>
+<li>Fig.&nbsp;&nbsp; 8&mdash;<a href="#image08">Radial Paralysis</a> <span class="ralign">78</span></li>
+<li>Fig.&nbsp;&nbsp; 9&mdash;<a href="#image09">Merillat's Method of Fixing Carpus in Radial Paralysis</a> <span class="ralign">79</span></li>
+<li>Fig. 10&mdash;<a href="#image10">Contraction of Carpal Flexors, "Knee Sprung"</a> <span class="ralign">95</span></li>
+<li>Fig. 11&mdash;<a href="#image11">Pericarpal Inflammation and Enlargement Due to Injury</a> <span class="ralign">99</span></li>
+<li>Fig. 12&mdash;<a href="#image12">Hygromatous Condition of the Right Carpus</a> <span class="ralign">100</span></li>
+<li>Fig. 13&mdash;<a href="#image13">Carpal Exostosis in Aged Horse</a> <span class="ralign">101</span></li>
+<li>Fig. 14&mdash;<a href="#image14">Exostosis of Carpus Resultant from Carpitis</a> <span class="ralign">102</span></li>
+<li>Fig. 15&mdash;<a href="#image15">Distal End of Radius, Illustrating Effects of Carpitis</a> <span class="ralign">102</span></li>
+<li>Fig. 16&mdash;<a href="#image16">Posterior View of Radius, Illustrating Effects of Splint</a> <span class="ralign">108</span></li>
+<li>Fig. 17&mdash;<a href="#image17">Phalangeal Exosteses</a> <span class="ralign">120</span></li>
+<li>Fig. 18&mdash;<a href="#image18">Rarefying Osteitis in Chronic Ringbone</a> <span class="ralign">121</span></li>
+<li>Fig. 19&mdash;<a href="#image19">Phalangeal Exostoses in Chronic Ringbone</a> <span class="ralign">122</span></li>
+<li>Fig. 20&mdash;<a href="#image20">Contraction of Superficial Digital Flexor Tendon Due to Tendinitis</a> <span class="ralign">138</span></li>
+<li>Fig. 21&mdash;<a href="#image21">Contraction of Deep Flexor Tendon Due to Tendinitis</a> <span class="ralign">139</span></li>
+<li>Fig. 22&mdash;<a href="#image22">Chronic Case of Contraction of Both Flexor Tendons of the Phalanges</a> <span class="ralign">140</span></li>
+<li>Fig. 23&mdash;<a href="#image23">Contraction of Superficial and Deep Flexor Tendons</a> <span class="ralign">141</span></li>
+<li><a name="Page_8" id="Page_8"></a>
+    Fig. 24&mdash;<a href="#image24">Contraction of Superficial Digital Flexor and Slight Contraction of Deep Flexor Tendon</a> <span class="ralign">142</span></li>
+<li>Fig. 25&mdash;<a href="#image25">"Fish Knees"</a> <span class="ralign">145</span></li>
+<li>Fig. 26&mdash;<a href="#image26">Extreme Dorsal Flexion</a> <span class="ralign">146</span></li>
+<li>Fig. 27&mdash;<a href="#image27">A Good Style of Shoe for Bracing the Fetlock</a> <span class="ralign">148</span></li>
+<li>Fig. 28&mdash;<a href="#image28">The Roberts Brace in Operation</a> <span class="ralign">149</span></li>
+<li>Fig. 29&mdash;<a href="#image29">Distension of Theca of Extensor of the Digit</a> <span class="ralign">151</span></li>
+<li>Fig. 30&mdash;<a href="#image30">Rarefying Osteitis Wherein Articular Cartilage Was Destroyed</a> <span class="ralign">153</span></li>
+<li>Fig. 31&mdash;<a href="#image31">Ringbone and Sidebone</a> <span class="ralign">156</span></li>
+<li>Fig. 32&mdash;<a href="#image32">Position Assumed by Horse Having Unilateral Navicular Disease</a> <span class="ralign">159</span></li>
+<li>Fig. 33&mdash;<a href="#image33">The Hoof in Chronic Laminitis</a> <span class="ralign">165</span></li>
+<li>Fig. 34&mdash;<a href="#image34">Effects of Laminitis</a> <span class="ralign">166</span></li>
+<li>Fig. 35&mdash;<a href="#image35">Cochran Shoe, Inferior Surface</a> <span class="ralign">168</span></li>
+<li>Fig. 36&mdash;<a href="#image36">Cochran Shoe, Superior Surface</a> <span class="ralign">169</span></li>
+<li>Fig. 37&mdash;<a href="#image37">Hyperplasia of Eight Forefoot Due to Chronic Quittor</a> <span class="ralign">176</span></li>
+<li>Fig. 38&mdash;<a href="#image38">Chronic Quittor, Left Hind Foot</a> <span class="ralign">177</span></li>
+<li>Fig. 39&mdash;<a href="#image39">Skiagraph of Foot</a> <span class="ralign">179</span></li>
+<li>Fig. 40&mdash;<a href="#image40">Sagital Section of Eight Hock</a> <span class="ralign">186</span></li>
+<li>Fig. 41&mdash;<a href="#image41">Muscles of Right Leg; Front View</a> <span class="ralign">187</span></li>
+<li>Fig. 42&mdash;<a href="#image42">Muscles of Lower Part of Thigh, Leg and Foot</a> <span class="ralign">189</span></li>
+<li>Fig. 43&mdash;<a href="#image43">Right Stifle Joint; Lateral View</a> <span class="ralign">190</span></li>
+<li>Fig. 44&mdash;<a href="#image44">Left Stifle Joint; Medial View</a> <span class="ralign">191</span></li>
+<li>Fig. 45&mdash;<a href="#image45">Left Stifle Joint; Front View</a> <span class="ralign">193</span></li>
+<li>Fig. 46&mdash;<a href="#image46">Oblique Fracture of the Femur</a> <span class="ralign">200</span></li>
+<li>Fig. 47&mdash;<a href="#image47">Fracture of Femur After Six Months' Treatment</a> <span class="ralign">201</span></li>
+<li>Fig. 48&mdash;<a href="#image48">Aorta and Its Branches Showing Location of Thrombi</a> <span class="ralign">210</span></li>
+<li>Fig. 49&mdash;<a href="#image49">Thrombosis of the Aorta, Iliacs and Branches</a> <span class="ralign">211</span></li>
+<li>Fig. 50&mdash;<a href="#image50">Chronic Gonitis</a> <span class="ralign">218</span></li>
+<li>Fig. 51&mdash;<a href="#image51">Position Assumed in Gonitis</a> <span class="ralign">219</span></li>
+<li>Fig. 52&mdash;<a href="#image52">Spring-halt</a> <span class="ralign">226</span></li>
+<li>Fig. 53&mdash;<a href="#image53">Lateral View of Tarsus Showing Effects of Tarsitis</a> <span class="ralign">228</span></li>
+<li>Fig. 54&mdash;<a href="#image54">Right Hock Joint</a> <span class="ralign">231</span></li>
+<li>Fig. 55&mdash;<a href="#image55">Spavin</a> <span class="ralign">235</span></li>
+<li><a name="Page_9" id="Page_9"></a>
+    Fig. 56&mdash;<a href="#image56">Bog Spavin</a> <span class="ralign">243</span></li>
+<li>Fig. 57&mdash;<a href="#image57">Thoroughpin</a> <span class="ralign">247</span></li>
+<li>Fig. 58&mdash;<a href="#image58">Fibrosity of Tarsus in Chronic Thoroughpin</a> <span class="ralign">248</span></li>
+<li>Fig. 59&mdash;<a href="#image59">Another View of Case Shown in Fig. 58</a> <span class="ralign">249</span></li>
+<li>Fig. 60&mdash;<a href="#image60">"Capped Hock"</a> <span class="ralign">252</span></li>
+<li>Fig. 61&mdash;<a href="#image61">Chronic Lymphangitis</a> <span class="ralign">258</span></li>
+<li>Fig. 62&mdash;<a href="#image62">Elephantiasis</a> <span class="ralign">259</span></li>
+</ul>
+
+<p><a name="Page_10" id="Page_10"></a></p>
+<p><a name="Page_11" id="Page_11"></a></p>
+
+
+
+<hr style="width: 65%;" />
+<h2><a name="INTRODUCTION" id="INTRODUCTION"></a>INTRODUCTION</h2>
+
+
+<p>Lameness is a symptom of an ailment or affection and is not to be
+considered in itself as an anomalous condition. It is the manifestation
+of a structural or functional disorder of some part of the locomotory
+apparatus, characterized by a limping or halting gait. Therefore, any
+affection causing a sensation and sign of pain which is increased by the
+bearing of weight upon the affected member, or by the moving of such a
+distressed part, results in an irregularity in locomotion, which is
+known as lameness or claudication. A halting gait may also be produced
+by the abnormal development of a member, or by the shortening of the leg
+occasioned by the loss of a shoe.</p>
+
+<p>For descriptive purposes lameness may be classified as <i>true</i> and
+<i>false</i>. <i>True lameness</i> is such as is occasioned by structural or
+functional defects of some part of the apparatus of locomotion, such as
+would be caused by spavin, ring-bone, or tendinitis. <i>False lameness</i> is
+an impediment in the gait not caused by structural or functional
+disturbances, but is brought on by conditions such as may result from
+the too rapid driving of an unbridle-wise colt over an irregular road
+surface, or by urging a horse to trot at a pace exceeding the normal
+gait of the animal's capacity, causing it to "crow-hop" or to lose
+balance in the stride. The latter manifestation might, to the
+inexperienced eye, simulate <i>true lameness</i> of the hind legs, but in
+reality, is merely the result of the animal having been forced to assume
+an abnormal pace and a lack of balance in locomotion is the consequence.</p>
+
+<p>The degree of lameness, though variable in different instances, is in
+most cases proportionate to the causative factor, and this fact serves
+as a helpful indicator in the matter of establishing a diagnosis and
+giving the prognosis, especially in cases of somewhat unusual character.
+An animal may be slightly lame and the exhibition of lameness be such as
+to render the cause bafflingly obscure. Cases of this nature are
+sometimes quite difficult to classify and in occasional instances a
+positive diagnosis is impossible. Subjects of this kind may not be
+sufficiently in<a name="Page_12" id="Page_12"></a>convenienced to warrant their being taken out of
+service, yet a lame horse, no matter how slightly affected, should not
+be continued in service unless it can be positively established that the
+degree of discomfort occasioned by the claudication is small and the
+work to be done by the animal, of the sort that will not aggravate the
+condition.</p>
+
+<p>Subjects that are very lame&mdash;so lame that little weight is borne by the
+affected member&mdash;are, of course, unfit for service and as a rule are not
+difficult of diagnosis. For instance, a fracture of the second phalanx
+would cause much more lameness than an injury to the lateral ligament of
+the coronary joint wherein there had occurred only a slight sprain, and
+though crepitation is not recognized, the diagnostician is not justified
+in excluding the possibility of fracture, if the lameness seems
+disproportionate to the apparent first cause.</p>
+
+<p>The course taken by cases of lameness is as variable as the degree of
+its manifestation, and no one can definitely predict the duration of any
+given cause of claudication.</p>
+
+<p>Because of the fact that horses are not often good self-nurses at best,
+and that it is difficult to enforce proper care for the parts affected,
+one can not wisely state that resolution will promptly follow in an
+acute involvement, nor can he predict that the case will or will not
+become chronic. Experience has proved that complete or partial recovery
+may result, or again, that no change may occur in any given case, and
+that in some instances even where rational treatment is early
+administered, a decided aggravation of the condition may follow
+unaccountably.</p>
+
+<p>However, because of the economic element to be reckoned with, it is of
+some value to be able to give a fairly accurate prognosis in the
+handling of cases of lameness, as in the majority of instances the
+treatment and manner of after-care are determined largely by the expense
+that any prescribed line of attention will occasion.</p>
+
+<p>A case of acute bone spavin in a horse of little value is not generally
+treated in a manner that will incur an expense equivalent to one-half
+the value of the subject. The fact is always to be considered in such
+cases, that even where ideal conditions favor proper treatment, the
+outcome is uncertain. Where less than <a name="Page_13" id="Page_13"></a>six weeks of rest can be allowed
+the animal, one affected with bone spavin would therefore not be treated
+with the expectation of obtaining good results, as six weeks' time, at
+least, is necessary for a successful outcome. If the cost attending the
+enforced idleness of an animal of this kind is considered prohibitive
+for the employment of proper measures to affect a cure, and if lameness
+is slight, the animal should be given suitable work, but in cases of
+articular spavin in aged subjects, they should be humanely destroyed and
+not subjected to prolonged misery.</p>
+
+<p>A thorough knowledge of the structure and functions of the affected
+parts is necessary to proceed in cases of lameness; likewise, the age,
+conformation and temperament of the subject need to be taken into
+consideration; the presence or absence of complications demand the
+attention; the kind of care the subject will probably receive directly
+influences the outcome; and the character of service expected of the
+subject, too, needs to be carefully considered before the ultimate
+outcome may reasonably be foretold.</p>
+
+<p>The practitioner is often confronted with the problem of how best to
+handle certain cases. Will they do better under conditions where
+absolute quiet is enforced, or is it preferable to allow exercise at
+will? The temperament of the animal must be considered in such cases,
+and if a lame horse is too active and playful when given his freedom,
+exercise must be restricted or prevented, as the case may require. In
+cases of strains of tendons, during the acute stage, immobilization of
+the affected parts is in order. In certain sub-acute inflammatory
+processes or in instances of paralytic disturbance where convalescence
+is in progress, moderate exercise is highly beneficial.</p>
+
+<p>Consequently, each case in itself presents an individual problem to be
+judged and handled in the manner experience has taught to be most
+effective, appropriate and practical, and the veterinarian should give
+due consideration to the comfort and welfare of the crippled animal as
+well as to the interests of the owner.</p>
+
+<p><a name="Page_14" id="Page_14"></a></p>
+<p><a name="Page_15" id="Page_15"></a></p>
+
+
+
+<hr style="width: 65%;" />
+<p><a name="SECTION_I" id="SECTION_I"></a></p>
+
+<h2 class="sectionhead">SECTION I.</h2>
+
+<h2><a name="ETIOLOGY" id="ETIOLOGY"></a>ETIOLOGY AND OCCURRENCE.</h2>
+
+
+<p>In discussions of pathological conditions contributing to lameness in
+the horse, cause is generally classified under two heads&mdash;<i>predisposing</i>
+and <i>exciting</i>. It becomes necessary, however, to adopt a more general
+and comprehensive method of classification, herein, which will enable
+the reader to obtain a better conception of the subject and to more
+clearly associate the parts so grouped descriptively.</p>
+
+<p>Though <i>predisposing</i> factors, such as faulty conformation, are often to
+be reckoned with, <i>exciting</i> causes predominate more frequently in any
+given number of cases. The noble tendency of the horse to serve its
+master under the stress of pain, even to the point of complete
+exhaustion and sudden death, should win for these willing servants a
+deeper consideration of their welfare. Too frequently are their
+manifestations of discomfort allowed to pass unheeded by careless,
+incompetent drivers lacking in a sense of compassion. Symptoms of
+malaise should never be ignored in any case; the humane and economic
+features should be realized by any owner of animals.</p>
+
+<p>In the consideration of group causes, lameness may be said to originate
+from affections of bones, ligaments, thecae and bursae, muscles and
+tendons, nerves, lymph vessels and glands, and blood vessels, and may
+also result from an involvement of one or several of the aforementioned
+tissues, caused by rheumatism. Further, affections of the feet merit
+separate consideration, and, finally, a miscellaneous grouping of
+various dissimilar ailments, which for the most part, do not directly
+involve the locomotory apparatus but do, by their nature, impede normal
+movement.</p>
+
+
+<h3><a name="AFFECTIONS_OF_BONES" id="AFFECTIONS_OF_BONES"></a>AFFECTIONS OF BONES.</h3>
+
+<p>The bony column serving as the framework and support of the legs,
+probably constitutes the most vital element having to do with weight
+bearing and locomotion, and therefore during the acute and painful stage
+of bone affections, the pain becomes <a name="Page_16" id="Page_16"></a>more intense in the process and
+pressure of standing than when the member is swung or advanced.</p>
+
+<p>Certain bones are so well protected by muscular structures that they are
+not frequently injured except as a result of violence which may produce
+fracture. However, there are certain bones which receive the constant
+shock of concussion when the animal is subjected to daily, rapid work on
+hard road surfaces. Splints, ringbones and spavins are the most general
+examples produced by these conditions.</p>
+
+<p>Varying pathological developments often result from concussion,
+contusion or other violent shocks to the bony structures. In such cases
+there either follows a simple periostitis which may resolve
+spontaneously with no obvious outward symptom, or osteitis, which may
+occur with tissue changes, as in exostosis; or the case may produce any
+degree of reaction between these two possible extremes.</p>
+
+
+<h3><a name="Rarefying_Osteitis" id="Rarefying_Osteitis"></a>Rarefying Osteitis, or Degenerative Changes.</h3>
+
+<p>Certain bone affections, such as osteomalacia or osteoporosis, are in
+the main, responsible for distortions and morphological changes of bone,
+causing lameness, permanent blemish and even resulting in death of the
+affected animal. The climatic conditions in some localities favor these
+occurrences but they may also be ascribed to improper food constituents
+and to possible infective agencies.</p>
+
+<p>Rarefying degenerative changes manifested by exostosis involving the
+phalanges of the young, causing ringbone, are fairly common in
+occurrence throughout this country. This is due, supposedly, to a lack
+of mineral substance in the bony structure of the affected animals, and
+is known as rachitis&mdash;commonly called rickets. Since the affected
+subjects suffer involvement of several of the extremities at the same
+time, the theory of rachitic origin seems well supported.</p>
+
+
+<h3><a name="Fractures" id="Fractures"></a>Fractures.</h3>
+
+<p>Fractures of bones constitute serious conditions and are always
+manifested by lameness. A sub-classification is essential here <a name="Page_17" id="Page_17"></a>for the
+student of veterinary medicine who would comprehend the technic of
+reduction and subsequent treatment in such cases.</p>
+
+<p>Fractures are classified by many authorities as being <i>simple</i>,
+<i>compound</i>, and <i>comminuted</i>. This method is practical because it
+separates dissimilar conditions. There are also grouped fractures, the
+pathologic anatomy of which is similar. Classification on an etiological
+basis would attempt to associate conditions, the morbid anatomy and
+gravity of which would justly preclude their being combined.</p>
+
+<p><b>Simple Fracture</b> is a condition where the continuity of the bone has
+been broken without serious destruction of the soft structures adjacent,
+and where no opening has been made to the surface of the flesh. Such
+fractures do not reduce the bone to fragments. Long bones are frequently
+subjected to simple fracture, while short thick bones, such as the
+second phalanx, may suffer multiple or comminuted fractures.</p>
+
+<p><b>Compound Fracture</b> designates a break of bone with the destruction of
+the soft tissues covering it, making an open wound to the surface of the
+skin. This form of fracture is serious because of the attendant danger
+of infection, and in treatment, necessitates special precaution being
+taken in the application of splints that the wound may be cared for
+without infection of the tissues. These fractures generally occur as a
+result of some forceful impact through the flesh to the bone, or where
+the bones are driven outward by the blow. Common examples are in
+fractures of the metacarpus and metatarsus of the first phalanx. This
+kind of injury in mature horses usually produces an irreparable
+condition, and viewed economically, is generally considered fatal.</p>
+
+<p><b>Comminuted Fractures</b>, as the term implies, are those cases wherein the
+bone is reduced to a number of small pieces. This kind of break may be
+classified as simple-comminuted fracture when the skin is unbroken, and
+when the bone is exposed as a result of the injury, it is known as a
+compound-comminuted fracture. Such fractures are caused by violent
+contusion or where the member is caught between two objects and
+crushed.</p>
+<p><a name="Page_18" id="Page_18"></a></p>
+
+
+<h3><a name="Multiple_Fractures" id="Multiple_Fractures"></a>Multiple Fractures.</h3>
+
+<p>Fractures are called <i>multiple</i> when the bone is reduced to a number of
+pieces of large size. This condition differs from a comminuted fracture
+in that the multiple fracture may break the bone into several pieces
+without the pieces being ground or crushed, and the affected bone may
+still retain its normal shape.</p>
+
+<p>Further classification is of value in describing fractures of bone with
+respect to the manner in which the bone is broken&mdash;the direction of the
+fissure or fissures in relation to its long axis.</p>
+
+<p>A fracture is <i>transverse</i> when the bone is broken at a right angle from
+its long axis. Such breaks when simple, are the least trouble to care
+for because there is little likelihood that the broken ends of bone will
+become so displaced that they will not remain in apposition. <i>Simple
+transverse</i> fracture of the metacarpus, for instance, constitutes a
+favorable case for treatment if other conditions are favorable.</p>
+
+<p><i>Oblique fractures</i>, as may be surmised, are solutions of continuity of
+bone in such manner that the fissure crosses the long axis of a bone at
+an acute or obtuse angle. These fractures are prone to injure the soft
+structures adjacent, and are frequently compound, as well. Moreover,
+because of the fact that the apposing pieces of bone are beveled, the
+broken ends of bone are likely to pass one another in such a way as to
+shorten the distance between the extremities of the injured member.
+Contraction of muscles also tends to exert traction upon a bone so
+fractured, resulting in a lateral approximation of the diaphysis and
+thus preventing union because the broken surfaces are not in proper
+contact.</p>
+
+<p>Fractures are <i>longitudinal</i> when the fissure is parallel with the long
+axis of the bone. This variety of break is not infrequent in the first
+phalanx; and a vertical fracture of the second phalanx is also said to
+be longitudinal, however, there is little difference (if any, in some
+subjects) between the vertical and transverse diameters of this
+particular bone.</p>
+
+<p><i>Green stick fractures</i> are essentially those resulting from falls to
+young animals. They are usually sub-periosteal and when <a name="Page_19" id="Page_19"></a>the periosteum
+is left intact or nearly so, no crepitation is discernible. If this
+fracture is <i>simple</i>, prompt recovery may be expected. Bones of young
+animals, because they do not contain proportionately as much mineral
+substance as do bones of adults, are more resilient and less apt to
+become completely fractured. They are, however, subject to what is known
+as green stick fracture.</p>
+
+<p><i>Impacted fractures</i> are usually occasioned by falls. When the weight of
+the body is suddenly caught by a member in such manner as to forcefully
+drive the epiphyseal portions of bone into and against the diaphysis,
+<i>multiple longitudinal</i> fractures occur at the point of least
+resistance. Parts so affected undergo a fibrillary separation,
+increasing the transverse diameter of the bone; or if the impact has
+been sufficiently violent, the portion becomes an amorphous mass.</p>
+
+<p>In a treatise on the subject of lameness, the bones chiefly concerned
+and most often affected must be especially considered. The shape and
+size of a bone when injured, determines in a measure, the course and
+probable outcome in most cases, but of first and greater importance is
+the function of the bone. A fracture of the fibula in the horse need not
+incapacitate the subject, but a tibial fracture is serious and generally
+proves cause for fatal termination. The body of the scapula may be
+completely fractured and recovery will probably result in most cases
+without much attention being given to the subject, yet a fracture of the
+neck of this same bone constitutes an injury of serious consequence. The
+difference in the function of different parts of this same bone, as well
+as its shape and mode of attachment, determine the gravity of the case;
+so it is in fractures of other bones with respect to the course and
+prognosis of the case&mdash;function is the important factor to be
+considered.</p>
+
+<p>Next in importance is the age of the animal suffering fracture of the
+bone. Capacity for regeneration is naturally greater in a vigorous,
+young animal than in aged or even middle-aged subjects. A healthy
+condition of the bone and the body favor the process of repair in case
+of fracture, and prognosis may be favorable or unfavorable, depending
+upon these factors mentioned for consideration. Individuals of the same
+species, differing in tem<a name="Page_20" id="Page_20"></a>perament, may comport themselves in a manner
+that is conductive to prompt recovery, or to early destruction. This
+feature cannot be overestimated in importance, as it is sometimes a
+decisive element, regardless of other conditions. A horse suffering from
+an otherwise remediable pelvic fracture may be so worried and tortured
+by being confined in a sling that the case calls for special attention
+and care because of the animal's temperament. Sometimes, the constant
+presence of a kind attendant will so reassure the subject that it will
+become resigned to unnatural confinement, in a day or two. This
+precaution may, in itself, determine the outcome, and the wise
+veterinarian will not overlook this feature or fail to deviate from the
+usual rote in the handling of average cases. Recovery may be brought
+about in irritable subjects by this concession to the individual
+idiosyncrasies of such animals.</p>
+
+
+<h3><a name="AFFECTIONS_OF_LIGAMENTS" id="AFFECTIONS_OF_LIGAMENTS"></a>AFFECTIONS OF LIGAMENTS.</h3>
+
+<p>Ligaments which have to do with the locomotory apparatus are, for the
+most part, inelastic structures which are composed of white fibrous
+tissue and serve to join together the articular ends of bones; to bind
+down tendons; and to act as sheathes or grooves through which tendons
+pass, and as capsular membranes for retention of synovia in contact with
+articular surfaces of bones.</p>
+
+<p>Ligaments are injured less frequently than are bones. Because of their
+flexibility they escape fracture in the manner that bones suffer. They
+are, however, completely severed by being cut or ruptured, though
+fibrillary fracture the result of constant or intermittent tensile
+strain is of more frequent occurrence.</p>
+
+<p>Simple inflammation of ligaments is of occasional occurrence but, unless
+considerable injury is done this tissue, no perceptible manifestation of
+injury results. No doubt many cases wherein fibrillary fracture of
+ligaments (sprain) takes place some lameness is caused, but because of
+the dense, comparatively nonvascular nature of these structures, little
+if any manifestation, except lameness, is evident. And such cases, if
+recognized are usually diagnosed by excluding the existence of other
+possible causes and conditions which might also cause lameness.</p>
+<p><a name="Page_21" id="Page_21"></a></p>
+
+<p>Certain ligaments are subjected to strain more than are others and
+therefore, when so involved, frequently cause lameness. Examples of this
+kind are affections of the collateral (lateral) ligaments of the
+phalanges. Because of the leverage afforded by the transverse diameter
+of the foot, when an animal is made to travel over uneven road surfaces,
+considerable strain is brought to bear on the collateral ligaments of
+the phalanges. A sequel to this form of injury is a circumscribed
+periostitis at the site of attachment of the ligaments and frequently
+the formation of an exostosis&mdash;ringbone&mdash;results.</p>
+
+<p>Where sudden and violent strain is placed upon a ligament and rupture
+occurs, the division is usually effected by the ligament being torn from
+its attachment to the bone. In such cases, a portion of periosteum and
+bone is usually detached and the condition may then properly be called
+one of fracture. In some cases of this kind recovery is tardy, because
+of the difficulty in maintaining perfect apposition of the divided
+structures, and reactionary inflammation is not of sufficient extent to
+enhance prompt repair. In fact, some cases of this kind seem to progress
+more favorably, when no attempt at immobilization of the affected member
+is attempted.</p>
+
+<p>If some freedom of movement is allowed, acute inflammation resulting in
+nature's provisional swelling soon develops and repair is hastened
+because of increased vascularity. But where luxation of phalanges
+accompanies sprain, reposition and immobilization are necessary&mdash;that is
+if cases are thought likely to benefit by any treatment.</p>
+
+
+<h3><a name="Luxations_Dislocations" id="Luxations_Dislocations"></a>Luxations&mdash;Dislocations.</h3>
+
+<p>Luxation or dislocation is a condition where the normal relation between
+articular ends of bones has been deranged to the extent that partial or
+complete loss of function results. When a bone is luxated (out of
+joint), there has occurred a partial or complete rupture of certain
+ligaments or tendons; or a bone may be luxated when an abnormal or
+unusual elasticity of inhibitory ligaments or tendons obtains.</p>
+
+<p>Luxations may be practically classified as <i>temporary</i> and <i>fixed</i>. In
+temporary luxations, disarticulation is but momentary and <a name="Page_22" id="Page_22"></a>spontaneous
+reposition always results; while a fixed luxation does not reduce
+spontaneously but remains luxated until reposition is effected by proper
+manipulation and treatment. Fixed luxation may be of such character as
+to be practically irreducible because of extensive damage done to
+ligaments or cartilage. Where a complete luxation of the
+metacarpophalangeal joint exists, it is probable that in most cases
+sufficient injury to collateral and capsular ligaments has been done to
+render complete recovery improbable, if not impossible.</p>
+
+<p>Temporary luxation of the patella is a common affection of the horse and
+fixed luxation of this bone also occurs. As a matter of fact, in the
+horse, patellar luxation is the one frequent affection of this kind.</p>
+
+<p>As a rule, complete disarticulation immobilizes the affected joint and
+in most instances there is noticeable an abnormal prominence in the
+immediate vicinity&mdash;in patellar luxation, the whole bone. In other
+instances the articular portion only, of the affected bone is
+malpositioned. Usually, luxation and fracture may be differentiated in
+that there is no crepitation in luxation and more or less crepitation
+exists in fracture.</p>
+
+<p>It is evident, when one considers the symptomatology and nature of the
+affection, that fixed luxation is usually caused by undue strain or
+violent and abnormal movement of a part. Joints having the greater
+freedom of movement are apt to suffer luxation more frequently.</p>
+
+
+<h3><a name="Arthritis" id="Arthritis"></a>Arthritis.</h3>
+
+<p>The study of arthritis in the horse is limited to a consideration of
+joint inflammations which, for the most part, are of traumatic origin.
+Unlike the human, the horse is not subject to many forms of specific
+arthritis&mdash;tubercular, gonorrheal, syphilitic, etc.</p>
+
+<p>A practical manner of classification of arthritis is <i>traumatic</i> and
+<i>metastatic</i>.</p>
+
+<p><i>Traumatic arthritis</i> may result from all sorts of accidents wherein
+joints are contused. Such cases may be considered as being caused by
+direct injuries. Instances of this kind, depending on the degree of
+insult, manifest evidence of injury which <a name="Page_23" id="Page_23"></a>ranges from a simple
+synovitis to the most active inflammatory involvement of the entire
+structure and adjacent tissues.</p>
+
+<p>The reactionary inflammation which attends a case of tarsitis caused by
+a horse being kicked is a good example of the result of direct injury.
+Such cases, if the contusion is of sufficient violence, result in
+arthritis and periarthritis. In inactive farm horses, during cold
+weather, this condition becomes chronic, swelling remains for weeks
+after all lameness and pain have subsided and occasionally hyperthrophy
+is permanent.</p>
+
+<p>Arthritis occasioned by indirect injury, such as characterizes joint
+inflammation from continuous concussion, is seen in horses that are
+worked at a rapid pace on city streets or other hard road surfaces. Such
+affections may be acute, as in some cases of spavin, but are usually
+inflammatory conditions that do not occasion serious disturbance when
+these affections become chronic. If the involvement persists with
+sufficient active inflammation, there may follow erosion of cartilage
+and incurable lameness. If extensive necrosis of cartilage takes place,
+the attendant pain will be sufficient to cause the animal to favor the
+diseased part and such immobilization enhances early ankylosis&mdash;nature's
+substitute for resolution in this disease.</p>
+
+<p>Wounds invading the tissues adjacent to joints, when these wounds are of
+considerable extent, cause inflammation of such articulations by
+contiguous extension of inflammation. As long as an injury remains
+practically aseptic, or if infected and the septic process does not
+involve the joint proper by direct extension, no more serious
+disturbance than a simple synovitis will result. If, instead, a
+periarthritic inflammation is serious or destructive in character, the
+type of arthritis will be grave&mdash;even though due to an indirect cause.</p>
+
+<p>Where a vulnerant body penetrates all structures and invades the
+interior of the joint capsule the result is that a more or less active
+disturbance is incited. The introduction of a sterile instrument into a
+joint cavity, under strict asepsis, where a perfect technic is executed,
+does not cause perceptible manifestation of the injury, if the opening
+so made is small&mdash;such as a suitable exploratory trocar makes. But a
+puncture made in a similar manner and with the same instrument without
+due regard <a name="Page_24" id="Page_24"></a>to asepsis is likely to cause an infectious synovitis and
+arthritis usually follows.</p>
+
+<p>A larger opening than is produced by means of an exploratory trochar may
+be made into a joint cavity, causing escape of synovia as it is secreted
+for days and even for weeks and no serious or permanent trouble is
+experienced in some cases. If the synovitis or arthritis remains
+non-infected and the wound, traumatic or surgical, is not too large,
+healing by granulation occurs, and the discharge of synovia ceases.
+However, if synovial discharge persists too long because of tardy
+closure of an open joint, there is great danger of infection gaining
+entrance into the synovial cavity, or in some instances, desiccation of
+endothelial cells of the articulation occurs, in areas, and the
+reactionary inflammation eventually results in ankylosis.</p>
+
+<p>A small puncture which introduces into the synovial cavity infectious
+material of active virulence will cause an arthritis that is more
+serious, much more painful and more difficult to handle than is
+occasioned by a wound of moderate size, that affords ready escape of
+synovia even through the virulence of the infection be the same.</p>
+
+<p>Synovia is a good culture medium and the environment is ideal for
+multiplication of bacteria; consequently, the grave disturbances which
+may attend the introduction of pathogenic organisms into a synovial
+cavity as the result of a puncture wound are not to be forgotten. The
+veterinarian is in no position to estimate the virulency of organisms so
+introduced; neither can he determine the exact degree of resistance
+possessed by the subject in any given case. Therefore, he is uncertain
+as to the best method of handling such cases where an injury has been
+recently inflicted and positive evidence of the existence of an
+infectious synovitis is not present. If one could determine in advance
+the degree of infection and injury that is to follow small penetrant
+wounds of joint capsules, it would then be possible to select certain
+cases and immediately drain away all synovia and fill the cavity by
+injection with suitable antiseptic solutions.</p>
+
+<p>This offers a broad field for experimentation which will in time be
+productive of a radical change in the manner of treating such cases.</p>
+<p><a name="Page_25" id="Page_25"></a></p>
+
+<p><i>Metastatic arthritis</i> is seen more frequently in colts or young animals
+than in mature horses and we here take the liberty of classifying with
+the arthritis of omphalophlebitis and strangles the so-called rheumatic
+variety.</p>
+
+<p>A specific polyarthritis or synovitis which attends navel infection of
+foals is perhaps the most frequent form of arthritis that is to be
+considered metastatic. This condition is truly a disease of young
+animals and, while it is a specific arthritis, the cause is yet to be
+attributed to any definite pathogenic organism with certainty. This
+condition is well defined by Bollinger as quoted by <span class="nowrap">Hoare,<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a></span> when he
+calls it a purulent omphalophlebitis due to local infection of the
+umbilicus and umbilical vessels, by pyogenic organisms, causing a
+metastatic pyemia.</p>
+
+<p>This affection is grave; its course is comparatively brief; the
+prognosis is usually unfavorable; and omphalophlebitis occasions a form
+of lameness which at once impresses the practitioner that serious
+constitutional disturbance exists. Its consideration properly belongs to
+discussions on practice or obstetrics and diseases of the new born, and
+it has received careful attention and is discussed at length in these
+works.</p>
+
+<p>A second form of metastatic arthritis is met with in strangles.
+Strangles occurs in the young principally and is not a frequent cause of
+synovitis or arthritis in the adult animal.</p>
+
+<p>Strangles or distemper is, according to most pathologists, due to the
+Streptococcus equi. <span class="nowrap">Hoare<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a></span> states that in this type of specific
+arthritis the contagium is probably carried by the blood. He gives it as
+his opinion that even laminitis has occurred as a result of the
+streptococcus-equi. This, indeed, would point toward probable extension
+by the blood as well as by way of lymph vessels.</p>
+
+<p>Septic synovitis and infectious arthritis are always serious affections
+even in young animals and much depends upon individual resistance and
+early rational treatment in such cases, if recovery is to follow.</p>
+
+<p>The same general plan of treatment is indicated in this kind of septic
+synovitis as is employed in all cases of infective syn<a name="Page_26" id="Page_26"></a>ovitis and septic
+infection in open joints. There is to be considered, however, the fact
+that the young animal is more agile, a better self-nurse, and in a
+general way more apt to recover than is the adult, under similar
+conditions.</p>
+
+<p><i>Rheumatic arthritis</i>, if one is justified in classifying rheumatic
+inflammation of joints as a metastatic form of arthritis, is not a
+common condition, though seen in mature and aged animals. Cases that may
+be diagnosed with certainty are usually advanced affections wherein
+dependable history is obtainable and the symptoms are well marked.</p>
+
+<p>Rheumatism may be thought of, with respect to arthritic inflammation
+caused thereby, as a sort of pyemia. Undoubtedly, exposure to wet and
+cold weather is an active factor, but probably a predisposing one only.
+Likewise a member that suffers from chronic inflammation due to
+recurrent injury or to constant or repeated strain is less able to
+resist the vicissitudes of climate and work.</p>
+
+<p>Consequently, rheumatic arthritis is to be seen affecting horses that
+are in service, more often at heavy draft work where they are exposed to
+severe straining of joints; where stabling is insanitary; and where they
+are obliged to lie down (if they do not remain standing) upon cold and
+wet ground or upon hard unbedded floors or paving.</p>
+
+<p>Where such inhumane and cruel treatment is given animals those
+responsible ought to be impressed with the unfairness to the animal as
+well as the economic loss occasioned by inflicting such unnecessary and
+merciless treatment upon their helpless and uncomplaining subjects. The
+very nature of the veterinarian's work affords him constant and frequent
+opportunity to convince those who are responsible for keeping animals in
+this manner, that it is inhumane and unprofitable.</p>
+
+<p>Cases of this kind are not uncommon about some grading and lumbering
+camps and in contract work where, often, shelter for animals is given
+little thought; the result is a cruel waste of horseflesh.</p>
+
+<p>Chronic articular rheumatism is occasionally observed in young animals
+that have never been in service. In these cases it seems that there
+exists an individual susceptibility and in <a name="Page_27" id="Page_27"></a>some instances the condition
+is recurrent. Each attack is of longer duration, and eventually death
+results from continued suffering, emaciation and intoxication.</p>
+
+
+<h3><a name="AFFECTIONS_OF_BURSAE_AND_THECAE" id="AFFECTIONS_OF_BURSAE_AND_THECAE"></a>AFFECTIONS OF BURSAE AND THECAE.</h3>
+
+<p>Acute bursitis and thecitis is of frequent occurrence in horses because
+of direct injury from contusion, punctures and other forms of
+traumatism. These synovial membranes, with few exceptions, when inflamed
+occasion a synovitis that may be very acute, yet there is less
+manifestation of pain than in arthritis.</p>
+
+<p>It is only in structures such as the bursa intertubercularis or in the
+sheath of the deep digital flexor that an inflammation causes much pain
+and is apt to result in permanent lameness. This is due to the peculiar
+character of the function of such structures.</p>
+
+<p>An acute inflammation of a small bursa may even result in the
+destruction of such synovial apparatus without serious inconvenience to
+the subject, either at the time of destruction or thereafter.
+Obliteration of the superficial bursa over the summit of the os calcis
+is not likely to cause serious inconvenience or distress to the subject
+unless it be due to an infected wound. Even then, with reasonably good
+care given the animal, recovery is almost certain. Complete return of
+function of the member and cessation of lameness takes place within a
+few weeks in the average case.</p>
+
+<p>Where an infectious synovitis involves a structure such as the sheath of
+the tendon of the deep digital flexor (perforans) the condition is grave
+and because of the location of this theca the prognosis is not much more
+favorable than in an articular synovitis.</p>
+
+<p>Inflammation of bursae and thecae may be classified on a chronological
+basis with propriety because the duration of such affections, in many
+cases, materially modifies the result. A chronic inflammatory
+involvement of a theca through which an important tendon plays may cause
+adhesions to form. Or there may occur erosions of the parts with
+eventual hypertrophy and loss of function, partial or complete.</p>
+
+<p>However, in general practice a classification on an etiological <a name="Page_28" id="Page_28"></a>basis
+is probably more practical and we shall consider inflammation of bursae
+and thecae as <i>infectious</i> and <i>noninfectious</i>.</p>
+
+<p><i>Infectious</i> bursitis and thecitis is usually the result of direct
+introduction of septic material into the synovial structure by means of
+injuries. Infection by contiguous extension occurs and also metastatic
+involvement is met with occasionally.</p>
+
+<p>The noninfectious inflammation of bursae and thecae usually result from
+contusions or strains and generally run their course without becoming
+infective in character, where vitality and resistance of the subject are
+normal.</p>
+
+<p>In a general way, inflammation and other affections of bursae and thecae
+are considered very similar to like affections of joints.</p>
+
+
+<h3><a name="AFFECTIONS_OF_MUSCLES_AND_TENDONS" id="AFFECTIONS_OF_MUSCLES_AND_TENDONS"></a>AFFECTIONS OF MUSCLES AND TENDONS.</h3>
+
+<p>Muscles and tendons having to do with locomotion are more frequently
+injured than are any of the other structures whose function is to propel
+the body or sustain weight. This is due in part to the exposed position
+of muscles and tendons. They serve as a protection to the underlying
+structures and in this manner receive many blows the force and violence
+of which are spent before injury extends beyond these tissues.</p>
+
+<p>Muscles of the breast, shoulder and rump are most frequently the
+recipient of injuries of various kinds. The abductors of the thigh are
+subjected to bruising when horses are thrown astride of wagon poles or
+similar objects. Thus in one way or another muscle injuries are
+occasioned and cause lameness.</p>
+
+<p>Traumatic affection of muscles of locomotion may be surface or
+subsurface&mdash;subsurface with little injury done the skin and fascia, but
+with subsurface extravasation of blood and masceration of tissue.
+Puncture wounds wherein the vulnerant body is of small diameter, are
+observed, and they occasion deep seated infectious inflammation of the
+parts affected, with surface wounds that are often unnoticeable. Such
+injuries&mdash;puncture wounds&mdash;are always serious, and because of the fact
+that, there exists little evidence of injury at the time of their
+infliction, treatment is usually deferred several days and often
+infection has become quite extensive when the practitioner is consulted.</p>
+
+<p>Where infective wounds of muscles of locomotion occur, the <a name="Page_29" id="Page_29"></a>course and
+gravity of the affection are directly influenced by the proximity of the
+injury to lymph plexuses. For instance, injuries causing an infectious
+inflammatory involvement of the adductors of the thigh may result in a
+generalization of the infection by way of the inguinal lymph glands.</p>
+
+<p>Large open wounds that extend deep into muscles, render inactive such
+structures, and even where division is not complete, the pain occasioned
+causes the subject to favor the part in every way possible. Contraction
+of muscular fibers of such parts increases pain and because of this fact
+groups of muscles are at times disabled because of injury done to one
+muscle. Instances of this kind are frequently seen where shoulder
+injuries, which affect but one muscle, exist; yet because of such injury
+a marked swinging-leg lameness is present.</p>
+
+<p>Tendons, because of their inelasticity, are subjected to injuries
+peculiar to themselves. In addition to being affected as are muscles,
+wounds of many kinds are found to affect tendons&mdash;contusions,
+interference wounds, penetrant wounds, incised wounds and lacerations.</p>
+
+<p>However, the commoner form of injury done tendons, is strain or sprain.
+Because of the sudden tensile strain brought to bear upon tendons in the
+shocks of concussion, as well as in propulsion of the body, there
+frequently occurs a rupture of fibers and this we know as sprain.</p>
+
+<p>Sprains may be considered as fibrillary fractures of soft structures and
+since this form of injury is subsurface, and limited to fractional
+portions of tendons, the inflammation occasioned usually remains an
+aseptic one. Reaction to this form of injury is characterized by
+inflammation, the course of which is erratic and variable. In chronic
+inflammation of tendons, where animals are continued in service, the
+usual sequel is contraction, or shortening of these structures.</p>
+
+<p>The degree of contraction as well as its import varies in different
+subjects and in the various tendons which may be affected. Contraction
+is a slow-going process that is progressive, gradually causing a
+decrease in the length of the affected structure and eventually
+rendering the animal useless.</p>
+
+<p>The practice of applying shoes with extended toe-calks for <a name="Page_30" id="Page_30"></a>the purpose
+of "stretching" contracted deep digital flexor tendons (flexor pedis
+perforans) cannot be too strongly condemned. While the addition of an
+extension such as is ordinarily employed to the toe of a shoe of this
+kind, prevents for a time, frequent stumbling in such cases, the
+increased tensile strain which is thus occasioned hastens further
+contraction and subjects animals so shod to much unnecessary pain.</p>
+
+
+<h3><a name="AFFECTIONS_OF_NERVES" id="AFFECTIONS_OF_NERVES"></a>AFFECTIONS OF NERVES.</h3>
+
+<p>Because of their being protected by other structures, nerve trunks,
+which supply muscles of locomotion, are not subjected to frequent
+injuries such as contusions. However, they do become injured at times
+and the result is lameness, more or less severe.</p>
+
+<p>Lameness originating from nerve affection, may involve central
+structures as, for example, the spinal cord, medulla oblongata or parts
+of the brain. In making an examination of some lame animals it is
+necessary to distinguish between cases of lameness that are of central
+origin and marked by inco&ouml;rdination of movement, and disturbances caused
+by other affections. Tetanus in its incipiency should not be confused
+with laminitis involving all four feet, or with certain forms of
+pleuritis, when careful examination is made, yet, in a way, to one not
+trained, the clinical symptoms are similar.</p>
+
+<p>Disturbances of nerve function are caused in a variety of ways. It is
+not within the scope of this work to discuss central nervous
+disturbances caused by ingestion of mouldy provender, or disturbances of
+the brain or cord occasioned by infectious diseases, but mention of the
+existence of such conditions is appropriate.</p>
+
+<p>By direct injury the result of blows, certain nerves are injured and
+muscles supplied by such nerves are rendered inactive. Depending upon
+the nature and extent of an injury thus inflicted, so the manner in
+which the affection is manifested varies. The suprascapular nerve is
+rather frequently injured causing partial or complete loss of function
+of the structures supplied by this nerve, and abduction of the
+scapulohumeral joint naturally results.</p>
+
+<p>In some cases of dystocia the obturator nerve, (or nerves, if the
+involvement is bilateral), becomes injured by being caught <a name="Page_31" id="Page_31"></a>between the
+maternal pelvis and some dense part of the fetus. This results in
+paralysis of the adductors of the thigh if sufficient injury is done.</p>
+
+<p>It is said that nerves become over-stretched and held tense, in certain
+positions in which animals are obliged to remain while cast in
+confinement such as in some instances where unusual methods of restraint
+are employed. When the fore feet are drawn backward in such manner that
+great strain is put upon the radial nerve, it suffers more or less
+injury, and this is followed by partial or complete paralysis which may
+be temporary or permanent.</p>
+
+<p>Degenerative changes affecting nerves, as in other tissues, occur and
+more or less locomotory impediment will follow&mdash;this depending upon the
+nerve or nerves affected and the nature of such involvement. Tumors may
+surround nerves and eventually the nerve so exposed becomes implicated
+in the destructive process. Before degenerative changes take place in
+the nerve substance, in such cases, pressure may completely paralyze a
+nerve when it is so situated. Melanotic tumors in the paraproctal tissue
+in some cases, because of the large size of the new-growths, cause
+paralysis of the sciatic nerve. The author has seen one case of brachial
+paralysis occasioned by an enormous development of fibrous tissue
+involving the structures about the ulna.</p>
+
+
+<h3><a name="AFFECTIONS_OF_BLOOD_VESSELS" id="AFFECTIONS_OF_BLOOD_VESSELS"></a>AFFECTIONS OF BLOOD VESSELS.</h3>
+
+<p>Lameness caused by disturbances of circulation may be due to structural
+affection of vessels, or functional disorders of the heart, and in some
+instances, a combination of these causes may be active.</p>
+
+<p>Direct involvement of vessels is the commoner form of circulatory
+disturbance which occasions lameness, and the most frequent cause is of
+parasitic origin. Sclerostomiasis with attendant arteritis, thrombus
+formation and subsequent lodgement of emboli in the iliac, femoral, or
+other arteries, causes sufficient obstruction to prevent free
+circulation of blood, and the characteristic lameness of thrombosis
+results.</p>
+
+<p>Indirect injury to vessels may occur because of contused wounds and
+subsequent inflammation of tissues supplied by such <a name="Page_32" id="Page_32"></a>vessels. If the
+injury be of sufficient extent, considerable extravasation of blood will
+take place and the painfully swollen parts necessarily impair
+locomotion. In such instances lymph vessels participate in the
+disturbance, and the condition then becomes one wherein lymphangitis is
+the predominant disturbing element.</p>
+
+<p>Angiomatous tumors are occasionally found affecting horses'
+legs&mdash;usually the result of some injury; and because of their size or
+position, they mechanically interfere with function. Furthermore, when
+such tumors are located on the inner or flexor side of joints, enough
+pain is occasioned that affected animals show evidence of distress,
+usually by intermittent lameness.</p>
+
+<p>Horses do not suffer from distension of veins as does man, that is,
+there is rarely to be seen a case wherein much disturbance from this
+source exists.</p>
+
+
+<h3><a name="AFFECTIONS_OF_LYMPH_VESSELS_AND_GLANDS" id="AFFECTIONS_OF_LYMPH_VESSELS_AND_GLANDS"></a>AFFECTIONS OF LYMPH VESSELS AND GLANDS.</h3>
+
+<p>Inflamed lymph vessels and glands, the result of various causes, is a
+rather common source of lameness of horses. When one considers the
+proportion of tissue that is composed of lymph vessels and glands, it is
+then obvious that inflammation of these structures should cause a
+painful affection of members, when so affected, and that marked lameness
+and, in some instances, general constitutional disturbance such as
+anorexia, hyperthermia and general circulatory disorder are to follow.</p>
+
+<p>Lymphangitis is most frequently occasioned by the introduction of septic
+material into the tissues; consequently, infectious lymphangitis is more
+frequently observed than the non-infectious type.</p>
+
+<p>Specific infectious forms of lymphangitis are seen in glanders and in
+strangles; infectious types of this disturbance are found in many
+instances where, initially, a localized or circumscribed infection has
+occurred&mdash;the contagium having been introduced by way of an injury. An
+example of this kind is to be seen in a wound perforating the tibial
+fascia, where the injury is inflicted by means of a horse being kicked
+by another animal shod with sharp shoe-calks. Cases of this kind
+invariably result in a septic lymphangitis, and frequently lymphadenitis
+also occurs, for the <a name="Page_33" id="Page_33"></a>inguinal lymph glands are so situated that their
+becoming contaminated is almost certain.</p>
+
+<p>The trite phrase that "the tissues are bathed in lymph" should make
+clear the reason for the frequent occurrence of infectious lymphangitis
+and lymphadenitis. Foreign substances, bacteria and their products,
+inorganic material and in fact, anything that is introduced into the
+tissues, if soluble or miscible, will be taken up and conveyed by the
+afferent lymph vessels and disseminated throughout the system&mdash;hence the
+constitutional disturbances so frequently thus caused.</p>
+
+<p>A non-infectious type of lymphangitis is frequently seen in the heavy
+draft breeds of horses and in such cases one or both hind legs are
+involved&mdash;it is very seldom that the thoracic limbs become so affected.
+<span class="nowrap">Law<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a></span> refers to this ailment as "Acute Lymphangitis of Plethora in
+Horse." When one takes into consideration that these cases so frequently
+occur in heavy draft animals that are not worked regularly, that the
+pelvic limbs are the ones involved, and that the disorder often runs a
+short course (recovery often taking place within two or three days, with
+no treatment given other than a purge, circulatory stimulants and
+walking exercise) it is plausible to ascribe the condition to idiopathic
+factors.</p>
+
+<p>Admitting the frequency of non-infectious lymphangitis, the practitioner
+must not confuse this type with similar lymphatic inflammation
+occasioned by nail punctures of the foot. It is very embarrassing indeed
+to make a diagnosis of lymphangitis&mdash;expecting that the disturbance will
+terminate favorably and uneventually&mdash;and later to discover a sub-solar
+abscess caused by a nail prick in the region of the heel.</p>
+
+<p>Recurrent attacks of this disturbance cause hypertrophy of the lymph
+vessels and in some cases lymphangiectasis. In old subjects used for
+dissection or surgical purposes, it is very evident that in the ones
+which have suffered from chronic lymphangitis there exists an excessive
+amount of sub-facial connective tissue, making subcutaneous neurectomies
+quite difficult in some instances.</p>
+
+<p>A sequel of chronic lymphangitis is a condition known as ele<a name="Page_34" id="Page_34"></a>phantiasis.
+In such cases there occurs a hyperplasia of the skin and subcutaneous
+tissues, resulting in some instances, in the affected member attaining
+an enormous size. Sporadic cases of this kind are to be seen
+occasionally, and are apparently caused by repeated attacks of
+lymphangitis. The affection is not benefited by treatment, and while a
+horse's leg may become so heavy and cumbersome as to mechanically impede
+its gait, as well as to fatigue the subject when made to do service even
+at a slow pace, elephantiasis causes no constitutional derangement. The
+hind legs, in elephantiasis, are affected and a unilateral involvement
+is more often seen than a bilateral one. The legs may be enlarged from
+the extremity to the body, but ordinarily the affection does not extend
+higher than the hock or the mid-tibial region.</p>
+
+<p>A chronic, progressive, hyperplastic-degeneration exists in some cases
+and the subjects are in time rendered unserviceable because of the
+burden of getting about encumbered by the affected extremity. In other
+animals hyperplasia progresses for a time&mdash;until the parts become
+greatly enlarged and conditions apparently attain an immutable state.
+Nevertheless animals so affected may continue in service for years
+without being distressed.</p>
+
+
+<h3><a name="AFFECTIONS_OF_THE_FEET" id="AFFECTIONS_OF_THE_FEET"></a>AFFECTIONS OF THE FEET.</h3>
+
+<p>Lameness is very often due to affections of the feet, and in all foot
+diseases probably the most constant cause is injury inflicted in some
+manner. Resultant from injury, there frequently develops complications
+and the one most often seen is infection.</p>
+
+<p>Because of the fact that the feet are constantly exposed to germ-laden
+soil and filth, if not actually bathed in such infectious materials, it
+naturally follows that septic infection of some part of the feet must be
+of frequent occurrence.</p>
+
+<p>Subsequent to being obliged to stand in mud and other damp or wet media,
+exposure to desiccating influences such as stabling upon dry floors, or
+at service on hot and dry road surfaces causes the insensitive parts of
+the feet to become dry, hard and brittle. This favors "checking" of the
+protecting structures and it frequently results in the formation of
+large fissures which expose <a name="Page_35" id="Page_35"></a>the underlying sensitive parts of the feet
+and lameness is the inevitable outcome.</p>
+
+<p>The function of the feet&mdash;bearing the weight of the animal at all times
+when the subject is not recumbent, and in addition to this, the
+increased strain put upon them at heavy draft work, together with the
+concussion and buffeting occasioned by locomotion, make the feet
+susceptible to frequent affections of various kinds.</p>
+
+<p>Being almost completely encased by a somewhat inexpansible and
+insensitive wall and sole, renders the foot subject to pathologic
+changes peculiar to itself. The very nature of the structure of the foot
+together with the function of the sensitive lamina is sufficient cause
+for an affection unlike that seen involving other tissues&mdash;laminitis.</p>
+
+<p>An exhaustive consideration of foot affections is a study in itself and
+one that comes within the realm of pathologic shoeing; nevertheless, a
+practical knowledge of diseases of the foot is indispensable in the
+diagnosis of lameness wherein the foot may be at fault.</p>
+
+<p>The peculiar nature of foot affections renders them difficult of
+classification on any sort of basis that is helpful in the consideration
+of this subject. Injuries are the most constant cause of foot lameness,
+yet one must admit that there results complications because of infection
+in most instances; and that in some cases the injury is slight&mdash;just
+enough to permit the introduction of vulnerant organisms into the
+tissues. Therefore, one might well classify affections of the feet as
+infectious and non-infectious. There can be grouped in the class of
+infectious affections such conditions as nail pricks, calk wounds and
+canker. In the class of non-infectious affections one may consider
+conditions such as laminitis, strain and fractures.</p>
+<p><a name="Page_36" id="Page_36"></a></p>
+
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<p class="footnote"><a name="Footnote_1_1" id="Footnote_1_1"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_1_1">[1]</a>&nbsp;&nbsp;A System of Veterinary Medicine by E. Wallis Hoare,
+F.R.C.V.S., Vol. I, page 519.</p>
+
+<p class="footnote"><a name="Footnote_2_2" id="Footnote_2_2"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_2_2">[2]</a>&nbsp;&nbsp;Ibid, page 807.</p>
+
+<p class="footnote"><a name="Footnote_3_3" id="Footnote_3_3"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_3_3">[3]</a>&nbsp;&nbsp;Vol. I, page 534, Veterinary Medicine, by James Law,
+F.R.C.V.S.</p>
+</div>
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_37" id="Page_37"></a></p>
+
+<p><a name="SECTION_II" id="SECTION_II"></a></p>
+
+<h2 class="sectionhead">SECTION II.</h2>
+
+<h2>DIAGNOSTIC PRINCIPLES.</h2>
+
+
+<p class="center">
+<i>To observe attentively is to remember distinctly.</i>&mdash;<i>Poe</i>.<br />
+</p>
+
+<p>Before treatment is administered in constitutional disturbances
+resulting in disease, <i>cause</i> is logically sought; so, in order to
+handle effectively any case of lameness, it is necessary first to
+discover the source of the trouble and contributing conditions affecting
+the structures. Hence, diagnostic ability is the prime requisite; and a
+thorough knowledge of pathologic anatomy or of surgical technic is of
+little value if this knowledge is not applied with the insight of the
+trained diagnostician.</p>
+
+<p>The cruel and unnecessary methods employed by those untrained for
+diagnostics, cannot be too vigorously condemned. For instance, the
+application of an active and depilating vesicant upon a large area on
+the gluteal or crural region, in a case where the practitioner "guesses"
+the condition to be one of "hip lameness," constitutes an exposition of
+gross ignorance, and at once stamps the perpetrator as a crude bungler
+without scientific insight whose works are no credit to his profession.
+How much better it would be, if the practitioner does not see fit to
+call in a competent consultant, to prescribe a suitable agent to be
+given internally, and to recommend complete rest for the subject.</p>
+
+<p>In establishing a diagnosis in such cases, the student or practitioner
+seldom has recourse to laboratory assistance, and his work is done by
+means of physical examination; therefore, a thorough knowledge and a
+clear conception of the physiology of locomotion are essential.
+Memorizing nosological facts without an understanding of underlying
+principles is of no more practical benefit for qualification as a
+diagnostician in cases of lameness, than is the employment of similar
+methods in the study of theory and practice. A knowledge of the dosage
+of drugs does not in itself qualify one as being competent to administer
+such therapeutic agents to a proper effect. How <a name="Page_38" id="Page_38"></a>much is a practitioner
+benefited by the knowledge that a high temperature is usually present in
+septic intoxication, if he is not possessed of a scientific
+understanding of anatomy, physiology, bacteriology and pathology, as
+well as the principles of clinical diagnosis?</p>
+
+<p>In order to determine the reasons for certain symptoms manifested by the
+subject, an analysis of these symptoms is the proper method of
+procedure, insofar as this is possible. If one may reason that an animal
+assumes a certain position while at rest to allow relaxation of an
+inflamed tendon or ligament, such a fact enables the diagnostician to
+recall that this is indicative of some specific ailment. In acute
+tendinitis, the subject while at rest, maintains the affected member in
+volar flexion because this position permits relaxation of the inhibitory
+apparatus, including the inflamed tendon. Likewise, the various abnormal
+positions assumed,&mdash;adduction, abduction, undue flexion or
+pointing&mdash;have their own significance and are taken into account by the
+trained diagnostician in the course of an examination.</p>
+
+<p>In the examination of lame subjects, where the cause is not obvious, a
+systematic method of diagnosis is pursued even by the most expert
+practitioners. In all obscure cases of lameness a methodical and
+thoroughly practical examination of the animal according to an
+established procedure is necessary to determine the nature and source of
+the affliction.</p>
+
+
+<h3><a name="Anamnesis" id="Anamnesis"></a>Anamnesis.</h3>
+
+<p>The first thing to be given consideration in diagnosis is the fact that
+related history of the case is not always dependable, because of lack of
+accurate observation or wilful deceit on the part of the owner or
+attendant. The successful veterinarian soon acquires the faculty of
+obtaining information in a manner best adapted to his client,&mdash;either by
+direct interrogation or by subtle means of suggestion, and in this way
+he draws out evaded facts essential to his diagnosis. In time he learns
+to make allowance for misstatements made to shield the owner or driver
+and to hide the facts of apparent neglect or abuse that the subject may
+have experienced. A suppurating cartilaginous quittor, <a name="Page_39" id="Page_39"></a>complicated by
+the presence of a large amount of hyperplastic tissue, cannot be
+successfully represented to be an acute and recently developed
+affection, where a trained practitioner is left to judge the validity of
+the statement.</p>
+
+<p>In complicated conditions, where there is evident a chronic disturbance
+which could not be conceived as sufficient cause for a marked
+manifestation of lameness, accurate history of the case may be of great
+aid in arriving at a diagnosis. An aged animal, having recently become
+very lame, showing a small exostosis on the first phalanx, and with the
+history given that the osseous deposit was of long standing, should at
+once lead the veterinarian to seek the source of trouble elsewhere.</p>
+
+
+<h3><a name="Visual_Examination" id="Visual_Examination"></a>Visual Examination.</h3>
+
+<p>As in all diagnostic work, a careful visual examination of the subject
+should be made before it is approached. The novice is given to hasty
+examination by palpation, not realizing how much may be revealed by a
+careful scrutiny of the subject. In this way he is led to erroneous
+conclusions which the skilled diagnostician has learned from experience
+to avoid. <i>Too much emphasis cannot be placed on the importance of
+making a thoughtful visual examination in every instance before the
+subject is approached.</i> In this examination, type, conformation and
+temperament are taken into account at once, for each of these qualities
+is in itself, a determining factor in predisposing a subject to certain
+ailments or inherent attributes, which may exert a favorable or
+unfavorable influence upon existing conditions and thus make recovery
+probable or otherwise.</p>
+
+<p>Draft animals are less likely to be permanently incapacitated as a
+result of tendinitis, than are thoroughbreds. Likewise, one would not
+expect to find this affection present in heavy harness horses as
+frequently as in light harness animals.</p>
+
+<p>Mal-formation of a part, or an asymmetrical development of the body as a
+whole, may render an animal susceptible to certain affections which
+cause lameness. A "tied in" hock predisposes the subject to curb, and an
+animal having powerful and well-developed hips and imperfectly formed
+hocks, will, if subjected to heavy work, be a favorable subject for bone
+spavin.</p>
+<p><a name="Page_40" id="Page_40"></a></p>
+
+<p>The matter of temperament cannot be disregarded in diagnosis, for in
+some instances, it is the chief determining factor which materially
+influences the outcome of the case. A nervous, excitable animal, that is
+kept at hard work, may, under some conditions, be expected to experience
+disturbances which more lethargic subjects escape. Nervous subjects, it
+is known, are more prone to azoturia than are those of lymphatic
+temperament. Furthermore, the lymphatic subject often recovers from
+certain bone fractures which are successfully treated only when the
+animal is sufficiently resigned by nature to remain confined in a sling
+for weeks without resistance.</p>
+
+<p>The physiognomy of a subject is often indicative of the gravity of its
+condition. The facial expression of an animal suffering the throes of
+tetanus, azoturia, or acute synovitis, is readily recognized by the
+experienced eye, and upon physiognomy alone, in many instances, may the
+opinions regarding prognosis be based. Particularly is this true where
+death is a matter of minutes, or at most is only a few hours distant.</p>
+
+<p>Due allowance should be made for restiveness manifested by some more
+nervous animals when the surroundings are strange and unusual. In such
+instances, even pathognomic symptoms may be masked to the extent that
+little, if any, sign of pain or malaise is evinced. In these cases the
+subject should be given sufficient time to adjust itself to the new
+environment, or it should be removed to a more suitable place for
+examination. Animals quickly detect the note of friendly reassurance in
+the human voice and can very often be calmed by being spoken to.</p>
+
+<p>By visual examination one may detect the presence of various swellings
+or enlargements, such as characterize bruises and strains of tendons
+where inflammation is acute. Inflammation of the plantar
+(calcaneocuboid) ligament in curb is readily detected when the affected
+member is viewed in profile. Spavin, ringbone, splints, quittor and many
+other anomalous conditions may all be observed from certain proper
+angles.</p>
+
+<p>The fact that the skins of most animals are pigmented and covered with
+hair, precludes the easy detection of erythema by visual examination,
+consequently this indicator of possible in<a name="Page_41" id="Page_41"></a>flammation is not often made
+use of in the examination of equine subjects.</p>
+
+
+<h3><a name="Attitude_of_the_Subject" id="Attitude_of_the_Subject"></a>Attitude of the Subject.</h3>
+
+<p>The position assumed while the subject is in repose, is often
+characteristic of certain affections and this, of course, is noted at
+once. The manner in which the weight is borne by the animal at rest,
+should attract the attention of the diagnostician and if the attitude of
+the subject is abnormal or peculiar, the examiner tries to determine the
+reason for it. If weight-bearing causes symptoms of pain, the affected
+member will invariably be favored and held in some one of a number of
+positions. The foot may contact the ground squarely and yet the leg may
+remain relaxed and free from pressure; volar flexion, in such cases, is
+indicative of inflammation of a part of the flexor apparatus. If the
+condition be very painful, position of the afflicted member is
+frequently shifted, but in all cases where the pain is not so keenly
+felt, the inflamed member is held in a state of relaxation. There is
+need then, for a knowledge of anatomy and certain principles in physics
+to enable the observer to determine just which structures are purposely
+eased in this manner. Where palpation of parts is possible, one does not
+need to depend on visual examination alone, and it is always wise to
+take into consideration every factor that may influence conditions.
+Manipulation or palpation of the structures thought to be involved,
+should not be resorted to until a careful and thorough observation of
+the subject has revealed all that it can reveal to the diagnostician.</p>
+
+<p>In all conditions where extreme pain is manifested by the constant
+desire of the animal to keep its foot in motion off the ground,
+examination should be made for local cause. This is seen in certain
+septic inflammations of the feet such as those caused by nail punctures
+invading the navicular joint, or in newly made wounds where nerves have
+been divided and the proximal end of such a nerve is exposed to pressure
+or irritation.</p>
+
+<p>"Pointing" affords a comfortable position in some cases of navicular
+disease, and in a unilateral affection, one may observe the subject
+bearing weight with one sound member, while the affected foot is planted
+well ahead of the sound one. In a bi<a name="Page_42" id="Page_42"></a>lateral involvement of this kind,
+weight may be frequently shifted from one foot to the other, or in
+chronic cases, where no marked pain is experienced, the subject stands
+squarely upon both front feet and no peculiar shifting of weight or
+pointing is evident.</p>
+
+<p>In some cases of hip or shoulder involvement, complete relaxation of all
+parts of the affected member may be noticed. In brachial paralysis, the
+pectoral member is held limply; if the patient is made to move, it is
+evident there is lack of innervation to the afflicted part. In some
+cases where contusion has caused acute inflammation of the member, the
+subject instinctively tries to keep it inactive to relieve the pain
+which movement occasions.</p>
+
+<p>Where there is an active and painful inflammation of the prescapular
+lymph glands and contiguous structures, in some cases of "levator-humeri
+abscess," the scapulohumeral joint is extended. This is brought about by
+flexion of the elbow and carpal joints.</p>
+
+<p>There are some cases of bi-lateral affections which occasion such pain
+during weight-bearing that the subject shifts its weight from one
+affected leg to the other; an example of this condition may be observed
+in any acute case of gonitis which affects both patellar regions, making
+it equally painful to bear the weight on either member.</p>
+
+<p>A peculiar characteristic position is assumed in acute laminitis of the
+fore feet. In such instances, the hind feet are brought forward under
+the body sufficiently to relieve the front feet of the weight, insofar
+as is possible by the abnormal position taken in cases of acute
+laminitis.</p>
+
+<p>So in each position that is abnormal to any degree, assumed by a
+suffering animal, there may be deduced, the fact that the subject is
+attempting to relieve the affected structures, and in each clinical
+picture of this kind, the trained diagnostician sees some index to the
+nature and source of the trouble. Further examination is rendered more
+effective because of this preliminary visual examination which has
+precluded the unnecessary annoyance of the animal by manipulating
+unaffected structures.</p>
+
+<p>It has been presupposed in the foregoing, that the one mak<a name="Page_43" id="Page_43"></a>ing visual
+examination of a lame animal for diagnostic purposes, will remember that
+with the normal animal the weight is borne equally well with both fore
+legs; and that this is done without shifting from one to the other; and
+that the pelvic limbs do not support the body in this manner. Normal
+subjects shift their weight from one hind leg to the other and the one
+relaxed, rests in a state of flexion with the toe on the ground and the
+heel raised.</p>
+
+
+<h3><a name="Examination_by_Palpation" id="Examination_by_Palpation"></a>Examination by Palpation.</h3>
+
+<p>In nearly every case where lameness exists an examination of the
+affected parts, by palpation or by digital manipulation, is necessary
+before an accurate conclusion may be drawn; but in making this kind of
+an examination one needs to exercise good judgment lest he fail to
+acquire a correct impression of the actual existent conditions. There is
+need for the diagnostician, here, as well as in other conditions where
+physical examination is made, to approach the subject in a manner that
+will not excite or disturb to the extent that the animal will, in one
+way or another, resist or object to the approach of the diagnostician,
+thereby masking the symptoms sought. The practitioner would best acquire
+skill as a horseman&mdash;if he is not possessed of such&mdash;and handle each
+individual subject in the manner calculated to best suit the temperament
+of the animal examined. The unbroken subject is not handled as
+satisfactorily as is the intelligent family horse; in the former, in
+some cases, little dependence is placed upon digital examination.</p>
+
+<p>By palpation one is enabled to recognize hyperthermia and this, <i>in
+lieu</i> of dependable history, is at times sufficient evidence upon which
+to determine the duration of any given inflammatory affection.</p>
+
+<p>By comparison of different parts of the same member or with an analogous
+portion of another member any marked increase in the apparently normal
+temperature of a part at once signalizes inflammation. In this manner,
+in examining a case where laminitis or other inflammation of the feet is
+suspected, one may arrive at a fairly accurate conclusion without the
+employment of other means. Throbbing vessels are not always easily
+recognized if the subject is a victim of chronic lymphangitis.</p>
+<p><a name="Page_44" id="Page_44"></a></p>
+
+<p>In some instances, where a moderate degree of lameness exists and cause
+is apparently obscure, the recognition of hyperthermia may be the
+deciding factor in establishing a diagnosis. In cases of sprained
+ligaments in the phalangeal region, because of the dense character of
+the structures involved, little if any evidence of the cause of
+lameness, other than local heat, may be found twenty-four hours after
+the injury has been inflicted.</p>
+
+<p>In order to determine the amount or extent of hyperthermia with a fair
+degree of accuracy in any given case, one must make due allowance for
+external conditions affecting temperature; also the effect of a
+considerable amount of hair covering an area, as well as any possible
+dirt contacting the surface of the skin must be taken into account. All
+dirt should be removed if practicable, so that the diagnostician's palms
+may come as nearly in contact with the inflamed structures as possible.
+Then, too, the sense of touch if the operator's hands are chilled, is
+not dependable. In such instances the novice will need to be deliberate
+as to his findings&mdash;whether or not hyperthermia really exists. Such an
+examination is of little value where the subject's feet are wet and an
+examination is hurriedly made, as in cases of suspected laminitis.</p>
+
+<p>Often, before being able to distinguish the presence of a hyperthermic
+condition, one is impressed with the fact that an animal manifests
+evidence of being supersensitive. In fact, some animals in the
+anticipation of pain at the touch of an injured part, will instinctively
+withdraw&mdash;in self-protection&mdash;such an ailing member or resist the
+approach of the practitioner. This sensitiveness is more apparent in
+animals that have been subjected to previous manipulation or treatment
+which has occasioned pain, and consequently, allowance must be made for
+this exhibition of fear. No better example of this condition can be
+imagined than is present in cases of "shoe boil," where there exists an
+extensive area of acute inflammation of the elbow. There is always more
+or less surface disturbance wherever vesication has been produced, and
+in cases where irritants of any kind have been employed for several days
+or a week previous to an examination, more or less supersensitiveness is
+to be expected.</p>
+<p><a name="Page_45" id="Page_45"></a></p>
+
+<p>One must not lose sight of the fact that unscrupulous
+dealers,&mdash;"traders"&mdash;make use of their knowledge of this principle in
+various way usually for the purpose of attracting attention to a part,
+which, presumably might have been blistered in order to intentionally
+produce inflammation of tissues, in this way, causing lameness which is
+not manifested until an animal has been kept by its new owner for
+twenty-four hours or more. This, to be sure, usually makes a
+dissatisfied purchaser who is willing to dispose of his newly acquired
+animal at a sacrifice, thus enabling the original owner or his agent to
+regain possession of the victimized animal at less than its real value.</p>
+
+<p>Some nervous animals, because of the manner of approach of the
+practitioner, are wont to flinch, and there is manifested a
+pseudo-supersensitiveness. Young animals not accustomed to being handled
+are likely to be timorous, and one must not hastily conclude that a part
+is painful to the touch because the subject resents even gentle digital
+manipulation of such parts. In instances of this kind, one needs to
+compare sensibility by manipulation of different parts of the subject's
+body in a careful and gentle manner; and by exercising patience and good
+judgment in such work, it is possible to actually distinguish between
+normal sensibility and abnormal sensitiveness, in most cases. Here,
+again, the diagnostician needs to possess skill as a horseman and good
+judgment as to individual temperament of different animals, under any
+condition which may exist at the time he makes his examination.</p>
+
+<p>By palpation alone, one can recognize the presence of fluctuating
+enlargements; one may not only recognize such conditions, but
+distinguish between a fluctuating mass such as exists in
+non-strangulated hernia and a large fibrous tumor. By palpation, for the
+recognition of density and for determining the presence or absence of
+hyperthermia, one may decide that there exists an abscess and not a
+tumor. Edematous swellings are recognized by palpation,&mdash;the
+characteristic indentations which may be made in dropsical swellings are
+pathognomonic indicators. In this manner it is easy to differentiate
+post-operative or post-traumatic edemas which may or may not cause
+lameness. At any rate, it is essential to take into account all
+determinate con<a name="Page_46" id="Page_46"></a>ditions that may assist in the prognosis of any given
+case, for the purpose of being able to outline rational remedial
+measures. To be able to distinguish between the generalization of a
+septic infection in its incipiency, and a more or less benign edema, is
+largely possible by digital manipulation alone. An extremity may be
+greatly swollen because of the existence of chronic lymphangitis,
+influenza, or an acute septic infection occasioned by the introduction
+of pathogenic and aerogenic organisms. Since the effect produced by
+these dissimilar ailments are productive of conditions that may
+terminate favorably or unfavorably, it becomes necessary for the
+diagnostician to develop a trained, discriminating, tactile-digital
+sense, in order to correctly interpret existing conditions, and handle
+cases in a rational and skillful manner.</p>
+
+<p>In order to ascertain the extent and exact location of a tumor, an
+exostosis, or other enlargements, the diagnostician, here also, needs to
+be in possession of a trained tactile sense and in addition if he be
+fortified with an accurate knowledge of normal anatomy and pathology, he
+is able to arrive at proper conclusions, when digital manipulations have
+been employed. Fibrous tumors are sometimes located in the inferior part
+of the medial side of the tarsus&mdash;exactly over the seat of bone-spavin.
+Such tumors, when the affected member is supporting weight, are not to
+be distinguished from exostoses; but as soon as the affected leg ceases
+to bear weight, it may be passively flexed and the nature of the
+enlargement recognized because it may be slightly displaced by digital
+manipulation. Displacement, of course, is not possible with an
+exostosis.</p>
+
+<p>A necessary qualification, which the diagnostician must possess, is that
+of being able to judge carefully the nearness of any given exostosis to
+articular structures. Also, the extent or area of the base of an
+exostosis as well as its exact position, needs be determined before one
+may estimate the probable outcome in any case,&mdash;whether treatment should
+be encouraged or discouraged by the practitioner. Periarticular ringbone
+may, because of the size and location of the exostosis, constitute a
+condition which cannot be relieved in any way in one case, and in
+another, because of the manner of distribution of such osseous
+<a name="Page_47" id="Page_47"></a>deposits, the condition may be such that prompt recovery will follow
+proper treatment. In the examination of an exostosis of the tarsus, it
+is particularly important to determine the exact location of the
+exostosis&mdash;whether or not the spavin involves the tibial tarsal
+(astragulus) bone very near its tibial articular portions. Obviously, if
+articular surfaces of joints are involved, complete recovery cannot
+result despite the most skillful attention given the subject.</p>
+
+
+<h3><a name="Passive_Movements" id="Passive_Movements"></a>Passive Movements.</h3>
+
+<p>Wherever it is possible to gain the confidence of a tractable animal to
+the extent that it will relax the structures sufficiently to make
+possible passive movement of affected parts, much is to be learned as a
+result of such manipulation. By this method one may differentiate true
+crepitation, false crepitation, luxation and inflammation of ligaments
+that have been injured, as in sprains of such structures in the
+phalangeal region.</p>
+
+<p><i>True crepitation</i> is recognizable by the characteristic vibration which
+is interpreted by tactile sense. It is possible to recognize fracture by
+the use of other methods&mdash;auscultation, tuning fork tests, etc., but in
+ordinary veterinary practice one must rely upon the sense of touch for
+recognition of crepitation.</p>
+
+<p>Where pain is not so great that relaxation of parts does not occur, one
+can, by gently moving an extremity in various directions&mdash;as in flexion,
+extension and lateral motion as well as by rotation&mdash;cause to be
+manifested this peculiar grating,&mdash;the friction of newly broken bone.
+This is known as <i>true crepitation</i>. Where the subject, suffering
+phalangeal fracture, manifests evidence of pain due to tensing the
+structures about a fractured part, one may anesthetize the parts by
+using about two cubic centimeters of a two per cent. solution of cocain
+upon the plantar nerves, proximal to the fracture. It is perhaps best to
+deposit the cocain solution by means of two hypodermic punctures at
+different points along the course of each nerve, though closely situated
+to one another, thereby making more sure of the solution actually
+contacting the nerve. In some multiple fractures of the first or second
+phalanx this is quite necessary; otherwise, pain produced by passive
+manipulation causes the <a name="Page_48" id="Page_48"></a>subject to keep the tendons so tense that
+crepitation may not be detected. The unnecessary infliction of pain is
+always to be avoided.</p>
+
+<p>We know as <i>false crepitation</i> a vibrating impulse occasioned by normal
+contact of articular portions of bones such as in the
+metacarpophalangeal joint when this structure is passively moved, where
+the subject permits the parts to remain in a state of complete
+relaxation.</p>
+
+<p>Attempts to recognize supersensitiveness or inflammation by means of
+passive movement of the shoulder or hip, whether gently or forcefully,
+is not productive of good, in any case, in large animals. Because of the
+bulk and weight of parts so manipulated, as well as the resistance the
+subject offers even in normal cases, no accurate conclusion is to be
+arrived at in this manner in the average instance. Animals nearly always
+resist the placing of members in any position that is so unusual and
+uncomfortable as that which is required to materially displace the
+component tissues of the shoulder or hip; therefore, such practice is
+useless because one can not distinguish between normal resistance and
+flinching caused by painful sensations in injured parts. Such
+manipulations are practical in small animals.</p>
+
+
+<h3><a name="Observing_the_Character_of_the_Gait" id="Observing_the_Character_of_the_Gait"></a>Observing the Character of the Gait.</h3>
+
+<p>In order to determine the degree of lameness as well as its character,
+it is necessary to cause the subject which is being examined, to move in
+some manner. The degree of inconvenience or distress experienced by a
+lame animal that is being so examined is manifested by the character of
+the claudication; and where much pain is occasioned in locomotion there
+is disturbance of respiration; perspiration may be noticeable and in
+some instances manifestation of nervous shock are very evident&mdash;this in
+timid, nervous animals that anticipate being punished when approached
+and, consequently, make every effort possible to move when urged to do
+so. An animal, then, should be moved only sufficiently to cause it to
+exhibit the degree of lameness present in any given case, and if a
+marked impediment is manifested it is not necessary to cause the subject
+to be exerted to <a name="Page_49" id="Page_49"></a>the extent of inflicting, in such manner, unnecessary
+punishment. Further or conclusive examination is made by palpation. To
+cause the subject to move, an assistant may simply lead the animal with
+a halter and compel it to walk a few steps. In this way, lameness,
+whether manifested during the weight-bearing period of an affected
+member, or when such a member is being advanced, or whether a
+combination of the two conditions exists, is made apparent. In the words
+of Dollar, one is thus enabled to recognize the existence of
+"supporting-leg-lameness," "swinging-leg-lameness" or "mixed lameness."</p>
+
+<p>When the cause of lameness is not strikingly apparent it becomes
+necessary to have the subject moved farther than a few steps and at
+different paces. Depending then, upon the character of lameness
+manifested, as well as upon its degree of intensity, one needs to
+exercise the subject in various ways, but this should not be overdone.</p>
+
+<p>The first thing apparent in the lame subject in action, is the lame leg.
+If this is not readily determinable, as in some complicated cases, the
+leg or legs which are at fault are to be discovered by further
+examination, and to do this,&mdash;word-pictures convey little that is
+helpful in difficult cases,&mdash;long practice is the one route by which one
+may become efficient; that is, by experience gained after fundamental
+principles in the diagnosis of lameness have been mastered.</p>
+
+<p>For a careful study of supporting-leg-lameness involving a fore limb,
+the subject is driven or led <i>toward</i> the one making such examination.
+If a hind leg is to be observed, the animal is made to travel <i>away
+from</i> the examiner. Where there exists swinging-leg-lameness, the
+subject should be caused to move past the diagnostician, so that he may
+get a side view of the subject while it is in motion.</p>
+
+<p>In every case such examinations are made to the best advantage if the
+practitioner can view his patient from a little distance. Here, again, a
+visual examination is made but this cannot be successfully executed, in
+difficult cases, if the practitioner is stationed at too close range.</p>
+
+<p>The average subject is best observed by being led, rather than being
+ridden, and in so doing the animal should be given moder<a name="Page_50" id="Page_50"></a>ately free
+rein. A close grasp on the lead may interfere somewhat with head
+movements. Nodding of the head with the catching up of weight by a sound
+member in supporting-leg-lameness of a fore leg, constitutes the chief
+symptom considered in detecting the lame leg.</p>
+
+<p>Where supporting-leg-lameness affects a hind limb the head is raised at
+the time weight is caught by the sound member&mdash;here the long axis of the
+subject's body may be likened unto a lever of the first class. The
+posterior part of the body, at the time weight is taken upon the sound
+leg, is as the long arm: the fore limbs the fulcrum, and the subject's
+head the weight, which is lifted. The head movements of a horse at a
+trot, in supporting-leg-lameness of a front leg, synchronize with the
+discharge of weight from a lame leg to the opposite one if sound; but in
+pelvic limb affections, the head is thrown or jerked upward as weight is
+caught by the sound member,&mdash;this peculiar nodding movement is
+<i>opposite</i> in the two instances.</p>
+
+<p>In pacing horses, since front and hind legs of the same side are
+advanced at the same time, there occurs in supporting-leg-lameness, a
+nodding of the head with discharge of weight from the lame leg, and a
+dropping of the hip as weight is caught by the sound pelvic member. In
+observing animals that are limping, (as in supporting-leg-lameness) one
+notices particularly the sacro-iliac region in hind leg affections and
+the occipital region in lameness of the front legs.</p>
+
+<p>Where there exists a bilateral affection, (such as characterizes some
+cases of navicular disease or other affections causing
+supporting-leg-lameness) there occurs no nodding of the head; weight is
+supported for an equal length of time upon each one of the two legs, but
+the <span class="nowrap">stride<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a></span> is shortened. The gait, in such cases, is peculiar,
+animals appearing stiff and they are said, by horsemen, to have a
+"choppy" gait.</p>
+
+<p>It is desirable, in some cases, to cause an animal to move from side to
+side; in other instances the subject is best made to walk or trot in a
+circle, and if the circle be very small the animal then particularly
+employs the inner fore leg as a pivotal sup<a name="Page_51" id="Page_51"></a>porting member. To augment
+the manifestation of certain affections, it is necessary to cause the
+patient to walk backward, and each one of these tests of locomotion
+serves to point out in a more or less characteristic manner, the site of
+the affection which is causing lameness in different cases.</p>
+
+<p>Sprains or injuries of lateral ligaments of the extremities, ringbone
+and certain foot affections, are made manifest by a side to side
+movement or a pivotal movement. In fact, wherever it is possible to
+cause undue or unusual tension to be exerted upon an inflamed structure,
+manifestation of pain is the response. In an inflamed condition of the
+lateral side of the phalanges, unequal weight-bearing such as a rough
+road surface will, by virtue of the leverage which the solar surface of
+the foot affords, cause undue strain upon such inflamed parts, and
+increased lameness is evident.</p>
+
+<p>When an animal is made to travel in a circle, when a member affected
+with supporting-leg-lameness is on the inner side of the circle,
+lameness is accentuated because weight is borne by the lame leg for a
+greater length of time, the result of such circuitous manner of
+locomotion. In swinging-leg-lameness, on the other hand, because pain is
+increased at the time an affected member is being advanced, lameness is
+increased when the subject is made to travel in a circle, with the lame
+leg on the outside of a circle thus described.</p>
+
+<p>In supporting-leg-lameness, the transientness of the weight-bearing
+period upon the affected member is the determining factor in the
+production of lameness. This unequal period of weight-bearing upon the
+front legs, for instance, causes an acceleration in the advancement of
+the sound member, in order to relieve the diseased one which is bearing
+weight. In other words, when an animal that is affected with
+supporting-leg-lameness travels in a straight line, since weight is
+borne by the diseased leg for an abnormally short period of time, the
+sound member needs be in the act of advancement a correspondingly short
+period. The result is then, an unequal division of stride; a nodding of
+the head with the catching up of weight by the sound leg,&mdash;in front leg
+affections&mdash;and this is termed <i>limping</i>.</p>
+
+<p>With continuous exertion as in travel for a considerable dis<a name="Page_52" id="Page_52"></a>tance, in
+some cases, lameness becomes less evident&mdash;as in spavin. This "warming
+out" process is due in a measure to the parts becoming less sensitive
+upon exertion, and is to be seen, to a limited extent, in all
+inflammatory affections that are not too severe; consequently, in some
+cases, examination of a lame animal should begin in the stall, for in
+instances where the impediment is not marked, there may be no evidence
+of lameness after the subject has walked a few steps. In other cases,
+lameness increases as the subject continues to travel, and often to the
+extent that the impediment becomes too severe to allow the animal being
+serviceable. Therefore, one can not, in every case of lameness observed,
+positively determine the gravity of the situation, without having seen
+the affected animal in action for a sufficient length of time to
+understand the nature of the condition existing. This necessitates
+driving the animal for several miles in certain cases.</p>
+
+<p>Sometimes it is impossible to arrive at any definite conclusion, as the
+result of a single examination, and it then becomes necessary to see the
+subject again at a later date, or under more favorable circumstances.
+This is to be expected in some conditions where there exists rheumatic
+affections, and also in some foot diseases.</p>
+
+<p>In the examination of young animals, unused to harness and to other
+strange incumbrances, one is obliged to make allowance for impediments
+of gait, which are not occasioned by diseased conditions. Such
+affections have been termed "false lameness." Young mules that are not
+well broken to harness, are difficult subjects for examination and in
+some cases it is necessary to have them led or driven for a considerable
+distance before one can definitely interpret the nature of the
+impediment in the gait when lameness is not pronounced. It is especially
+difficult to satisfactorily examine such subjects, for the reason that
+their normal rebellious temperaments cause resistance whenever a strange
+person approaches them, as it is necessary to do for an examination by
+palpation. In such cases&mdash;if an examination does not reveal the cause of
+trouble, rest must be recommended and further examination made at a
+later date, whereupon any new developments may be noted, if such changes
+exist.</p>
+<p><a name="Page_53" id="Page_53"></a></p>
+
+
+<h3><a name="Special_Methods_of_Examination" id="Special_Methods_of_Examination"></a>Special Methods of Examination.</h3>
+
+<p>After having completed a general examination of a lame animal&mdash;obtaining
+the history of the case, noting its temperament, type, size,
+conformation, position assumed while at repose, swellings or
+enlargements if present, causing the subject to move to note the degree
+and character of lameness manifested; palpating and manipulating the
+parts affected to acquire a fairly definite notion of the nature of an
+inflammation or to recognize crepitation it becomes necessary in some
+cases to employ peculiar means of examination in singular instances.
+This may be done by making use of cocain in solution for the production
+of local anesthesia as in lameness of the phalanges. Such means are not,
+in themselves, dependable but are valuable when used in conjunction with
+all other available and practical methods.</p>
+
+<p>Trial use of various shoes in order to shift the weight from one part of
+the foot to another or to cause an animal to "break over" in a different
+manner so that the gait may be changed, constitutes a special test
+procedure. The use of hoof testers or of a hammer to note the degree or
+presence of supersensitiveness is another means that is of practical
+service. No examination, in any case of lameness, is complete without
+having removed the shoe and scrutinized the solar surface of the foot.</p>
+
+<p class="figcenter"> <a name="image01" id="image01"></a>
+   <a href="./images/img01-full.png"><img src="./images/img01.png"
+   alt="Fig. 1&mdash;Hoof testers with special jaws of sufficient size to grasp the largest foot."
+   title="Fig. 1&mdash;Hoof testers with special jaws of sufficient size to grasp the largest foot." /></a><br />
+   Fig. 1&mdash;Hoof testers with special jaws of sufficient size to grasp the largest foot.</p>
+
+<p>Diagnosis by exclusion, finally, is resorted to, and, as in any other
+case where the recognition of cause is difficult, exclusion of the
+existence of conditions,&mdash;one at a time, by an analysis of
+symptoms&mdash;generally enables the practictioner to eliminate all but the
+disturbing element.</p>
+
+<p><a name="Page_54" id="Page_54"></a></p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<p class="footnote"><a name="Footnote_4_4" id="Footnote_4_4"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_4_4">[4]</a>&nbsp;&nbsp;By stride is meant the distance between two successive
+imprints of the same foot. The term is not used in this work as being
+synonymous with step.</p>
+</div>
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_55" id="Page_55"></a></p>
+
+<p><a name="SECTION_III" id="SECTION_III"></a></p>
+
+<h2 class="sectionhead">SECTION III.</h2>
+
+<h2>LAMENESS IN THE FORE LEG.</h2>
+
+
+<h3><a name="Anatomo-Physiological_Review_of_parts_of_the_Fore_Leg" id="Anatomo-Physiological_Review_of_parts_of_the_Fore_Leg"></a>Anatomo-Physiological Review of parts of the Fore Leg.</h3>
+
+<p>For supporting weight, whether the subject is at rest or in motion, the
+bony column of the leg, together with attached ligaments, tendons and
+muscles, is wonderfully well adapted by nature for the function which
+they perform. The several bones which go to make up the supportive
+portion of the leg, are so joined at their points of articulation, that
+a minimum degree of strain is put upon each attachment.</p>
+
+<p>The upper third of the scapula, with its cartilage of prolongation, is
+sufficiently broad and flattened that it fits snugly against the thorax
+without necessity for a complicated method of attachment&mdash;the clavicle
+being absent, attachment is muscular.</p>
+
+<p><span class="nowrap">Smith<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a></span> has very aptly stated that:</p>
+
+<p>"It seems quite legitimate to regard the muscular union between the
+thorax and forelimb as a joint. There are no bones resting on each
+other, no synovia; but where the scapula has its largest range of
+movement there is a remarkable amount of areolar tissue, which renders
+movement easy. The whole central area beneath the scapula and humerus
+not occupied by muscular attachment, is filled with this easy-moving,
+apparently gaseously distended, crepitant, areolar tissue over which the
+fore legs glide on the chest wall as freely as if the parts were a
+large, well lubricated joint."</p>
+
+<p>The scapulohumeral articulation (shoulder joint) is an enarthrodial
+(ball and socket) joint but because of its being held more or less
+firmly against the thoracic wall by muscular and tendinous attachment,
+and because a part of this attachment affords a means of support for the
+body itself, there is no need for binding ligaments and movement is
+possible in all directions even though restricted as to extent.</p>
+
+<p><a name="Page_56" id="Page_56"></a></p>
+
+<p class="figcenter"><a name="image02" id="image02"></a>
+   <a href="./images/img02-full.jpg"><img src="./images/img02.jpg"
+   alt="Fig. 2&mdash;Muscles of Left Thoracic Limb from Elbow Downward; Lateral (External) View. a, Extensor carpi radialis; g, brachialis; g', anterior superficial
+pectoral; c, common digital extensor; e, ulnaris lateralis. (After
+Ellenberger-Baum, Anat. f&uuml;r K&uuml;nstler.) (From Sisson's ''Anatomy of the
+Domestic Animals'')."
+   title="Fig. 2&mdash;Muscles of Left Thoracic Limb from Elbow Downward; Lateral (External) View. a, Extensor carpi radialis; g, brachialis; g', anterior superficial
+pectoral; c, common digital extensor; e, ulnaris lateralis. (After
+Ellenberger-Baum, Anat. f&uuml;r K&uuml;nstler.) (From Sisson's ''Anatomy of the
+Domestic Animals'')." /></a></p>
+<p class="captioncenter">Fig. 2&mdash;Muscles of Left Thoracic Limb from Elbow Downward; Lateral (External) View.<br />
+a,&nbsp;Extensor carpi radialis; g,&nbsp;brachialis; g',&nbsp;anterior superficial
+pectoral; c,&nbsp;common digital extensor; e,&nbsp;ulnaris lateralis. (After
+Ellenberger-Baum, Anat. f&uuml;r K&uuml;nstler.) (From Sisson's "Anatomy of the
+Domestic Animals").</p>
+
+<p><a name="Page_57" id="Page_57"></a></p>
+
+<p class="figcenter"><a name="image03" id="image03"></a>
+   <a href="./images/img03-full.jpg"><img src="./images/img03.jpg"
+   alt="Fig. 3&mdash;Muscles of Left Thoracic Limb from Elbow Downward; Medial (Internal) View. The fascia and the ulnar head of the flexor carpi ulnaris have been
+removed. 1, Distal end of humerus; 2, median vessels and nerve. (From
+Sisson's ''Anatomy of the Domestic Animals'')."
+   title="Fig. 3&mdash;Muscles of Left Thoracic Limb from Elbow Downward; Medial (Internal) View. The fascia and the ulnar head of the flexor carpi ulnaris have been
+removed. 1, Distal end of humerus; 2, median vessels and nerve. (From
+Sisson's ''Anatomy of the Domestic Animals'')." /></a></p>
+<p class="captioncenter">Fig. 3&mdash;Muscles of Left Thoracic Limb from Elbow Downward; Medial (Internal) View.<br />
+The fascia and the ulnar head of the flexor carpi ulnaris have been
+removed. 1,&nbsp;Distal end of humerus; 2,&nbsp;median vessels and nerve. (From
+Sisson's "Anatomy of the Domestic Animals").</p>
+
+<p><a name="Page_58" id="Page_58"></a></p>
+
+<p>Undue extension, (by extension is meant such movement as will cause the
+long axis of two articulating bones to assume a position which
+approaches or forms a straight line&mdash;opposite to flexion), of the
+scapulohumeral joint is impossible while weight is borne, because of the
+normally flexed position of the humerus on the scapula; whereas flexion,
+beyond desirable limits, is inhibited by the biceps brachii (flexor
+brachii or coracoradialis) muscle.</p>
+
+<p>The distal end of the humerus, however, articulating with the radius and
+ulna in a fashion that no support is lent by any sort of contact with
+the body, is a ginglymus (hinge) joint and lateral motion, because of
+the long transverse diameter of its articular portions, is easily
+prevented by the medial and lateral ligaments (internal and external
+ligaments). Flexion of this, the humeroradioulnar joint (elbow), is
+restrained by the triceps brachii and extension is checked by the biceps
+brachii (flexor brachii).</p>
+
+<p>The carpal joint (erroneously called the knee joint), is composed of the
+several carpal bones which interarticulate and, when taken as a group,
+serve as a means of attachment and articulation for the radius and
+metacarpal bones.</p>
+
+<p>The transverse diameter of this joint is long, thus giving it contacting
+surfaces that are sufficiently extensive to minimize the strain upon the
+mesial and lateral ligaments (internal and external lateral common
+ligaments). Motion is that of flexion and extension; slight rotation is
+possible when the position is that of flexion. While supporting weight
+the carpus is fixed in position by a slight dorsal flexion, but undue
+dorsal flexion is prevented by the flexor muscles and tendons and
+volar-carpal or annular ligament, together with the superior check
+ligament.</p>
+
+<p>The metacarpophalangeal articulation (fetlock joint), is a hinge joint
+and its articular surfaces contact one another, with respect to their
+having a long bearing surface from side to side, as do all ginglymus
+(hinge) joints. Two common lateral ligaments bind the bones together.
+While bearing weight, there is assumed a position of slight dorsal
+flexion, undue flexion being checked by the inhibitory apparatus of the
+joint&mdash;check ligaments, and their tendons and the suspensory ligament.
+The inhibitory apparatus of the fetlock joint is materially reinforced
+<a name="Page_59" id="Page_59"></a>by the proximal sesamoid bones. Situated as they are, between the
+bifurcating portions of the suspensory ligament and the posterior part
+of the distal end of the metacarpus&mdash;with which they articulate&mdash;the
+sesamoid bones serve to change the course of the branches of the
+suspensory ligament in a manner that they give firm support to this
+joint. Volar flexion is limited by the extensors of the phalanges.</p>
+
+<p class="figcenter"><a name="image04" id="image04"></a>
+   <a href="./images/img04-full.jpg"><img src="./images/img04.jpg"
+   alt="Fig. 4&mdash;Sagital Section of Digit and Distal Part of Metacarpus.
+A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third
+phalanx; E, distal sesamoid bone; 1, volar pouch of capsule of fetlock
+joint; 2, inter-sesamoidean ligament; 3, 4, proximal end of digital
+synovial sheath; 5, ring formed by superficial flexor tendon; 6, fibrous
+tissue underlying ergot; 7, ergot; 8, 9, 9', branches of digital
+vessels; 10, distal ligament of distal sesamoid bone; 11, suspensory
+ligament of distal sesamoid bone; 12, 12', proximal and distal ends of
+bursa podotrochlearis. (From Sisson's ''Anatomy of the Domestic
+Animals'')."
+   title="Fig. 4&mdash;Sagital Section of Digit and Distal Part of Metacarpus.
+A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third
+phalanx; E, distal sesamoid bone; 1, volar pouch of capsule of fetlock
+joint; 2, inter-sesamoidean ligament; 3, 4, proximal end of digital
+synovial sheath; 5, ring formed by superficial flexor tendon; 6, fibrous
+tissue underlying ergot; 7, ergot; 8, 9, 9', branches of digital
+vessels; 10, distal ligament of distal sesamoid bone; 11, suspensory
+ligament of distal sesamoid bone; 12, 12', proximal and distal ends of
+bursa podotrochlearis. (From Sisson's ''Anatomy of the Domestic
+Animals'')." /></a></p>
+<p class="captioncenter">Fig. 4&mdash;Sagital Section of Digit and Distal Part of Metacarpus.<br />
+A,&nbsp;Metacarpal bone; B,&nbsp;first phalanx; C,&nbsp;second phalanx, D,&nbsp;third
+phalanx; E, &nbsp;distal sesamoid bone; 1,&nbsp;volar pouch of capsule of fetlock
+joint; 2,&nbsp;inter-sesamoidean ligament; 3,&nbsp;4,&nbsp;proximal end of digital
+synovial sheath; 5,&nbsp;ring formed by superficial flexor tendon; 6,&nbsp;fibrous
+tissue underlying ergot; 7,&nbsp;ergot; 8,&nbsp;9,&nbsp;9',&nbsp;branches of digital
+vessels; 10,&nbsp;distal ligament of distal sesamoid bone; 11,&nbsp;suspensory
+ligament of distal sesamoid bone; 12,&nbsp;12',&nbsp;proximal and distal ends of
+bursa podotrochlearis. (From Sisson's "Anatomy of the Domestic
+Animals").</p>
+
+<p>The first phalanx (os suffraginis) normally sets at an angle <a name="Page_60" id="Page_60"></a>of about
+50 to 55 degrees from a horizontal plane while weight is being
+supported. Its distal end articulates with the second or median phalanx
+(os corona) and forms the proximal interphalangeal (pastern or
+suffraginocoronary) joint. This also, is a ginglymus joint, having but
+slight lateral motion, and that only when it is in a state of flexion. A
+rather broad articular surface&mdash;from side to side&mdash;exists here,
+lessening the strain on the collateral ligaments somewhat. Dorsal
+flexion is checked by the flexor tendons and dorsal ligaments. Volar
+flexion is restrained by the extensor tendons.</p>
+
+<p>The distal end of the second phalanx (os corona) has but slight lateral
+motion and this is manifested principally when it is in a state of volar
+flexion. Undue dorsal flexion is prevented by the deep flexor tendon
+(perforans) and volar flexion is inhibited by the extensor of the digit
+(extensor pedis). Thus it is seen, that when the leg is a weight-bearing
+member, weight is supported by the bony framework whose constituent
+parts are joined together by ligaments and tendons and each one of the
+several bones articulates in such manner that the joint is locked. The
+articular parts of bones rest upon or against an inhibitory apparatus,
+and are slightly flexed, as in the carpus, or considerably flexed such
+as in the fetlock joint when weight is being supported. In the first
+instance, for example, the flexors of the carpus and the superior check
+ligament assisted by the flexors of the phalanges constitute the
+inhibitory apparatus.</p>
+
+<p>It will be noted that provision for weight bearing is so arranged that
+muscular energy is not required except in the matter of suspension of
+the body between the scapulae and here tonic impulses only are necessary
+to maintain an <span class="nowrap">equilibrium<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a>,</span> yet in every instance where weight is not
+supported by bones, inelastic ligaments or tendinous structures relieve
+the musculature of this constant strain. This explains the fact that
+some horses do not lie in the stall, yet in spite of their constant
+standing position, they are able to rest and sleep.</p>
+
+<p>The student of lameness is interested in the function of the legs in the
+r&ocirc;le of supporting weight and as propelling parts, and not particularly
+in the capacity of these members for in<a name="Page_61" id="Page_61"></a>flicting offense or as weapons
+of defense. Yet, in the exercise of their functions other than that of
+locomotive appliances, injury often results, but usually it is the
+recipient of a blow that suffers the injury, such as an animal may
+receive upon being kicked. Therefore, we do not often concern ourselves
+with strains or other injuries that the subject experiences as the
+result of efforts put forth in kicking or striking. Where such injuries
+occur, however, a diagnosis is established by making use of the
+principles heretofore discussed.</p>
+
+<p>As propelling members the front legs bear weight and are advanced
+alternately when the horse is walking or trotting&mdash;in cantering this is
+not so. When the normal subject travels in a straight line, at a walk or
+a trot, the length of the stride is the same with the right and left
+members. The stride of the right foot then, for example, is equally
+divided by the imprint of the left foot, in the normal horse, when
+traveling at a walk and in a straight line.</p>
+
+
+<h3><a name="Shoulder_Lameness" id="Shoulder_Lameness"></a>Shoulder Lameness.</h3>
+
+<p>This enigmatical term is frequently employed by the diagnostician when
+he is baffled in the matter of definitely locating the cause of
+lameness; when he has by exclusion and otherwise arrived at a decision
+that lameness is "high up." Shoulder lameness may be caused by any one
+or several of a number of conditions, e.g., fractures of the scapula or
+humerus; arthritis of the shoulder or elbow joint; luxation of the
+shoulder or elbow joint (rarely); injuries of muscles and tendons of the
+region due to strains, contusions or penetrant wounds; paralysis of the
+brachial plexus or of the prescapular nerve; involvement of lymph
+glands; arterial thrombosis; metastatic infections; rheumatic
+disturbances; and as the result of inflammation, infectious or
+non-infectious occasioned by collar bruises. In some instances such
+inflammation is due to the manner of treatment of collar injuries.
+Therefore, when one considers the numerous and dissimilar possible
+causes of shoulder lameness, it behooves the practitioner to become
+proficient in diagnostic principles.</p>
+
+<p>A principle which is elemental in the diagnosis of locomotory
+impediment, is that lameness of the shoulder or hip is usually
+<a name="Page_62" id="Page_62"></a>manifested by more or less difficulty in swinging the affected member.
+Swinging-leg-lameness, then, is usually present in shoulder affections.
+In some instances lameness is mixed as in joint ailments, involvement of
+the bicipital bursa (bursa intertubercularis), etc. In affections of the
+extremity there exists supporting leg lameness. Consequently, we employ
+this elemental principle, and, by a visual examination of the subject,
+which is being made to travel suitably, one may decide that lameness is
+either "high up"&mdash;shoulder lameness or, "low down"&mdash;of the extremity.</p>
+
+<p class="figcenter"><a name="image05" id="image05"></a>
+   <a href="./images/img05-full.png"><img src="./images/img05.png"
+   alt="Fig. 5&mdash;Ordinary type of heavy sling."
+   title="Fig. 5&mdash;Ordinary type of heavy sling." /></a></p>
+<p class="figcenter">Fig. 5&mdash;Ordinary type of heavy sling.</p>
+
+
+<p>To make practical use of this principle, the examiner must be thoroughly
+familiar with the anatomy of the various structures concerned in
+advancing the leg&mdash;those which support weight as well as those concerned
+both in weight bearing and swinging the member.</p>
+
+
+<h3><a name="Fracture_of_the_Scapula" id="Fracture_of_the_Scapula"></a>Fracture of the Scapula.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Fractures of the body of the scapula are of
+infrequent occurrence in horses for the reason <a name="Page_63" id="Page_63"></a>that protection is
+afforded this bone because of its position. Its function, too, is such
+that very unusual conditions are necessary to subject it to fracture.
+The spine is occasionally broken due to blows such as kicks, etc., and
+here frequently a compound fracture exists.</p>
+
+<p class="figcenter"><a name="image06" id="image06"></a>
+   <a href="./images/img06-full.png"><img src="./images/img06.png"
+   alt="Fig. 6&mdash;A sling made in two parts so that horses may be
+supported without use of central part or bodice. This sling is more
+comfortable than is the ordinary style and is particularly useful in
+cases that require a long period of this manner of confinement."
+   title="Fig. 6&mdash;A sling made in two parts so that horses may be
+supported without use of central part or bodice. This sling is more
+comfortable than is the ordinary style and is particularly useful in
+cases that require a long period of this manner of confinement." /></a></p>
+<p class="captioncenter">Fig. 6&mdash;A sling made in two parts so that horses may be
+supported without use of central part or bodice. This sling is more
+comfortable than is the ordinary style and is particularly useful in
+cases that require a long period of this manner of confinement.</p>
+
+<p>Where fractures of the body of the scapula occur, heavy contusions have
+been the cause as a rule, and serious injury is done the subject;
+consequently, treatment of fracture of the body of the scapula is seldom
+successfully practised. Fractures of the body of this bone resulting
+from accidents not involving internal injury or other disturbances and
+which would not seriously interfere with the vitality of the subject,
+are not necessarily serious unless compound.</p>
+
+<p>Fractures of the neck of the scapula are serious because of the fact
+that there occurs displacement of the broken parts and <a name="Page_64" id="Page_64"></a>perfect
+apposition of the fractured ends is difficult, if not impossible.</p>
+
+<p>Fractures that extend to the articular surface are very serious, and
+complete recovery in such instances is practically impossible. The
+cartilage of prolongation of the scapula is sometimes seriously involved
+in certain cases of fistulous withers, and in some instances it has been
+separated from its attachment to the rhomboidea muscles, and lameness
+has resulted. In such instances, the upper portion of the scapula is
+disjoined from all attachment, and with every movement the animal makes,
+the scapula is moved back and forth. Complete recovery in such cases
+does not occur.</p>
+
+<p><b>Symptomatology.</b>&mdash;Fractures of the scapular spine are ordinarily
+readily recognized because there is usually visible displacement of the
+broken part. Crepitation is also detected without difficulty.</p>
+
+<p>In fractures of the body of the scapula where an examination may be made
+before much swelling has taken place, and in subjects that are not
+heavily muscled, one should have no difficulty in recognizing the
+crepitation.</p>
+
+<p>Fractures of the neck of the scapula are recognized by crepitation, by
+passively moving the leg, but it is necessary to exclude fractures of
+the humerus when one depends upon the finding of crepitation by this
+means. However, unless undue swelling exists, the exact location of the
+crepitation is recognized without serious difficulty.</p>
+
+<p><b>Treatment.</b>&mdash;The treatment of compound fractures of the scapular spine
+consists in the removal of the broken piece of bone by way of a
+cutaneous incision so situated that good drainage of the wound will
+follow.</p>
+
+<p>Simple fractures of the body of the scapula are best treated by placing
+the subject in a sling, if the animal is halter broken, and enforcing
+absolute quiet for a period of from three to six weeks. Splints or
+similar appliances are not of practical value in scapular fractures.</p>
+
+<p>Compound fractures of the scapula usually result from violence, which at
+the same time does serious injury to adjacent <a name="Page_65" id="Page_65"></a>structures, and it then
+becomes necessary to administer an expectant treatment, observing
+general surgical principles and providing in so far as possible for the
+comfort of the patient.</p>
+
+
+<h3><a name="Scapulohumeral_Arthritis" id="Scapulohumeral_Arthritis"></a>Scapulohumeral Arthritis.</h3>
+
+<p><b>Anatomy.</b>&mdash;The scapulohumeral joint is an enarthrodial (ball and
+socket) joint wherein the ball or humeral articulating head greatly
+exceeds in size the socket or glenoid cavity of the scapula. The
+capsular ligament surrounding this joint is very large and admits of
+free and extensive movement of the articulation. There exist no lateral
+or common ligaments jointing the scapula and humerus as in other joints,
+but instead the tendinous portions of muscles perform this function. The
+principal ones which are attached to the scapula and humerus that act as
+ligaments are the supraspinatus (antea-spinatus), infraspinatus
+(postea-spinatus) biceps-brachii (flexor brachii) and subscapularis
+muscles.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Inflammation of the scapulohumeral
+articulation results from injuries of various kinds, including punctures
+which perforate the joint capsule, bruises from collars, metastatic
+infections and involvement as a result of direct extension of infectious
+conditions situated near the joint.</p>
+
+<p><b>Classification.</b>&mdash;Acute arthritis may be septic or aseptic, and there
+seems to be a remarkable tendency for recovery in cases of septic
+arthritis involving this joint in the horse.</p>
+
+<p>Chronic arthritis with destruction of articular surfaces and ankylosis,
+is seldom observed. It is only in cases of severe injury, where the
+articular portions of the bones are damaged at the time of infliction of
+the injury, and where the articulation remains exposed for weeks at a
+time, together with immobility of the parts because of attending pain,
+that permanent ankylosis results.</p>
+
+<p>Scapulohumeral arthritis may result then from <i>infections</i>, local or
+metastatic; from <i>injuries</i>, such as contusions of various kinds; from
+<i>wounds</i>, which break the surface structure or perforate the joint
+capsule; or from <i>luxations</i>.</p>
+<p><a name="Page_66" id="Page_66"></a></p>
+
+
+<h3><a name="Infectious_Arthritis" id="Infectious_Arthritis"></a>Infectious Arthritis.</h3>
+
+<p>Infectious arthritis of the scapulohumeral joint the result of local
+causes other than produced by septic wounds, seldom causes serious
+inconvenience to the subject. Where such occurs, however, there is
+manifested mixed lameness and complete extension of the extremity is
+impossible. Local swelling is present and manifestations of pain are
+evident upon palpation of the affected area.</p>
+
+<p><b>Treatment.</b>&mdash;During the first stage of the infection, local
+applications, hot or cold, are indicated. A hot poultice of bran or
+other suitable material contained within a muslin sack, may be supported
+by means of cords or tapes which are passed over the withers and tied
+around the opposite fore leg. Such an appliance may be held in position
+more securely by attaching it to the affected member. Following the
+acute stage of such an infection, any local counter-irritating
+application or even a vesicant is in order.</p>
+
+<p>Where abatement of the infectious process does not take place, and
+suppuration of the structures in the vicinity of the joint occurs, it is
+necessary to provide drainage for pus. In some cases of strangles, for
+instance, large pus cavities are formed and drainage is imperative.
+However, metastatic inflammation of this joint is seldom observed except
+in cases of strangles. The animal should be kept perfectly quiet until
+recovery has taken place.</p>
+
+
+<h3><a name="Injuries" id="Injuries"></a>Injuries.</h3>
+
+<p>Injuries to the scapulohumeral joint may be the result of kicks, runaway
+accidents or bruises from the collar, and there may result, because of
+such injuries, reactionary inflammation which will vary in intensity
+from the mildest synovitis to the most severe arthritis, causing more or
+less lameness.</p>
+
+<p><b>Treatment.</b>&mdash;The general plan of treatment in this form of arthritis is
+the same as has been outlined under the head of infectious arthritis,
+with the exception that there is seldom occasion to provide for drainage
+of pus.</p>
+<p><a name="Page_67" id="Page_67"></a></p>
+
+
+<h3><a name="Wounds" id="Wounds"></a>Wounds.</h3>
+
+<p>Wounds which cause a break of the skin and fascia overlying the
+scapulohumeral joint are usually of little consequence, unless the blow
+is of sufficient force to directly injure the articulation, and in such
+cases, the treatment of the injury along general surgical principles,
+such as cleansing the area, providing drainage for wound secretion, and
+the administration of suitable dressing materials such as antiseptic
+dusting powder, is all that is required for the wound. The symptoms
+manifested by the subject in such cases are the same as have been
+discussed heretofore and merit no special consideration.</p>
+
+<p><b>Prognosis.</b>&mdash;Unless very serious injury be done the articular portions
+of the scapula or the humerus, resulting in the destruction of the
+capsular ligament, prognosis is entirely favorable.</p>
+
+<p><b>Open Joint.</b>&mdash;Where the capsular ligament is perforated and the
+condition becomes one of open joint, then a special wound treatment
+becomes necessary. The surface of the skin is first freed from all hair
+and filth in the vicinity of the wound. The wound proper is cleared of
+all foreign material either by clipping with the scissors, curetting or
+mopping with cotton or gauze pledgets. The whole exposed wound surface
+as well as the interior of the joint cavity, if much exposed, is
+moistened with tincture of iodin. Subsequent treatment consists in a
+local application of a desiccant dusting powder, which should be applied
+five or six times daily. The composition of the powder should be such as
+to permit of its liberal use, thereby affording mechanical protection to
+the wound as well as exerting a desiccative effect. Equal parts of boric
+acid and exsiccated alum serve very well in such cases.</p>
+
+<p>Animals suffering from open joints of this kind should be confined in a
+standing position, preferably in slings, and kept so confined for three
+or four weeks. Since they usually bear weight upon the affected member,
+there is no danger of laminitis resulting.</p>
+
+
+<h3><a name="Luxation_of_the_Scapulohumeral_Joint" id="Luxation_of_the_Scapulohumeral_Joint"></a>Luxation of the Scapulohumeral Joint.</h3>
+
+<p>Because of the large humeral head articulating as it does with <a name="Page_68" id="Page_68"></a>a
+glenoid cavity, scapulohumeral luxations are very rare in the horse.
+According to <span class="nowrap">Moller<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a>,</span> luxation is generally due to excessive flexion
+of the scapulohumeral joint. In such cases the head of the humerus is
+displaced anterior to the articular portion of the scapula and remains
+so fixed.</p>
+
+<p><b>Symptoms.</b>&mdash;Complete luxation of the scapula is recognized because of
+immobility of the scapulohumeral joint and of the abnormal position of
+the head of the humerus, which can be recognized by palpation, unless
+the swelling be excessive. Immobility of the scapulohumeral joint is
+noticeable when one attempts to passively move the parts.</p>
+
+<p><b>Treatment.</b>&mdash;Reduction of the luxation is effected by making use of the
+same general principles that are employed in the reduction of all
+luxations, and they are&mdash;the control of the animal so that the
+manipulations of the operator are not antagonized by muscular
+contraction, which is best accomplished by anesthesia; placing the
+luxated bones in the position which they have taken to become unjointed;
+and then making use of force which is directed in a manner opposite to
+that which has effected the luxation.</p>
+
+<p>In a forward luxation of this kind, the operator should further flex the
+humerus, and while it is in this flexed position, force is exerted upon
+the articular head of this bone, and it is pushed downward and backward
+into its normal position.</p>
+
+<p>After-care consists in restriction of exercise and, if necessary,
+confining the subject in a sling and the application of a vesicant over
+the scapulohumeral region.</p>
+
+
+<h3><a name="Inflammation_of_the_Bicipital_Bursa" id="Inflammation_of_the_Bicipital_Bursa"></a>Inflammation of the Bicipital Bursa.<br />
+(Bursitis Intertubercularis.)</h3>
+
+<p><b>Anatomy.</b>&mdash;There is interposed between the tendon of the biceps brachii
+(flexor brachii) and the intertubercular or bicipital groove a heavy
+cartilaginous pad, which is a part of the bursa of the biceps brachii.
+This synovial bursa forms a smooth groove through which the biceps
+brachii glides in the anterior scapulo<a name="Page_69" id="Page_69"></a>humeral region. Great strain is
+put upon these parts because the biceps brachii is the chief inhibiting
+structure of the scapulohumeral articulation&mdash;the one which prevents
+further flexion of the humerus during weight bearing. Passing, as it
+does, over two articulations, the biceps brachii has a somewhat
+complicated function, being a flexor of the radius and an extensor of
+the humerus. Thus it is seen, the biceps brachii is a weight bearing
+structure, as well as one that has to do with swinging the leg.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Because of the exposed position of the
+bicipital bursa (bursa-intertubercularis) it is occasionally injured.
+Blows and injuries received in runaway accidents do serious injury to
+the bursa and because of the peculiar and important part it plays during
+locomotion, serious injuries are not likely to resolve, and too often
+chronic lameness results. It is to be noted that the tendon of the
+biceps brachii (flexor brachii) is always involved in cases of
+inflammation of the bicipital bursa, and according to the late Dr.
+<span class="nowrap">Bell<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a></span> strain of the biceps brachii is a frequent cause of lameness in
+city horses, more frequent than is generally supposed.</p>
+
+<p><b>Pathological Anatomy.</b>&mdash;More or less destruction of the cartilaginous
+portion of the bursa, sometimes involving the tendinous portion of the
+biceps, takes place and, according to Moller, in some instances there
+occurs ossification of the tendon. Autopsies in some old horses reveal
+the presence of erosions of cartilage and hyperthrophy of the inflamed
+parts.</p>
+
+<p><b>Symptoms.</b>&mdash;In acute inflammations, there is always marked lameness.
+This is manifested to a greater degree when the subject advances the
+affected leg. There is incomplete advancement of the member; the toe is
+dragged when the horse is made to walk and the foot kept in a position
+posterior to the opposite or weight bearing foot while the subject is at
+rest. Lameness is disproportionate to the amount of local manifestation
+in the way of heat, swelling and pain that is to be recognized on
+palpation. In fact, in some cases so much pain attends the condition
+that no weight is borne by the affected member, and when compelled to
+walk, the subject hops on the sound leg.</p>
+<p><a name="Page_70" id="Page_70"></a></p>
+
+<p>Chronic inflammation of the bicipital bursa is occasionally met with
+wherein both members are affected. Because of the nature of the
+structures involved, when inflamed, chronic inflammation is a more
+frequent termination than is complete recovery. Bilateral affections are
+seen in horses that are driven for years, regularly at a fast pace on
+paved streets. In such cases, the gait is stilted, that is, there is
+incomplete advancement of both members and, of course, the period of
+weight bearing is correspondingly shortened; hence the short strides.</p>
+
+<p>In chronic cases, little if any evidence of inflammation is to be
+detected by digital manipulation of the parts. If flinching occurs, one
+is often unable to interpret the manifestation as to whether it is due
+to inflammation or not.</p>
+
+<p>There is no marked "warming out" in this condition, and animals are
+nearly as lame after having been driven a considerable distance as when
+started, although the lameness is not as a rule very great.</p>
+
+<p><b>Treatment.</b>&mdash;In very painful cases acute inflammation is treated by
+employing cold applications during the initial stage. Cracked ice when
+contained in a suitable sack may be held in contact with the affected
+part and the pack is supported by means of cords or tapes as suggested
+in the discussion on treatment of scapulohumeral arthritis on page <a href="#Page_66">66</a>.
+Later, hot applications may be employed to good advantage.</p>
+
+<p>In the course of ten days or two weeks, if the acute painful condition
+has entirely subsided, vesication is indicated. The ordinary mercury and
+cantharides combination does very well. Depending upon the course taken
+in any given case, one is guided in the treatment employed. If prompt
+resolution comes to pass, the subject may be given free run at pasture
+after three or four weeks confinement in a box stall. If, however, the
+case does not progress in a prompt and satisfactory manner, absolute
+quiet must be enforced for six weeks or more. Repeated blistering is
+beneficial, although it is doubtful if firing is of sufficient benefit
+in the average chronic case of intertubercular bursitis to justify the
+punishment which this form of treatment inflicts, unless infliction of
+pain is the thing sought, to en<a name="Page_71" id="Page_71"></a>force repose in restless subjects.
+Patients are best given a long rest at pasture and returned to work for
+two or three months after an acute attack of inflammation of the bursa,
+lest the condition become chronic. When due consideration is given the
+pathology of such cases, the frequent unsatisfactory termination under
+the most careful treatment, is readily understood.</p>
+
+
+<h3><a name="Contusions_of_the_Triceps_Brachii" id="Contusions_of_the_Triceps_Brachii"></a>Contusions of the Triceps Brachii.<br />
+(Triceps Extensor Brachii: Caput Muscles.)</h3>
+
+<p><b>Anatomy.</b>&mdash;The triceps brachii is the principal structure which fills
+the space between the posterior border of the scapula and the humerus.
+The several heads originate for the most part on the border of the
+scapula, the deltoid tuberosity of the humerus and the shaft of the
+humerus. Insertion of this large muscular mass is effected by means of
+several tendons to the olecranon. A synovial bursa is situated
+underneath the tendinous attachment of the posterior portion of the
+triceps brachii&mdash;the long head or caput magnum.</p>
+
+<p>The function of the triceps as a whole is to flex the shoulder joint and
+extend the forearm. The triceps brachii is the chief antagonist of the
+biceps brachii.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Owing to the exposed position of this
+structure, it is not infrequently contused, the result of falls, kicks
+and other injuries. The function of the triceps is such that it becomes
+strained upon rare occasions when a horse resists confinement of
+restraint in such manner that the parts are unduly tensed in
+contraction. This sort of resistance may stretch the radial nerve or its
+branches in a way that paralysis results. A condition known as "dropped
+elbow" is described by Henry Taylor, F.R.C.V.S., in the Veterinary
+<span class="nowrap">Record<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>,</span> wherein a two-year-old colt while resisting confinement was
+so injured.</p>
+
+<p>The triceps group because of its convenient location, constitutes the
+site for hypodermic injection of drugs and biologic agents, with some
+practitioners; and as a result, more or less inflammation may occur. The
+author has observed and treated some twenty cases where an intensely
+painful infectious inflam<a name="Page_72" id="Page_72"></a>mation of the triceps brachii was caused by
+the intramuscular injection of a caustic solution by a cruel and
+unscrupulous empiric, whose object was to increase his practice.</p>
+
+<p><b>Symptomatology.</b>&mdash;As the triceps brachii is not particularly taxed
+during weight bearing in the subject at rest, there may be no unnatural
+position assumed during inflammation of the triceps. More or less
+swelling and supersensitiveness is always present, however, and great
+care and discrimination must be exercised in digital manipulation of the
+triceps region because many animals are normally sensitive to palpation
+of these parts. It is sometimes difficult to correctly interpret the
+true state of conditions because of this peculiarity.</p>
+
+<p>There is always swinging-leg-lameness, which is accentuated when the
+subject is urged to trot. Where symptoms are pronounced, it is
+unnecessary to cause the subject to move at a faster pace than at a walk
+to recognize the condition. The forward stride is shortened and in
+extremley painful conditions, no attempt is made to extend the leg. It
+is simply carried <i>en une pi&eacute;ce</i>&mdash;flexion of the shoulder and elbow
+joints is carefully avoided.</p>
+
+<p><b>Treatment.</b>&mdash;During the early stage of inflammation, hot or cold
+applications are beneficial. Long continued use of moist
+heat&mdash;fomentations&mdash;allays pain and stimulates resolution. Keeping in
+contact with the painfully swollen parts a suitable bag filled with
+bran, which can be moistened at intervals with warm water, constitutes a
+practical and easy means of treatment. By employing this method, one is
+more likely to succeed in having his patient properly cared for, in that
+less work is entailed than if hot fomentations are prescribed.</p>
+
+<p>After the acute and painful stage has subsided, a stimulating liniment
+is of benefit. The subject should be kept within a comfortable and roomy
+box stall for a sufficient length of time to favor prompt resolution.
+Wild and nervous subjects, if not so confined, will probably overexert
+the affected parts if allowed the freedom of a paddock or pasture.</p>
+
+<p>Where the inflammation becomes infective, surgical interference is
+necessary. The prompt evacuation of pus, with adequate <a name="Page_73" id="Page_73"></a>provision for
+wound discharge, should be attended to before extensive destruction of
+tissue takes place. Resolution is prompt as a rule in such cases because
+of the vascularity of the structures and the ease with which proper
+drainage may be effected. No special after-care is necessary if drainage
+is perfect, except that one should avoid injecting the wound cavity with
+aqueous solutions unless it be absolutely necessary to cleanse such
+cavity, and then it is best to swab the wound rather than to irrigate it
+freely.</p>
+
+
+<h3><a name="Shoulder_Atrophy" id="Shoulder_Atrophy"></a>Shoulder Atrophy.<br />
+(Sweeny or Swinney)</h3>
+
+<p>No satisfactory consideration of the pathogeny of this condition is
+recorded, but practitioners have long distinguished between muscular
+atrophies which are apparently caused without doing serious injury to
+nerves and muscular atrophy which seems to be due to nerve affection. In
+the first instance, recovery when proper attention is given, is prompt;
+whereas, in the latter, regeneration of the wasted tissues requires
+months in spite of the best sort of treatment.</p>
+
+<p>The parts more frequently affected are the supra- and infrascapularis
+(antea- and posteaspinatus) muscles. But in some cases the triceps group
+is involved; however, this occurs in unusual and chronic affections. No
+doubt, these chronic cases are due to suspended innervation and are not
+to be classed with the ordinary case of atrophy of the abductor muscles
+of the humerus (supra- and infraspinatus) as in the usual case of
+"sweeny."</p>
+
+<p><b>Occurrence.</b>&mdash;Shoulder atrophy such as the general practitioner
+commonly meets with, is an affection, more often seen in young animals
+and it seems to be due to injuries of various kinds which contuse the
+muscles of the shoulder. Ill-fitting collars and pulling in a manner
+that there occurs side draft with unusual strain on the muscles of one
+side of the neck and shoulder, seem to be the more frequent causes of
+this trouble. Blows such as are occasioned by kicks and falls frequently
+result in atrophy of shoulder muscles.</p>
+<p><a name="Page_74" id="Page_74"></a></p>
+
+<p><b>Course.</b>&mdash;In some cases a rapidly progressive atrophy characterizes the
+case and lameness and atrophy appear at about the same time. The
+affection in such instances does not recover spontaneously but
+constitutes a condition which requires prompt and rational treatment so
+that function may be fully restored to the parts involved.</p>
+
+<p>Occasionally one may observe cases where there is but slight atrophy;
+where the disease progresses slowly and atrophy is not extensive or
+marked. In vigorous young animals that are left to run at pasture when
+so mildly affected, spontaneous recovery occurs.</p>
+
+<p><b>Symptomatology.</b>&mdash;Lameness is the first manifestation of shoulder
+atrophy, and in many cases where lameness is slight, the veterinarian
+may fail to discover the exact nature of the trouble if he is not very
+proficient as a diagnostician of lameness or if he is careless in taking
+into consideration obtainable history, age of the subject, etc. Because
+of the fact that the average layman believes that practically every case
+of fore-leg lameness wherein it is not obvious that the cause is
+elsewhere, is due to a shoulder affection of some kind, we may be too
+hasty in giving the client assurance that no "sweeny" exists. In some of
+these cases where a diagnosis of "shoulder lameness" has been made and
+the client has been assured that no sweeny exists, the patient is
+returned in about a week and there is then marked atrophy of one or both
+of the spinatus muscles.</p>
+
+<p>A mixed type of lameness characterizes this affection, and in the
+average case there exists little evidence of local pain. The salient
+points in recognizing the condition are a consideration of history if
+obtainable; age of the subject; finding slight local soreness, by
+carefully manipulating the muscles which are usually involved; noting
+the character of the lameness if any is present; and where atrophy is
+evident, of course, the true condition is obvious.</p>
+
+<p><b>Treatment.</b>&mdash;Subcutaneous injections of equal parts of refined oil of
+turpentine and alcohol, with a suitable hypodermic syringe, is a
+practical and ordinarily effective treatment. From five to fifteen cubic
+centimeters (the quantity varies with <a name="Page_75" id="Page_75"></a>the size of the animal), of this
+mixture is injected into the atrophied parts at different points, taking
+care to introduce only about one to two cubic centimeters at each point
+of injection. The syringe should be sterile and, needless to say, the
+site of injections must be surgically clean.</p>
+
+<p>Other agents, such as tincture of iodin, solutions of silver nitrate,
+saline solutions and various more or less irritating preparations have
+been employed; but in the use of these preparations one may either fail
+to stimulate sufficient inflammation to cause regeneration to take
+place, or infection is apt to occur. Where suppuration results, surgical
+evacuation of pus must be promptly effected else large suppurating
+cavities form.</p>
+
+<p>The employment of setons constitutes a dependable method of treatment of
+shoulder atrophy, but because of the attendant suppurative process which
+inevitably results, this method is not popular with modern surgeons and
+is a last resort procedure.</p>
+
+<p><b>After-care.</b>&mdash;Regular exercise such as the horse usually takes when at
+pasture, is very helpful in treating atrophy, and in some cases it has
+been found that no reasonable amount of irritation would stimulate
+muscular regeneration; but by later allowing patients to exercise at
+will, recovery took place in a satisfactory manner. No special attention
+is ordinarily necessary.</p>
+
+
+<h3><a name="Paralysis_of_the_Suprascapular_Nerve" id="Paralysis_of_the_Suprascapular_Nerve"></a>Paralysis of the Suprascapular Nerve.</h3>
+
+<p><b>Anatomy.</b>&mdash;The suprascapular (anterior scapular) nerve, a small branch
+of the brachial plexus, is given off from the anterior portion of this
+plexus. The nerve rounds the anterior border of the neck of the scapula,
+passing upward and backward under the supraspinatus (antea-spinatus)
+muscle and terminating in the infraspinatus (postea-spinatus) muscle.</p>
+
+<p class="figleftleft">
+   <a href="./images/img07-full.jpg"><img src="./images/img07.jpg"
+   alt="Fig. 7&mdash;Paralysis of the suprascapular nerve of the left shoulder"
+   title="Fig. 7&mdash;Paralysis of the suprascapular nerve of the left shoulder" /></a><br />
+Fig. 7&mdash;Paralysis of the <br />
+suprascapular nerve <br />
+of the left shoulder</p>
+
+<p><a name="image07" id="image07"></a><b>Etiology and Occurrence.</b>&mdash;As the result of direct injury to this nerve
+by contusion such as may be received in runaway accidents, collar
+bruises, especially collar bruises in young horses that are not
+accustomed to pulling and that walk in a manner to cause side draft,
+injury to the nerve occurs, and partial or complete paralysis
+supervenes. Some writers state that it may be produced by confining an
+animal in recumbency, with the <a name="Page_76" id="Page_76"></a>casting harness. The common cause of
+paralysis or paresis of this nerve in cases such as one observes in
+country practice, is bruises from the collar in colts that are put to
+heavy farm work or where ill fitting collars are used.</p>
+
+<p><b>Symptomatology.</b>&mdash;With partial or complete suspension of function of
+the suprascapular nerve there results enervation of the supraspinatus
+and infraspinatus muscles. Since these muscles act as external lateral
+ligaments of the scapulohumeral joint, when they are incapacitated,
+there naturally follows more or less abduction of the shoulder when
+weight is borne.</p>
+
+<p>In extreme cases, as soon as the ailing animal is caused to support
+weight with the affected member, the joint is suddenly thrown outward in
+a manner that the average layman at once concludes that there must be
+scapulohumeral luxation, and the veterinarian receives a call to see a
+case wherein the "shoulder is out of place." There exists, however, no
+luxation in such cases.</p>
+
+<p>If serious injury is done the nerve so that it undergoes degenerative
+changes, there will result atrophy of the muscles that derive their
+nerve supply from the suprascapular nerve.</p>
+
+
+<p><b>Treatment.</b>&mdash;During the first few days following injuries which result
+in this form of paralysis, it is well to keep the subject inactive, and
+if much inflammation of the injured structures contiguous to the nerve
+exists, the application of cold packs is beneficial. Later, as soon as
+acute inflammation has subsided, vesication of a liberal area around the
+anteroexternal part of the scapulohumeral joint and over the course of
+the suprascapular nerve, will stimulate recovery in favorable cases. As
+a rule, in mild cases, the subject is in a condition to return to work
+in two or three weeks.</p>
+<p><a name="Page_77" id="Page_77"></a></p>
+
+
+<h3><a name="Radial_Paralysis" id="Radial_Paralysis"></a>Radial Paralysis.</h3>
+
+<p>Described under the titles of "Radial Paralysis" and "Brachial
+Paralysis," there is to be found in veterinary literature a discussion
+of conditions which vary in character from the almost insignificant form
+of paresis to the incurably affected conditions wherein the whole
+shoulder is completely paralyzed.</p>
+
+<p>When one considers the anatomy of the brachial nerve plexus and the
+distribution of its various branches, the location of this plexus and
+its proximity to the first rib, and the inevitable injury it must suffer
+in fracture of this bone, together with the inaccessibility of the
+plexus, it is not strange that a correct diagnosis of the various
+affections of the brachial plexus and the radial nerve is often
+impossible until several days or weeks have passed. And, in some
+instances, diagnosis is not established until an autopsy has been
+performed. Here, too, we fail to find cause for paralysis in some rare
+instances.</p>
+
+<p><b>Anatomy.</b>&mdash;The radial nerve is a large branch of the brachial plexus
+and is chiefly derived from the first thoracic root of the plexus and is
+here situated posterior to the deep brachial artery. It is directed
+downward and backward under the subscapularis and teres major muscles,
+rounding the posterior part of the humerus, and passing to the anterior
+and distal end of the humerus, it finally terminates in the anterior
+carpal region. The radial nerve supplies branches to the three heads of
+the triceps brachii, to the common and lateral extensors of the digit
+and also to the skin covering the forearm.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Nothing definite is known about the cause of
+some forms of radial paralysis. However, radial paralysis is encountered
+following injury to the nerve occasioned by its being stretched, as in
+cases where the triceps brachii is unduly extended in restraining
+subjects by means of a casting harness. <span class="nowrap">Berns<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a></span> states that in
+confining horses on an old operating table where it was necessary to
+draw the affected foot forward twenty-four to thirty-six inches in
+advance of its fellow,<a name="Page_78" id="Page_78">&nbsp;</a> which was secured in a natural vertical
+position, radial paralysis of a mild form was of frequent occurrence.
+Country practitioners, in restraining colts by casting with harness or
+ropes, occasionally observe a form of paresis wherein the radial nerve
+suffers sufficient injury that there is caused a temporary loss of
+function of the triceps brachii. Such cases recover within three or four
+days and are not a true paralysis, but nevertheless constitute
+conditions wherein normal nerve function is temporarily suspended.</p>
+
+<p class="figcenter"><a name="image08" id="image08"></a>
+   <a href="./images/img08-full.jpg"><img src="./images/img08.jpg"
+   alt="Fig. 8&mdash;Radial paralysis."
+   title="Fig. 8&mdash;Radial paralysis." /></a><br />
+Fig. 8&mdash;Radial paralysis.</p>
+
+
+<p><b>Symptoms.</b>&mdash;Immediately subsequent to injuries which involve the radial
+nerve, there is manifested more or less impairment of function.
+Remembering the structures supplied by the radial nerve and its
+branches, one can readily understand that there should occur as
+<span class="nowrap">Cadiot<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a></span> has stated:</p>
+<p><a name="Page_79" id="Page_79"></a></p>
+
+<div class="blockquot"><p>In complete paralysis, the joints of the affected limb with the
+exception of the shoulder are usually flexed when the horse is
+resting. In consequence of loss of power in the triceps and
+anterior brachial muscles, the arm is extended and straightened on
+the shoulder, the scapulohumeral angle is open, and the elbow
+depressed. The forearm is flexed on the arm by the contraction of
+the coracoradialis (biceps brachii), while the metacarpus and
+phalanges are bent by the action of the posterior antibrachial
+muscles. The knee is carried in advance, level with, or in front
+of, a vertical line dropped from the point of the shoulder. The
+hoof is usually rested on the toe, but when advanced beyond the
+above mentioned vertical line, it may be placed flat on the ground,
+the joints then being less markedly bent. When the limb as a whole
+is flexed, it may be brought into normal position by thrusting back
+the knee with sufficient force to counteract the action of the
+flexor muscles.</p></div>
+
+<p class="figcenter"><a name="image09" id="image09"></a>
+   <a href="./images/img09-full.jpg"><img src="./images/img09.jpg"
+   alt="Fig. 9&mdash;Merillat's method of fixing carpus in radial paralysis. Courtesy, Alex. Eger."
+   title="Fig. 9&mdash;Merillat's method of fixing carpus in radial paralysis. Courtesy, Alex. Eger." /></a><br />
+Fig. 9&mdash;Merillat's method of fixing carpus in radial paralysis. Courtesy, Alex. Eger.</p>
+
+
+<p>When made to walk, the animal being unable to exert muscular action with
+the paralyzed structures, limply carries the member as a whole, and
+there is shortening of the anterior portion of the stride. There being
+loss of function of the triceps brachii, it is impossible for the
+subject to straighten the leg in the normal position for supporting
+weight; therefore, any attempt to bear <a name="Page_80" id="Page_80"></a>weight results in further
+flexion of the affected member and the animal will fall if the body is
+not suddenly caught up with the sound leg.</p>
+
+<p><b>Differential Diagnosis.</b>&mdash;In making examination of these cases, one can
+exclude fracture by absence of crepitation and usually, also, swelling
+is absent in radial paralysis. In a typical case of radial paralysis,
+the affected leg can sustain its normal share of weight if placed in
+position, that is, if the carpal joint is extended in such manner that
+the leg is positioned as in its normal weight-bearing attitude. In
+brachial paralysis, whether due to fracture of the first rib or to other
+serious injury, it is impossible for the subject to support weight with
+the affected member even when it is passively placed in position.</p>
+
+<p>No difficulty is ordinarily experienced in differentiating radial
+paralysis from muscular injuries to the triceps; yet, in some cases of
+"dropped elbow," it is necessary to observe the progress of the case for
+ten days or two weeks before one can positively establish a diagnosis.</p>
+
+<div class="blockquot"><p>Quoting <span class="nowrap">Merillat<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a>:</span> "When, after four weeks, there is no
+amelioration of the paralysis, the muscles have atrophied, and the
+patient has become emaciated from pain and discomfort, the
+diagnosis of brachial paralysis with fracture of the first rib may
+then be announced."</p></div>
+
+<p><b>Prognosis.</b>&mdash;When no complete paralysis of the brachial plexus or no
+fracture of the first rib exists, the majority of cases recover
+completely in from ten days to six weeks. Some writers claim that
+recoveries occur in ninety per cent of cases when conditions are
+favorable.</p>
+
+<p><b>Treatment.</b>&mdash;When incomplete radial paralysis exists, little needs be
+done except to allow the subject moderate exercise and to provide for
+its comfort. Local applications, stimulative in character, are
+beneficial, and the internal administration of strychnin is indicated.</p>
+
+<p>In the cases where weight is not supported without the affected leg
+being passively placed in position, it is necessary to provide for the
+subject's comfort in several ways.</p>
+
+<p>Mechanical appliances such as braces of some kind in order <a name="Page_81" id="Page_81"></a>to keep the
+affected leg in a position of carpal extension, constitute the essential
+part of treatment. The leg is supported in such a manner that flexion of
+the carpus is impossible. Due regard is given to prevent chafing or
+pressure necrosis by contact of the skin with the braces&mdash;this may be
+done by bandaging with cotton. The supportive appliance is kept in
+position for ten days or two weeks. At the end of this time the brace
+may be removed and the subject given a chance to walk, and improvement,
+if any exists, will be evident. When there is manifested an amelioration
+of the condition, moderate daily exercise and massage of the affected
+parts are helpful.</p>
+
+<p>Should the subject be seriously inconvenienced by the application of a
+brace or other supportive appliances, it is necessary to employ slings.
+Further, if weight is supported entirely by the unaffected member,
+laminitis may supervene if a sling is not used.</p>
+
+
+<h3><a name="Thrombosis_of_the_Brachial_Artery" id="Thrombosis_of_the_Brachial_Artery"></a>Thrombosis of the Brachial Artery.</h3>
+
+<p>Thrombosis of the brachial artery or of its principal branches is of
+very rare occurrence in horses.</p>
+
+<p><b>Etiology.</b>&mdash;Partial or complete obstruction of arteries (brachial or
+others) occurs as the result of direct injury to the vessel wall from
+compression and tension of muscles and resultant arteritis; lodging of
+emboli; and parasitic invasion of vessel walls causing internal
+arteritis.</p>
+
+<p><b>Symptomatology.</b>&mdash;If sufficient collateral circulation exists to supply
+the parts with blood, no inconvenience is manifested while the subject
+is at rest. Where the lumen of the affected vessel is not completely
+occluded, there may be no manifestation of lameness when the ailing
+animal is moderately exercised. Consequently, the degree of lameness
+depends upon the extent of the obstruction to circulation; and,
+likewise, the course and prognosis depend upon the character and extent
+of such obstruction.</p>
+
+<p>In severe cases, lameness is markedly increased by causing the animal to
+travel at a fast pace for only a short distance. There are evinced
+symptoms of pain, muscular tremors and sudation, but the affected member
+remains dry and there is a marked dif<a name="Page_82" id="Page_82"></a>ference of temperature between the
+normal areas and the cool anemic parts. When the subject is allowed to
+rest, circulation is not taxed, and there is a return to the original
+and apparently normal condition, only to recur again with exertion. This
+condition characterizes thrombosis.</p>
+
+<p><b>Treatment.</b>&mdash;In these cases, little if any good directly results from
+any sort of treatment in the way of medication. Absolute rest is thought
+to be helpful. Potassium iodid, alkaline agents such as ammonium
+carbonate and potassium carbonate, have been administered. Circulatory
+stimulants also have been given, but it is doubtful if any good has come
+from medication.</p>
+
+
+<h3><a name="Fracture_of_Humerus" id="Fracture_of_Humerus"></a>Fracture of Humerus.</h3>
+
+<p>The shaft of the humerus, protected as it is by heavy muscles, is not
+frequently fractured; and fractures of its less protected parts, as for
+example, the head, are complicated in such manner that resultant
+arthritis soon constitutes the more serious condition.</p>
+
+<p>As a result of falls on frozen ground, kicks or any other form of heavy
+contusion, the humerus is occasionally broken. It is rarely fractured
+otherwise. Because of the force of contusions usually required to effect
+humeral fracture, the manner in which the bone is broken, with respect
+to direction, is variable. Often oblique fractures exist and
+occasionally there occurs multiple fracture. In addition to the
+ordinarily serious nature of the fracture itself, there is always much
+injury done the adjoining structures.</p>
+
+<p><b>Symptomatology.</b>&mdash;Mixed lameness and manifestation of severe pain
+characterize this affection. Considerable swelling which increases, in
+some cases for a week or more, is to be observed. Crepitation is readily
+detected, if pain and swelling is not too great to prevent passive
+movement of the member. Where intense pain is not manifested, because of
+manipulation, one may abduct the extremity and thereby occasion distinct
+crepitation; but when it is possible to recognize crepitation by holding
+the hand in contact with the olecranon while the animal is made to walk,
+this method is to be preferred, if the subject <a name="Page_83" id="Page_83"></a>can move without serious
+difficulty. The pathognomonic symptom here is recognition of
+crepitation, but this may be very difficult to recognize in fracture of
+condyles, and in such instances, a careful examination is necessary.
+Gentle manipulation in a manner that pain is not aggravated will tend to
+inspire confidence on the part of the subject and relaxation of muscles
+will enable the operator to detect crepitation.</p>
+
+<p><b>Course and Prognosis.</b>&mdash;Because of the direction of the long axis of
+the humerus, with relation to the bony column of the extremity, it is
+obvious that any lateral movement of the leg tends to rotate the shaft
+of this bone. In fractures of the shaft of the humerus, then, it is
+apparent that immobilization is very difficult if at all possible.</p>
+
+<p>The proximity to the axillary lymph glands makes for easy dissemination
+of infection when the contused musculature becomes infected. The
+adjacent brachial nerve plexus is so very apt to become involved, if not
+actually injured at the time fracture occurs, that paralysis is a
+probable complication. Consequently, it is logical to reason that
+because of the many possible serious complications, such as shock,
+occasioned by the injury and the distress and pain which this accident
+produces, recovery must be the exception in fracture of the humerus.
+However, recoveries do take place and in addition to the reported
+recoveries by Liautard, Moller, Stockfleth, Lafosse, Frohner and others,
+we have instances cited by American practitioners where cases resulted
+in recovery. <span class="nowrap">Thompson<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a></span> reports a good recovery in a 1600-pound mare
+where there existed an oblique fracture of the humerus. This mare was
+kept in slings for eight weeks. <span class="nowrap">Walters<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a></span> reports complete recovery in
+humeral fracture in a foal three days old. The only treatment given was
+the application of a pitch plaster from the top of the scapula to the
+radius. The colt was kept in a comfortable box stall and in about four
+weeks regained use of the leg. Complete recovery eventually resulted. In
+the experience of the author, recovery has not occurred in humeral
+fractures.</p>
+<p><a name="Page_84" id="Page_84"></a></p>
+
+<p><b>Treatment.</b>&mdash;When animals are not aged and of sufficient value to
+justify treatment, they are best supported in a sling, if halter broken.
+If subjects are nervous, wild and unbroken, it is possible to employ the
+sling, if care is given to train the animal to this manner of restraint.
+The presence of an attendant for a day or two will reassure such
+subjects so that even in these cases it may be practicable to employ the
+sling.</p>
+
+<p>Braces and other mechanical appliances intended to immobilize the parts
+are not of practical benefit in the horse. Unlike the dog, the horse as
+yet has not been successfully subjected to tolerating rigid braces for
+the shoulder and hip.</p>
+
+<p>Everything possible must be done that will make for the patient's
+comfort. If the subject turns out to be a good self nurse, and the
+nature of the fracture is such that practical apposition of the broken
+ends of bone may be maintained, recovery will occur in some cases.</p>
+
+
+<h3><a name="Inflammation_of_the_Elbow" id="Inflammation_of_the_Elbow"></a>Inflammation of the Elbow.<br />
+(Arthritis.)</h3>
+
+<p>Affections of this articulation other than those which are produced by
+traumatism are rare. This joint has wide articular surfaces, and
+securely joined as they are by the heavy medial and lateral ligaments
+(internal and external lateral ligaments), luxation is practically
+impossible. When luxation does occur, irreparable injury is usually
+done. Castagn&eacute; as quoted by <span class="nowrap">Liautard<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a>,</span> reports a case of true
+luxation of the elbow joint in a horse where reduction was effected and
+complete recovery took place at the end of twenty-five days. This is an
+unusual case. The average practitioner does not meet with such
+instances.</p>
+
+<p><b>Anatomy.</b>&mdash;The condyles of the humerus articulate with the glenoid
+cavities of the radius and a portion of the ulna. Two strong collateral
+ligaments pass from the distal end of the humerus to the head of the
+radius. The capsular ligament is a large, loose membrane which encloses
+the articular portion of the humerus with the radius and ulna and also
+the radioulnar articulation. It is attached anteriorly to the tendon of
+the biceps <a name="Page_85" id="Page_85"></a>brachii (flexor brachii). The capsule extends downward
+beneath the origin of these digital flexors. This fact should be
+remembered in dealing with puncture wounds in the region, lest an error
+be made in estimating their extent and an open joint be overlooked at
+the initial examination.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Exclusive of specific or metastatic
+arthritis, which is seldom observed except in young animals,
+inflammation of the elbow joint is usually caused by injury. This
+articulation is not subject to pathologic changes due to concussion or
+sprains as occasioned by ordinary service, but is frequently injured by
+contusion from falls, blows from the wagon-pole and kicks. Wounds which
+affect the elbow joint, then, may be thought of in most cases, as
+resultant from external violence. They may be contused wounds or
+penetrant wounds. Sharp shoe-calks afford a means of infliction of
+penetrant wounds which may occasion open joint and infectious arthritis.</p>
+
+<p><b>Classification.</b>&mdash;A practical manner of classifying inflammation of the
+elbow is on an etiological basis. Eliminating the forms of elbow
+inflammation, such as are caused by metastatic infection and other
+conditions which properly belong to the domain of theory of practice, we
+may consider this affection under the classification of <i>contusive
+wounds</i> and <i>penetrative wounds</i>.</p>
+
+<p><b>Symptomatology.</b>&mdash;Any injury which is of sufficient violence to
+occasion inflammation of the elbow causes marked lameness and
+manifestation of pain. The degree of lameness and distress manifested by
+the subject, depends upon the nature and extent of the involvement. A
+contusion suffered as the result of a fall, which occasions a
+circumscribed inflammation of the structures covering this joint and
+where little inflammation of the articulating parts exists, marked
+evidence of pain and lameness might be absent. On the other hand, if a
+true arthritis is incited, there will be evident distress manifested,
+such as hurried respiration, accelerated pulse, inappetence, mixed
+lameness, local evidence of inflammation and particularly marked
+supersensitiveness of the affected parts. Considering these two extremes
+of manifested distress and injury, one may readily conclude that in the
+frequently seen case, wherein contusion has occasioned a moderate
+<a name="Page_86" id="Page_86"></a>degree of injury, prognosis is favorable and recovery ordinarily
+follows in the course of a few weeks' treatment.</p>
+
+<p>In cases of arthritis due to penetrative wounds (because of the
+important function of this joint and its large capsule, which when
+inflamed discharges synovia in a manner that closure of such an open
+joint is seldom possible) a very grave condition results.</p>
+
+<p><b>Treatment.</b>&mdash;Inflammation of the elbow, such as is frequently seen in
+general practice where horses are turned out together and exposed to
+kicks and other injuries, yields to treatment readily, if an open joint
+does not exist.</p>
+
+<p>Hot packs supported in contact with the elbow and kept around the
+inflamed articulation for a few days, materially decrease pain and tend
+to reduce inflammation. The subject must be kept quiet in a comfortable
+stall and, if necessary, a sling used. Where it is impossible for the
+animal to support much weight with the injured member the sling should
+be employed.</p>
+
+<p>As inflammation abates, which it does in the course of from one to three
+weeks in uncomplicated cases, the subject may be allowed the freedom of
+a comfortable box stall. Vesication of the parts is in order, and this
+may be repeated in the course of two weeks, if it is deemed necessary.</p>
+
+<p>Penetrative wounds resulting in open joint are not treated with success
+as a rule, and because of the handicap under which veterinarians labor,
+methods of handling such cases, where large, important articulations are
+affected, are not being rapidly improved. Prognosis is usually
+unfavorable, and for humane and economic reasons, animals so affected
+should be destroyed.</p>
+
+<p>Ordinary wounds of the region of the elbow are treated along general
+lines usually employed. They merit no special consideration, except that
+it may be mentioned that with such injuries concomitant contusion of the
+parts occasions injury that does not recover quickly.</p>
+
+
+<h3><a name="Fracture_of_the_Ulna" id="Fracture_of_the_Ulna"></a>Fracture of the Ulna.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Fractures of the ulna in the horse are not
+common in spite of the exposed position of the olecranon. This bone when
+broken, is usually fractured by heavy blows <a name="Page_87" id="Page_87"></a>and any form of ulnar
+fracture is serious because of its function and position in relation to
+the joint capsule. Transverse fractures do not readily unite because of
+the tension of the triceps muscles, which prevent close approximation of
+the broken ends of the bone.</p>
+
+<p><span class="nowrap">Thompson<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a>,</span> however, reports a case of transverse simple fracture of
+the ulna in a mare, the result of a kick, in which complete recovery
+took place. He kept the subject in a sling for six weeks and then
+allowed six months rest.</p>
+
+<p><b>Symptomatology.</b>&mdash;The position assumed by a horse suffering from a
+transverse fracture of the ulna, is similar to that in radial paralysis.
+Crepitation may be detected by manipulating the parts, and in some
+instances of fracture of the olecranon, there occurs marked displacement
+of the broken portions of the bone. Lameness is intense and the parts
+are swollen and supersensitive. The capsular ligament of the elbow joint
+is usually involved in the injury because fracture of the ulna may
+directly extend within the capsular ligament. In such cases, there is
+synovitis, and later arthritis causes a fatal termination.</p>
+
+<p><b>Treatment.</b>&mdash;The impossibility of applying a bandage in any way to
+practically immobilize these parts in fracture of the ulna, prevents our
+employing bandages and splints. Therefore, one can do little else than
+to put the patient in a sling and try to keep it quiet and as nearly
+comfortable as circumstances allow.</p>
+
+
+<h3><a name="Fracture_of_the_Radius" id="Fracture_of_the_Radius"></a>Fracture of the Radius.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;From heavy blows received such as kicks,
+collision with trees or in falls in runaway accidents, the radius is
+occasionally fractured. In very young foals, fracture of the radius, as
+well as of the tibia and other bones, results from their being trampled
+upon by the mother.</p>
+
+<p><b>Symptomatology.</b>&mdash;Excepting in some cases of radial fracture of foals
+where considerable swelling has taken place, there is no difficulty in
+readily recognizing this condition. The heavy brachial fascia materially
+contributes to the support of the ra<a name="Page_88" id="Page_88"></a>dius, and in cases where swelling
+is marked, crepitation may not be readily detected. In fact, a
+sub-periosteal fracture may exist for several days or a week or more and
+then, with subsequent fracture of the periosteum, crepitation and
+abnormal mobility of the member are to be recognized. In such cases, the
+subject will bear some weight upon the affected member, but this causes
+much distress. In one instance the author observed a transverse fracture
+of the lower third of the radius which was not positively diagnosed
+until about ten days after injury was inflicted. In this case, without
+doubt, the subject originally suffered a sub-periosteal fracture of the
+bone and because the animal was a good self nurse, the brachial fascia
+supported the radius until the periosteum gave way and the leg dangled.
+In this instance infection took place and suppuration resulted. It was
+deemed advisable to destroy this animal.</p>
+
+<p><b>Prognosis.</b>&mdash;In adult animals, radial fracture constitutes a grave
+condition; generally speaking, prognosis, in such cases, is unfavorable.
+Because of the leverage afforded by the extremity, immobilization of the
+radius is difficult. Any sort of mechanical appliance, which will
+immobilize these parts, is likely to produce pressure-necrosis of the
+soft structures so contacted. There is occasioned thereby much pain and
+the subject becomes restive, unmanageable and sometimes the splints are
+completely deranged because of the animal's struggles, and much
+additional injury to the leg is done. Occasionally, an otherwise
+favorable case is thus rendered hopelessly impossible to handle, and the
+subject must be destroyed several days after treatment has been
+instituted.</p>
+
+<p>Consequently, unless all conditions are good, and the affected animal a
+favorable subject, young, of good disposition, and the fracture a simple
+transverse one, complete recovery is not likely to result from any
+practical means of handling.</p>
+
+<p><b>Treatment.</b>&mdash;Mature subjects ought to be put in slings and kept so
+restrained throughout the entire time of treatment. Immobilization of
+the broken parts of the bone is the object sought. This is attempted by
+practitioners who employ various methods, and each method has its
+advocates.</p>
+<p><a name="Page_89" id="Page_89"></a></p>
+
+<p>Casts are used by some and serve very well in many cases; but because of
+their bulk and unyielding and rigid nature, they are not well adapted to
+use on fractures of bones proximal to the carpus and tarsus. This is in
+reference to plaster-of-paris casts or those of any similar material.</p>
+
+<p>Appliances which depend on glue or other adhesive substances combined
+with leather, wood or fiber for their support, are efficacious but not
+comfortable.</p>
+
+<p>The use of heavy leather when the member has been suitably padded with
+cotton and bandages, constitutes a very good manner of reducing fracture
+of the radius or of the tibia. Leather when cut to fit both the medial
+and lateral sides of a leg, and firmly held with bandages, will form a
+firm support that yields slightly to changes of position, thus making
+for comfort of the subject.</p>
+
+<p>Such a splint or support should extend from the fetlock region to the
+elbow, but the cotton and bandages are to reach to the foot. When one
+considers that, with the supportive appliance placed on each side of the
+affected member, rigidity is accomplished as much from tensile strain
+put upon the leather as from its own stiffness, it is seen that the
+leather need not be of the heaviest&mdash;sole leather is unnecessary.
+Because of the more comfortable immobilizing appliance, the subject is
+less restive, and chances for a successful outcome are materially
+increased thereby.</p>
+
+<p>In the mature subject, six or eight weeks' time is required for union of
+the parts to occur sufficiently so that splints may be dispensed with.
+Rearrangement of the supportive apparatus, however, is possible and
+usually necessary during the first few weeks of treatment. By employing
+care in handling the parts, the subject will be unlikely to do itself
+injury at the time readjustment of splints is being effected.</p>
+
+<p>In foals, it is best to give them the run of a box stall with the
+mother. Being agile, they get up and lie at will without doing injury to
+the fractured member. The splints (leather is preferable in these cases
+also) are looked after and readjusted as necessity demands.</p>
+
+<p>Three or four weeks time is all that is required for the average <a name="Page_90" id="Page_90"></a>young
+colt to be kept in splints when suffering from simple transverse
+fracture of the radius.</p>
+
+<p>Compound fractures are necessarily more difficult to treat than are the
+simple variety, but even in such cases recovery results sometimes, and
+the practitioner is justified in attempting treatment after having
+explained the situation to his client.</p>
+
+<p>Oblique fractures, even when simple, do not completely recover. Muscular
+and tendinous contraction, together with the natural tendency for the
+beveled contacting parts of the broken bone to pass one another in
+oblique fracture, results in shortening of the leg and, if union
+results, a large callus usually forms. Where shortening of bones occur,
+necessarily, permanent lameness follows.</p>
+
+
+<h3><a name="Wounds_of_the_Anterior_Brachial_Region" id="Wounds_of_the_Anterior_Brachial_Region"></a>Wounds of the Anterior Brachial Region.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Contusions and lacerations of the forearm
+are of frequent occurrence in horses and are troublesome cases to
+handle; particularly is this noticeable where extensive laceration of
+the parts occurs. These injuries are caused by animals being kicked; by
+striking the forearm against bars in jumping; and in sections of the
+country where barbed wire is used to enclose pastures, extensive
+lacerated wounds are met with when horses jump into such fences.</p>
+
+<p><b>Symptomatology.</b>&mdash;Any wound which causes inflammation of the structures
+of the anterior half of the forearm, is characterized by
+swinging-leg-lameness. Depending upon the nature and extent of the
+injury, manifestation varies. In cases where laceration has practically
+divided all of the substance of the extensor tendons, it is, of course,
+impossible for the subject to advance the leg; but where lacerated
+wounds involve only a part of the extensor apparatus of the foreleg, not
+so much inconvenience is evident, unless the wound is seriously infected
+and inflammation involves contiguous structures. Therefore, in many
+instances, lameness is more pronounced in contusions of the anterior
+brachial region than where tissues have been divided more or less
+keenly.</p>
+
+<p>In every instance diagnosis is easily established. The injury is quite
+evident, and the manner of locomotion is not in itself <a name="Page_91" id="Page_91"></a>an essential
+feature to be considered in a discussion of symptoms. Where a contusion
+of the anterior brachial structures occurs, there is, in addition to
+lameness, swelling which is painful because of the pressure occasioned
+by the heavy non-yielding brachial fascia. And where suppuration occurs,
+there is then an intensely painful condition which is not relieved until
+pus has been evacuated. Rather frequently, drainage for wound secretions
+is a difficult problem, and approximation of the divided ends of muscles
+is always difficult to maintain.</p>
+
+<p><b>Treatment.</b>&mdash;Contused wounds of the anterior brachial region are
+treated along usual lines; that is, attempt is made to stimulate prompt
+resolution. Hot or cold applications are employed throughout the acute
+stage of the affection. Complete rest is provided for until all pain has
+subsided. Later, stimulating liniments are beneficial.</p>
+
+<p>Where no injury is done the periosteum or bone, complete resorption of
+all products of inflammation usually occurs, though in many instances,
+this is tardy&mdash;six weeks or more are sometimes required for recovery to
+take place.</p>
+
+<p>If suppuration occurs, it is necessary to provide for drainage as soon
+as it is possible to distinguish the presence of pus. Due regard is
+given the manner of establishing drainage because of the usual existence
+of sub-fascial fistulae. In these cases, one avoids injecting solutions
+of aqueous antiseptics. By gently compressing the parts, pus is caused
+to drain out and in enforcing a moderate amount of exercise at a walk,
+when lameness is not intense, drainage is maintained. Cotton packs,
+moistened with hot antiseptic solutions, and kept around the forearm for
+several hours daily, are helpful because drainage is facilitated, and
+resolution is stimulated by the increase of blood thus attracted to the
+parts, and pain materially diminishes.</p>
+
+<p>In lacerated wounds of the anterior brachial region, after having
+controlled hemorrhage, an area around the wound margin is freed of hair
+by clipping or shaving. The wound is carefully examined, and the best
+site for drainage is selected and a suitable opening for wound discharge
+is provided for. Where the extensor carpiradialis (metacarpi magnus)
+with other structures, is divided and the distal portion is torn
+downward, as <a name="Page_92" id="Page_92"></a>frequently is the case in barbed wire cuts, it is
+necessary to make careful provision for drainage. The wound is
+thoroughly cleansed by means of ablutions if necessary; but preferably
+by swabbing with pledgets of cotton or gauze which are moistened in
+antiseptic solutions. All shreds of macerated tissue are clipped with
+scissors and finally the whole wound surface is painted with tincture of
+iodin.</p>
+
+<p>If drainage is made by cutting through the tissues in the median portion
+of the structures that have been displaced, the opening should be packed
+with gauze so that it may remain patent after swelling has occurred.
+Such packing is left <i>in situ</i> for twenty-four hours.</p>
+
+<p>The pendant muscular portions of tissues are sutured up by means of
+tapes and, while perfect apposition is not ordinarily possible, it is
+very essential to train the pendant tissues in their normal position
+even if they require resuturing within a week. This minimizes
+granulation of tissue, and there results less scar if the detached
+portions are kept near, even if not in contact with the proximal wound
+margins. The skin together with subcutaneous fascia is sutured on either
+side unless drainage is to be provided for on one side, and the
+lowermost part of that side is left unsutured.</p>
+
+<p><b>After-care.</b>&mdash;Where extensive suturing of tissues has been necessary,
+subjects must be kept quiet. They are best confined in box stalls and
+not taken out for several weeks. Particularly is this true where
+transverse division of extensors has taken place. Sutures are removed at
+the end of from ten days to three weeks as cases permit. Drainage of
+wound secretions, which usually become infected, is necessary, because
+with obstructed drainage in an infected wound of this kind, there will
+result an early destruction of tissue at some point sutured. Daily
+irrigation done in a manner that practical asepsis is carried out, is
+necessary for about a week. All irrigation is done by way of the
+drainage opening, and this with warm aqueous solutions of suitable
+antiseptics. After a week or ten days' time, the wound should not be
+dressed more frequently than twice weekly.</p>
+
+<p>If it is necessary to leave a portion of the wound uncovered, <a name="Page_93" id="Page_93"></a>as in
+cases where skin is destroyed, the frequent (three or four daily)
+application of a suitable antiseptic powder is necessary to check
+exuberant granulation. This may be directly effected by the use of an
+astringent or desiccant preparation, and such dressing serves as a
+mechanical protection as well.</p>
+
+<p>When such wounds are kept clean, where drainage is properly maintained,
+and the subject kept quiet, no particular attention other than the local
+application of an astringent lotion (such as the zinc and lead lotion)
+is necessary after the first three or four weeks. Usually, if the animal
+gnaws at the parts or otherwise manifests evidence of discomfort, it is
+an indication that new areas of infection are being established because
+of obstructed drainage or retained eschars. A thorough cleansing of the
+wound with a two per cent solution of Liquor Cresolis Compositus and
+this followed by moistening every part of the wound with tincture of
+iodin, will check all such disturbance if done promptly.</p>
+
+<p>Where practically all of the anterior surface of the radius has been
+denuded, recovery is tardy and there is in some cases imperfect
+extension of the leg for months after the wound has healed. But in such
+instances, animals gradually regain complete use of the affected member
+and in the course of a year function is fully restored.</p>
+
+
+<h3><a name="Inflammation_and_Contraction_of_the_Carpal_Flexors" id="Inflammation_and_Contraction_of_the_Carpal_Flexors"></a>Inflammation and Contraction of the Carpal Flexors.</h3>
+
+<p><b>Anatomy.</b>&mdash;The structures which are usually considered as true flexors
+of the carpus are a group of three muscles, which have separate heads of
+origin and different points of tendinous insertion.</p>
+
+<p>The <i>flexor carpiradialis</i> (flexor metacarpi internus) originates from
+the medial epicondyle of the humerus. It is inserted to the proximal end
+of the medial metacarpal (inner metacarpal or splint) bone. This muscle
+is the smaller of the three and is not usually divided in doing carpal
+tenotomy.</p>
+
+<p>The <i>flexor carpiulnaris</i> (flexor metacarpi medius) has two heads of
+origin; one, the larger, originates from the epicondyle of the humerus
+and the other from the posterior surface of the <a name="Page_94" id="Page_94"></a>olecranon. The two
+heads unite at the upper third of the radius and the muscle, becoming
+tendinous, as is the case with the other carpal flexors, is attached by
+one point of insertion to the accessory carpal bone (trapezum). The
+other blends with the posterior annular ligament of the carpus.</p>
+
+<p>The <i>ulnaris lateralis</i> (flexor metacarpi externus) has its origin from
+the lateral epicondyle of the humerus and inserts to the proximal
+extremity of the fourth metacarpal (outer splint) bone and by another
+attachment to the accessory carpal bone (trapezium) with the tendon of
+the flexor carpiulnaris (flexor metacarpi medius).</p>
+
+<p>Acting together, these muscles flex the carpus or extend the elbow and
+this action is antagonized by the biceps brachii (flexor brachii) and
+extensors of the carpus and phalanges.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Inflammation of the muscular or tendinous
+parts of the carpal flexors, does not occur as frequently as does
+inflammation of the flexors of the extremity. They are subject to injury
+such as is occasioned by hard work and concussion and contract as a
+result; but, more frequently a congenital malformation of the leg is
+responsible for undue strain upon these parts. Horses that are "knee
+sprung" or that have a congenital condition where in the anterior line,
+as formed by the radius, carpal and metacarpal bones, is bent forward at
+the carpus, are subject to inflammation and contraction of the carpal
+flexors. When these flexors are contracted, the condition is commonly
+known among horsemen as "buck knee." In itself, inflammation of the
+carpal flexors is not a condition which is likely to prove troublesome,
+but because of carpal involvement (which is often present) the cause of
+the trouble remains, and inflammation of the carpal flexors recurs or
+becomes chronic and contraction of tendons results.</p>
+
+<p><b>Symptomatology.</b>&mdash;Inflammation of the carpal flexors, when acute and
+uncomplicated, is characterized by a painfully swollen condition of the
+affected tendons. No weight is borne upon the affected leg and the
+carpal joint is flexed. Mixed lameness is present. There is no
+difficulty encountered in arriving at a diagnosis because of the very
+noticeably inflamed parts.</p>
+<p><a name="Page_95" id="Page_95"></a></p>
+
+<p>Many fully developed cases of contraction of the tendons of the carpal
+flexors are observed where the condition has become established
+gradually and no lameness has resulted from tendinitis or carpitis. In
+some of these cases, subjects are stumblers and when they are carelessly
+handled or kept at fast work over irregular or hard roads, chronic
+carpitis with hyperplasia of the structures of the anterior carpal
+region results, owing to frequent bruising from falls.</p>
+
+<p class="figcenter"><a name="image10" id="image10"></a>
+   <a href="./images/img10-full.jpg"><img src="./images/img10.jpg"
+   alt="Fig. 10&mdash;Contraction of carpal flexors, ''knee sprung.''"
+   title="Fig. 10&mdash;Contraction of carpal flexors, ''knee sprung.''" /></a><br />
+Fig. 10&mdash;Contraction of carpal flexors, "knee sprung."</p>
+
+<p>Where inflammation is caused by a puncture wound and subfascial
+infection occurs, there is evident manifestation of pain. No weight is
+supported by the affected member and because of the pressure, occasioned
+by the swollen muscles confined within the non-yielding brachial fascia,
+there exists marked supersensitiveness of the affected parts. Flexion of
+the elbow is avoided because contraction of the biceps brachii (flexor
+brachii) or the extensors, which are antagonists of the flexors of the
+carpus, tenses the carpal flexors and pain is thereby increased.</p>
+
+<p>However, in most instances, the practitioner's attention is not directed
+to typical and uncomplicated cases, but to subacute or chronic
+inflammations which are often attended with contraction of the tendinous
+parts of the carpal flexors, and in such cases <a name="Page_96" id="Page_96"></a>carpitis is present.
+Animals so affected have lost the rigidity which characterizes the
+normal carpal joint when the leg is a weight bearing member, and because
+of its sprung condition, the leg trembles when supporting weight.</p>
+
+<p><b>Treatment.</b>&mdash;Acute inflammation is treated by means of local
+application of cold or hot packs until the pain and acute stage of
+inflammation has subsided and later stimulating liniments are indicated.
+Absolute quiet must be enforced. Especially where the carpus is involved
+must the subject be kept quiet until all evidence of inflammation has
+subsided.</p>
+
+<p>The application of vesicants or line-firing is beneficial in subacute
+inflammation of the tendons of the carpal flexors. Where contraction of
+tendons exists and no osseous or ligamentous change prevents correction
+of the condition, tenotomy is necessary. The reader is referred to
+Merillat's "Veterinary <span class="nowrap">Surgery"<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a></span> for a good description of the
+technic of this operation.</p>
+
+<p>In all serious cases of inflammation of the carpal flexors, whether
+tenotomy has been performed or not, the subject needs a long period of
+rest subsequent to treatment. In fact, three or four months at pasture
+is necessary to permit of recovery and this where no congenital
+deformity has predisposed the subject to such affection of the flexors.
+Return to work must be gradual and the character of the work such as to
+enable the animal to become inured to service without a recurrence of
+the trouble if possible.</p>
+
+<p>It follows then, that tenotomy, here as in other cases, is not practical
+from an economic viewpoint, unless the animal be of sufficient value to
+justify the long period of rest for recovery. Tenotomy is not of
+practical benefit unless ample time is allowed for regeneration of
+divided tendinous tissue.</p>
+
+
+<h3><a name="Fracture_and_Luxation_of_the_Carpal_Bones" id="Fracture_and_Luxation_of_the_Carpal_Bones"></a>Fracture and Luxation of the Carpal Bones.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Fracture of the carpal bones is of
+infrequent occurrence in horses and, when it does occur, it is usually
+due to injuries, and because of their nature (resulting as they
+generally do from heavy falls or in being run over by <a name="Page_97" id="Page_97"></a>street cars or
+wagons), a comminuted fracture of one or more bones exists. The
+accessory carpal bone (trapezium) is said to be fractured at times
+without being subjected to blows or like injuries, but this is
+exceptional.</p>
+
+<p>Luxations of the carpal joint are of rare occurrence, and very few cases
+of this kind are on record. <span class="nowrap">Walters<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a></span> reports a case of
+carpometacarpal luxation in a pony wherein reduction was spontaneous and
+an uneventful recovery followed. His reason for reporting the case, as
+he states, is its rarity.</p>
+
+<p><b>Symptomatology.</b>&mdash;Fractures of the carpal bones as they usually take
+place are diagnosed without difficulty. Because of their usually being
+comminuted, abnormal movement of the joint is possible. Such movement is
+not restricted and flexion of the leg at the carpus in any direction is
+possible. Crepitation is readily detected and frequently these fractures
+are of the compound-comminuted variety.</p>
+
+<p>In fracture of the accessory carpal bone (trapezium) or in fracture of
+any other single bone when such exists, there is no increase in the
+movement of the joint. The accessory carpal bone may be readily
+manipulated and when fractured, its parts are more or less displaced.
+Recognition of fracture of any other single carpal bone must be done by
+detecting crepitation unless it be a compound fracture, whereupon
+probing is of aid in establishing a diagnosis.</p>
+
+<p>Carpal luxation when present is to be recognized by finding the apposing
+carpal bones joined in an abnormal manner&mdash;that is, out of position.
+There is restricted or suspended function of the joint, and in the cases
+recorded, no difficulty has been experienced in making a diagnosis. The
+carpometacarpal portion of the articulation is the part which is usually
+affected.</p>
+
+<p><b>Prognosis and Treatment.</b>&mdash;There is no chance for complete recovery in
+the usual case of carpal fracture because of the fact that there results
+sufficient arthritis to destroy articular cartilage beyond repair. In
+the average instance, because of arthritis which persists for a
+considerable length of time, more or less ankylosis results. At best,
+one can only hope for partial re<a name="Page_98" id="Page_98"></a>covery, that is to say, the member may
+regain its usefulness as a weight-supporting part, but because of
+restricted or abolished joint function, locomotion is more or less
+difficult. Exostoses, articular and periarticular, occur and the carpus
+usually becomes a large immobile articulation. There is danger of
+infection resulting in simple carpal fractures and, needless to say, in
+a compound-comminuted fracture of the carpus, infection usually occurs
+and a fatal outcome is probable.</p>
+
+<p>When treatment is instituted, antiseptic precautions are taken in
+handling the compound fractures, and in any case immobilization of the
+parts is sought. Here, as has been previously pointed out, it is best to
+employ leather splints, so that a maximum degree of rigidity with a
+minimum of distress and inconvenience to the patient will result. The
+leg must be bandaged from the hoof upward, making use of a sufficient
+amount of cotton to ensure against pressure-necrosis. The leather
+splints are placed mesially and laterally and, of course, need to extend
+as high as the proximal end of the radius. Subjects must be kept in
+slings until union of bones has become established, and as a rule there
+will then exist marked ankylosis.</p>
+
+<p>There is no particular difference in the handling of carpal luxation and
+dislocation of other bones. Where ligaments have not been destroyed to
+the extent that reduction is of no practical use, the parts are kept
+immobilized, if thought necessary. Later, vesication of the whole
+pericarpal region is done and the subject allowed exercise at will.</p>
+
+
+<h3><a name="Carpitis" id="Carpitis"></a>Carpitis.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Inflammation of the carpus is caused by
+contusions, such as are occasioned in falling, by kicks by striking the
+carpus against objects in jumping and sometimes by striking it against
+the manger in pawing. The condition is of rather frequent occurrence.</p>
+
+<p><b>Symptomatology.</b>&mdash;Evident symptoms of inflammation in carpitis are
+always present&mdash;hyperthermia, supersensitiveness and swelling. Also,
+there exists lameness which is characterized by an apparent inability to
+flex the leg, and there is circum<a name="Page_99" id="Page_99"></a>duction of the leg as it is advanced
+because in this way little if any flexion of the carpus (which increases
+pain) is necessary.</p>
+
+<p>Depending upon the nature of the cause, there occurs a marked difference
+in the character and amount of swelling.</p>
+
+<p class="figcenter"><a name="image11" id="image11"></a>
+   <a href="./images/img11-full.jpg"><img src="./images/img11.jpg"
+   alt="Fig. 11&mdash;Pericarpal inflammation and enlargement due to injury."
+   title="Fig. 11&mdash;Pericarpal inflammation and enlargement due to injury." /></a><br />
+Fig. 11&mdash;Pericarpal inflammation and enlargement due to injury.</p>
+<p class="captioncenter"></p>
+
+<p>Naturally, when much extravasation of serum and blood takes place, there
+is occasioned a fluctuating swelling which is usually less painful to
+the subject upon manipulation than is a dense inflammatory change
+without marked extravasation.</p>
+
+<p>In acute carpitis, there is present, then, a very painful condition
+which involves the articulation, causing marked lameness, disturbance of
+appetite and some elevation of temperature.</p>
+
+<p>Chronic cases do not occasion serious pain or constitutional
+disturbances, but do interfere with locomotion in direct proportion to
+the existing articular inflammation and periarticular hypertrophy of
+ligamentous and tendinous structures.</p>
+
+<p><b>Treatment.</b>&mdash;If possible, keep the subject absolutely quiet, employing
+the sling if necessary. During the first stages of inflammation, the
+application of ice packs to the affected parts, is <a name="Page_100" id="Page_100"></a>of marked benefit.
+At the end of forty-eight hours, hot applications may be used and this
+treatment continued throughout several days. Anodyne liniments are of
+service and should be employed throughout the acute stage of
+inflammation during intervals between the hydrotherapeutic treatments.</p>
+
+<p>As inflammation subsides, a counterirritating application such as a
+suitable liniment and later blistering or line-firing is helpful in
+stimulating resolution.</p>
+
+<p class="figcenter"><a name="image12" id="image12"></a>
+   <a href="./images/img12-full.jpg"><img src="./images/img12.jpg"
+   alt="Fig. 12&mdash;Hygromatous condition of the right carpus, also
+distension of sheaths of extensor tendons of both fore legs."
+   title="Fig. 12&mdash;Hygromatous condition of the right carpus, also
+distension of sheaths of extensor tendons of both fore legs." /></a></p>
+<p class="captioncenter">Fig. 12&mdash;Hygromatous condition of the right carpus, also
+distension of sheaths of extensor tendons of both fore legs.</p>
+
+
+<h3><a name="Open_Carpal_Joint" id="Open_Carpal_Joint"></a>Open Carpal Joint.</h3>
+
+<p><b>Anatomy.</b>&mdash;The carpal bones as they articulate with one another and
+with the radius and metacarpal bones, as classed by anatomists, form
+three distinct articular parts of the joint as a whole and are known as
+radiocarpal, intercarpal and carpometacarpal. These three pairs of
+articulating surfaces are all enclosed within one capsular ligament. On
+the anterior face of the bones, the capsular ligament is attached to the
+carpal bones in <a name="Page_101" id="Page_101"></a>such manner that an imperfect partitioning of the three
+joint compartments is formed. Posteriorly, the capsule is very heavy and
+forms a sort of padding over the irregular surfaces of the bones, and
+also its reflexions constitute the sheaths of the flexor tendons. The
+anterior portion of the capsular ligament forms sheaths for the extensor
+tendons, and both portions of the joint have an attachment around the
+distal end of the radius and another at the proximal end of the
+metacarpal bones.</p>
+
+<p class="figcenter"><a name="image13" id="image13"></a>
+   <a href="./images/img13-full.jpg"><img src="./images/img13.jpg"
+   alt="Fig. 13&mdash;Carpal exostosis in aged horse."
+   title="Fig. 13&mdash;Carpal exostosis in aged horse." /></a><br />
+Fig. 13&mdash;Carpal exostosis in aged horse.</p>
+<p class="captioncenter"></p>
+
+
+<p><b>Etiology and Occurrence.</b>&mdash;Puncture wounds of any kind may serve to
+perforate the joint capsule and such traumatisms are occasioned by
+falls, kicks and in various ways in runaway accidents, and open carpal
+joint may follow.</p>
+
+<p><b>Symptomatology.</b>&mdash;The pathognomonic symptoms of the existence of an
+open joint is the exposure to view of articular surfaces of bones or
+noting the escape of synovia from the joint capsule. As has been
+previously referred to, there always exists a peculiar suspension of
+carpal flexion in all cases of carpitis.</p>
+
+<p>Non-infective wounds which may cause open joint are not necessarily
+productive of an active carpitis&mdash;a synovitis may be the extent of the
+disturbance. Unlike synovitis, which may <a name="Page_102" id="Page_102"></a>characterize a non-infectious
+penetrative wound of the capsular ligament, septic arthritis which may
+supervene is a very painful inflammatory disturbance. It is
+characterized by all of the symptoms which attend the case of open joint
+and synovitis plus the obvious manifestation of great pain. There is an
+elevation of temperature of from two to five degrees above normal;
+circulation is accelerated; the pulse is bounding; respiration is
+hurried; there is an expression of pain as indicated by the physiognomy;
+and because of rapid erosive changes of cartilages which take place,
+there is soon so much of the articulation destroyed that death is
+inevitable. Death is usually due to generalization of the arthritic
+infection.</p>
+
+
+
+<table class="center" width="600">
+<tr>
+<td><a name="image14" id="image14"></a>
+   <a href="./images/img14-full.jpg"><img src="./images/img14.jpg"
+   alt="Fig. 14&mdash;Exostosis of carpus resultant from carpitis."
+   title="Fig. 14&mdash;Exostosis of carpus resultant from carpitis." /></a>
+</td>
+<td class="padded"><a name="image15" id="image15"></a>
+   <a href="./images/img15-full.jpg"><img src="./images/img15.jpg"
+   alt="Fig. 15&mdash;Distal end of radius. Illustrating the effects of chronic carpitis."
+   title="Fig. 15&mdash;Distal end of radius. Illustrating the effects
+of chronic carpitis." /></a>
+</td>
+</tr>
+<tr>
+<td class="botpad">Fig. 14&mdash;Exostosis of carpus <br />
+resultant from carpitis.</td>
+<td>Fig. 15&mdash;Distal end of radius. <br />
+Illustrating the effects of<br />
+chronic carpitis.</td>
+</tr>
+</table>
+
+
+<p>In the meanwhile, if the character of the infectious material is not so
+virulent, the disease will take on a slower course and the subject may
+experience laminitis from supporting weight upon the sound member, or
+because of continued recumbency, decubital gangrene and emacia<a name="Page_103" id="Page_103"></a>tion
+sometimes cause death. If the subject does not soon succumb, it is
+compelled to undergo days or even weeks of unnecessary suffering, and
+too often in such cases, it is later deemed advisable to destroy the
+animal because of the cost of continuing treatment until the horse is
+serviceable. Therefore, it is evident that when such joints as the
+carpus or tarsus are open and infection exists, if they are not promptly
+treated and the infectious process checked, it is neither humane nor
+practical to prolong treatment.</p>
+
+<p>Distinction must be made between the different joints when infected as
+the condition is much more serious in some cases than in others. All
+things considered, perhaps open joints rank, with respect to being
+serious cases as follows: elbow, navicular, stifle, tarsus, carpus,
+fetlock and pastern. This, of course, is restricted to articulations of
+the locomotory apparatus.</p>
+
+<p><b>Treatment.</b>&mdash;Preliminary care in the treatment of an open carpal joint,
+is the same as has been described in this condition as it affects the
+scapulohumeral articulation described on page <a href="#Page_65">65</a>. Likewise the further
+treatment of such cases is along the same lines except that where it is
+possible, the parts are kept covered with cotton and bandages. However,
+in some cases, animals have been successfully treated without bandaging
+and by keeping the patient in a standing position and on pillar reins
+until recovery resulted. Such cases were of the non-infectious type and
+recovery was possible within three or four weeks. Further, the condition
+is not sufficiently painful in such instances as to prevent the subjects
+bearing weight with the affected member; hence, no danger of resulting
+laminitis is incurred. And finally, where bandages are not employed, the
+frequent use of antiseptic dusting powders is substituted for cotton as
+a protector.</p>
+
+<p>When bandaged, such wounds need dressing more or less frequently, as
+individual instances demand. The purulent infective inflammation of a
+carpal joint will require daily dressing; whereas, in other cases
+(non-infective), semi-weekly change of bandages is sufficient. Equal
+parts of boric acid and exsiccated alum constitute a suitable
+combination for the treatment of these cases, and this powder should be
+liberally employed. Tincture of iodin may be injected into the joint
+capsule where there is <a name="Page_104" id="Page_104"></a>provision for its ready evacuation, as
+conditions seem to require. Daily injections for three, four or five
+days, are not harmful and will control infection in many instances.</p>
+
+
+<h3><a name="Thecitis_and_Bursitis" id="Thecitis_and_Bursitis"></a>Thecitis and Bursitis.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;The thecae and bursae of the leg are several
+in number. In the carpal region, the flexors of the phalanges are
+contained together in the carpal sheath, and this is the principal theca
+in the carpal region. Each of the tendons is provided with synovial
+sheaths which are subject to inflammation and occasionally synovitis and
+distension of these synovial sheaths occur.</p>
+
+<p>Because of faulty conformation, some animals are subject to inflammation
+of these sheaths, and all forms of strenuous work which taxes the
+tendons greatly is apt to result in synovitis. Direct injury such as
+blows may be the cause of synovial distension of thecae and the
+affection is to be seen in all horses that have done much fast work on
+hard road surfaces or pavements.</p>
+
+<p>The usual case as it occurs in practice is a non-infective synovitis,
+but where puncture wounds cause the trouble, an infectious inflammation
+obtains.</p>
+
+<p><b>Symptomatology.</b>&mdash;No trouble is experienced in diagnosing distension of
+tendon sheaths, for the affection is very palpable. During acute
+inflammatory stages of this affection, some lameness is present&mdash;in
+infectious inflammation lameness is intense. Local heat and pain upon
+manipulation are readily discernible in all acute cases. And finally,
+where there is reason for doubt, an aseptic exploratory puncture of the
+wall of the fluctuating enlargement may be made with a suitable trocar,
+and the discharging synovia will be proof of the existence of synovial
+distension.</p>
+
+<p>After the affection becomes subacute or chronic, no lameness or
+inconvenience is manifested, and the condition is undesirable only
+because of its being a blemish.</p>
+
+<p><b>Treatment.</b>&mdash;Acute non-infectious synovial distension of tendon sheaths
+is treated by aspirating as much synovia as possible from the affected
+theca (this is, of course, done under <a name="Page_105" id="Page_105"></a>strict asepsis) and by means of
+bandages, a uniform degree of pressure is kept over the parts for ten
+days or two weeks. The patient is kept quiet and in the course of two
+weeks an active blistering agent is employed over the region affected.
+Usually, at the end of a month's time, complete recovery has taken place
+and the subject may be gradually returned to work.</p>
+
+<p>When synovial distensions are of long standing, it is necessary to take
+special precautions to check excessive secretion of synovial fluid, and,
+also because of the atonic condition of the tissues affected, resolution
+is tardy. In addition to aspirating synovia, the introduction of equal
+parts of alcohol and tincture of iodin into the theca is necessary. The
+quantity of this combination injected, depends upon the size of the
+sheath affected and the amount of synovia retained at the time injection
+is made. Experience is necessary to judge as to this part of the work,
+but one may consider that a quantity between three and ten cubic
+centimeters of equal parts of tincture of iodin and alcohol constitutes
+the proper amount to employ. Where much synovia is contained within the
+sheath at the time of injection, there occurs great dilution of the
+agent injected and consequently less irritation results.</p>
+
+<p>The object of such injections is to check synovial secretion, and this
+is sought by the local effect of iodin in contact with the secreting
+cells together with the reactionary swelling which occasions pressure.
+An increase in the local blood supply also follows. In all cases where
+it is possible to employ suitable bandages, this should be done. The
+ordinary derby bandages serve well and if their use is continued for a
+sufficient length of time, good results follow.</p>
+
+<p>There are other methods of treating these affections, and each has its
+advantages and disadvantages. Line-firing, instead of the vesicant is
+made use of by some, but the object desired is the same and results
+obtained are similar.</p>
+
+<p>Sheaths may be opened surgically by means of a knife, and the removal of
+a portion of the wall of distended and atonic tendon sheaths is
+possible. These operations belong to the realm of surgery and are not
+properly a part of this treatise. However, in passing, it may be said
+that if a perfect technic is possible in <a name="Page_106" id="Page_106"></a>doing the last named
+operation, a permanent recovery is the outcome.</p>
+
+
+<h3><a name="Fracture_of_the_Metacarpus" id="Fracture_of_the_Metacarpus"></a>Fracture of the Metacarpus.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;As the result of all sorts of violence, such
+as falls and injuries in accidents of various kinds wherein the
+metacarpals are subjected to contusions, fractures may result. In the
+horse it is unusual for fracture of one of the small metacarpal bones to
+take place without there being at the same time a fracture of the third
+(large) metacarpal bone.</p>
+
+<p><b>Classification.</b>&mdash;Fractures of the metacarpal bones as they occur, are
+as likely to be compound as simple, and the multiple and comminuted
+varieties are occasionally observed. The manner in which the third
+(large) metacarpus is fractured, largely determines the outcome in any
+given case.</p>
+
+<p><b>Symptomatology.</b>&mdash;Abnormal mobility of the broken parts of bone and
+crepitation mark fracture of the metacarpus, and the condition is easily
+diagnosed. In many instances, when compound fracture exists, broken ends
+of bone are protruding through the skin. No weight is borne upon the
+fractured member ordinarily, although during the excitement occasioned
+by runaways, horses are sometimes seen to support weight with a broken
+leg even when the protruding bone is sunk into the ground in so doing.</p>
+
+<p><b>Prognosis.</b>&mdash;Generally speaking, fractures other than the
+simple-transverse in young animals, are considered unfavorable cases.
+With the metacarpus, however, there are instances where compound
+fracture occurs in colts that justify treatment. But in all cases of
+compound fracture, the element of infection in addition to the increased
+difficulty in maintaining immobility of the broken bone, creates almost
+insuperable difficulties in the average instance. And unless the
+practitioner distinctly explains to his client the various reasons which
+make treatment an economic impracticability, dissatisfaction is likely
+to follow if treatment is instituted without such an understanding.</p>
+
+<p><b>Treatment.</b>&mdash;Perfect apposition of the broken ends of bone is easily
+effected and less difficulty is encountered in maintain<a name="Page_107" id="Page_107"></a>ing such
+relations in metacarpal fractures than in fractures of the radius.
+However, reduction and immobilization of this as in all fractures, must
+be done without delay. In simple fracture, the metacarpus is covered
+with enough cotton to pad the parts, and this is retained in position by
+bandages. Splints of heavy leather or of thin pieces of tough flexible
+wood are placed on each side of the leg and firmly held in position with
+bandages. Bandages may be put on in layers and a coating of glue applied
+over each layer if this is thought necessary. The advantage gained in
+using glue or other adhesive materials is that the cast thus formed is
+more rigid than where such material is not employed. On the other hand,
+all elasticity is lost as soon as the cast adapts itself to the contour
+of the extremity, and because of this rigidity, it is doubtful if
+anything is gained by the incorporation of glue, except in the way of
+added strength of the cast. Since the animal does not walk upon the
+broken leg, it is possible to employ splints of suitable materials which
+are retained in position without glue and frequent readjustment of a
+part of the immobilizing apparatus is possible. This is impossible with
+casts.</p>
+
+<p>In compound fractures, provision ought to be made for dressing the wound
+of the soft structures. This entails adjusting the splints in such
+manner that one splint may be retained and others removed for dressing
+the wound and readjusted as often as wound dressing is necessary.</p>
+
+
+<h3><a name="Splints" id="Splints"></a>Splints.</h3>
+
+<p>By this term is meant a condition where there exists an exostosis which
+involves usually the second (inner small) and third (large) metacarpal
+bones. While an exostosis involving any one of the splint bones, even
+when directly caused by an injury, is called a "splint," the term is
+employed here, in reference to exostoses not due to direct injury such
+as in contusions.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This condition is one wherein there is
+osseous formation following a periostitis and the region of the upper
+portion of the second (inner small) metacarpal bone is the usual site of
+the exostosis. There is incited an inflamma<a name="Page_108" id="Page_108"></a>tion of the periosteum at
+the site of the interosseous ligament which attaches the small to the
+large metacarpal bone. This ligament is involved in the inflammatory
+process, and according to Havemann, whose view is supported by Moller,
+this inflammation is the origin of the trouble.</p>
+
+<p>Various theories attempting an explanation of the frequent affection of
+this one certain part so regularly involved have been offered, but no
+proof of the correctness of any exists. It follows, however, that
+splints occur in young animals; that the affection seldom starts in
+subjects that are ten years of age or older, and that when the exostosis
+has formed, lameness usually subsides. Anything which will cause undue
+strain or irritation of the metacarpal bones in young animals, is quite
+apt to result in a splint being formed. Concussion such as is caused by
+fast work on hard roads, or work on rough or irregular road surfaces
+which cause unequal distribution of weight, will cause splint lameness
+and exostosis follows.</p>
+
+<p class="figcenter"><a name="image16" id="image16"></a>
+   <a href="./images/img16-full.jpg"><img src="./images/img16.jpg"
+   alt="Fig. 16&mdash;Posterior view of radius (right) illustrative of
+effects of splint. Note the extent of exostosis."
+   title="Fig. 16&mdash;Posterior view of radius (right) illustrative of
+effects of splint. Note the extent of exostosis." /></a><br />
+Fig. 16&mdash;Posterior view of radius (right) illustrative of
+effects of splint. Note the extent of exostosis.</p>
+
+<p><b>Course.</b>&mdash;Because of the peculiar manner in which the second and third
+metacarpal bones articulate in young animals, until the bones become
+ossified and permanently joined, the inflammation which attends the
+acute stage of this affection, causes lameness. Later, unless an
+unusually large exostosis is formed, which may cause a constant
+irritation due to its size and juxtaposition to the carpus, lameness is
+discontinued.</p>
+<p><a name="Page_109" id="Page_109"></a></p>
+
+<p><b>Symptomatology.</b>&mdash;Lameness is usually the first manifestation of this
+disorder, and the thing which characterizes splint lameness is its
+peculiar intermittence. There is a mixed form of lameness which may not
+be in evidence when an affected animal is started on a drive, but which
+is marked after the subject has gone some distance. The animal may,
+however, go lame throughout the whole of a drive and continue to be lame
+for several days or weeks in some cases. It is noticeable that lameness
+is augmented or produced when the subject travels on rough road surfaces
+and that little or no difficulty is encountered when roads are smooth.</p>
+
+<p>The heavy brachial fascia is inserted in part to the head of the second
+metacarpal (inner small) bone together with the oblique digital extensor
+(extensor metacarpi obliquus) and this explains the reason for pain
+being manifested during extension of the member.</p>
+
+<p>Before there is a visible exostosis, supersensitiveness is readily
+recognized upon palpation of the parts, if careful comparison is made
+between the sound and unsound members. However, frequently splints occur
+on both forelegs at the same time and in some instances exostoses are
+several in number upon each member affected. In some instances, the
+affection involves the outer splint bone and no evident involvement of
+the inner one exists.</p>
+
+<p><b>Treatment.</b>&mdash;At the onset complete rest should be provided and the
+local application of some good cataplasm is in order. A stimulating
+liniment is beneficial when employed several times daily and massage is
+also quite helpful. Later, the application of a blistering ointment is
+good treatment. The use of the actual cautery stimulates prompt
+resolution, but there is seldom any resorption of products of
+inflammation following firing. Whereas, in cases where other treatment
+is begun early, there usually follows considerable diminution in the
+size of the exostosis. A rest of four or five weeks is necessary and
+very young animals should not be put to work too soon, if the character
+of the work is such as to induce a recurrence of the trouble.</p>
+
+<p>Many cases are treated successfully in draft types of animals (where the
+subjects are not kept at work that occasions seri<a name="Page_110" id="Page_110"></a>ous irritation to the
+affected parts) by blistering the exostosis repeatedly and allowing the
+animals to continue in service. In such cases, it is unreasonable to
+expect to check the size of the exostosis and, of course, such methods
+are not employed where lameness causes distress to the subject.</p>
+
+<p>Firing usually causes prompt recovery from lameness and is a dependable
+manner of treating such cases but there remains more blemish following
+cauterization than where vesication is done.</p>
+
+
+<h3><a name="OPEN_FETLOCK_JOINT" id="OPEN_FETLOCK_JOINT"></a>OPEN FETLOCK JOINT.</h3>
+
+<p>This condition, because of the frequency with which it occurs may be
+taken as typal, from the standpoint of treatment and results obtained
+therefrom. While it serves to constitute a basis from which other
+joints, when open, are to be considered, due allowance must be made for
+the fact that, as has been previously mentioned, some articulations when
+open constitute cause for grave consequences; while with others an open
+capsule, even when infected, does not cause disturbance enough to be
+classed as difficult to handle. Moreover, the fetlock joint is admirably
+suited, anatomically, to bandaging; and when wounded, is easily kept
+protected by means of surgical dressings. This fact is of great
+importance in influencing the course and termination in any given case
+of open fetlock joint and should not be forgotten.</p>
+
+<p>There is no logical reason for comparing the pedal joint with the
+pastern on the basis that it may also be completely and securely
+bandaged. Open navicular joint does not occur, as a rule, except by way
+of the solar surface of the foot, and the introduction of active and
+virulent contagium is certain to happen; consequently, an acute
+synovitis quickly resulting in an intensely septic and progressively
+destructive arthritis soon follows in perforation of the capsule of the
+distal interphalangeal articulation.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Wounds of the fetlock region resulting in
+perforation or destruction of a part of the capsular ligament are caused
+by all sorts of accidents, such as wire cuts, incised wounds occasioned
+by plowshares, disc harrows, stalk cutters and other farming implements.
+In runaways the joint <a name="Page_111" id="Page_111"></a>capsule is sometimes punctured by sharp pieces of
+wood or other objects. In horses driven on unpaved country roads the
+fetlock is occasionally wounded by being struck against the sharp end of
+some object, the other end of which is firmly embedded in the ground. In
+one instance the author treated a case wherein the fetlock joint was
+perforated by the sickle-guard of a self-binder. In this case there
+occurred complete perforation causing two openings through the
+<i>cul-de-sac</i> of the joint. Such wounds are produced by implements which
+are, to say the least, non-sterile, and this perforation of the
+uncleansed skin conveys infectious material into the joint capsule. Yet
+in many instances, especially in country practice, no infectious
+arthritis results where cases are promptly cared for.</p>
+
+<p><b>Symptomatology.</b>&mdash;A difference in the character of symptoms is
+evidenced when dissimilar causes exist. Small penetrant wounds which
+infect the synovial membranes cause infectious arthritis in some cases,
+whereas a wound of sufficient size to produce evacuation of all synovia
+will, in many instances, cause no serious distress to the subject, even
+when not treated for several days. If it is not evident that an open
+joint exists and the articular cavity is not exposed to view a positive
+diagnosis may be early established by carefully probing the wound. In
+some cases where a small wound has perforated the joint capsule,
+swelling and slight change of relation of the overlying tissues may
+preclude all successful exploratory probing. In such instances it is
+necessary to await development of symptoms. Twenty-four hours after
+injury has been inflicted, there is noticeable discharge of synovia
+which coagulates about the margin of the orifice, where synovial
+discharge is possible. Particularly evident is this accumulation of
+coagulated synovia where wounds have been bandaged&mdash;there is no
+mistaking the characteristic straw-colored coagulum which, in such
+cases, is somewhat tenacious.</p>
+
+<p>No difference exists between other symptoms in infectious arthritis
+caused by punctures, and non-infectious arthritis, excepting the
+intensity of the pain occasioned, the rise in temperature, circulatory
+disturbances, etc.; all of which have been previously mentioned.</p>
+<p><a name="Page_112" id="Page_112"></a></p>
+
+<p><b>Treatment.</b>&mdash;Just as has been stated in discussions on the subject of
+open joint, probing or other instrumentation is to be avoided until the
+exterior of the wound and a liberal area surrounding has been thoroughly
+cleansed&mdash;too much importance can not be placed on this preliminary
+measure. In cases of open joint where ragged wound margins exist and the
+interior of the joint capsule is contaminated, much time is required to
+thoroughly cleanse all soiled parts. In some instances an hour's time is
+required for this cleansing process after the subject has been
+restrained and prepared. In order to thoroughly cleanse these delicate
+structures without doing them serious injury, one ought to be skillful
+and careful in all manipulations of the exposed parts of the joint
+capsule.</p>
+
+<p>The general plan of treatment, after preliminary cleansing has been
+accomplished, has been outlined on page <a href="#Page_66">66</a> in the consideration of
+scapulohumeral joint affections. The injection of undiluted tincture of
+iodin in ounce quantities, it must be remembered, is not to be done
+unless there is provision for its free exit. Where good drainage from
+the joint cavity exists all infected wounds should be thus treated, and
+this treatment may be repeated as conditions seem to require&mdash;until
+infection is checked.</p>
+
+<p>If daily injections are necessary, dilution of the tincture of iodin
+with an equal amount of alcohol is advisable in order to avoid doing
+irreparable damage to the articular cartilages and synovial membranes.</p>
+
+<p>An antiseptic powder composed of equal parts of boric acid and
+exsiccated alum is employed to protect the wound surfaces and the
+margins, and the parts are then bandaged. In bandaging wounds of this
+kind a liberal amount of cotton should be employed, and after a large
+surface surrounding the wound has been thoroughly cleansed, it must be
+so kept thereafter. This is impossible, if one uses a small amount of
+cotton, particularly if such meager quantity of dressing material is
+carelessly wrapped in position with an insufficient amount of bandage
+material. Mention, without description of the elemental problem of
+applying cotton and bandages to a wound, would be sufficient, were it
+not that this is a very important part of the hand<a name="Page_113" id="Page_113"></a>ling of such cases,
+and many practitioners are not only thoughtless in this part of their
+work, but also apparently careless. What does it profit to prepare a
+part and cleanse a wound with painstaking care and then neglect to take
+every possible precaution to prevent its subsequent contamination?</p>
+
+<p>In the handling of open joint capsules where the perforation of the
+capsular ligament is small and discharge of synovia does not immediately
+follow, there is presented a problem which is difficult to decide upon
+and that is the manner in which such wounds are to be handled. One
+hesitates to enlarge such openings to drain or irrigate the capsule when
+there is no proof that serious trouble will follow because of infectious
+material which has probably been introduced at the time the wound was
+inflicted. It is especially difficult to decide upon the manner of
+handling such cases where the tarsal joint is wounded, although one
+hesitates to invade any joint to the extent of incising its capsule,
+unless there is urgent need of so doing.</p>
+
+<p><span class="nowrap">Frost<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a></span> offers the following suggestion in such instances:</p>
+
+<div class="blockquot"><p>The treatment recommended by us for open joints, in which we wish
+to prevent ankylosis, is, first, to shave all hair from the area
+surrounding the wound, following with a thorough cleansing of the
+skin and disinfection of the wound, and then to inject a twenty per
+cent Lugol's solution in glycerin into the wound. This should be
+repeated two or three times a day, each time enough of the solution
+being injected to fill the joint capsule, thereby securing the
+flushing effect. As this solution does not cause irritation to the
+tissue and yet is a strong antiseptic, it serves to shorten the
+period of congestion and inflammation and to overcome the infection
+without causing a destruction of the secreting membrane until the
+external wound has had time to heal. The injection of this solution
+seems to retard the excessive secretion of synovia. The larger the
+joint capsule and the smaller the external wound, the longer our
+antiseptic will remain in contact with the inflamed tissues as the
+glycerin, being thick, does not flow through a small opening.</p></div>
+
+<p><b>After-care.</b>&mdash;Following the initial cleansing and treatment of open
+joint, subsequent dressing is necessary as frequently as conditions
+demand. If the parts are badly infected and profuse discharge of pus
+exists a daily change of dressings is necessary.<a name="Page_114" id="Page_114"></a> In the average
+instance, however, semi-weekly treatments are sufficient. And in many
+instances where one is obliged to travel a considerable distance to
+handle the affected animal one weekly dressing of the wound will suffice
+after the second treatment.</p>
+
+<p>The same general plan of treatment concerning the subject's comfort that
+has been previously mentioned in arthritis, is carried out here. A
+further and detailed consideration of the subject of handling of open
+joints <span class="nowrap">follows.<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a></span></p>
+
+<div class="blockquot"><p>* * * Such wounds may be classified in two general groups as
+follows: First, wounds in which the trauma has exposed the
+articulation to view, and second, those the result of punctures, in
+which the external wound is small and free drainage is lacking.</p>
+
+<p>Wounds in which the articulation is exposed to view have drainage
+either all ready provided for, or it is established without
+hesitancy surgically. With free drainage thus established there is
+little or no chance for the adjacent tissues to become infiltrated
+with infected wound discharge. This prevents an extension of the
+injury and the establishment of a good field for the growth of
+anaerobic bacteria.</p>
+
+<p>Open joints caused by punctures, unless the puncture is aseptic,
+produce a swelling which is more painful than is the open wound
+which exposes the joint to view. Especially is this true if the
+puncture is of small diameter, allowing the tissues to partially
+close the opening immediately after the wound has been made. Where
+drainage is lacking there follows an exudation which congests the
+tissues surrounding the injury and all factors favoring germ growth
+are present. It is perhaps advisable to establish good drainage in
+such cases as soon as a diagnosis is made.</p>
+
+<p>It is not always an easy matter to recognize an open-joint, when
+first made, but twelve to twenty-four hours later there is no cause
+for doubt. The condition is then a very painful one; lameness is
+excessive; there is rise in temperature; acceleration of the pulse
+and manipulation or palpation of the region affected, occasions
+great pain.</p>
+
+<p>The treatment of open joints must be varied to suit the disposition
+of the animal, the nature and location of the injury, the length of
+time intervening between the infliction of the wound and the first
+attention given, and the surroundings in which the patient is kept.</p>
+
+<p>In each and every case in which there exists an open wound <a name="Page_115" id="Page_115"></a>the
+surface surrounding the wound is cleansed thoroughly, the hair is
+shaved if possible, and the margin of the wound is curretted and
+cleansed thoroughly with antiseptic solutions.</p>
+
+<p>If there is evidence that the articulation contains infective
+material, it is washed out with copious quantities of peroxide of
+hydrogen&mdash;usually as much as six or eight ounces. This is followed
+by injection of an ounce or two of tincture of iodin. Even though
+the joint appears to be clean some tincture of iodin is used, as it
+checks the secretion of synovia and is, in every way, beneficial.
+Care is taken to apply the iodin also to the surface immediately
+surrounding the wound. The entire wound is then covered with a
+dusting powder composed of zinc oxide, boric acid, exsiccated alum,
+phenol and camphor.</p>
+
+<p>This powder is used in abundance and the wound is then covered with
+a heavy layer of absorbent cotton and well bandaged. This bandage
+is not disturbed for at least three days and may be left in place
+for a week. In cases in which it is necessary to keep the dressing
+on for a week, or in cases where the patient is, through necessity,
+kept in quarters that are wet or unclean, the first bandage is
+covered with a layer of oakum which has been saturated in oil of
+tar and this in turn is held in place by means of several layers of
+bandages. The bandages are also saturated with oil of tar.</p>
+
+<p>In from one to two months wounds so treated, unless they are
+foot-wounds, will be ready to dress without being bandaged. It is
+ordinarily unnecessary to dress foot-wounds oftener than every
+second week after the discharge of synovia has ceased. When the
+wound has filled with granulation, a protective dressing is applied
+which is rendered water proof by the use of bandages covered with
+oil of tar. The patient can now be turned out for a month or six
+weeks without disturbing the dressing. After the removal of the
+bandages, the only treatment necessary is an occasional application
+of some mildly antiseptic ointment.</p>
+
+<p>Except in nail pricks of the foot, occasioned by punctures, a five
+per cent tincture of iodin is injected into open joints, if the
+wound remains sufficiently open, and this treatment is continued so
+long as there is a discharge of synovia. Surgical drainage is
+established if it is considered practicable and the remainder of
+the treatment is about the same as for wounds which are open.</p>
+
+<p>Open joints occur in horses at pasture and are sometimes not
+discovered until several days or a week after the injury, and in
+some instances the wounds are filled with maggots. The only
+difference in the treatment of these cases is that more time and
+care is taken in cleansing the wound, more curetting is necessary,
+and after cleansing the wound with peroxide of hydrogen, <a name="Page_116" id="Page_116"></a>the joint
+is thoroughly washed out with equal parts of tincture of iodin and
+chloroform. This is followed by the injection of a quantity of
+seventy-five percent alcohol and the wound is dressed and bandaged
+as already described. At each subsequent dressing of infected
+wounds so treated less suppuration is noticed and the synovial
+discharge usually ceases in from one to two months.</p>
+
+<p>About <i>ninety percent of all cases of open joint make complete
+recoveries</i>, about four per cent partially recover and six per cent
+are fatal. Among the fatal cases are the open joints with
+complications as severed tendons, those occasioned by calk wounds
+in horses that are stabled, and nail punctures of the feet. The
+following report of twelve favorable cases is taken from a record
+of sixty-two cases. The favorable ones are reported, chiefly
+because there are now enough reports on record of such cases which
+have terminated fatally.</p>
+
+<p><b>Case 1.</b>&mdash;A gray gelding used as a saddle pony received a
+horizontal wire cut laying completely bare the scapulohumeral
+articulation. The margins of the wound were cleansed as heretofore
+described, a drainage was provided surgically, tincture of iodin
+was injected and the wound was covered with equal parts of boric
+acid and exsiccated alum. The horse was kept tied and a diluted
+tincture of iodin was injected into the wound once daily and the
+powder applied often enough to keep the wound covered. The case
+made a complete recovery and the pony was again in service within
+sixty days.</p>
+
+<p><b>Case 2.</b>&mdash;A twelve-hundred-pound bay mare with an open carpal
+joint. The wound was an open one about two and one-half inches in
+length, and made transversely and when the member was flexed the
+articular surface of the carpal bones were presented to view. An
+ounce of tincture of iodin was injected into this joint after
+having cleansed the margin of the wound and the mare was cross-tied
+in a single stall to keep her from lying down. The owner was
+instructed to keep the outside of the wound powdered with air
+slaked lime and a very unfavorable prognosis was given.</p>
+
+<p>I heard nothing further from this case until fifty-nine days from
+the date of the injury, when I met the owner driving this mare to a
+buggy. The wound had healed by first intention and at that time so
+little cicatrix remained that it was difficult to find it.</p>
+
+<p><b>Case 3.</b>&mdash;A brown mare with an open fetlock joint due to a
+spike-nail puncture. Lameness was excessive, and joint greatly
+swollen. Tincture of iodin was injected into the wound and towels
+dipped in hot antiseptic solutions were applied for several <a name="Page_117" id="Page_117"></a>hours
+daily until the acute stage had passed. Later the mare was turned
+out to pasture and a vesicant was applied once or twice a month
+until recovery was complete which was in about six months.</p>
+
+<p><b>Case 4.</b>&mdash;A four-year-old bay mare having a wire-cut which opened
+the tarsus joint was treated as heretofore described. The wound was
+kept bandaged for about two weeks and later it was dressed without
+being bandaged. In ninety days she had completely recovered.</p>
+
+<p><b>Case 5.</b>&mdash;A twelve-year-old mare with an open fetlock joint due to
+a puncture wound. The margins of the wound were cleansed and the
+external wound enlarged to facilitate drainage. Tincture of iodin
+was injected; the wound was bandaged and dressed for a month in the
+manner heretofore described, when all discharge had stopped. A
+vesicant was applied; the mare was put to pasture and within sixty
+days from the date of the injury she was being driven on short
+trips.</p>
+
+<p><b>Case 6.</b>&mdash;A two-year-old brown gelding with a wire-cut on the left
+front foot. The wound extended down through the sole and opened the
+navicular joint. This colt was very wild and it was necessary to
+tie it down each time the wound was dressed. The wound was dressed
+weekly for a month and less frequently thereafter. It was handled
+eight times; the last dressing was left in place until worn out.
+Six months later the colt was practically well, a very little
+lameness being shown when walking on frozen ground.</p>
+
+<p><b>Case 7.</b>&mdash;A seven-year-old saddle-horse weighing eleven hundred
+and fifty pounds received a wound of the tarsus, laying bare the
+articular surfaces of a part of the joint. It was impossible to
+keep this wound bandaged because of the restless disposition of the
+subject. Injections of a dilute tincture of iodin were employed
+every second or third day for a month and the wound was kept
+covered with the antiseptic dusting powder referred to heretofore.
+In five months complete recovery had taken place, with the
+exception of a stubborn skin disturbance which was successfully
+treated six months after the wound was inflicted. The horse is
+still in use and is absolutely free from lameness.</p>
+
+<p><b>Case 8.</b>&mdash;A two-year-old brown gelding with a wire-wound opening
+the scapulohumeral joint. This wound was large enough to expose to
+view the articular portion of the humerus. The same treatment as
+that given case No. one was instituted and in ninety days the colt
+was practically well.</p>
+<p><a name="Page_118" id="Page_118"></a></p>
+
+<p><b>Case 9.</b>&mdash;A three-year-old bay filly was found at pasture with one
+fore foot badly injured. The owner intended to destroy her, but a
+neighbor prevailed upon him to have her treated. Apparently the
+wound was of about a week's standing and in a very bad condition,
+filled with maggots and dirt. Both the navicular and coronary
+articulations were open. This wound was cleansed in the usual
+manner and the owner cared for the case the balance of the time
+because the distance from my office was too great to give her
+personal attention. She made an almost complete recovery in five
+months.</p>
+
+<p><b>Case 10.</b>&mdash;At two-year-old mule with an open navicular joint due
+to a barbed wire wound. Usual care was given this case and in five
+months recovery was complete and little scar is to be seen. This
+case received seven treatments.</p>
+
+<p><b>Case 11.</b>&mdash;An eighteen-months-old colt at pasture was found down
+and unable to rise without help. In addition to several wounds of
+lesser importance there was a large wound on the inner side of the
+elbow, the joint was open and the entire leg was greatly swollen
+and in a state of acute infectious inflammation. The colt could not
+walk, its temperature was 105&deg;, pulse was rapid and respiration was
+a little hurried. After advising the owner to put the poor animal
+out of its misery I left the place. Four days later the owner came
+to my office and asked if he could borrow some old shears to "trim
+off some loose hide from that colt." He left the colt in the
+pasture and all the care it received was the regular application of
+a proprietary dusting powder. It made a complete recovery.</p>
+
+<p><b>Case 12.</b>&mdash;A family mare, heavy in foal, received a vertical wound
+of the fetlock joint inflicted by a disc-harrow. The <i>cul-de-sac</i>
+of the ligament of this joint was opened freely. The wound was
+dressed in the usual manner and again three days later when no
+suppuration had taken place. Four days later the patient gave birth
+to a colt and suckled it right along through her convalescence.
+This wound healed by first intention and seventy-nine days from the
+date of the injury the mare was driven to town, two and one-half
+miles distant, and showed but little lameness.</p></div>
+
+
+<h3><a name="Phalangeal_Exostosis_Ringbone" id="Phalangeal_Exostosis_Ringbone"></a>Phalangeal Exostosis (Ringbone)</h3>
+
+<p>This term is applied to exostoses involving the first and second
+phalanges (suffraginis and corona), regardless of their size, extent or
+location. It is a misnomer, in a sense, and the veterinarian is
+frequently obliged to spend considerable time with his <a name="Page_119" id="Page_119"></a>clients in order
+to convince them that a spherodial exostosis of the proximal phalanx, in
+certain cases, is in reality "ringbone," even though there exists no
+exostosis which completely encircles the affected bone.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Exostosis of the first and second phalanges
+is usually due to some form of injury, whether it be a contusion, a
+lacerated wound which damages the periosteum, or periostititis and
+osteitis incited by concussions of locomotion, or ligamentous strain.
+Practically the only exception is in the rachitic form of ringbone which
+affects young animals.</p>
+
+<p>There are predisposing causes that merit consideration, chief among
+which is the normal conformation of the coronet joint. This proclivity
+is constant; the normal interphalangeal articulation is an incomplete
+ginglymoid joint and while its dorso-volar diameter is great, this in no
+wise compensates for its disproportionately narrow transverse diameter.
+The pivotal strain which is sometimes thrown upon this articulation when
+an animal turns on one foot, as well as the tension which is put on the
+collateral ligaments when the inner or the outer quarter of the foot
+rests in a depression of the road surface, tends to detach the insertion
+of these ligaments or to cause fibrillary fractures of their substance.</p>
+
+<p>Short, upright, pasterns receive greater concussion during fast travel
+on hard roads than do the longer more sloping and well formed
+extremities. Those who are advocates of the theory that this type of
+osteitis with its complications has its origin in the articular portion
+of the joint, claim that the upright pastern constitutes an important
+tendency toward ringbone. Howbeit, ringbone is an active, serious and
+frequent cause of lameness and it affects animals of all ages and occurs
+under various conditions. Horses having good conformation and kept at
+work wherein no great amount of strain is put upon these parts, are
+occasionally victims of this affection.</p>
+
+<p><b>Classification.</b>&mdash;The arrangement employed by <span class="nowrap">Moller<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a></span> is intensely
+practical and logical. He considers ringbone as <i>articular</i>,
+<i>periarticular</i>, <i>rachitic</i> and <i>traumatic</i>. A mode of classifica<a name="Page_120" id="Page_120"></a>tion
+that is common and in a practical way, good, is, high and low ringbone.
+When prognosis is considered, for instance, it is very convenient to
+state that the chances for recovery are much better in high ringbone
+than in low ringbone. The classification of M&ouml;ller will be followed
+here.</p>
+
+<p class="figcenter"><a name="image17" id="image17"></a>
+   <a href="./images/img17-full.jpg"><img src="./images/img17.jpg"
+   alt="Fig. 17&mdash;Phalangeal exostoses."
+   title="Fig. 17&mdash;Phalangeal exostoses." /></a><br />
+Fig. 17&mdash;Phalangeal exostoses.</p>
+
+<p><b>Symptomatology.</b>&mdash;In all forms of incipient ringbone except rachitic,
+the first manifestation of its existence, or of injury to the ligaments
+in the region of the pastern joint which causes periostitis, or
+affections of the articular portions of the proximal inter-phalangeal
+joint, is lameness. Lameness which typifies ringbone is of the
+supporting-leg variety and by compelling the subject to step from side
+to side, marked flinching is observed, especially in periarticular
+ringbone; causing the affected animal to turn abruptly on the diseased
+member, using it as a pivot, likewise accentuates the manifestation. In
+fact, many subjects that exhibit no evidence of locomotory impediment
+while walking or trotting in a straight line on a smooth road surface,
+will manifest the characteristic form of lameness from ringbone when the
+aforementioned side to side movement is performed.</p>
+<p><a name="Page_121" id="Page_121"></a></p>
+
+<p>When the manner in which pain is occasioned is considered, it will be
+understood why lameness is intermittent in the early stages of this
+affection and may even be unnoticed by the driver. An animal may travel
+on a smooth road without giving evidence of any inconvenience, but as
+soon as a rough and irregular pavement or road surface is reached, will
+limp. As the subject is driven farther on level streets the lameness may
+disappear. This intermittent type of lameness may continue until there
+is developed a large exostosis, or until articular involvement causes so
+much distress during locomotion that lameness is constant. On the other
+hand, resolution may occur during the stage of periosteal inflammation,
+or, an exostosis forms which causes no interference with function.</p>
+
+<p class="figcenter"><a name="image18" id="image18"></a>
+   <a href="./images/img18-full.jpg"><img src="./images/img18.jpg"
+   alt="Fig. 18&mdash;Rarefying osteitis in chronic ringbone and
+ossification of lateral cartilages."
+   title="Fig. 18&mdash;Rarefying osteitis in chronic ringbone and
+ossification of lateral cartilages." /></a><br />
+Fig. 18&mdash;Rarefying osteitis in chronic ringbone and
+ossification of lateral cartilages.</p>
+
+
+<p>Before there is evidence of an exostosis, diagnosis of ringbone is not
+easy, for it is then a problem of detecting the presence of a
+ligamentous sprain, periostitis, or osteitis. The diagnostician should
+take note of local manifestations of hypersensitiveness, or heat if such
+exist, and, in addition, other conditions must be excluded before
+definite conclusions are possible.</p>
+
+<p>In <i>articular</i> ringbone as soon as there is developed an exostosis, <a name="Page_122" id="Page_122"></a>it
+occupies a position on the dorsal (anterior) part of the articulation
+and extends around the sides of the joint.</p>
+
+<p><i>Periarticular</i> ringbone is characterized by exostoses which are
+situated on the sides of the phalanges and not extending around to the
+anterior part of the joint. This type of ringbone as well as the
+articular may occur "high" or "low."</p>
+
+<p class="figcenter"><a name="image19" id="image19"></a>
+   <a href="./images/img19-full.jpg"><img src="./images/img19.jpg"
+   alt="Fig. 19&mdash;Phalangeal exostoses in chronic ringbone. Museum
+specimen of the Kansas City Veterinary College."
+   title="Fig. 19&mdash;Phalangeal exostoses in chronic ringbone. Museum
+specimen of the Kansas City Veterinary College." /></a></p>
+<p class="captioncenter">Fig. 19&mdash;Phalangeal exostoses in chronic ringbone. Museum
+specimen of the Kansas City Veterinary College.</p>
+
+
+<p>With the <i>traumatic</i> form of ringbone, all consequences, as to the size
+and form the exostosis is to assume, depend upon the nature and extent
+of the injury.</p>
+
+<p><i>Rachitic</i> ringbone is frequently observed in some sections of the
+country and does not ordinarily cause much if any lameness. It is a
+disease of colts and may affect one or all of the phalanges at the same
+time. As the subject advances in age there is more or less diminution in
+the size of the enlargements.</p>
+<p><a name="Page_123" id="Page_123"></a></p>
+
+<p><b>Treatment.</b>&mdash;Rest is essential in the treatment of ringbone. If
+diagnosed during its incipiency, remedial measures such as are usually
+employed to treat sprains, are indicated and later the parts should be
+blistered. When an exostosis has developed puncture firing is the remedy
+<i>par excellence</i>. Not that this method of treatment is infallible, for
+to any thinking one who takes into consideration the pathological
+anatomy of this condition, it is evident that no manner of treatment is
+beneficial in some cases. If the exostosis is so situated that it does
+not mechanically interfere with function, and is not so large that it
+may inhibit flexion and extension, and where the articular portions of
+the joint are not eroded, good results attend the use of the actual
+cautery.</p>
+
+<p>In firing, after having anesthetized the extremity, and prepared the
+surgical area, the cautery is deeply inserted in numerous places, taking
+care, however, not to open the joint. The parts are immediately covered
+with aseptic absorbent cotton and this dressing is left in position for
+forty-eight hours and if perchance there is evidence of synovial
+discharge, the parts are again aseptically dressed in order to prevent
+infection of the articulation. If, as is the case usually, no
+perforation of the joint capsule exists, the openings made by the
+cautery have been closed by the coagulation of serum and there is then
+little chance of infection causing trouble, even though the member is
+left unbandaged.</p>
+
+<p>In several instances, the author has treated ringbone by this method
+where the periarticular type existed and lameness was marked, and in
+three weeks the subjects were in service and not lame&mdash;this, in one
+instance in a valuable polo pony where the subject continued in service
+for more than a year without any evidence of recurrence of the lameness.
+The production of a deep-seated and acute inflammation with the actual
+cautery is preferable to any sort of counter-irritation which may be
+produced by vesicants.</p>
+
+<p>There is no occasion for any difference in the treatment of either of
+the first three classes of ringbone, but in the rachitic type where
+treatment is given, the application of a vesicant is <a name="Page_124" id="Page_124"></a>all that is
+required. In most instances treatment is not necessary.</p>
+
+<p>The affected animals require a month to three months' time for recovery
+to take place in the average favorable cases of ringbone.</p>
+
+<p>Median neurectomy is of service in many instances where lameness is not
+completely relieved by the use of the actual cautery and no bad results
+attend the performance of this operation even though no benefit is
+derived thereby. Plantar neurectomy is contraindicated in all cases
+where there exists much lameness. If lameness is due to acute
+inflammation bad results such as sloughing and loss of the hoof may
+follow; and if large exostoses mechanically interfere with function of
+the joint, or where articular erosions exist, no possible good can come
+from neurectomy. Careful discrimination should be employed in selecting
+cases for neurectomy for this operation; otherwise, it is very likely to
+prove disappointing.</p>
+
+
+<h3><a name="Open_Sheath_of_the_Flexors_of_the_Phalanges" id="Open_Sheath_of_the_Flexors_of_the_Phalanges"></a>Open Sheath of the Flexors of the Phalanges.</h3>
+
+<p>This condition does not differ from a like affection involving other
+tendons except that the function of these tendons is such that large
+synovial sheaths are necessary, and when synovitis exists, the condition
+then becomes more serious.</p>
+
+<p>Infectious synovitis involving these tendons in the fetlock region is of
+more frequent occurrence than a like affection of carpal or tarsal
+sheaths. With the exception of the extent of the involvement and
+distress occasioned thereby, synovitis the result of open tendon
+sheaths, is similar wherever it occurs.</p>
+
+<p><b>Etiology.</b>&mdash;The same conditions which are responsible for open fetlock
+joint and other wounds of the pastern region, cause open tendon sheaths
+of the flexor tendons.</p>
+
+<p><b>Symptomatology.</b>&mdash;Because of the size and extent of this sheath and the
+different manner in which it is opened, there is manifested dissimilar
+symptoms in different cases. A nail puncture which perforates the sheath
+in the pastern region and at the same time produces an infectious
+synovitis, will cause a markedly different manifestation than will a
+wound which <a name="Page_125" id="Page_125"></a>freely opens the sheath above the fetlock. In the first
+instance, the condition is much more painful; swelling is intense in
+some cases; and if the subject does not possess sufficient resistance so
+that spontaneous resolution promptly occurs, surgical evacuation of pus
+is usually necessary. When these tendon sheaths are opened, there
+follows a reaction which is quite analogous to that which exists in
+arthritic synovitis, but instead of ankylosis, adhesions with thecal
+obliteration occur. Rarely there result cartilaginous and osseous
+formations.</p>
+
+<p>The constitutional disturbances which characterize this condition vary
+with the degree of distress occasioned. As the infection is virulent and
+causes serious destruction of the affected parts, so does evidence of
+malaise and finally distress appear. Detailed discussions of
+symptomatology in similar conditions have heretofore been given, and
+further repetition is unnecessary.</p>
+
+<p><b>Treatment.</b>&mdash;The same general plan of treatment which is employed for
+handling open joint is put in practice in these cases. Following the
+preoperative cleansing of the external wound and adjacent surfaces,
+where liberal drainage exists, tincture of iodin is injected into the
+sheath, the parts covered with a suitable dressing powder, and the
+entire member is carefully dressed with cotton and bandages.</p>
+
+<p>Subsequent treatment is the same as has been outlined in the discussion
+of open fetlock joint on page <a href="#Page_112">112</a>. The same general plan of after-care
+is necessary. Recovery, however, does not require so much time
+ordinarily, yet punctures of the sheath occasioned by nails or other
+small implements make for long drawn out cases of infective synovitis.</p>
+
+
+<h3><a name="Luxation_of_the_Fetlock_Joint" id="Luxation_of_the_Fetlock_Joint"></a>Luxation of the Fetlock Joint.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;The manner of construction of the fetlock
+joint is such that disarticulation without irreparable injury resulting,
+is practically impossible. Logically, this joint in the fore legs (not
+so in the pelvic limbs) should disarticulate in such manner that either
+all of the inhibitory apparatus (flexor tendons and suspensory ligament)
+must rupture or a lateral luxation is necessary. Lateral disarticulation
+must necessarily <a name="Page_126" id="Page_126"></a>sever the attachment of one of the common collateral
+ligaments. Because of the width (transverse diameter) of the
+articulating surfaces of this joint, lateral luxation requires a great
+strain; and a force that is sufficient to occasion this trauma usually
+causes serious additional injury. Therefore, the condition is considered
+one wherein prognosis is always unfavorable in so far as practical
+methods of treatment are concerned.</p>
+
+<p>Mr. A. <span class="nowrap">Barbier<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a></span> reports a case of bilateral luxation of the fetlock
+joints of the hind legs in a horse. This was done in jumping, and the
+extensor tendon of each leg was ruptured and the anterior portion of the
+metatarsus was protruding through the skin. Profuse hemorrhage had taken
+place due to tearing of the blood vessels.</p>
+
+<p><b>Symptomatology.</b>&mdash;Entire luxation of this joint when present is so
+evident that one cannot fail to recognize the condition. Complete
+disarrangement of normal relation occurs and there is either a breaking
+down of the inhibitory apparatus, or if a lateral disarticulation
+exists, the normally straight line formed by the bones of the front leg,
+as viewed from the front or rear, is broken at the fetlock.</p>
+
+<p>Often fracture of bones are concomitant and then, of course, mobility is
+increased and not decreased as is the case in uncomplicated luxation.</p>
+
+<p>Such violence occurs at times, when this joint is disarticulated, that
+the joint capsule is also completely ruptured and the articular portion
+of the bones is exposed to view.</p>
+
+<p><b>Treatment.</b>&mdash;The condition being practically a hopeless one,
+destruction of the subject is the thing which should be promptly done.
+In valuable breeding animals, owners may prefer that treatment be
+attempted when a lateral luxation and detachment of but one common
+ligament have permitted luxation without complete disarticulation and
+rupture of the joint capsule. In such cases, by immobilizing the
+affected parts as in fracture, and confining the subject in a sling for
+about sixty days, partial recovery may occur in some instances.</p>
+
+<p>Experience has shown that where luxation with detachment of <a name="Page_127" id="Page_127"></a>a
+collateral ligament occurs, recovery is slow and incomplete&mdash;there
+always results considerable exostosis at the site of injury.</p>
+
+
+<h3><a name="Sesamoiditis" id="Sesamoiditis"></a>Sesamoiditis.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Inflammation of the proximal sesamoid bones
+is caused by any kind of irritation which may involve this part of the
+inhibitory apparatus. Positioned as they are, between the bifurcations
+of the suspensory ligament and the pastern joint, they serve as fulcra
+and effectively assist in minimizing concussion which is received by the
+suspensory ligament. The flexor tendons also, in contracting, exert
+strain upon the inter-sesamoidean ligament, which has a similar effect
+upon the sesamoid bones as that which is produced by the suspensory
+ligament.</p>
+
+<p>The condition occurs quite frequently, and because of the important
+function performed by these bones, active inflammation of the sesamoids
+constitutes a serious affection. Because of the fact that these bones
+have proportionately large articular surfaces, when they are inflamed to
+the extent that degenerative changes affect the articular cartilage,
+complete recovery seldom results.</p>
+
+<p>The same pathological changes occur here that are to be seen in any case
+of arthritis. No special pathological condition characterizes
+sesamoiditis but this condition causes incurable lameness when the
+sesamoid bones are much inflamed.</p>
+
+<p><b>Symptomatology.</b>&mdash;In acute inflammation, there exist all the symptoms
+which portray any arthritic inflammation of like character. The parts
+are readily palpable and are found to be hot, supersensitive, and more
+or less infiltration of the tissues contiguous to the joint causes
+swelling. There is volar flexion of the phalanges when the subject is at
+rest. Lameness is intense; in some acute inflammatory disturbances the
+subject is unable to bear weight on the affected member.</p>
+
+<p>In chronic sesamoiditis, constant lameness is the one salient feature
+which marks the condition. While it is possible for one sesamoid bone to
+become involved without its fellow being affected, this is not usual.
+Considerable organization of tissue surrounding the joint is present and
+no particular evidence of<a name="Page_128" id="Page_128">&nbsp;</a>supersensitiveness exists. However,
+supporting weight brings sufficient pressure to bear upon the inflamed
+and more or less eroded bones so that pain is occasioned and lameness
+results.</p>
+
+<p><b>Treatment.</b>&mdash;During acute inflammation, absolute quiet is, of course,
+of first consideration. Cold packs are to be kept in contact with the
+parts until acute inflammatory symptoms subside. The fetlock region is
+then enveloped with a poultice or an iodin and glycerin combination
+(iodin one part to seven parts of glycerin) is applied and a dressing of
+cotton is kept in contact with the inflamed region. Following this, a
+vesicant is employed and the subject is allowed a month's rest.</p>
+
+<p>In sub-acute cases, the entire region surrounding the pastern is
+blistered or the actual cautery is used. Line-firing is preferable. The
+subject is given a month or six weeks rest and one may be guided by the
+presence or absence of lameness as to whether improvement or recovery is
+taking place.</p>
+
+<p>Old chronic cases, and particularly those where there are considerable
+induration and fibrous organization of tissue surrounding the joint, are
+not to be benefited by treatment.</p>
+
+<p>The chief consideration in handling sesamoiditis is checking
+inflammation as early as possible and preventing, if this can be done,
+the erosion of articular surfaces. If destruction of any part of the
+articular surfaces can be prevented and the patient allowed ample time
+for complete resolution of the affected parts to occur, permanent relief
+is possible.</p>
+
+
+<h3><a name="Fracture_of_the_Proximal_Sesamoids" id="Fracture_of_the_Proximal_Sesamoids"></a>Fracture of the Proximal Sesamoids.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Fracture of the proximal sesamoid bones is
+caused by violent strain when there exists <i>fragilitas osseum</i>, or by
+contusions. The author treated a case where fracture of one sesamoid was
+occasioned by a horse receiving a puncture wound wherein the sharp end
+of a steel bar was protruding from the ground where it was firmly
+embedded. The subject in this case was injured while being driven along
+a country road. <span class="nowrap">Frost<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a></span> reports simultaneous fracture of all of the
+proximal sesamoids occurring in a sixteen-year-old pony. The <a name="Page_129" id="Page_129"></a>condition
+is of rather common occurrence in some countries because of the fragile
+condition of horses' bones.</p>
+
+<p><b>Symptomatology.</b>&mdash;If the parts can be examined before extravasation of
+blood and swelling mask the condition, crepitation may be detected. In
+other instances, it is possible to note a displacement of parts of the
+sesamoid bones&mdash;this in horizontal fracture. There occurs more or less
+descent of the fetlock which must not be attributed to rupture of the
+superficial flexor tendon (perforatus). By outlining the course of this
+tendon with the fingers, when it is passively tensed sufficiently to
+follow its course, one may exclude rupture of the superficial flexor.
+Finding the suspensory ligament intact from its origin to the sesamoid
+attachments, one may also eliminate rupture of this structure as a cause
+of the trouble. Needless to say, marked lameness and swelling of the
+fetlock soon take place. The condition is painful, and ordinarily,
+recovery is impossible.</p>
+
+<p><b>Treatment.</b>&mdash;Where treatment is attempted, immobilization as in
+luxation is in order. The patient's comfort is sought, and if the
+fractured parts can be kept in close proximity, their union may occur in
+time. However, chances for partial recovery (which is the best to be
+hoped for) are so remote that early destruction of the subject is the
+humane and economical thing to do.</p>
+
+<p>Where treatment is instituted, it is found that there is required a long
+time for union of the fractured bones to occur (where union does take
+place) and the cost of treatment together with the uncertainty of even
+partial recovery, makes for an unfavorable outcome. When the best
+possible results succeed treatment, a large callosity is formed and
+movement of the pastern joint is restricted. Lameness, though not
+intense, in the case referred to, where one bone was broken, was
+permanent and the subject was out of service for nearly a year.</p>
+
+
+<h3><a name="Inflammation_of_the_Posterior_Ligaments_of_the_Pastern_Proximal" id="Inflammation_of_the_Posterior_Ligaments_of_the_Pastern_Proximal"></a>Inflammation of the Posterior Ligaments of the Pastern (Proximal
+Interphalangeal) Joint.</h3>
+
+<p><b>Anatomy.</b>&mdash;The ligaments here involved are the four volar ligaments
+described by <span class="nowrap">Sisson<a name="FNanchor_24_24" id="FNanchor_24_24"></a><a href="#Footnote_24_24" class="fnanchor">[24]</a></span> as follows: "The <i>volar ligaments</i><a name="Page_130" id="Page_130"></a> (Ligg
+Volaria) consist of a central pair and a lateral and medial bands which
+are attached below to the posterior margin of the proximal end of the
+second phalanx and its complementary fibro-cartilage. The lateral and
+medial ligaments are attached above to the middle of the borders of the
+first phalanx, the central pair lower down and on the margin of the
+triangular rough area."</p>
+
+<p>This portion of the inhibitory apparatus is described by Strangeways'
+Anatomy as two posterior ligaments which run each from three points on
+the sides of the os suffraginis to a piece of fibro cartilage, described
+as the glenoid cartilage, and attached to the postero-superior edge of
+the os coronae; between them is the insertion of the inferior
+sesamoidean ligament.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Everything tending to increase strain upon
+these ligaments is contributory to possible fibrillary fracture of these
+structures. Excessive leverage as furnished by long toes, long toe-calks
+and low heels increases the normal tension on the posterior ligaments of
+the pastern joint. Faulty conformation, which throws an abnormal strain
+on these ligaments, is a predisposing cause of inflammation of these
+structures. Hard pulling upon slippery and rough or frozen roads is a
+common exciting cause of this injury. The condition is of comparatively
+frequent occurrence and is seen affecting draft horses frequently, in
+the hind legs.</p>
+
+<p><b>Symptomatology.</b>&mdash;Lameness is the first manifestation of this affection
+and weight bearing is painful in direct proportion to the extent of
+injury present. Volar flexion of the phalanges relieves tension on the
+parts; therefore, this position is assumed while the subject is at rest.
+When considerable tissue has been ruptured, and the condition is very
+painful, the foot is held off the ground as in all painful affections of
+the extremity.</p>
+
+<p>By palpation evidence of pain is discernible, though very little
+swelling occurs. Pain is increased by manual tension of the parts which
+is done by grasping the toe of the foot and exerting traction on the
+flexor apparatus. Care must be taken in executing such manipulations,
+and it is only by comparison of the affected member with the sound one
+and noting the difference <a name="Page_131" id="Page_131"></a>in the manifestations of discomfort that we
+may arrive at the proper conclusion.</p>
+
+<p>Some hyperthermia is to be recognized in acute inflammation, by
+comparing the extremities. In the fore legs, navicular disease is
+differentiated by noting absence of contraction at the heel. By use of
+the hoof testers one may recognize evidence of inflammation of the
+navicular apparatus. In inflammation of the posterior ligaments of the
+pastern joint, there is also absence of the characteristic stumbling
+which is seen in navicular disease.</p>
+
+<p><b>Treatment.</b>&mdash;Rest is the first requisite, and in addition every
+mechanical means possible to change the center of gravity in the
+phalangeal region, is to be employed. This is best accomplished by
+shortening the toe and paring the sole at the toe as much as conditions
+will permit. The heel is raised by means of a shoe with moderately high
+heel calks.</p>
+
+<p>The iodin-glycerin combination heretofore mentioned may be applied and
+the parts covered with cotton and bandage. Subjects require from three
+weeks to several months' rest and must be returned to work carefully,
+lest the incompletely regenerated tissues suffer injury.</p>
+
+<p>Regeneration of tissue in such cases, as has been pointed out, is slow
+and sufficient time for complete recovery must be allowed or relapses
+will occur.</p>
+
+
+<h3><a name="Fracture_of_the_First_and_Second_Phalanges" id="Fracture_of_the_First_and_Second_Phalanges"></a>Fracture of the First and Second Phalanges.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Fractures of the first phalanx (suffraginis)
+occur with respect to frequency, second to pelvic fractures. Often,
+almost insignificant injuries cause phalangeal fractures. On city
+streets, horses shod with shoes having long calks get caught in frogs of
+street railways or by slipping on rails, and phalangeal bones are often
+broken. The author observed a case of comminuted fracture of both the
+first and second phalanges (suffraginis and corona) in a polo pony
+caused by making a sudden turn while in action in a contest on the turf.</p>
+
+<p><b>Symptomatology.</b>&mdash;Fracture of the phalanges is nearly always signalized
+by lameness, and this is marked during the period of weight bearing.
+Lameness is usually intense and where <a name="Page_132" id="Page_132"></a>the pathognomonic symptom
+(crepitation) is not recognized, the intensity of the claudication, when
+other causes are absent, is indicative of fracture. The subject does not
+bear weight upon the affected member and where pain is intense, the foot
+is held in an elevated position and swung back and forth. In hind legs
+the member is often flexed in abduction and held in this position for
+several minutes, being rested on the ground only during short intervals.
+When compelled to walk, if pain is excruciating, the animal hops with
+the sound leg, no weight being supported by the fractured member.</p>
+
+<p>When an examination of the subject is possible before the extremity is
+swollen, crepitation is usually found without great difficulty, except
+in a subperiosteal break or in some cases of vertical or oblique
+fracture. Great care is necessary in handling the injured extremity in
+these cases, and particularly in nervous subjects or in excited animals
+that have been recently injured in runaways, is it necessary to be
+gentle in manipulating the extremity, if definite deductions are to be
+made. As has been mentioned in the chapter on diagnostic principles, if
+the condition is so painful that the subject does not relax the parts
+and crepitation is masked, local anesthesia is necessary. An anesthetic
+solution of cocain or novocain may be applied to the metacarpal or
+metatarsal nerves and an entirely satisfactory examination is then
+possible.</p>
+
+<p>Passive movement of the phalanges in all directions is practised in
+order to produce crepitation. When rotation of the parts does not
+occasion crepitation, gentle flexion and extension may do so. And in
+many instances, considerable manipulation of the phalanges is necessary
+before the pathognomonic symptom is to be recognized.</p>
+
+<p>In cases where crepitation is not found and lameness is pronounced, out
+of proportion with other possible existing causes, one may by exclusion
+of other causes establish a diagnosis of fracture in the course of
+forty-eight hours. In the meanwhile, support is given the affected
+member by applying an effective leather splint, so that pain may be
+diminished. To combat inflammation, a suitable cataplasm may be applied
+directly to the skin, the extremity bandaged, and the temporary
+immobilizing <a name="Page_133" id="Page_133"></a>appliance may be secured over all. In this manner one may
+make repeated examinations of the subject, and if slings are used and
+every other necessary precaution taken to promote comfort for the
+subject, no harm will result in delaying for several days the
+application of permanent immobilization&mdash;bandages and splints or casts.
+In fact, where much swelling exists at the time one is called to treat
+such cases, it is advisable to delay the application of a permanent
+dressing or cast until inflammation has somewhat subsided.</p>
+
+<p><b>Course and Prognosis.</b>&mdash;Where conditions are favorable, the nature of
+the fracture one that will yield to treatment, the subject not aged, and
+facilities for giving good attention to the affected animal are ample,
+fractures of the first and second phalanges recover completely in from
+six weeks to four months. Only simple fractures are considered curable
+from a practical and economical point of view, excepting in foals, where
+compound, and even comminuted, fractures may be so handled that animals
+may eventually become serviceable though blemished.</p>
+
+<p>Age retards the process of osseous regeneration, but in one instance at
+the Kansas City Veterinary College, a very aged mare suffering from a
+multiple fracture of the first phalanx was treated and at the end of
+sixty days was able to walk into an ambulance. Large exostoses had
+developed and the subject remained lame, but union of the broken bone
+took place in a surprisingly prompt and effective manner, when age of
+the subject and nature of the fracture are considered.</p>
+
+<p>As a rule, one is loath to recommend treatment, even in a simple
+transverse fracture of the first phalanx, in animals ten years of age or
+older. The conditions which exist in any given locality that regulate
+the expense of caring for an animal during the period of treatment,
+especially influence the course to be pursued in treating fractures.</p>
+
+<p><b>Treatment.</b>&mdash;For permanent immobilization of the phalanges in fracture,
+materials which might adapt themselves to the irregular contour of the
+member and at the same time contribute sufficient rigidity to the parts
+without doing injury to the soft <a name="Page_134" id="Page_134"></a>structures, would constitute ideal
+means of treatment; but no such materials have yet been devised, and
+opinions are various as to the most efficient and practical method to
+employ.</p>
+
+<p>After the fetlock has been shorn of hair and the ergot trimmed, the skin
+is thoroughly cleansed and allowed to dry. Several thin layers of long
+fiber cotton are then wrapped around the extremity&mdash;enough to pad well
+the member&mdash;and this is retained in position with a wide bandage. Gauze
+bandages are preferable to heavier bandages of cotton fabric because
+they are somewhat more elastic and yield to the irregular contour of the
+parts to a better advantage. Layers of three inch gauze bandages, which
+are soaked with a cold starch paste are wound about the extremity.
+Strips of leather that are flexible and not more than an inch in width
+are placed in a vertical position around the leg and these are also
+covered with the starch and securely held in position with the bandages.
+In this way, one is able to provide a sufficient degree of rigidity and
+at the same time, where the cast is carefully applied, little if any
+injury is done the skin. Such a cast is not difficult to remove and is
+so inexpensive that it may be removed and reapplied at any time it
+should be thought preferable to do so. Of course, this does not
+constitute an effective means of support if the parts are to be
+frequently and thoroughly soaked with water, but animals undergoing this
+sort of treatment are usually kept sheltered.</p>
+
+<p>The same after-care is necessary in such cases as is given in fractures
+of other bones. Two months after the injury has been done, the
+application of a blistering ointment to the entire region is of benefit.</p>
+
+<p><b>Results.</b>&mdash;Much depends on the nature of fractures as to the success
+one may attain in approximating the parts of a broken bone, and in some
+cases of oblique fracture for instance, complete recovery is impossible,
+despite the most skillful and painstaking attention given. On the other
+hand, cases of simple transverse fractures make perfect recoveries in
+some instances. All fractures are serious, and in every instance the
+practitioner would best be careful to impress his client with the many
+difficulties which usually attend the treatment of fracture in horses.</p>
+<p><a name="Page_135" id="Page_135"></a></p>
+
+
+<h3><a name="Tendinitis" id="Tendinitis"></a>Tendinitis.</h3>
+
+<h3>Inflammation of the Flexor Tendons.</h3>
+
+<p>One of the most common causes of lameness in light harness and saddle
+horses is tendinitis, and because of the character of the structure of
+tendons and because of their function, an active inflammation of these
+parts is always serious.</p>
+
+<p>Being almost inelastic and not well supplied with blood, tendinous
+tissue is slowly regenerated, and so much time is required for complete
+recovery to take place in tendinitis, that affected animals seldom fully
+recover before they are in service or vigorously exercising at will. As
+a result, complete recovery is delayed or prevented.</p>
+
+<p>The extensor tendons, because of the nature of their function, are very
+seldom strained; they are often bruised and occasionally divided, but
+unlike this condition in the flexors, tendinitis of the extensors is of
+rare occurrence.</p>
+
+<p>For a concise discussion of this subject the most practical
+classification is one made on a chronological basis and we may then
+consider tendinitis as <i>acute</i> and <i>chronic</i>.</p>
+
+
+<p class="center">ACUTE TENDINITIS.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Causes of tendinitis, as in almost all
+diseases, may be considered under the heads of predisposing and
+exciting. Among the predisposing causes of tendinitis may be mentioned,
+faulty conformation. Everything which has to do with increasing the
+strain upon tendons adds to the probability of their being over-taxed.
+Long, sloping, pastern bones; disproportionate development of parts,
+such as a heavy body and small, weak tendons and long hoofs, are the
+principal factors which usually predispose to tendinous sprains.
+Degenerative changes which take place in tendons following
+constitutional diseases such as influenza may also be classed as a
+predisposing cause.</p>
+
+<p>Excessive strain when put upon tendons in any possible manner, such as
+is occasioned in running and jumping; making missteps and catching up
+the weight of the body with one foot, when the force thus thrown upon
+the supporting structure is great <a name="Page_136" id="Page_136"></a>because of momentum gained at a rapid
+pace, are exciting causes of tendinitis.</p>
+
+<p><b>Symptomatology.</b>&mdash;In all cases of acute tendinitis there is presented a
+characteristic attitude by the subject. Volar flexion in a sufficient
+degree to relax the inflamed structures is always evident. The foot may
+be rested on the toe or placed slightly in advance of the one supporting
+weight, but the fetlock is always thrown forward. More or less swelling
+of the inflamed tendons is present. Where the deep flexor (perforans) is
+involved swelling is marked and with swelling there is present the other
+symptoms of inflammation&mdash;heat and supersensitiveness.</p>
+
+<p>In manipulating tendons for the purpose of detecting supersensitiveness,
+care must be taken so that no false conclusion be drawn, because of the
+aversion many horses have to submitting to palpation of the tendons even
+when they are in a normal condition.</p>
+
+<p>Supporting-leg-lameness is present and varies in degree with the
+intensity of the pain caused by weight bearing. In many instances, as
+soon as the subject has traveled a considerable distance, lameness
+diminishes or discontinues. As soon as the affected animal is permitted
+to stand long enough to "cool out" there is a return of the lameness,
+which is then marked.</p>
+
+<p>No difficulty is encountered in making a practical diagnosis in
+tendinitis; that is, one may fail to readily recognize the extent of the
+involvement as it affects the superficial flexor tendon, for instance,
+but this has no practical bearing on the prognosis and treatment, when
+existing inflammation of the deep flexor is recognized.</p>
+
+<p>The course of each tendon is readily outlined by palpation; all parts
+are easily manipulated; and with experience one may readily recognize
+the extent and degree of the inflammation.</p>
+
+<p><b>Treatment.</b>&mdash;In some cases of acute tendinitis, pain is intense and the
+application of cold packs during this stage is very beneficial in that
+pain is controlled and inflammation subsides. The extremity may be
+bandaged with a liberal quantity of absorbent cotton or with woolen
+material. Ice water is then poured<a name="Page_137" id="Page_137">&nbsp;</a> around the bandaged member every
+fifteen minutes and this should be continued for about forty-eight
+hours. In some cases this treatment is not necessary for more than
+twelve hours; at the end of this length of time, pain has subsided and
+the acute stage of inflammation has passed or its intensity has been
+diminished.</p>
+
+<p>Following the application of cold packs, the use of a poultice such as
+some of the sterile, medicated muds, is of marked benefit. The author
+has made use of tincture of iodin and glycerin in the proportion of one
+part of iodin to seven parts glycerin, with very satisfactory results.
+This combination is hygroscopic, anodyne and antiseptic and is easily
+applied. A liberal quantity is directly applied all around the affected
+tendons and the leg covered with a heavy layer of cotton, and this is
+snugly held in position with bandages. The application may be used once
+or twice daily, or if it is thought necessary, an attendant may pour a
+quantity of the iodized-glycerin around the leg and under the bandage
+once daily without removing the cotton and bandage. Needless to say,
+absolute rest is imperative.</p>
+
+<p>When all evidence of acute inflammation has subsided vesication is
+indicated. At this stage walking exercise is beneficial and the subject
+may be allowed the freedom of a paddock.</p>
+
+<p>Some practitioners are partial to the use of the actual cautery in these
+cases, but it is doubtful if it is necessary to produce such a great
+degree of counter-irritation in cases where the subject is suffering the
+first attack of tendinitis.</p>
+
+<p>As has been indicated, ample time should be allowed for recovery and
+depending upon conditions, it takes from three weeks to six months for
+complete recovery to become established.</p>
+
+
+<h3><a name="Chronic_Tendinitis_and_Contraction_of_the_Flexor_Tendons" id="Chronic_Tendinitis_and_Contraction_of_the_Flexor_Tendons"></a>Chronic Tendinitis and Contraction of the Flexor Tendons.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Acute inflammation of the flexor tendons may
+result in chronic tendinitis. Recurrent attacks in cases where
+insufficient time is allowed for complete recovery to result, is
+followed by chronic inflammation and hypertrophy of the tendons. Again,
+in subjects where conformation is faulty, no amount of care will be
+sufficient to prevent a recurrence of the inflammation and the condition
+must become chronic.</p>
+<p><a name="Page_138" id="Page_138"></a></p>
+
+<p><b>Symptomatology.</b>&mdash;On visual examination of the subject at rest, one may
+note the hypertrophied condition of the affected tendons. Their
+transverse diameter is usually perceptibly increased and in many cases,
+there is an increase in the antero-posterior diameter. The latter
+condition causes a bulging of the tendon that is so noticeable, because
+of the convexity thus formed, it is commonly known as "bowed tendon."</p>
+
+<p class="figcenter"><a name="image20" id="image20"></a>
+   <a href="./images/img20-full.jpg"><img src="./images/img20.jpg"
+   alt="Fig. 20&mdash;Contraction of the superficial digital flexor
+tendon (perforatus) of the right hind leg, due to tendinitis."
+   title="Fig. 20&mdash;Contraction of the superficial digital flexor
+tendon (perforatus) of the right hind leg, due to tendinitis." /></a></p>
+<p class="captioncenter">Fig. 20&mdash;Contraction of the superficial digital flexor
+tendon (perforatus) of the right hind leg, due to tendinitis.</p>
+
+
+<p>In chronic tendinitis there occurs repeated attacks of inflammation
+wherein lameness is pronounced and there exists in reality, at such
+times, acute inflammation of a hypertrophic structure, where at no time
+does inflammation completely subside. Therefore, in chronic tendinitis
+there is to be found at times the same conditions which characterize
+acute inflammation, except that there is usually a variance of symptoms
+because of the difference in the degree of inflammation and pain.</p>
+
+<p>The diagnosis of contraction of tendons is an easy matter because of the
+fact that relations between the phalanges are constantly changed with
+tendinous contraction. If one bears in mind the attachments and function
+of the digital flexors, no difficulty is encountered in recognizing
+contraction of either tendon.</p>
+<p><a name="Page_139" id="Page_139"></a></p>
+
+<p>Contraction of the superficial digital flexor (perforatus), when
+uncomplicated, is characterized by volar flexion of the pastern joint.
+The foot is flat on the ground and the heel is not raised because the
+superficial flexor tendon does not have its insertion to the distal
+phalanx (os pedis) and therefore can not affect the position of the
+foot.</p>
+
+<p>By causing the subject to stand on the affected member, one may outline
+the course of the flexor tendons by palpation, and in this way recognize
+any lack of tenseness or contraction of tendons or of the suspensory
+ligament.</p>
+
+<p class="figcenter"><a name="image21" id="image21"></a>
+   <a href="./images/img21-full.jpg"><img src="./images/img21.jpg"
+   alt="Fig. 21&mdash;Contraction of the deep flexor tendon
+(perforans) of the right hind leg, due to tendinitis."
+   title="Fig. 21&mdash;Contraction of the deep flexor tendon
+(perforans) of the right hind leg, due to tendinitis." /></a><br />
+Fig. 21&mdash;Contraction of the deep flexor tendon
+(perforans) of the right hind leg, due to tendinitis.</p>
+
+<p>Contraction of the suspensory ligament would cause the pastern joint to
+assume the same position as is occasioned by contraction of the
+superficial digital flexor (perforatus) tendon, but when the subject is
+bearing weight on the affected member, it is easy to determine that no
+contraction of the suspensory liga<a name="Page_140" id="Page_140"></a>ment exists, by noting an absence of
+abnormal tenseness of this structure. And finally, contraction of the
+suspensory ligament is of rare occurrence.</p>
+
+<p>Contraction of the deep flexor tendon (perforans) causes an elevation of
+the heel. The foot can not set flat because the insertion of the deep
+flexor tendon to the solar surface of the distal phalanx (os pedis)
+causes when the tendon is contracted&mdash;a rotation of the distal phalanx
+on its transverse axis&mdash;hence the raised heel. No other tendon has this
+same effect on the distal phalanx and the condition is correctly
+diagnosed without difficulty.</p>
+
+<p class="figcenter"><a name="image22" id="image22"></a>
+   <a href="./images/img22-full.jpg"><img src="./images/img22.jpg"
+   alt="Fig. 22&mdash;A chronic case of contraction of both flexor
+tendons of the phalanges. In this case (presented at a clinic of the
+Kansas City Veterinary College) because of long continued contraction of
+the flexors, which prevented weight being supported with any degree of
+comfort, there resulted a partial paralysis of the extensors, and
+consequently the extremity was dragged on the ground."
+   title="Fig. 22&mdash;A chronic case of contraction of both flexor
+tendons of the phalanges. In this case (presented at a clinic of the
+Kansas City Veterinary College) because of long continued contraction of
+the flexors, which prevented weight being supported with any degree of
+comfort, there resulted a partial paralysis of the extensors, and
+consequently the extremity was dragged on the ground." /></a></p>
+<p class="captioncenter">Fig. 22&mdash;A chronic case of contraction of both flexor
+tendons of the phalanges. In this case (presented at a clinic of the
+Kansas City Veterinary College) because of long continued contraction of
+the flexors, which prevented weight being supported with any degree of
+comfort, there resulted a partial paralysis of the extensors, and
+consequently the extremity was dragged on the ground.</p>
+
+
+<p><b>Course and Complications.</b>&mdash;This condition may exist for years without
+causing the subject any serious inconvenience, if the affected animal is
+kept at suitable work. In other instances recurrent attacks of lameness
+are of such frequent occurrence that the subject is not fit for service.
+Many affected animals that are kept in service in spite of lameness (and
+in some in<a name="Page_141" id="Page_141"></a>stances where no lameness is present), soon become
+unserviceable because of contraction of the inflamed tendon. This, in
+fact, is the condition which eventually becomes established in most
+instances.</p>
+
+<p><b>Treatment.</b>&mdash;Where conformation is not too faulty so that recovery may
+be expected, good results are obtained by line-firing the tendons and
+allowing the subject a few months' rest. In some cases median neurectomy
+is advisable. This is recommended by <span class="nowrap">Breton<a name="FNanchor_25_25" id="FNanchor_25_25"></a><a href="#Footnote_25_25" class="fnanchor">[25]</a></span> as being productive of
+good results even where contraction of tendons exists and tenotomy is
+done.</p>
+
+<p class="figcenter"><a name="image23" id="image23"></a>
+   <a href="./images/img23-full.jpg"><img src="./images/img23.jpg"
+   alt="Fig. 23&mdash;Contraction of the superficial and deep flexor
+tendons (perforatus and perforans) of the left fore leg."
+   title="Fig. 23&mdash;Contraction of the superficial and deep flexor
+tendons (perforatus and perforans) of the left fore leg." /></a></p>
+<p class="captioncenter">Fig. 23&mdash;Contraction of the superficial and deep flexor
+tendons (perforatus and perforans) of the left fore leg.</p>
+
+
+<p>By shoeing with high heel-calks considerable strain is taken from the
+inflamed tendons because of the changed position of the foot which
+alters the distribution of weight on different parts of the leg. Rubber
+pads materially diminish concussion and <a name="Page_142" id="Page_142"></a>should be made use of when the
+subject is returned to work, if the character of the work is such as to
+occasion much concussion.</p>
+
+<p>It is to be remembered, however, that in sprains there occurs fibrillary
+fracture of soft structures and time is required for regeneration of
+tissue which has been injured or destroyed. Absolute rest is necessary
+where inflammation is acute and in sub-acute or chronic tendinitis
+avoidance of all work which causes irritation to the affected tendons is
+imperative.</p>
+
+<p class="figcenter"><a name="image24" id="image24"></a>
+   <a href="./images/img24-full.jpg"><img src="./images/img24.jpg"
+   alt="Fig. 24&mdash;Contraction of superficial digital flexor and
+slight contraction of deep flexor tendon."
+   title="Fig. 24&mdash;Contraction of superficial digital flexor and
+slight contraction of deep flexor tendon." /></a><br />
+Fig. 24&mdash;Contraction of superficial digital flexor and
+slight contraction of deep flexor tendon.</p>
+
+
+<p>Where contraction of tendons exists surgical treatment is necessary. No
+good comes from appliances which are calculated to stretch the affected
+tendons; in fact, they aggravate the inflamed condition and hasten
+complete loss of function of the affected member. Where there exists no
+articular or ligamentous diseases which would defeat the purpose,
+tenotomy is the only remedy for contracted tendons.</p>
+<p><a name="Page_143" id="Page_143"></a></p>
+
+
+<h3><a name="Contracted_Tendons_of_Foals" id="Contracted_Tendons_of_Foals"></a>Contracted Tendons of Foals.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This condition is occasionally observed and
+no positive explanation of the reason for its existence can be given.
+That mal-position <i>en utero</i> causes the metacarpal bones to develop in
+length so rapidly that the tendons are too short, is an explanation that
+is offered. Be that as it may, in breeding sections of the country the
+general practitioner is obliged to handle these cases and successful
+methods of treatment are essential even though cause is not removable.</p>
+
+<p><b>Symptomatology.</b>&mdash;The superficial flexor tendon (perforatus) alone, is
+the one usually contracted, and while both flexors are at times
+involved, this rarely occurs. The condition is usually bilateral.</p>
+
+<p>The degree of contraction varies greatly in different cases. In some,
+contraction exists to such extent that it is impossible for the colt to
+stand, and because of continual decubitus where no relief is given, the
+subject is lost because of gangrenous infection occasioned by bed sores.
+Otherwise the same symptoms are to be observed in this condition, that
+exist in contraction of tendons of the mature animal.</p>
+
+<p><b>Treatment.</b>&mdash;Wherever contraction is not too marked and weight is borne
+with the affected members, and where the feet can be kept on the ground
+in a nearly normal position, it is possible to correct the condition
+without doing tenotomy. That is, in cases where the subject is simply
+"cock-ankled", where volar flexion of the pastern joint exists but the
+foot is kept flat on the ground, correction is possible without
+tenotomy.</p>
+
+<p>In such instances the foal must be treated early&mdash;before the skin on the
+anterior pastern region has been badly damaged by knuckling over. It is
+possible in many cases to stretch the flexor tendons by grasping the
+colt's foot with one hand, and with the other hand one may push the
+pastern in the direction of dorsal flexion. This may be tried and when a
+reasonable amount of force is employed, no harm is done, even though no
+material benefit results. Some veterinarians claim good results from
+this treatment alone and direct their clients to repeat the stretching
+process several times daily.</p>
+<p><a name="Page_144" id="Page_144"></a></p>
+
+<p>Whether the tendons are manually stretched or not, splints should be
+adjusted to the affected members. The legs are padded with cotton and
+bandages and a suitable splint is applied on either side of the members
+and securely fixed in position by bandaging.</p>
+
+<p>The splints are kept in position for four or five days and then removed
+for inspection of the affected parts. If necessary, they are reapplied
+and left in position for a week; however, this is unnecessary in the
+average case that is treated in this manner.</p>
+
+<p>Where contraction exists to the extent that the subject can not stand
+and where no weight is borne by the feet, it is necessary to divide the
+affected tendons surgically. The same technic is put into practice that
+is employed in the mature subject but there is much greater chance for a
+favorable outcome in the foal. Further, if necessary, one may divide
+with impunity, both tendons on each leg, at the same time. In all cases
+this operation is done by observing strict aseptic precautions and the
+legs are, of course, bandaged. If both tendons are divided, splints
+should be employed and kept in position for ten days or two weeks.
+Primary union of the small surgical wound of the skin and fascia occurs
+in forty-eight hours.</p>
+
+<p>The reader is referred to William's "Veterinary Surgical and Obstetrical
+Operations," for a complete description of this operation.</p>
+
+<div class="blockquot"><p>In veterinary literature there is occasionally described a
+condition which affects young foals wherein symptoms similar to
+those of contraction of the flexors are manifested, but upon
+examination it is found that rupture of the extensor of the digit
+(extensor pedis) exists. This affection is briefly described by
+Cadiot but no complete treatise on this condition has been
+published.</p>
+
+<p>In parts of Canada foals of from one to three days of age are found
+affected in such manner that more or less interference with the
+gait is to be seen in those moderately affected. There is, in some
+subjects, only a slight impediment in locomotion which is
+occasioned by inability to properly extend the digit. In other
+subjects, while able to stand and walk, great difficulty is
+experienced because of volar flexion of the phalanges. The more
+seriously affected animals are unable to stand and, in most
+instances, perish because of the effects of prolonged decubitus.</p>
+<p><a name="Page_145" id="Page_145"></a></p>
+
+<p>A local enlargement occurs at the anterior carpal region and the
+mass is somewhat fluctuating, extravasated fluids becoming infected
+in many instances, and necrosis of the skin and fascia provide
+means for spontaneous discharge of the contents of the enlargement
+if it is not opened. The infection when it becomes generalized
+causes a fatal termination in most cases that are not treated.</p>
+
+<p class="figcenter"><a name="image25" id="image25"></a>
+   <a href="./images/img25-full.jpg"><img src="./images/img25.jpg"
+   alt="Fig. 25&mdash;''Fish knees.''&mdash;Photo by Thos. Millar,
+M.R.C.V.S."
+   title="Fig. 25&mdash;''Fish knees.''&mdash;Photo by Thos. Millar,
+M.R.C.V.S." /></a><br />
+Fig. 25&mdash;"Fish knees."&mdash;Photo by Thos. Millar,
+M.R.C.V.S.</p>
+
+
+<p>Native stock owners of some parts of Canada know this condition as
+"fish knees" because of the presence of the ruptured end of the
+extensor tendon which is found coiled in the cavity of the
+enlargements caused by the ruptured tendon.</p>
+
+<p>Local practitioners have treated the condition by incising the
+swollen mass and removing the part of tendon contained within such
+cavities. Treatment has not proved entirely satisfactory in the
+majority of instances, perhaps because of tardy interference.</p>
+
+<p>In a colt's leg sent the author by Mr. Thomas Millar, M.R.C.V.S.,
+of Asquith, Saskatchewan, a careful dissection of the carpal region
+revealed the fact that in this case the ruptured extensor tendon
+was due to injury. The colt may have been trampled upon by its dam
+in such manner that the tendon was divided. No noticeable evidence
+of injury to the skin was to be seen on its outer surface, but on
+the fascial side a cyanotic congested area, which was situated
+immediately over the site of the ruptured tendon, was very
+evident.</p>
+<p><a name="Page_146" id="Page_146"></a></p>
+
+<p>With the execution of a good surgical technic, the ruptured tendon
+might be sutured; the wound of the tendon sheath as well as that of
+the skin carefully united by means of gut sutures, the leg bandaged
+and immobilized with leather splints and recovery follow in a
+reasonable percentage of cases so treated. These cases afford an
+opportunity for the perfection of practical means of treatment by
+those who frequently meet with this affection.</p></div>
+
+
+<h3><a name="Rupture_of_the_Flexor_Tendons_and_Suspensory_Ligament" id="Rupture_of_the_Flexor_Tendons_and_Suspensory_Ligament"></a>Rupture of the Flexor Tendons and Suspensory Ligament.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Rupture of the flexor tendons or of the
+suspensory ligament is of rare occurrence. Frequently, these structures
+are divided as the result of wounds; but rupture, due to strain, is not
+frequent.</p>
+
+<p class="figcenter"><a name="image26" id="image26"></a>
+   <a href="./images/img26-full.jpg"><img src="./images/img26.jpg"
+   alt="Fig. 26&mdash;Extreme dorsal flexion said to have resulted
+from an attack of distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No. 4."
+   title="Fig. 26&mdash;Extreme dorsal flexion said to have resulted
+from an attack of distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No. 4." /></a></p>
+<p class="captioncenter">Fig. 26&mdash;Extreme dorsal flexion said to have resulted
+from an attack of distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No. 4.</p>
+
+
+<p>In some cases in running horses, or in animals that are put to strenuous
+performances, such as are jumpers, rupture of tendons or of the
+suspensory ligament takes place. However, more frequently this follows
+certain debilitating diseases such as influenza or local infectious
+inflammation of the parts which results in degenerative changes and
+rupture follows.</p>
+
+<p>The non-elastic suspensory ligament receives some heavy strains <a name="Page_147" id="Page_147"></a>during
+certain attitudes which are taken by horses in hurdle jumping as is
+explained in detail by Montan&eacute; and <span class="nowrap">Bourdelle<a name="FNanchor_26_26" id="FNanchor_26_26"></a><a href="#Footnote_26_26" class="fnanchor">[26]</a></span> under the description
+of this ligament. But in spite of the frequent and unusually heavy
+strains, which these structures receive, complete rupture is not
+frequently seen.</p>
+
+<p><b>Symptomatology.</b>&mdash;When the anatomy and function of the flexor tendons
+and suspensory ligament is thoroughly understood, recognition of rupture
+of either of these structures is easily recognized. When one considers
+that in rupture, a position directly opposite to that which is seen in
+contraction in either one of these structures, is assumed, a detailed
+description of each separate condition is needless repetition.</p>
+
+<p>However, it is pertinent to suggest that rupture of the deep flexor
+tendon (perforans) allows a turning up of the toe. Whether it be torn
+loose from its point of attachment or ruptured at some point proximal
+thereto, the position is the same&mdash;heel flat on the ground, toe slightly
+raised and this raising of the toe varies in degree as the subject moves
+about.</p>
+
+<p>When the superficial flexor (perforatus) is ruptured there is no change
+in the position of the foot but the fetlock joint is slightly lowered.
+The pathognomonic symptom is the lax tendon during weight bearing, which
+may be felt by palpation of the tendon along its course in the
+metacarpal region.</p>
+
+<p>With complete rupture of the suspensory ligament there occurs a marked
+dropping of the fetlock joint and an abnormal amount of weight is then
+thrown upon the superficial flexor tendon (perforatus), causing it to be
+markedly tensed. This is readily recognized by palpation. By palpating
+the suspensory ligament from its proximal portion down to and beyond its
+bifurcation, while the affected member is supporting weight, it is
+possible to diagnose rupture of one of its branches.</p>
+
+<p><b>Prognosis and Treatment.</b>&mdash;In rupture of the superficial flexor tendon
+(perforatus) because of its comparatively less important function,
+prognosis is favorable and recovery takes place when proper treatment is
+put into practice.</p>
+<p><a name="Page_148" id="Page_148"></a></p>
+
+<p>With rupture of the deep flexor tendon (perforans), especially when it
+occurs at or near its point of insertion and sometimes following
+disease, prognosis is unfavorable.</p>
+
+<p>Rupture of the suspensory ligament constitutes a condition which is, as
+a rule, hopeless, because of the impracticability of treating such
+cases.</p>
+
+<p>The salient feature which characterizes any practical attempt at
+treatment of ruptured tendons or other portions of the inhibitory
+apparatus of the fetlock region, is to retain the phalanges in their
+normal position for a sufficient length of time that the approximated
+ends of ruptured tendons or ligaments may unite. The length of time
+required for this to occur, together with the difficulties encountered
+in confining the affected extremities in suitable braces or supportive
+appliances, precludes all possibility of this condition's being
+practically amenable to treatment when the deep flexor tendon
+(perforans) and suspensory ligament are simultaneously ruptured. It does
+not follow, even so, that recovery does not succeed treatment in some of
+these unfavorable cases.</p>
+
+<p class="figcenter"><a name="image27" id="image27"></a>
+   <a href="./images/img27-full.jpg"><img src="./images/img27.jpg"
+   alt="Fig. 27&mdash;A good style of shoe for bracing the fetlock
+where tenotomy has been performed, or in case of traumatic division of
+the flexor tendons. An invention of Dr. G.H. Roberts."
+   title="Fig. 27&mdash;A good style of shoe for bracing the fetlock
+where tenotomy has been performed, or in case of traumatic division of
+the flexor tendons. An invention of Dr. G.H. Roberts." /></a></p>
+<p class="captioncenter">Fig. 27&mdash;A good style of shoe for bracing the fetlock
+where tenotomy has been performed, or in case of traumatic division of
+the flexor tendons. An invention of Dr. G.H. Roberts.</p>
+
+<p><a name="Page_149" id="Page_149"></a></p>
+
+<p>Affected subjects are kept in slings as long as it seems
+necessary&mdash;until they learn to get up without deranging the braces worn.</p>
+
+<p>Several styles of braces are in use and each has its objections;
+nevertheless some sort of support to the affected member is necessary
+and steel braces which are connected with shoes are usually employed.</p>
+
+<p>The principal difficulty which attends the use of braces is
+pressure-necrosis of the skin which is caused by the constant and firm
+contact of the metal support. The practitioner's ingenuity is taxed in
+every case to contrive practical means of padding the exposed parts in
+order to prevent or minimize necrosis from pressure. This is
+attempted&mdash;with more or less success&mdash;by frequent changing of bandages
+and the local application of such agents as alcohol or witch hazel.
+Needless to say, the skin must be kept perfectly clean and the dressings
+free from all irritating substances.</p>
+
+<p class="figcenter"><a name="image28" id="image28"></a>
+   <a href="./images/img28-full.jpg"><img src="./images/img28.jpg"
+   alt="Fig. 28&mdash;Showing the Roberts brace in operation."
+   title="Fig. 28&mdash;Showing the Roberts brace in operation." /></a><br />
+Fig. 28&mdash;Showing the Roberts brace in operation.</p>
+
+
+
+<p>The fact that tendons or ligaments which are ruptured, do not regenerate
+as readily as in cases where traumatic or surgical division occurs, must
+not be lost sight of, and prognosis is given in accordance.</p>
+<p><a name="Page_150" id="Page_150"></a></p>
+
+
+<h3><a name="Thecitis_and_Bursitis_in_the_Fetlock_Region" id="Thecitis_and_Bursitis_in_the_Fetlock_Region"></a>Thecitis and Bursitis in the Fetlock Region.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Synovial distension of tendon sheaths and
+bursae in the region of the fetlock are caused by the same active
+agencies which produce this condition in other parts. The fetlock region
+is exposed to more frequent injury than is the carpus and as a
+consequence is more often affected. The same proportionate amount of
+irritation affects this part of the leg, owing to strains, as affect the
+carpus from a similar cause; and synovitis from this cause, is as
+frequent in one case as in the other. Therefore, it is a natural
+sequence that the tendon sheaths of the metacarpophalangeal region are
+frequently distended because of chronic synovitis and thecitis. These
+inflammations are usually non-infective in character.</p>
+
+<p>The <i>cul-de-sac</i> of the capsular ligament of the fetlock joint which
+extends upward between the bifurcation of the suspensory ligament is the
+most frequently affected structure in this region. When distended, two
+spheroidal masses bulge laterally and anterior to the flexor tendons in
+a characteristic manner. This condition is known among horsemen as
+"wind-gall" or "fetlock-gall."</p>
+
+<p>The sheath of the flexor tendons, which begins about the middle portion
+of the lower third of the metacarpus, and continues downward below the
+pastern joint is often distended.</p>
+
+<p>Excepting in cases of acute inflammation attending synovitis of these
+parts, no lameness marks its existence and in chronic cases of synovial
+distension the service of affected animals is not interfered with. These
+distensions constitute unsightly blemishes and they are treated chiefly
+for this reason.</p>
+
+<p>No difficulty is encountered in recognizing these conditions even where
+considerable organization of tissue overlying distended thecae occurs.
+In such cases there may be only slight fluctuation of the enlargement,
+but if necessary, an aseptic exploratory puncture may be made with a
+suitable needle or trocar.</p>
+<p><a name="Page_151" id="Page_151"></a></p>
+
+<p><b>Treatment.</b>&mdash;Complete rest and the local application of cold packs are
+in order in acute synovitis when there is distension of tendon sheaths.
+In the fetlock region, because of the ease with which pressure may be
+employed, the parts should be kept snugly wrapped with cotton, and derby
+bandages are used to exert the desired amount of pressure over the
+affected region. The pressure-bandages should be employed as soon as all
+acute and painful inflammation has subsided; and then they should be
+continued, day and night, for ten days or two weeks. The bandages should
+be removed morning and night. After the skin of the leg has thoroughly
+dried off, an infriction of alcohol or distilled extract of hamamelis is
+given the parts and the cotton and bandages are readjusted. A good, even
+and firm pressure in such cases is productive of satisfactory results.</p>
+
+<p class="figcenter"><a name="image29" id="image29"></a>
+   <a href="./images/img29-full.jpg"><img src="./images/img29.jpg"
+   alt="Fig. 29&mdash;Distension of theca of the extensor of the digit
+(extensor pedis)."
+   title="Fig. 29&mdash;Distension of theca of the extensor of the digit
+(extensor pedis)." /></a><br />
+Fig. 29&mdash;Distension of theca of the extensor of the digit
+(extensor pedis).</p>
+
+
+<p>In chronic distensions of tendon sheaths synovia may be aspirated and
+about five cubic centimeters of equal parts of tincture of iodin and
+alcohol is injected into the cavity. This is not done, however, without
+usual aseptic precautions. If no marked <a name="Page_152" id="Page_152"></a>swelling results within
+forty-eight hours the entire fetlock region is thoroughly vesicated and,
+as soon as the skin has recovered from the effects of the vesicant,
+pressure bandages may be employed. In these cases, subjects may be put
+into service after all swelling which the injection or the vesicant has
+produced has subsided. The pressure bandages are used at night or during
+the time that the horse is in its stall and they are not worn by the
+subject while at work.</p>
+
+<p>Where no marked swelling occurs within ten days, as the result of the
+injection of iodin, the injection may be repeated and, if thought
+necessary, the quantity may be materially increased. If swelling does
+not occur it is indicative that no particular irritation has been
+caused.</p>
+
+<p>Some swelling is desirable and much swelling sometimes results and
+persists for weeks. This is not in any way likely to cause permanent
+trouble; and if the technic of injection is skilfully executed no
+infection will follow.</p>
+
+<p>By persistent and careful use of suitable elastic bandages, the support
+thus given the parts, together with the absorption of products of
+inflammation which constant pressure occasions, some chronic cases of
+synovial distension of tendon sheaths recover in two or three months and
+this without other treatment. Such good results are not to be expected
+in aged subjects, nor in horses having at the same time, chronic
+lymphangitis.</p>
+
+<p>Where bandages of pure rubber are employed great care is necessary, if
+one is not experienced in their use, lest necrosis result. Where
+bandages are uncomfortably tight the subject will manifest discomfort,
+and an attendant should observe the animal at intervals for a few hours
+(where there may be some doubt as to the degree of pressure which is
+exerted by elastic bandages) and readjustment made before any harm is
+done.</p>
+
+
+<h3><a name="Arthritis_of_the_Fetlock_Joint" id="Arthritis_of_the_Fetlock_Joint"></a>Arthritis of the Fetlock Joint.</h3>
+
+<p><b>Anatomy.</b>&mdash;The anatomy of the metacarpophalangeal articulation is
+briefly reviewed on page <a href="#Page_58">58</a> under the heading of "Anatomo-Physiological
+Review of Parts of the Foreleg."</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;The chief causes of non-infective <a name="Page_153" id="Page_153"></a>arthritis
+of the fetlock joint are irritations from concussion and contusions due
+to interfering. The condition occurs in young animals that are
+over-driven in livery service or other similar exhausting work, where
+they become so weary that serious injury is done these parts by striking
+the pasterns with the feet&mdash;interfering. In these "leg-weary" animals,
+that are always kept shod with fairly heavy shoes, much direct injury is
+done at times by concussion due to self-inflicted blows. In older
+animals, where there exists similar conditions, with respect to their
+being worn from fatigue and, in addition, periarticular inflammatory
+organizations, arthritis is not of uncommon occurrence.</p>
+
+<p class="figcenter"><a name="image30" id="image30"></a>
+   <a href="./images/img30-full.jpg"><img src="./images/img30.jpg"
+   alt="Fig. 30&mdash;Rarefying osteitis wherein articular cartilage
+was destroyed in a case of arthritis of fetlock joint."
+   title="Fig. 30&mdash;Rarefying osteitis wherein articular cartilage
+was destroyed in a case of arthritis of fetlock joint." /></a></p>
+<p class="captioncenter">Fig. 30&mdash;Rarefying osteitis wherein articular cartilage
+was destroyed in a case of arthritis of fetlock joint.</p>
+
+
+<p><b>Symptomatology.</b>&mdash;In true arthritis there exists a very painful
+affection which is characterized by manifestations of distress. The
+subject may keep the extremity moving about&mdash;where pain is
+great&mdash;suspended and swinging. There is swelling which is more or less
+hot to the touch and compression of the parts with the fingers increases
+pain. Lameness is always pronounced and no weight is supported with the
+affected member in very acute and generalized arthritic inflammations.
+There occurs the usual <a name="Page_154" id="Page_154"></a>facial manifestations of pain&mdash;the tense
+condition of the facial muscles and the fixed eye and nostril are in
+evidence.</p>
+
+<p>In cases where there exists a synovitis or where a very limited portion
+of the articulation is involved, a somewhat different clinical picture
+is presented. Then, the disturbance causes less distress; local swelling
+and evidence of supersensitiveness are not so pronounced and lameness is
+not intense, though weight-bearing is painful.</p>
+
+<p><b>Prognosis.</b>&mdash;There is a constant difference in the degree of pain
+manifested, as well as the other symptoms of inflammation, between true
+arthritis, which involves much of the joint, and synovitis; or synovitis
+plus a small circumscribed area of joint involvement. This difference is
+present in all joint affections of the extremities and, in passing, it
+is well to say that infection usually increases every manifestation of
+pain. Infection occasions more pronounced local symptoms of inflammation
+and, because of the rapid progress of necrotic destruction of cartilage,
+the course of the affection is usually rapid; ankylosis is a frequent
+result and loss of the subject is often inevitable. However, in
+non-infective arthritis of the fetlock joint, prognosis is favorable.</p>
+
+<p><b>Treatment.</b>&mdash;The same general principles which are employed in
+arthritis of other joints are used here. Rest and comfort for the
+patient is sought in every available manner. If the subject remains
+standing too long, the sling should be used and a well-bedded box-stall
+will contribute much to the comfort of the patient.</p>
+
+<p>Pain and acute inflammation is diminished or controlled, if possible, by
+using ice-cold packs. In nervous, well-bred animals analgesic agents may
+be employed; or small doses of morphin sulphate&mdash;one to two
+grains&mdash;given at intervals of three hours during the first stages of the
+affection is very beneficial. This is especially indicated in infectious
+arthritis.</p>
+
+<p>As inflammation subsides, hot applications are used and finally counter
+irritants are employed. Their selection is a matter of choice with the
+practitioner. The object sought is the same with every practitioner and
+while methods employed vary, re<a name="Page_155" id="Page_155"></a>sults are not markedly different except
+in so far as the degree of counter irritation which is produced varies
+in given cases. Where a great degree of counter irritation is thought
+necessary, line-firing with the actual cautery is the remedy <i>par
+excellence</i>.</p>
+
+<p><b>After-care.</b>&mdash;In the course of three or four weeks subjects may be
+allowed the run of a paddock and, after a complete rest of six weeks at
+pasture, they may be returned to work with care, if the work is not of a
+nature to occasion concussion or other manner of irritation to the
+articulation.</p>
+
+<p>Neurectomy is not indicated even though there is a recurrence of
+lameness, unless the lameness is not pronounced and inflammation is
+periarticular and no osseous enlargements mechanically interfere with
+function of the joint. There are few cases then, where neurectomy is
+materially helpful.</p>
+
+
+<h3><a name="Ossification_of_the_Cartilages_of_the_Third_Phalanx" id="Ossification_of_the_Cartilages_of_the_Third_Phalanx"></a>Ossification of the Cartilages of the Third Phalanx.<br />
+(Ossification of the Lateral Cartilages.)</h3>
+
+<p><b>Anatomy and Function of the Cartilages.</b>&mdash;Surmounting each wing of the
+distal phalanx (os pedis) is the irregularly-quadrangular cartilage. The
+superior border of this cartilage is thin, generally convex, and
+perforated for vessels to pass to the frog; the inferior border is
+attached to the wing of the third phalanx and posteriorly, it is
+reflected inward and is continuous with the inferior surface of the
+sensitive frog. The anterior border which is directed obliquely downward
+and backward becomes blended with the anterior lateral ligament of the
+coffin joint. The fibrous expansion of the anterior digital extensor
+(extensor pedis) is united to the anterior borders of the lateral
+cartilages.</p>
+
+<div class="blockquot"><p>According to <span class="nowrap">Smith<a name="FNanchor_27_27" id="FNanchor_27_27"></a><a href="#Footnote_27_27" class="fnanchor">[27]</a>:</span> These structures form an elastic wall to
+the sensitive foot, and attachment to the vascular laminae; they
+also admit of increase in width occurring at the posterior part of
+the foot without destroying the union of the two set of leaves.
+Further, by their connection with the vascular system of the foot,
+their elastic movements materially assist the circulation. The
+primary use of the lateral cartilages is to render the internal
+foot elastic, and admit of its change in shape which occurs under
+the influence of the weight of the body. The <a name="Page_156" id="Page_156"></a>alteration in the
+shape of the foot is brought about by pressure on the pad, which
+widens and in consequence presses on the bars. The pressure
+received by the pad is also transmitted to the plantar cushion,
+which likewise flattens and spreads under pressure. Both of these
+factors force the cartilages slightly outwards. When the posterior
+wall recoils the cartilages are carried back to their original
+position. Should the elastic cartilage under pathological
+conditions become converted into bone, its functions are destroyed,
+and lameness may occur.</p></div>
+
+<p><b>Etiology and Occurrence.</b>&mdash;The causes of ossification of these
+cartilages are several. No doubt there exists a predisposition to this
+condition for it is of such frequent occurrence in heavy draft types of
+horses. Concussion plays an important r&ocirc;le and, according to
+<span class="nowrap">M&ouml;ller's<a name="FNanchor_28_28" id="FNanchor_28_28"></a><a href="#Footnote_28_28" class="fnanchor">[28]</a></span> theory, which is sound, high heel calks prevent the frog
+from contacting the ground, and as weight is placed upon the foot "the
+lateral cartilages are subjected to a continuous inward and downward
+dragging strain."</p>
+
+<p class="figcenter"><a name="image31" id="image31"></a>
+   <a href="./images/img31-full.jpg"><img src="./images/img31.jpg"
+   alt="Fig. 31&mdash;Ringbone and sidebone."
+   title="Fig. 31&mdash;Ringbone and sidebone." /></a><br />
+Fig. 31&mdash;Ringbone and sidebone.</p>
+
+<p>The condition affects the cartilages of the fore feet more frequently
+than those of the hind and the outer cartilage is more often ossified
+than is the inner. This fact may be accounted for by its more exposed
+position; it is also frequently injured by <a name="Page_157" id="Page_157"></a>being trampled upon and
+otherwise contused or cut, as in lacerated wounds of the quarter.</p>
+
+<p><b>Symptomatology.</b>&mdash;Ossification of the cartilages is known by grasping
+the free borders with the fingers and attempting their flexion; the
+rigid inflexible ossified cartilage is thus easily recognized.</p>
+
+<p>Lameness during weight-bearing occurs in the majority of cases at some
+time. Much depends on the conformation of the foot and whether the
+involvement affects one or both cartilages as to the degree and duration
+of lameness which marks this affection. In narrow and contracted heels
+it is reasonable to expect more lameness than in well formed feet. Where
+only one cartilage is ossified, the other being flexible, there is less
+inconvenience experienced by the subject during weight-bearing, because
+of the expansion of the heel which the one normal cartilage allows.</p>
+
+<p><b>Treatment.</b>&mdash;There is little if anything to be done in case the
+cartilage has become ossified except to shoe without high calks but
+preferably with rubber pads. The hoof should be kept moist; the wall at
+the quarter may be rasped thin and kept anointed. Firing is of no
+practical benefit in these cases, and it is doubtful if vesication is
+helpful excepting where only a part of the cartilage is ossified.</p>
+
+<p>Subjects which continue somewhat lame, because of complete ossification
+of both cartilages, are best put to slow work on soft ground and not
+driven on pavements.</p>
+
+
+<h3><a name="Navicular_Disease" id="Navicular_Disease"></a>Navicular Disease.</h3>
+
+<p>This more or less ambiguous term has been applied to various diseases
+affecting the structures which make up the coffin joint. We consider
+this name to be applicable to inflammatory involvement of the third
+sesamoid (navicular bone), the deep flexor tendon (perforans) and the
+bursa podotrochlearis or navicular bursa.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;In 1864 Thomas <span class="nowrap">Greaves<a name="FNanchor_29_29" id="FNanchor_29_29"></a><a href="#Footnote_29_29" class="fnanchor">[29]</a></span> wrote on the
+subject of navicular disease as follows: "The opinion I <a name="Page_158" id="Page_158"></a>entertain upon
+the subject of navicular disease is, that in by far the greater majority
+(if not all) of these cases there exists in the animal affected a
+congenital tendency or predisposition, that, generally speaking, it is
+the high stepper, the good goer, that becomes the victim to this
+disease; and it is a fact well attested, that it as frequently develops
+itself in the feet with wide frogs, bulbous heels, shallow heels, spread
+flattish feet, as in the narrow upright feet.... I have known foals,
+born from defective parents, in which this condition was so strongly
+developed, that all men would at once pronounce them affected with
+navicular disease, and such lameness was permanent."</p>
+
+<p>Often both fore feet are affected and this would point toward its being
+a disease wherein either conformation or congenital tendencies exists.
+It is rare that hind feet are involved.</p>
+
+<p>There are many theories regarding the possible exciting causes of
+navicular disease and, when one has carefully considered the
+explanations as offered by Peters, M&ouml;ller, Branell, Schrader and others,
+he may conclude that navicular disease is a non-infectuous inflammatory
+affection of the third sesamoid (navicular) bone, deep flexor tendon
+(perforans) and adjoining structures. Whether it originates in the
+flexor tendon or whether the bone is the original part affected, the
+disease is frequently met, and of all possible causes, jars and
+irritation incident to concussion of travel, are probably the principal
+causative agents.</p>
+
+<p><b>Symptomatology.</b>&mdash;Lameness is the primary indicator and a constant
+symptom which attends navicular disease wherever much structural change
+affects the infirm parts. As the degree of intensity or extent varies,
+so is there a dissimilarity in the character of the impediment.
+Incipient cases of bilateral involvement are more difficult to diagnose
+than are unilateral affections, particularly when lameness is not
+marked. There is manifested a supporting-leg-lameness which varies as to
+degree in the same subject at different times. This may be noticed
+during the same trip in an animal that is being driven. There is a
+tendency for the subject to stumble and, of course, where the affection
+is bilateral, there is a stilted gait owing to shortened strides.</p>
+<p><a name="Page_159" id="Page_159"></a></p>
+
+<p>At rest the lame animal usually points with the affected member. Because
+of the fact that the distance is lessened between the origin and
+insertion of the deep flexor tendon (perforans) by this attitude, one
+may readily understand the reason for the position assumed by the
+subject. Pressure on the navicular bone is diminished and tension on the
+flexor tendon is relieved by even slight volar flexion.</p>
+
+<p>In acute inflammatory affections abnormal heat may be detected in the
+region of the heel. By exerting tension on the flexor tendon, by means
+of passive dorsal flexion of the member, evidence of hyperesthesia may
+be detected. With the hoof testers one may determine supersensitivenss
+in most instances. There occurs more or less contraction of the hoof in
+navicular disease, but this is not to be taken as a cause of the
+affection, but rather a sequence.</p>
+
+<p class="figcenter"><a name="image32" id="image32"></a>
+   <a href="./images/img32-full.jpg"><img src="./images/img32.jpg"
+   alt="Fig. 32&mdash;''Pointing''&mdash;the position assumed by horse having
+unilateral navicular disease."
+   title="Fig. 32&mdash;''Pointing''&mdash;the position assumed by horse having
+unilateral navicular disease." /></a><br />
+Fig. 32&mdash;"Pointing"&mdash;the position assumed by horse having
+unilateral navicular disease.</p>
+
+
+<p>In some cases of unilateral navicular disease there is a marked contrast
+in size between the sound and unsound foot. However, one must not be
+misguided in this particular, for in some pairs of sound feet there
+exists considerable difference in size. Finally, by a change from the
+normal position of the foot to one in which the heel is somewhat
+elevated (as may be obtained by shoeing with high heel calks), relief is
+evident, and in the opposite <a name="Page_160" id="Page_160"></a>position, the condition is aggravated.
+This experiment may be used for diagnostic purposes.</p>
+
+<p><b>Treatment.</b>&mdash;When the anatomy of the diseased parts is taken into
+consideration, and an analysis of the lesions which occur in cases where
+considerable structural change is occasioned by this affection, it is
+obvious that recovery is impossible. Only in cases where the
+inflammation is promptly checked before damage has been done the
+navicular bone or the flexor tendon, is permanent recovery possible. The
+disease is not frequently treated during this stage, however, and in the
+majority of instances the condition becomes chronic.</p>
+
+<p>As soon as a diagnosis is made the shoes must be removed, the toe
+shortened with the hoof pincers and rasp and the subject is put in a
+well bedded box-stall. If the animal is very lame and the inflammation
+is acute, ice-cold packs should be applied to the feet. As soon as acute
+inflammation has subsided the foot may be so pared that all excess of
+sole and frog is removed without lowering the heels, and the animal may
+be blistered about the coronet region. The subject may be shod later,
+with heel calks that raise the heel moderately and a protracted period
+of rest should be enforced.</p>
+
+<p>In cases where no acute inflammatory condition exists, neurectomy is
+beneficial. One must discriminate, however, between favorable and
+unfavorable subjects. This is not a last resort expedient to be employed
+in cases where extensive lesions of the navicular structures exists.
+With proper shoeing, and by putting the subject at suitable work, where
+concussion of fast travel on hard roads is not necessary, the best
+results are obtainable.</p>
+
+
+<h3><a name="Laminitis" id="Laminitis"></a>Laminitis.</h3>
+
+<p>This disease is primarily a non-infective inflammation of the sensitive
+laminae which very frequently affects the front feet. Often all four
+feet are affected, less frequently one foot (when its fellow is unable
+to sustain weight) and rarely the hind feet alone.</p>
+
+<p><b>Occurrence.</b>&mdash;Probably a greater number of cases of laminitis occur in
+localities where horses that are worked on heavy trans<a name="Page_161" id="Page_161"></a>fer wagons are,
+when in a state of perspiration, allowed to stand exposed to sudden
+lowering of temperature and to stand in a cool or cold shower of rain
+such as occurs near the coast of the Great Lakes or the ocean in some
+parts of this country.</p>
+
+<p>This disease occurs in connection with digestive disorders of various
+kinds and, because of the frequent association of the two conditions,
+the common term "founder" has long been employed to designate laminitis.
+In cases of "over-loading," particularly when a large quantity of wheat
+has been eaten by animals that are unaccustomed to this diet, laminitis
+almost constantly results.</p>
+
+<p>Large draughts of cold water, when drunk by animals that are overheated
+is often followed by laminitis. Concussion, such as attends hard
+driving, especially in unshod horses or on rough and hard roads, is
+often succeeded by this affection. Likewise, as has been stated, injury
+such as is occasioned by long continued standing on the same foot is
+followed by laminitis. Some horses that are frequently shod, suffer from
+this affection a few hours after shoes have been reset. Dr. Chas. R.
+Treadway of Kansas City reports the rather frequent occurrence of such
+conditions in horses that are in the fire department service in his
+city.</p>
+
+<p>Age in no way influences the occurrence of laminitis and the general
+condition of an animal with regard to its vigor or state of flesh has no
+apparent influence toward predisposing horses to this ailment.</p>
+
+<p><b>Etiology and Classification.</b>&mdash;As it is with some other diseases, one
+may unprofitably theorize on cause and readily enumerate many conditions
+which are apparently contributory toward producing the affection. Causes
+may well be grouped, however, and a more definite understanding of
+laminitis is possible as a result. Such collocation would include
+conditions which directly or indirectly affect the digestion, such as
+puerperal laminitis, drinking of large quantities of cold water and
+exposure to cold and rain when the body is warm. All of these various
+conditions might be said to affect the vaso-constrictor nerves in such
+manner that the natural tendency (because of the peculiar structure of
+the sensitive laminae and their mode of <a name="Page_162" id="Page_162"></a>attachment to the non-sensitive
+wall) which solipeds have for this affection is indirectly due to this
+one cause&mdash;vaso-constriction. According to Dr. D.M. Campbell, the effect
+of toxic materials, which may be absorbed from the digestive tract or
+the uterus in parturient females, upon the vaso-constrictor nerves, is
+such that a passive congestion of the sensitive laminae occurs and
+laminitis is the result. He believes that even the chilling of the
+surface of the body when very warm, by a cold rain, constitutes a
+condition wherein the effect upon the vaso-constrictors is the same.</p>
+
+<p>This grouping does not include the effect of direct injuries of any and
+all kinds to which the feet are subjected such as: Concussion in fast
+road work, injuries occasioned by tight or ill fitting shoes, contusions
+of any kind resulting in non-infectious inflammation of the sensitive
+laminae, as well as the causes which produce laminitis where weight is
+borne by one foot when its fellow is out of function.</p>
+
+<p>A classification which is practical is that of <i>acute</i> and <i>chronic</i>
+laminitis. To the practicing veterinarian it is this manner of
+consideration that is essential in the handling of these cases.</p>
+
+<p><b>Symptomatology.</b>&mdash;In the acute attack the condition is so well
+described by Dr. R.C. <span class="nowrap">Moore<a name="FNanchor_30_30" id="FNanchor_30_30"></a><a href="#Footnote_30_30" class="fnanchor">[30]</a></span> that we quote him in part as follows:</p>
+
+<div class="blockquot"><p>The acute form is generally ushered in very suddenly. Often a horse
+that is perfectly free from symptoms of the disease is found a few
+hours later so stiff and sore that he will scarcely move. They
+stand like they were riveted to the ground. If forced to move the
+evidence of pain subsides to some extent after they have gone a
+short distance, to return more severe than ever after they have
+been allowed to stand for a short time. If the disease is confined
+to the two front feet, the hind feet are placed well under the
+center of the body to support the weight and the front ones are
+advanced in front of a perpendicular line so as to lessen the
+weight they must bear. If they are made to move, the same position
+of the feet is maintained. If made to turn in a small circle, they
+do so by using the hind feet as a pivot, bringing the front parts
+around by placing as little weight on them as possible.</p>
+
+<p>Placing the hind feet so far under the body, arches the back <a name="Page_163" id="Page_163"></a>and
+often leads to errors in diagnosis, the condition sometimes being
+taken for diseases of the loins or kidneys.</p>
+
+<p>If all four feet are involved, the animal stands in the usual
+position assumed in health, but if urged to move, the least effort
+to do so usually brings on chronic spasms of the entire body. In
+very severe cases, a slight touch of the hand will develop the
+spasms. At times they are so severe, and have such short
+intermissions, that the disease has been mistaken for tetanus.
+However, the clonic nature of the spasm should prevent such an
+error. If they are lying down, it is difficult to get them to
+arise, and if they do so, they show marked symptoms of pain for
+some time after rising.</p>
+
+<p>If the disease is confined to the hind feet, they are placed well
+forward to relieve the strain on the toe caused by the downward
+pull of the perforans (deep flexor) tendon, but in place of the
+front feet being kept in front of a perpendicular line, as they are
+when the disease is confined to the front ones, they are placed far
+back under the body, so they will carry the maximum share of the
+body weight of which they are capable. The position of the feet is
+of great importance and offers symptoms that should not be
+overlooked.</p></div>
+
+<p>When the subject is caused to walk, symptoms of excruciating pain are
+manifested in all acute cases of laminitis. In some cases where all four
+feet are affected, no reasonable amount of persuasion will cause the
+suffering animal to move from its tracks.</p>
+
+<p>There is acceleration of the rate of heart action; the pulse is full and
+in some cases, bounding. As the affection progresses the pulse becomes
+rather weak and irregular. The character of the pulse in the region of
+the extremity is a reliable indicator; but one has to learn to make
+necessary discrimination because of the condition of the parts, as in
+some cases of lymphangitis or where the skin is abnormally thick. The
+characteristic throbbing pulse is, however, easily recognized in most
+cases. Temperature is variable, though usually elevated from one to four
+degrees above normal. This symptom varies with the type and stage of the
+affection. In a subject that has been down, unable to rise for several
+days, where there is a suppurative and sloughing condition of the
+laminae, the temperature is high. Whereas, in some other and less
+destructive cases there may be little thermic disturbance after the
+first few hours have lapsed.</p>
+
+<p>A constant symptom in bilateral affections of acute laminitis <a name="Page_164" id="Page_164"></a>is the
+difficulty with which the subject supports weight with one foot. It is
+this which causes the victim to stand as if "rooted to the ground" when
+all four feet are involved. If one attempts to take up one foot, thus
+causing the subject to stand on the other, there is much resistance and
+in many cases the animal refuses to give the foot.</p>
+
+<p>When we consider that the sensitive parts of the foot are encased by a
+horny, unyielding box and that, when the laminae are congested, a great
+pressure is brought to bear upon the sensitive structures, it is easy to
+understand why the condition is so painful.</p>
+
+<p><i>Chronic laminitis</i> is a sequel of acute inflammation of the sensitive
+laminae. It varies as to intensity and the exact manner of its
+manifestation depends upon pre&euml;xisting disturbances.</p>
+
+<p>In some mild cases of laminitis there are recurrent attacks wherein no
+particular structural change exists, and diagnosis is established
+chiefly by noting the character of the pulse at the bifurcation of the
+large metacarpal (or metatarsal) artery just above the fetlock. The same
+manifestation of pain is present when weight is supported by one foot,
+though in a lesser degree. There is less local heat to be detected by
+palpation than in the acute cases.</p>
+
+<p>Chronic laminitis as it occurs following acute attacks which have
+resulted in structural changes of the foot, present the same symptoms
+just described and, in addition, the peculiar alterations in structure
+exist. When, owing to acute inflammation of the sensitive laminae, there
+has resulted necrosis of this sensitive tissue together with
+infiltration between the anterior surface of the distal phalanx (os
+pedis) and the contacting hoof, the lower portion of the distal phalanx
+is turned downward and backward (rotated upon its transverse axis).
+Because of the traction which is exerted by the deep flexor tendon
+(perforans), as it attaches to the solar surface of the distal phalanx,
+this rotation is facilitated. With hyperplasia of lamina, at the
+anterior portion of the distal phalanx, there results a thick "white
+line." Rotation of the distal phalanx necessitates a descent of its
+apical portion and there occurs a "dropped sole."</p>
+
+<p><a name="Page_165" id="Page_165"></a></p>
+
+<p>In time, partly because of excessive wear of hoof at the heel, owing to
+an altered condition in the normal antagonistic relation between the
+flexor and extensor tendons, the toe makes an excessive growth, and the
+concavity of the anterior line is accentuated owing to this abnormal
+length of hoof. The hoof, because of recurrent inflammatory attacks, is
+corrugated&mdash;elevations of horn in parallel rings are usually present.</p>
+
+<p class="figcenter"><a name="image33" id="image33"></a>
+   <a href="./images/img33-full.jpg"><img src="./images/img33.jpg"
+   alt="Fig. 33&mdash;The hoof in chronic laminitis. Note the
+concavity. This animal was serviceable for any work that could be
+performed at a walk."
+   title="Fig. 33&mdash;The hoof in chronic laminitis. Note the
+concavity. This animal was serviceable for any work that could be
+performed at a walk." /></a></p>
+<p class="captioncenter">Fig. 33&mdash;The hoof in chronic laminitis. Note the
+concavity. This animal was serviceable for any work that could be
+performed at a walk.</p>
+
+
+<p>Animals that are so affected in traveling strike the heel first and the
+toe is later contacted with the ground surface. Rotation of the distal
+phalanx upon its transverse axis produces a condition, with respect to
+this peculiar impediment, that is equivalent to added and excessive
+length of the deep flexor tendon.</p>
+
+<p>Where there occurs suppuration, by careful inspection of the coronary
+region, one may early recognize detachment of hoof. In such cases
+animals remain recumbent and, while the condition is not so painful at
+this stage, the practitioner must not overlook the real state of
+affairs. History, if obtainable, will be a helpful guide in such cases.
+Separation of hoof occurs as <a name="Page_166" id="Page_166"></a>a rule in from four to ten days after the
+initial attack of acute laminitis. Needless to say these cases are
+hopeless, when the economic phase of handling subjects is considered.</p>
+
+<p class="figcenter"><a name="image34" id="image34"></a>
+   <a href="./images/img34-full.jpg"><img src="./images/img34.jpg"
+   alt="Fig. 34&mdash;Showing the effects of laminitis. By permission,
+from Merillat's ''Veterinary Surgical Operations.''"
+   title="Fig. 34&mdash;Showing the effects of laminitis. By permission,
+from Merillat's ''Veterinary Surgical Operations.''" /></a></p>
+<p class="captioncenter">Fig. 34&mdash;Showing the effects of laminitis. By permission,
+from Merillat's "Veterinary Surgical Operations."</p>
+
+
+<p><b>Treatment.</b>&mdash;Much depends upon the concomitant disturbances (or causes
+if one is justified in referring to them as such) as to the manner in
+which laminitis is to be treated. In all cases where digestive
+disturbances exist, the prompt unloading of the contents of the
+alimentary canal is certainly indicated. D.M. <span class="nowrap">Campbell<a name="FNanchor_31_31" id="FNanchor_31_31"></a><a href="#Footnote_31_31" class="fnanchor">[31]</a></span> in a
+discussion of laminitis has the following to say regarding the treatment
+of such cases:</p>
+
+<div class="blockquot"><p>Because superpurgation may be followed by laminitis, the
+advisability of using the active hypodermic cathartics is
+questioned. Neither arecolin nor eserin can cause superpurgation.
+The action of the former does not continue longer than an hour
+after administration and of the latter not more than eight hours.
+The action of either is mild after the first few minutes.</p>
+
+<p>I do not think that anyone has recommended either arecolin or
+eserin where there is severe purgation. Where the intestinal canal
+is fairly well emptied and its contents fluid, I should be inclined
+to rely upon intestinal antiseptics to hold in check harmful
+bacterial growth.</p></div>
+
+<p><a name="Page_167" id="Page_167"></a></p>
+
+<div class="blockquot"><p>The use of alum in the treatment of laminitis is held to be without
+reason other than the empirical one that it is beneficial. If
+laminitis is due chiefly to an autointoxication, good and
+sufficient reason for the administration of alum can be shown based
+upon its known physiological action. It is the most powerful
+intestinal astringent that I know of and has the fewest
+disadvantages. I have not noted constipation following its use nor
+diarrhea, nor a stopping of peristalsis, nor indigestion, and in
+any case its action lasts at most only a few hours, and if it did
+all these, it could not much matter. Quitman says, that it
+constricts the capillaries. If this is true, a thing of which I am
+not certain, is it not reasonable to suppose that as with other
+vaso-constrictors, e.g., digitalis, there is a selective action on
+the part of the capillaries (not of the drug) and those that need
+it most, i.e., those of the affected feet in laminitis, are
+constricted most? All body cells exert this selective action in the
+assimilation of food, the tissue needing most any particular kind
+of food circulating in the blood, gets it.</p>
+
+<p>Our first consideration in laminitis should be to remove the
+cause&mdash;to stop the absorption of the toxin in the intestinal tract
+that is producing the condition. This we accomplish by partially
+unloading it by the use of the active hypodermic cathartics and
+stopping absorption by the surest and most harmless of intestinal
+astringents. Whether the astonishingly prompt and certain action of
+alum in this case is due wholly to its astringent action or whether
+alum combines with the harmful bacterial products chemically and
+forms an innocuous combination, I can only surmise, and it is
+unimportant. At any rate, when alum is administered, the onslaught
+of the disease is promptly stopped. Irreparable damage may already
+have been done if the case is a neglected one, but whether
+administered early or late in acute attacks, the progress of the
+disease is stopped immediately.</p></div>
+
+<p>The same authority may be profitably quoted in the matter of handling
+all cases wherein the revulsive effect of agents which diminish vascular
+tension are chiefly indicated or necessary as adjuvants. In this
+connection, Campbell says:</p>
+
+<div class="blockquot"><p>The early and vigorous administration of aconitin in laminitis to
+its full physiological effect, is more logical. Assuming that
+laminitis is due to absorption of harmful products from the
+intestinal tract permitted through the deranged functioning of the
+organs of digestion, or assuming that it is due to an extension of
+the inflammation from the mucosa to the sensitive lamina, or that
+it is a reflex from a sudden chilling of the skin, we have in any
+of these conditions a disturbed circulation, and aconitin <a name="Page_168" id="Page_168"></a>is the
+first and foremost of circulation "equalizers." Furthermore, in
+laminitis there is an elevation of the temperature, an almost
+invariable indication for aconitin. A speedy return of the
+temperature to normal, a very marked diminution of the pain and
+improved conditions generally, appear coincident with the symptoms
+of full physiological effect of aconitin when given in cases of
+laminitis, which constitutes assuredly an important part of its
+treatment.</p></div>
+
+<p class="figcenter"><a name="image35" id="image35"></a>
+   <a href="./images/img35-full.jpg"><img src="./images/img35.jpg"
+   alt="Fig. 35&mdash;Inferior (convex) surface of Cochran shoe."
+   title="Fig. 35&mdash;Inferior (convex) surface of Cochran shoe." /></a><br />
+Fig. 35&mdash;Inferior (convex) surface of Cochran shoe.</p>
+
+
+<p>Where lameness is not great as in cases wherein no marked structural
+change of the foot has occurred, proper shoeing is very beneficial. By
+keeping the heels as low as possible and shoeing without heel calks a
+more comfortable position is made possible. Thin rubber pads which do
+not elevate the heel are of service in diminishing concussion.</p>
+<p><a name="Page_169" id="Page_169"></a></p>
+
+<p>Dr. David W. Cochran of New York City has attained unusual success in
+cases of chronic laminitis with dropped sole by the use of a specially
+designed shoe.</p>
+
+<p class="figcenter"><a name="image36" id="image36"></a>
+   <a href="./images/img36-full.jpg"><img src="./images/img36.jpg"
+   alt="Fig. 36&mdash;Superior surface, showing concavity or bowl, as
+formed by the toe and branches of the shoe, as designed by Dr. David W. Cochran."
+   title="Fig. 36&mdash;Superior surface, showing concavity or bowl, as
+formed by the toe and branches of the shoe, as designed by Dr. David W. Cochran." /></a></p>
+<p class="captioncenter">Fig. 36&mdash;Superior surface, showing concavity or bowl, as
+formed by the toe and branches of the shoe, as designed by Dr. David W. Cochran.</p>
+
+<p>Cochran claims that, not only are horses with dropped soles that would
+otherwise have to be put off the streets enabled to do a fair amount of
+work by means of this shoe, but that continually wearing it, meanwhile
+keeping the convexity of the front of the hoof rasped thin, in time
+brings about a marked improvement, and that after some months or years
+of use the animals are able to work with ordinary rubber-pad shoes,
+provided they are arranged to facilitate breaking over.</p>
+
+<p>From having been successfully used on some race horses of <a name="Page_170" id="Page_170"></a>high value,
+the Cochran shoe has attained considerable notoriety and is being used
+by a number of practitioners. A disadvantage, however, arises from the
+fact that few horseshoers other than Doctor Cochran seem able to make
+the shoe, the peculiar shape of which offers considerable difficulty in
+forging. Concerning the application of the shoe <span class="nowrap">Cochran<a name="FNanchor_32_32" id="FNanchor_32_32"></a><a href="#Footnote_32_32" class="fnanchor">[32]</a></span> says:</p>
+
+<div class="blockquot"><p>"The most important primary procedure is the preparation of the
+foot to receive the shoe. All excess of growth must be removed from
+the anterior face of the hoof. The outer face must be reduced at
+the toe (not shortened), but rasped down thin for the lighter the
+top of the foot is, the more chance the sole and coffin bone will
+have of resuming their former normal position. The pressure of the
+wall at the toe upon the exudate between wall and coffin bone,
+tends to force the coffin bone and sole out of their normal
+position. Leave the sole alone. You can lower the excess of growth
+at the heels.</p>
+
+<p>"There are many designs of shoes to relieve this condition. A great
+deal depends on the judgment of the shoer to meet the conditions
+presented, depending on the degree of the convexity and strength of
+the sole. In some cases we use a shoe that admits of a large amount
+of sole room. Again, we shoe with a shoe of wide cover. In other
+cases a shoe with even pressure over the whole sole. In some cases
+a high, narrow shoe, resting only on the wall, or the ordinary
+plain shoe with side calks welded close to the outside edge and the
+shoe dished well from these as a foundation. Then we have the air
+cushion pad designed after the model of the bowl shoe."</p></div>
+
+<p>In cases when slight and persistent lameness interferes sufficiently to
+prevent using an animal at any sort of work on hard roads, median
+neurectomy will relieve all lameness in most instances. This is a safe
+operation, moreover, in that no bad after effects are to be feared, even
+though lameness were to continue.</p>
+
+
+<h3><a name="Calk_Wounds_Paronychia" id="Calk_Wounds_Paronychia"></a>Calk Wounds. (Paronychia.)</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Injuries of various kinds are inflicted upon
+the coronary region but usually they are due to the foot being trampled
+upon. When the foot that inflicts the injury happens to be unshod, a
+contusion of the injured member is occasioned, but in the majority of
+instances, wounds that demand attention are the result of shoe calks
+which have pene<a name="Page_171" id="Page_171"></a>trated the tissues in the region of the coronary band.
+Often calk wounds are self-inflicted. When animals are excited and in
+turning crowd one another, they often perform dancing movements which
+frequently result in deep calk wounds of the coronet. Some horses have a
+habit of resting the heel of one hind foot upon the anterior coronary
+region of the other. While sleeping in this position, if they are
+suddenly awakened, the weight is abruptly shifted to the uppermost foot
+and the one underneath is (because of the pain attending its being
+wounded) quickly drawn out from under its fellow. In this way deep cuts
+may divide the coronary band and inflict extensive injury to the
+sensitive lamina as well.</p>
+
+<p>An infectious type of coronary inflammation occurs in some localities
+during the winter months, wherein the condition is enzootic.</p>
+
+<p><b>Symptomatology.</b>&mdash;Depending upon the manner in which the injury has
+been produced, the appearance of the wound varies and likewise lameness
+is more or less pronounced. If the tissues are not divided and the wound
+is chiefly of the subsurface structures, there will not immediately
+occur pronounced local evidence of the existence of injury; but as soon
+as the lame animal is made to move, the peculiar character of the
+impediment (supporting-leg lameness with the affected foot kept well in
+advance of its normal position) directs attention to the extremity and
+all of the symptoms of acute inflammation are discovered.</p>
+
+<p>Where a wound is inflicted which divides, in some manner, the surface
+structures (skin, coronary band, or the hoof wall) one's attention is at
+once called to the existence of the wound.</p>
+
+<p>Because of the fact that there is every facility for the production of a
+sub-coronary and podophylous infection, these wounds should receive
+prompt attention. In some instances, the pastern joint is opened by calk
+wounds and then, of course, an infectious arthritis succeeds the injury.</p>
+
+<p><b>Treatment.</b>&mdash;In all contused wounds of the coronary region the parts
+need thorough cleansing; the hair, if long is clipped and a cataplasm is
+applied. Or preferably, an iodin-glycerin combination of one part of
+iodin to four parts of glycerin is <a name="Page_172" id="Page_172"></a>poured on a layer of cotton, and
+this is confined in contact with the inflamed parts by means of a
+bandage.</p>
+
+<p>Where normal resistance to infection obtains, the subject usually
+suffers no suppurative disturbance when the surface structures are not
+broken; and daily applications of the antiseptic lotion above referred
+to stimulates complete resolution. This may be expected in from four to
+ten days depending upon the extent of the injury.</p>
+
+<p>If a calk wound has been inflicted, the adjoining surface structures are
+freed of hair and the parts cleansed in the usual manner, (which in
+wounds recently inflicted, should be done without employing quantities
+of water) and after painting the wound surface with tincture of iodin
+and saturating its depths with the same agent, the wound is cleansed, if
+it contains filth, by means of a small curette. By using a small and
+sharp curette, one is enabled to cleanse the average wound quickly and
+almost painlessly.</p>
+
+<p>In such cases, equal parts of tincture of iodin and glycerin are
+employed. The wound is filled with this preparation and a quantity of it
+is poured upon a suitable piece of aseptic gauze or cotton and this is
+contacted with the wound. The extremity is carefully bandaged and this
+dressing is left in position for forty-eight hours unless there occurs,
+in the meanwhile, evidence of profuse suppuration&mdash;which is unusual.</p>
+
+<p>One is to be guided as to the progress made by the degree of lameness
+present. If little or no lameness develops, it is reasonable to expect
+that infection has been checked; that the wound is dry and redressing
+every second day is sufficiently frequent.</p>
+
+<p>Where cases progress favorably, recovery (unless infectious arthritis
+results) should occur in from ten days to three weeks. Where extensive
+sub-coronary fistulae result, either from lack of prompt or proper
+attention, the condition is then one requiring a radical operation to
+establish drainage and to disinfect if possible, the suppurating
+tissues.</p>
+
+
+<h3><a name="Corns" id="Corns"></a>Corns.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;In horses, because of a tendency toward
+contraction of the heel in some subjects, together with <a name="Page_173" id="Page_173"></a>work on hard
+roads and pavements, where the feet become dry and brittle, and because
+of neglect of the matter of shoeing, this affection is of frequent
+occurrence. Unshod horses are rarely affected. If conformation is faulty
+and too much weight is borne on the inner or the outer quarter, and the
+hoof wall at the quarter tends to turn inward, corns are usually
+present. They occur more frequently on the inner quarters of the front
+feet, though the outer quarters are occasionally also affected and in
+rare instances corns are found at the toes. They do not often affect the
+hind feet.</p>
+
+<p>As soon as injury by pressure, such as is supposed to cause the
+formation of corns, is brought to bear on the sensitive sole, an
+extravasation of blood occurs. In time when the cause remains active,
+this discoloration is evident in the substance of the insensitive sole
+and consists in a red or yellowish spot which varies in size&mdash;this is
+ordinarily termed dry corn.</p>
+
+<p>In some cases where infection of this extravasation of blood and serum
+occurs, instead of desiccation and discoloration of the insensitive
+parts, there is, in time, manifested a circumscribed area of destruction
+of the insensitive sole and the abscess may, where no provision for
+drainage exists, burrow between sensitive and insensitive laminae and
+perforate the tissues at the coronet. If the suppurative material
+discharges readily by way of the sole, no disturbance of the heel or
+quarters occurs above the hoof.</p>
+
+<p><b>Symptomatology.</b>&mdash;A supporting-leg-lameness characterizes this
+condition; and this lameness in most instances varies in degree with the
+amount of distress which is occasioned by pressure upon the inflamed
+parts. By an examination of the sole after having removed all dirt, and
+exposed the horny sole to view, no difficulty is encountered in locating
+the cause of the trouble.</p>
+
+<p><b>Treatment.</b>&mdash;Before suppuration has taken place and in the cases where
+suppuration does not occur, the horse-shoer's method of paring out the
+diseased tissue affords a means of temporary relief; but unless
+frequently done, in many cases, lameness results within about three
+weeks after such treatment has been given. In other instances temporary
+relief is not to be gotten <a name="Page_174" id="Page_174"></a>in this manner for any great length of time
+or until a more rational mode of treatment becomes necessary so that the
+subject may experience a cessation of the inconvenience or distress.</p>
+
+<p>The general plan which meets with the approval of most practitioners
+consists in careful leveling of the foot and removing enough of the wall
+and sole at the quarters to make possible frog pressure by means of a
+bar shoe. With frog pressure, expansion of the heel follows in time, and
+permanent relief is obtainable in this manner. Thinning the wall of the
+quarter is advocated by many practitioners and is undoubtedly beneficial
+in chronic cases where marked contraction has taken place. The wall must
+be thinned with a rasp until it is readily flexible by compressing with
+the thumbs.</p>
+
+<p>There are instances, however, where corns and contraction of the heel
+have existed so long that they do not yield to treatment. Such cases are
+found in old light-harness or saddle-horses that have been more or less
+lame for years and where there exists marked contraction of the heels,
+rough hoof walls, and hard and atrophied frogs.</p>
+
+<p>Suppurating corns require surgical attention in the way of removal of
+the purulent necrotic mass and making provision for drainage. Dry
+dressings, such as equal parts of zinc sulphate and boric acid, may be
+employed to pack the cavity. After the infectious condition has been
+controlled, and the wound is dry, the same plan of treatment is
+indicated that is employed in the non-suppurating corn. Ample time is
+allowed, however, for the surgically invaded tissues to granulate and,
+if the subject is to be put in service, a leather pad, under which there
+has been packed oakum and tar, affords good protection.</p>
+
+
+<h3><a name="Quittor" id="Quittor"></a>Quittor.</h3>
+
+<p>This name is employed to designate an infectious inflammation of the
+lateral cartilage and adjoining structures. The disease is characterized
+by a slowly progressive necrosis and by a destruction of more or less of
+the cartilage and by the presence of fistulous tracts.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;The disease is due to the introduction of
+pus producing organisms into the subcoronary region <a name="Page_175" id="Page_175"></a>of the foot under
+conditions which favor the retention of such contagium and extension of
+infection into contiguous tissues.</p>
+
+<p>Morbific material is introduced into the region of the lateral cartilage
+by means of calk wounds and other penetrant injuries of the foot. A
+sub-coronary abscess which, because of lack of proper care or because of
+virulency of the contagium or low vitality of the subject, is quite apt
+to result in cartilaginous affection and its perforation by necrosis
+follows.</p>
+
+<p><b>Symptomatology.</b>&mdash;Quittor is readily diagnosed on sight in many
+instances. Where there is dependable history or other evidence of the
+chronicity of an infectious inflammation of the kind, quittor is easily
+identified. If no positive evidence of the disease exists, by means of
+careful exploration of sinuses with the probe, one may distinguish
+between true cartilaginous quittor and superficial abscess formation
+that is often accompanied by hyperplasia.</p>
+
+<p>Lameness depends upon the extent of the involvement as it affects the
+structures contiguous to the cartilage. A variable degree of lameness is
+manifested in different cases.</p>
+
+<p><b>Treatment.</b>&mdash;Two general plans of handling this disease are in vogue.
+One, the more popular method, consists in the injection of caustic
+solutions of various kinds into the fistulous openings with the object
+of causing sloughing of necrotic tissue and the stimulation of healthy
+granulation of such wounds. The other mode consists in either complete
+surgical removal of the cartilage or its remaining portions, or removal
+of the diseased parts of curettage.</p>
+
+<p>When quittor has not extensively damaged the foot and the lateral
+cartilage is not partly ossified as it is in some old chronic cases, the
+complete removal of the lateral cartilage by means of the Bayer
+operation or a modification thereof is indicated. A complete description
+of the Bayer operation as well as Merillat's operation for this disease
+(the latter consisting in part, in the removal of diseased cartilage
+with the curette) are given in Volume three of Merillat's "Veterinary
+Surgical Operations."</p>
+
+<p>Treatment by injection of caustic solutions has many advocates and
+because of the fact that, in many instances the condition is <a name="Page_176" id="Page_176"></a>such that
+they are not desirable surgical cases and also because some animals may
+be put in service before treatment is completed, the injection method is
+popular.</p>
+
+<p>The mode of treatment advocated by Joseph Hughes, M.R.C.V.S.,
+constitutes a very successful manner of handling quittor and we can do
+no better than quote Dr. J.T. <span class="nowrap">Seeley<a name="FNanchor_33_33" id="FNanchor_33_33">&nbsp;</a><a href="#Footnote_33_33" class="fnanchor">[33]</a></span> on his manner of using this
+particular treatment.</p>
+
+<p class="figcenter"><a name="image37" id="image37"></a>
+   <a href="./images/img37-full.jpg"><img src="./images/img37.jpg"
+   alt="Fig. 37&mdash;Hyperplasia of right fore foot, due to chronic
+quittor."
+   title="Fig. 37&mdash;Hyperplasia of right fore foot, due to chronic
+quittor." /></a><br />
+Fig. 37&mdash;Hyperplasia of right fore foot, due to chronic
+quittor.</p>
+
+
+<div class="blockquot"><p><b>Preparation.</b>&mdash;First remove the shoe, have the foot pared very
+thin and balanced as nicely as possible. Moreover, all loose
+fragments of horn must be detached and all crevices cleaned
+thoroughly.</p>
+
+<p>Next, have the leg brushed and hair clipped from the knee or hock
+to the foot and scrubbed with ethereal soap and warm water, after
+which the foot must be scrubbed in like manner. The foot is then
+placed in a bichlorid bath several hours daily, <a name="Page_177" id="Page_177"></a>for from two to
+five days, depending upon whether or not soreness is shown. The
+bichlorid solution is 1 to 1,000 strength.</p>
+
+<p>On removing the horse from the bath a liberal layer of gauze is
+soaked in 1 to 1,000 bichlorid solution and placed so as to cover
+the entire foot. On discontinuing the bath, cover the foot with
+gauze saturated with a 1 to 1,000 bichlorid solution. This is to be
+covered with absorbent cotton and a gauze bandage, and over all is
+placed an oil cloth or silk covering. This pack is kept moist with
+bichloride solution for forty-eight hours. The foot is then ready
+for injection.</p>
+
+<p class="figcenter"><a name="image38" id="image38"></a>
+   <a href="./images/img38-full.jpg"><img src="./images/img38.jpg"
+   alt="Fig. 38&mdash;Chronic quittor, left hind foot. Showing
+position assumed because of painfulness of the affection."
+   title="Fig. 38&mdash;Chronic quittor, left hind foot. Showing
+position assumed because of painfulness of the affection." /></a></p>
+<p class="captioncenter">Fig. 38&mdash;Chronic quittor, left hind foot. Showing
+position assumed because of painfulness of the affection.</p>
+
+
+<p><b>Preparation of the Injection Fluids.</b>&mdash;Have on hand a pint of a
+one per cent aqueous solution of formaldehyd made under cleanly
+conditions, even to a clean bottle and cork, and a clean container
+when ready to use the liquid. Prepare also a bichlorid of mercury
+solution as follows: Hydrarg. Chlor. Corros. 3IV; Acid Hydrochlor.
+3Iss.; Aqua Bulliens, Oij. This should be <a name="Page_178" id="Page_178"></a>thoroughly triturated,
+and then filtered into a clean bottle, when it is ready for use.</p>
+
+<p><b>Injection.</b>&mdash;The patient should be laid on a table, if one is
+available, or cast, and the foot securely fixed. Then, with an
+ordinary one-ounce hard rubber syringe, with a good plunger (tried
+first to note whether or not any fluid works around between the
+barrel and the plunger), introduce one syringe full of the
+formaldehyd solution, then thoroughly probe the quittor to
+determine the number of sinuses. This done, inject each sinus. If
+two sinuses open on the surface, close one with cotton while
+filling the other so that if there is a connection the solution
+will come in contact with all tissues involved. Irrigate with the
+full pint of formaldehyd solution first, then follow with six or
+eight ounces of the bichlorid solution. Never probe the foot nor
+allow it to be tampered with except in the manner prescribed.</p>
+
+<p><b>After-Treatment.</b>&mdash;Put on a pack saturated with a solution of
+bichlorid of mercury 1 to 1,000 and let it remain two days. Remove
+pack, and once daily afterwards wipe off with cotton the secretion
+which accumulates on the outside, and apply a dry dressing or
+healing oil composed of phenol, camphor gum and olive oil.</p>
+
+<p><b>When Dangerous to Inject.</b>&mdash;Never inject a quittor in the acute
+stage. Never inject a quittor if considerable lameness is present.
+On injecting a solution of formalin, hold cotton tightly around the
+nozzle of the syringe, when the plunger is down, then withdraw the
+syringe gently and note particularly if the fluid returns through
+the opening; if none returns cease operations at once, as it is
+dangerous to proceed farther, it indicates that the sinus is not
+well defined and the fluid retained will cause much trouble and
+often the death of the patient.</p></div>
+
+<p>Experience has taught that, if extensive destructive changes of the foot
+exist, the Bayer operation is not indicated. In the country, where
+quittors are not so frequently met as in urban practice, the Merillat
+operation is preferable in all cases. However, the cost of the
+protracted period of idleness, which convalescent surgical patients
+require, renders the Hughes method more satisfactory in the hands of the
+general practitioner, especially in the city.</p>
+
+
+<h3><a name="Nail_Punctures" id="Nail_Punctures"></a>Nail Punctures.</h3>
+
+<p>Nail punctures, as herein considered, embrace all penetrant wounds of
+the solar surface of the horse's foot due to trampling <a name="Page_179" id="Page_179"></a>upon street
+nails. This does not include accidental nail pricks occasioned in
+shoeing. In city practice, in some stables, these cases are of frequent
+occurrence; and, generally speaking, nail punctures are observed more
+frequently in urban horses than in animals that are kept in the country.</p>
+
+<p><b>Occurrence and Method of Examination.</b>&mdash;This condition, then, is a
+rather common cause of lameness and in no case, where cause of the
+claudication is not obvious, is the practitioner warranted in concluding
+his examination without careful search for the possible existence of
+nail puncture of the solar surface of the foot.</p>
+
+<p class="figcenter"><a name="image39" id="image39"></a>
+   <a href="./images/img39-full.jpg"><img src="./images/img39.jpg"
+   alt="Fig. 39&mdash;Skiagraph of foot. The X-ray offers very limited
+possibilities in the diagnosis of lameness. The location of a ''gravel''
+or a nail that had worked its way some distance from the surface, or of
+an abscess of some proportion, deep in the tissues, might be facilitated
+under some circumstances by the aid of the X-ray. Its use in the
+detention of fractures is very limited, owing to the difficulty
+encountered in getting a view from the right position&mdash;many trials being
+necessary in most cases. The case shown above was diagnosed clinically
+as incipient ringbone. The X-ray revealed no lesions. (Photo by L.
+Griessmann.)"
+   title="Fig. 39&mdash;Skiagraph of foot. The X-ray offers very limited
+possibilities in the diagnosis of lameness. The location of a ''gravel''
+or a nail that had worked its way some distance from the surface, or of
+an abscess of some proportion, deep in the tissues, might be facilitated
+under some circumstances by the aid of the X-ray. Its use in the
+detention of fractures is very limited, owing to the difficulty
+encountered in getting a view from the right position&mdash;many trials being
+necessary in most cases. The case shown above was diagnosed clinically
+as incipient ringbone. The X-ray revealed no lesions. (Photo by L.
+Griessmann.)" /></a></p>
+<p class="captioncenter">Fig. 39&mdash;Skiagraph of foot. The X-ray offers very limited
+possibilities in the diagnosis of lameness. The location of a "gravel"
+or a nail that had worked its way some distance from the surface, or of
+an abscess of some proportion, deep in the tissues, might be facilitated
+under some circumstances by the aid of the X-ray. Its use in the
+detention of fractures is very limited, owing to the difficulty
+encountered in getting a view from the right position&mdash;many trials being
+necessary in most cases. The case shown above was diagnosed clinically
+as incipient ringbone. The X-ray revealed no lesions. (Photo by L.
+Griessmann.)</p>
+
+<p>In occasional instances there co-exists an obvious cause for
+supporting-leg-lameness and an occult cause&mdash;a nail puncture. Where such
+complications are met, the practitioner is not necessarily guilty of
+neglect or carelessness when the nail puncture <a name="Page_180" id="Page_180"></a>is not discovered at
+once, nevertheless, an examination is not complete until practically
+every possible cause of lameness has been located or excluded in any
+given case.</p>
+
+<p>In a search for nail puncture it is necessary to expose to view every
+portion of the sole and frog in such manner that the existence of the
+smallest possible wound will be revealed. This necessitates removal of
+the shoe, if, after a preliminary examination, a puncture is not found,
+when there is good reason to suspect its presence. However, where it is
+readily possible to locate and care for a wound without removal of the
+shoe, allowing the shoe to remain materially facilitates retaining
+dressings in position and relieves the solar surface of contact with the
+ground. If extensive injury or infection exists, it is of course
+necessary to remove the shoe and leave it off. By removing a superficial
+portion of all of the sole and frog, thus carefully and completely
+exposing to view all parts of the solar surface of the foot, and with
+the aid of hoof-testers one is enabled to positively determine the
+existence of nail punctures. Because of the tendency of puncture wounds
+of the foot to close, and since the superficial portion of the solar
+structures are usually soiled, it is absolutely necessary to conduct
+examinations of this kind in a thorough manner.</p>
+
+<p><b>Symtomatology.</b>&mdash;Not all cases of nail puncture cause lameness during
+the course of the disturbance and in many instances no lameness is
+manifested for some time after the injury has been inflicted&mdash;not until
+infection has been the means of causing considerable inflammation of
+sensitive structures. Nevertheless, this lack of manifestation occurs
+only in cases where serious injury has not taken place and the degree of
+lameness is a constant and reliable indicator of the character and
+extent of nail punctures within twenty-four hours after injury has been
+inflicted.</p>
+
+<p>The position assumed by the affected animal inconstantly varies with the
+location and nature of the injury and is not of particular importance in
+establishing a diagnosis. The subject may support some weight with the
+affected member and stand "base-wide" or "base-narrow," or no weight may
+be borne with the foot or the animal may point or keep the ex<a name="Page_181" id="Page_181"></a>tremity in
+a state of volar flexion. In cases where extensive injury has been
+inflicted, and great pain exists, the foot is kept off the ground much
+of the time and it may be swung back and forth as in all painful
+affections of the extremity.</p>
+
+<p>Nail punctures cause typical supporting-leg-lameness and in some cases
+certain peculiarities of locomotory impediment are worthy of notice.
+Punctures of the region of the heel, which directly affect or involve
+the deep tendon sheath, cause a type of lameness wherein pain is
+augmented, when dorsal flexion of the extremity occurs as well as when
+weight is borne. Wounds in the region of the toe of the hind feet
+sometimes cause the subject to carry the extremity considerably in
+advance of the point where it is planted and, just before placing the
+foot on the ground, it is carried backward a little way&mdash;ten or twelve
+inches.</p>
+
+<p>However, diagnosis of nail puncture is based on the finding of the
+characteristic wound or resultant local changes.</p>
+
+<p><b>Course and Prognosis.</b>&mdash;The nature of the progress and the manner of
+termination of these cases are variable. If the coffin joint has been
+invaded, and a septic arthritis exists, the condition is at once grave.
+An open and infected tendon sheath, while not so serious, constitutes a
+condition which is distressing, and recovery is slow even under the most
+favorable conditions. Where a heavy, rigid and sharp nail enters the
+foot, in such manner that fracture of the third phalanx (os pedis)
+occurs, this complication makes for a protraction of the condition.
+Experience teaches that the natural course and termination in these
+cases are modified by the location and depth of the injury, virulency of
+the contagium and resistance of the subject to such infection.</p>
+
+<p><b>Prevention.</b>&mdash;In all horses which are kept at such work that exposure
+to nail punctures is frequent, a practical means of prevention of such
+injuries consists in the employment of heavy sole leather or suitable
+sheet metal to cover the sole of the foot and, at the same time, confine
+oakum and tar in contact with the solar surface to prevent the
+introduction of foreign material between the foot and such protecting
+appliances. Further, if drivers and owners could be impressed with the
+serious complications which so frequently attend wounds of this kind,
+undoubt<a name="Page_182" id="Page_182"></a>edly many cases which are now lost, because of ignorance or
+neglect on the part of the teamsters or proprietors of horses, would be
+saved by prompt and rational treatment.</p>
+
+<p><b>Treatment.</b>&mdash;The treatment of this condition falls so largely within
+the dominion of surgery that we can give little more than an outline
+here.</p>
+
+<p>In cases where there exists no evidence of open joint or open tendon
+sheath as judged by the site of the puncture and degree of lameness
+present (after having thoroughly cleansed the solar surface of the foot
+and enlarged the opening in the nonsensitive sole) a little phenol is
+introduced into the wound. In such cases, where it is possible for the
+antiseptic to contact every part of wound surface to the extreme depths
+of the puncture, infection is prevented when such treatment is promptly
+administered. This may be considered as first aid, or emergency care,
+and is indicated in all wounds of the foot whether the injury be serious
+or almost insignificant.</p>
+
+<p>Subsequently one of two general courses may be pursued in the treatment
+of cases of nail puncture. One, by the employment of means to keep the
+wound patent and injection of suitable antiseptics, or agents that are
+more or less caustic in conjunction with strict observance of asepsis
+and wound protection. The other method consists in prompt establishment
+of drainage by surgical means and includes exploration and curettage.</p>
+
+<p>The first method is better adapted to the use of the average general
+practitioner and he would do well to keep the opening in the
+nonsensitive structures patent. By introducing equal parts of tincture
+of iodin and glycerin daily, good results will follow in most instances.
+The wound is protected in unshod horses, either by completely bandaging
+the foot and retaining, in contact with the wound, cotton that is
+saturated with iodin and glycerin, or, if a minor injury exists, the
+moderately enlarged opening in the nonsensitive sole or frog, which has
+been moistened with the antiseptic, is packed with a very small quantity
+of cotton. A little practice in this mode of closing benign puncture
+wounds will enable the practitioner to successfully protect the
+sensitive parts in the treatment of such cases in unshod country
+horses.</p>
+<p><a name="Page_183" id="Page_183"></a></p>
+
+<p>When the condition progresses favorably the wound may be dressed every
+second day or twice weekly, and in the course of from two to six weeks
+recovery should be complete.</p>
+
+<p>If the practitioner is somewhat proficient as a surgeon, and has at his
+command facilities for doing surgery, the second method is preferable in
+many cases. By using a local anesthetic on the plantar nerves and
+confining the subject on an operating table, restraint should be
+perfect. The solar surface of the foot is first thoroughly cleansed, the
+puncture wound is enlarged in the nonsensitive structures and the parts
+are then moistened with phenol or other suitable antiseptics. By means
+of a small probe the puncture is explored and, depending on the
+character of the wound and the structures involved, surgical
+intervention is varied to suit the case. If necessary, all of the
+insensitive frog is removed, and in wounds affecting the region of the
+heel the tissues may be incised from the puncture outward dividing all
+of the tissues outward and backward to the surface. A suitable surgical
+dressing is then applied.</p>
+
+<p>If, on the other hand, the puncture extends into the navicular bursa,
+the radical operation is perhaps indicated, though not until one is sure
+that infection of the bursa and serious consequences are to follow if
+this operation is not performed. Detailed description of the technic of
+this operation belongs to the realm of surgery and a good discussion of
+it is to be found in William's work on veterinary surgical and
+obstetrical operations.</p>
+
+<p>One may summarize the discussion of treatment of nail puncture by saying
+that emergency care as herein described is of first consideration. In
+every case an immunizing dose of anti-tetanic serum should be given.
+Subsequently, the method employed must suit the character of the wound,
+existing facilities for handling the subject and the skill and aptitude
+of the practitioner.</p>
+<p><a name="Page_184" id="Page_184"></a></p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<p class="footnote"><a name="Footnote_5_5" id="Footnote_5_5"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_5_5">[5]</a>&nbsp;&nbsp;Manual of Veterinary Physiology, by Major-General F. Smith,
+page 590.</p>
+
+<p class="footnote"><a name="Footnote_6_6" id="Footnote_6_6"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_6_6">[6]</a>&nbsp;&nbsp;Manual of Veterinary Physiology by Major-General F. Smith,
+page 589.</p>
+
+<p class="footnote"><a name="Footnote_7_7" id="Footnote_7_7"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_7_7">[7]</a>&nbsp;&nbsp;Regional Veterinary  Surgery and Operative Technique, Jno.
+A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 765.</p>
+
+<p class="footnote"><a name="Footnote_8_8" id="Footnote_8_8"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_8_8">[8]</a>&nbsp;&nbsp;Dr. Roscoe R. Bell in the Proceedings, N.Y. State
+Veterinary Medical Society, 1899.</p>
+
+<p class="footnote"><a name="Footnote_9_9" id="Footnote_9_9"></a>&nbsp;&nbsp;<a class="footnotea" href="#FNanchor_9_9">[9]</a>&nbsp;&nbsp;American Veterinary Review, Vol. 35, P. 456.</p>
+
+<p class="footnote"><a name="Footnote_10_10" id="Footnote_10_10"></a><a class="footnotea" href="#FNanchor_10_10">[10]</a>&nbsp;&nbsp;"Radial Paralysis and Its Treatment by Mechanical Fixation
+of Knee and Ankle," Geo. H. Berns, D.V.S. Proceedings of the American
+Veterinary Medical Association, 1912, p. 219.</p>
+
+<p class="footnote"><a name="Footnote_11_11" id="Footnote_11_11"></a><a class="footnotea" href="#FNanchor_11_11">[11]</a>&nbsp;&nbsp;As quoted by Berns, in Radial Paralysis, etc., Proceedings
+of the A.V.M.A., 1912.</p>
+
+<p class="footnote"><a name="Footnote_12_12" id="Footnote_12_12"></a><a class="footnotea" href="#FNanchor_12_12">[12]</a>&nbsp;&nbsp;Veterinary Surgical Operations, by L.A. Merillat, V.S., p.
+507.</p>
+
+<p class="footnote"><a name="Footnote_13_13" id="Footnote_13_13"></a><a class="footnotea" href="#FNanchor_13_13">[13]</a>&nbsp;&nbsp;A paper presented before the Illinois Veterinary Medical
+Assn. by Dr. H. Thompson of Paxton, Ill., American Veterinary Review,
+Vol. 15, p. 134.</p>
+
+<p class="footnote"><a name="Footnote_14_14" id="Footnote_14_14"></a><a class="footnotea" href="#FNanchor_14_14">[14]</a>&nbsp;&nbsp;"Fractures in Foals," by Dr. Wilfred Walters, M.R.C.V.S.,
+American Journal of Veterinary Medicine, Vol. 8, p. 669.</p>
+
+<p class="footnote"><a name="Footnote_15_15" id="Footnote_15_15"></a><a class="footnotea" href="#FNanchor_15_15">[15]</a>&nbsp;&nbsp;American Veterinary Review, Vol. 26, p. 1068.</p>
+
+<p class="footnote"><a name="Footnote_16_16" id="Footnote_16_16"></a><a class="footnotea" href="#FNanchor_16_16">[16]</a>&nbsp;&nbsp;Fractures, by H. Thompson, Paxton, Ill., American
+Veterinary Review, Vol. 15, p. 134.</p>
+
+<p class="footnote"><a name="Footnote_17_17" id="Footnote_17_17"></a><a class="footnotea" href="#FNanchor_17_17">[17]</a>&nbsp;&nbsp;Veterinary Surgical Operations, by L.A. Merillat, Vol. 3,
+p. 198.</p>
+
+<p class="footnote"><a name="Footnote_18_18" id="Footnote_18_18"></a><a class="footnotea" href="#FNanchor_18_18">[18]</a>&nbsp;&nbsp;Wilfred Walters, American Journal of Veterinary Medicine,
+Vol. 8, p. 606.</p>
+
+<p class="footnote"><a name="Footnote_19_19" id="Footnote_19_19"></a><a class="footnotea" href="#FNanchor_19_19">[19]</a>&nbsp;&nbsp;J.N. Frost, assistant professor of Surgery, Veterinary
+Dept., Cornell University, in "Wound Treatment," page 159.</p>
+
+<p class="footnote"><a name="Footnote_20_20" id="Footnote_20_20"></a><a class="footnotea" href="#FNanchor_20_20">[20]</a>&nbsp;&nbsp;Open Joints and Their Treatment in my practice, by J.V.
+Lacroix, American Journal of Veterinary Medicine, Vol. 5, page 203.</p>
+
+<p class="footnote"><a name="Footnote_21_21" id="Footnote_21_21"></a><a class="footnotea" href="#FNanchor_21_21">[21]</a>&nbsp;&nbsp;Regional Veterinary Surgery M&ouml;ller&mdash;Dollar, page 605.</p>
+
+<p class="footnote"><a name="Footnote_22_22" id="Footnote_22_22"></a><a class="footnotea" href="#FNanchor_22_22">[22]</a>&nbsp;&nbsp;Extract from Receuil de M&eacute;decine V&eacute;t&eacute;rinaire in Ameircan
+Veterinary Review, Vol. 23, p. 893.</p>
+
+<p class="footnote"><a name="Footnote_23_23" id="Footnote_23_23"></a><a class="footnotea" href="#FNanchor_23_23">[23]</a>&nbsp;&nbsp;Fracture of All the Sesamoid Bones, by R.F. Frost,
+M.R.C.V.S., A.V.D., Rangoon, Burmah, in American Veterinary Review, Vol.
+5, p. 362.</p>
+
+<p class="footnote"><a name="Footnote_24_24" id="Footnote_24_24"></a><a class="footnotea" href="#FNanchor_24_24">[24]</a>&nbsp;&nbsp;The Anatomy of the Domestic Animal, by Septimus Sisson,
+S.B., V.S.</p>
+
+<p class="footnote"><a name="Footnote_25_25" id="Footnote_25_25"></a><a class="footnotea" href="#FNanchor_25_25">[25]</a>&nbsp;&nbsp;Trait&eacute; De Th&eacute;rapeutique Chirurgicale Des Animaux
+Domestique, par P.J. Cadiot et J. Almy, Tome Second, page 547.</p>
+
+<p class="footnote"><a name="Footnote_26_26" id="Footnote_26_26"></a><a class="footnotea" href="#FNanchor_26_26">[26]</a>&nbsp;&nbsp;Anatomie Regionale Des Animaux Domestique, page 695.</p>
+
+<p class="footnote"><a name="Footnote_27_27" id="Footnote_27_27"></a><a class="footnotea" href="#FNanchor_27_27">[27]</a>&nbsp;&nbsp;Manual of Veterinary Physiology, by Major-General F.
+Smith, C.B., C.M.G., page 678.</p>
+
+<p class="footnote"><a name="Footnote_28_28" id="Footnote_28_28"></a><a class="footnotea" href="#FNanchor_28_28">[28]</a>&nbsp;&nbsp;M&ouml;ller's Regional Veterinary Surgery, by Dollar, page
+630.</p>
+
+<p class="footnote"><a name="Footnote_29_29" id="Footnote_29_29"></a><a class="footnotea" href="#FNanchor_29_29">[29]</a>&nbsp;&nbsp;Edinburgh Veterinary Review, Vol. VI, page 616.</p>
+
+<p class="footnote"><a name="Footnote_30_30" id="Footnote_30_30"></a><a class="footnotea" href="#FNanchor_30_30">[30]</a>&nbsp;&nbsp;Equine Laminitis or Pododermatitis, by R.C. Moore, D.V.S.,
+American Journal of Veterinary Medicine, Vol. XI, page 284.</p>
+
+<p class="footnote"><a name="Footnote_31_31" id="Footnote_31_31"></a><a class="footnotea" href="#FNanchor_31_31">[31]</a>&nbsp;&nbsp;American Journal of Veterinary Medicine, Vol. XI, page
+318.</p>
+
+<p class="footnote"><a name="Footnote_32_32" id="Footnote_32_32"></a><a class="footnotea" href="#FNanchor_32_32">[32]</a>&nbsp;&nbsp;The Shoeing of a Dropped Sole Foot by Dr. David W.
+Cochran, New York City, The Horse Shoers Journal, March, 1915.</p>
+
+<p class="footnote"><a name="Footnote_33_33" id="Footnote_33_33"></a><a class="footnotea" href="#FNanchor_33_33">[33]</a>&nbsp;&nbsp;Quittor and Its Treatment by the Hughes Method, J.T.
+Seeley, M.D.C., Seattle, Washington, Chicago Veterinary College
+Quarterly Bulletin, Vol. 9, page 27.</p>
+</div>
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_185" id="Page_185"></a></p>
+
+<p><a name="SECTION_IV" id="SECTION_IV"></a></p>
+
+<h2 class="sectionhead">SECTION IV.</h2>
+
+<h2>LAMENESS IN THE HIND LEG.</h2>
+
+
+<h3><a name="Anatomo-Physiological_Consideration_of_the_Pelvic_Limbs" id="Anatomo-Physiological_Consideration_of_the_Pelvic_Limbs"></a>Anatomo-Physiological Consideration of the Pelvic Limbs.</h3>
+
+<p>The pelvic bones as a whole constitute the analogue of the scapulae with
+respect to their function as a part of the mechanism of locomotive and
+supportive apparatus of the horse. The manner of attachment or
+connection between the ilia and the trunk is materially different from
+that of the scapulae, however, and the angles as formed by the long axes
+of the ilia in relation to the spinal column are maintained by two
+functionally antagonistic structures&mdash;the sacrosciatic ligaments, and
+the abdominal muscles by means of the prepubian tendon. The sacro-iliac
+articulations are such that a very limited amount of movement is
+possible; free movement, however, is unnecessary because of the
+enarthrodial (ball and socket) femeropelvic joint.</p>
+
+<p>The various muscles which exert their effect upon the pelvis in changing
+their relationship between the long axes of the ilia and spinal column,
+are concerned but little more in propulsion and weight bearing than are
+the pectoral muscles. A general treatise on the subject of lameness does
+not properly include such structures any more than it does the various
+affections of the dorsal, lumbar and sacral vertebrae or inflammation of
+the abdominal parietes. Involvement of such parts cause manifestations
+of lameness but the matter of establishing a diagnosis is difficult in
+many instances and in some cases impossible.</p>
+
+<p>The femeropelvic articulation is formed by the hemispherical head of the
+femur and the acetabulum; the latter constituting a cotyloid cavity
+which is deepened by the cotyloid ligament.</p>
+
+<p>The round ligament (ligamentum teres) is the principal binding structure
+of the hip joint and it arises in a notch in the head of the femur and
+is attached in the subpubic groove close to the acetabular notch.
+Another ligament, peculiar to Equidae&mdash;the accessory (pubiofemoral)&mdash;is
+attached to the head of the femur near the round ligament and passes
+through the cotyloid <a name="Page_186" id="Page_186"></a><a name="Page_187" id="Page_187"></a><a name="Page_188" id="Page_188"></a>notch and along the under side of the pubis. It
+is inserted or blends with the prepubic tendon. This ligament prevents
+extreme abduction of the leg. The joint capsule encompasses the
+articulation and is attached to the brim of the acetabulum and the edge
+of the head of the femur.</p>
+
+<p class="figcenter"><a name="image40" id="image40"></a>
+   <a href="./images/img40-full.jpg"><img src="./images/img40.jpg"
+   alt="Fig. 40&mdash;Sagital section of right hock. The section
+passes through the middle of the groove of the trochlea of the tibial
+tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick
+part of joint capsule over which deep flexor tendon plays. 4. Fibular
+tarsal bone (sustentaculum). A large vein crosses the upper part of the
+joint capsule (in front of 1). (From Sisson's ''Anatomy of the Domestic
+Animals.'')"
+   title="Fig. 40&mdash;Sagital section of right hock. The section
+passes through the middle of the groove of the trochlea of the tibial
+tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick
+part of joint capsule over which deep flexor tendon plays. 4. Fibular
+tarsal bone (sustentaculum). A large vein crosses the upper part of the
+joint capsule (in front of 1). (From Sisson's ''Anatomy of the Domestic
+Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 40&mdash;Sagital section of right hock. The section
+passes through the middle of the groove of the trochlea of the tibial
+tarsal bone. 1&nbsp;and 2.&nbsp;Proximal ends of cavity of hock joint. 3.&nbsp;Thick
+part of joint capsule over which deep flexor tendon plays. 4.&nbsp;Fibular
+tarsal bone (sustentaculum). A large vein crosses the upper part of the
+joint capsule (in front of 1). (From Sisson's "Anatomy of the Domestic
+Animals.")</p>
+
+<p class="figcenter"><a name="image41" id="image41"></a>
+   <a href="./images/img41-full.jpg"><img src="./images/img41.jpg"
+   alt="Fig. 41&mdash;Muscles of right leg; front view. The greater
+part of the long extensor has been removed. 1, 2, 3. Stumps of patellar
+ligaments. 4. Tuberosity of tibia. (From Sisson's ''Anatomy of the
+Domestic Animals.'')"
+   title="Fig. 41&mdash;Muscles of right leg; front view. The greater
+part of the long extensor has been removed. 1, 2, 3. Stumps of patellar
+ligaments. 4. Tuberosity of tibia. (From Sisson's ''Anatomy of the
+Domestic Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 41&mdash;Muscles of right leg; front view. The greater
+part of the long extensor has been removed. 1,&nbsp;2,&nbsp;3.&nbsp;Stumps of patellar
+ligaments. 4.&nbsp;Tuberosity of tibia. (From Sisson's "Anatomy of the
+Domestic Animals.")</p>
+
+<p>The stifle joint is analagous to the knee joint of man and is to be
+considered an atypical ginglymus (hinge) articulation formed by the
+femur, tibia and patella. The ligaments are femerotibial, femeropatellar
+and capsular.</p>
+
+<p>In addition to the usual provision for articulation of bones there are
+situated cartilaginous <i>menisci</i> between the condyles of the femur and
+the head of the tibia. These discs surround the tibial spine and are
+otherwise shaped to fit perfectly between the articular portions of the
+femur and tibia.</p>
+
+<p>Collateral ligaments (internal and external lateral) pass from the
+distal end of the femur to the proximal portion of the tibia. The mesial
+(internal) arises from the internal condyle of the femur and is attached
+to a rough area below the margin of the medial (internal) condyle of the
+tibia. The lateral (external), shorter and thicker, arises from the
+depression on the lateral epicondyle and inserts to the head of the
+fibula.</p>
+
+<p>The crucial or interosseus, anterior and posterior, are situated between
+the femur and tibia, and according to <span class="nowrap">Smith,<a name="FNanchor_34_34" id="FNanchor_34_34"></a><a href="#Footnote_34_34" class="fnanchor">[34]</a></span> the crucial ligaments
+are necessary to properly join the two bones, because of the character
+of the structure of the articular ends of the femur and tibia.</p>
+
+<p>The femeropatella ligaments are two thin bands which reinforce the
+capsular ligament. They arise from the lateral aspects of the femur,
+just above the condyles and are inserted to the corresponding surfaces
+of the patella.</p>
+
+<p>The patellar ligaments are three strong bands which arise from the
+antero-inferior surface of the patella, and are inserted to the anterior
+aspect of the tuberosity of the tibia.</p>
+
+<p>Taken as a whole, the tarsal bones, interarticulating and articulating
+with the tibia and metatarsal bones form the hock joint and this
+articulation is analagous to the carpus. As with the carpus, there is
+less movement in the inferior portion of the <a name="Page_189" id="Page_189"></a><a name="Page_190" id="Page_190"></a>joint than in the
+superior part of the articulation. The chief articulating parts are the
+tibia with the tibial tarsal bone (astragulus).</p>
+
+<p class="figcenter"><a name="image42" id="image42"></a>
+   <a href="./images/img42-full.jpg"><img src="./images/img42.jpg"
+   alt="Fig. 42&mdash;Muscles of lower part of thigh, leg and foot;
+lateral view, o', Fascia lata; q, q', q'', biceps femoris; r,
+semitendinosus; 21', lateral condyle of tibia. The extensor brevis is
+visible in the angle between the long and lateral extensor tendons.
+(After Ellenberger-Baum, Anat. f&uuml;r K&uuml;nstler.) (From Sisson's ''Anatomy of
+the Domestic Animals.'')"
+   title="Fig. 42&mdash;Muscles of lower part of thigh, leg and foot;
+lateral view, o', Fascia lata; q, q', q'', biceps femoris; r,
+semitendinosus; 21', lateral condyle of tibia. The extensor brevis is
+visible in the angle between the long and lateral extensor tendons.
+(After Ellenberger-Baum, Anat. f&uuml;r K&uuml;nstler.) (From Sisson's ''Anatomy of
+the Domestic Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 42&mdash;Muscles of lower part of thigh, leg and foot;
+lateral view, o',&nbsp;Fascia lata; q,&nbsp;q',&nbsp;q",&nbsp;biceps femoris;
+r,&nbsp;semitendinosus; 21',&nbsp;lateral condyle of tibia. The extensor brevis is
+visible in the angle between the long and lateral extensor tendons.
+(After Ellenberger-Baum, Anat. f&uuml;r K&uuml;nstler.) (From Sisson's "Anatomy of
+the Domestic Animals.")</p>
+
+<p>The capsular ligament is attached around the margin of the articular
+surfaces of the tibia, to the tarsal bones, the collateral ligaments
+(internal and external lateral) and to the metatarsus.</p>
+
+<p class="figcenter"><a name="image43" id="image43"></a>
+   <a href="./images/img43-full.jpg"><img src="./images/img43.jpg"
+   alt="Fig. 43&mdash;Right stifle joint; lateral view. The
+femoro-patellar capsule was filled with plaster-of-Paris and then
+removed after the cast was set. The femoro-tibial capsule and most of
+the lateral patellar ligament are removed. M. Lateral meniscus. (From
+Sisson's ''Anatomy of the Domestic Animals.'')"
+   title="Fig. 43&mdash;Right stifle joint; lateral view. The
+femoro-patellar capsule was filled with plaster-of-Paris and then
+removed after the cast was set. The femoro-tibial capsule and most of
+the lateral patellar ligament are removed. M. Lateral meniscus. (From
+Sisson's ''Anatomy of the Domestic Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 43&mdash;Right stifle joint; lateral view. The
+femoro-patellar capsule was filled with plaster-of-Paris and then
+removed after the cast was set. The femoro-tibial capsule and most of
+the lateral patellar ligament are removed. M. Lateral meniscus. (From
+Sisson's "Anatomy of the Domestic Animals.")</p>
+
+
+<p>The common ligaments of the tarsal joint are the collateral, the plantar
+(calcaneo-metatarsal and c. cuboid) and dorsal ligaments (oblique).</p>
+
+<p>The medial (internal lateral) ligament serves to join the medial
+(internal) tibial malleolus with tibial tarsal (astragalus) and other
+tarsal bones.</p>
+<p><a name="Page_191" id="Page_191"></a></p>
+
+<p>The lateral (external lateral) ligament is inserted to the lateral
+(external) tibial malleolus and its distal portions are attached to the
+tibial tarsal (astragalus), fibular tarsal (calcaneum) bone, fourth
+tarsal (cuboid) and metatarsus bones.</p>
+
+<p class="figcenter"><a name="image44" id="image44"></a>
+   <a href="./images/img44-full.jpg"><img src="./images/img44.jpg"
+   alt="Fig. 44&mdash;Left stifle joint; medial view. The capsules are
+removed. (From Sisson's ''Anatomy of the Domestic Animals.'')"
+   title="Fig. 44&mdash;Left stifle joint; medial view. The capsules are
+removed. (From Sisson's ''Anatomy of the Domestic Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 44&mdash;Left stifle joint; medial view. The capsules are
+removed. (From Sisson's "Anatomy of the Domestic Animals.")</p>
+
+
+<p>The plantar ligament (calcaneo-cuboid) is a strong flat band which is
+attached to the plantar surface of the fibular and fourth tarsal bones
+(calcaneum and cuboid) and the head of the lateral metatarsal (external
+small) bone.</p>
+
+<p>The dorsal (oblique) ligament is attached above to the distal tuberosity
+on the inner side of the tibia. It is inserted below to the central
+(cuneiform magnum) and third (c. medium) tarsal <a name="Page_192" id="Page_192"></a>bones, to the proximal
+ends of the large and outer small metatarsal bones.</p>
+
+<p>The tarsus is a true hinge joint and because of the great strain which
+it sustains, is subject to frequent injury. About seventy-five percent
+of cases of lameness affecting the hind leg may be said to arise from
+disease of the hock.</p>
+
+<p>As members of locomotion the legs receive strains of two kinds: those of
+concussion and weight-bearing and strains of propulsion; the latter are
+the greater. In the horse as a work animal, the hind legs are probably
+subjected to greater strains than are the front but the manner of
+construction of the various parts of the pelvic limbs with the possible
+exception (according to some authorities) of the tibial tarsal joint,
+offsets this condition.</p>
+
+<p>The femur may be considered analagous to the humerus in that it bears a
+similar relationship to the ilium, that exist between the humerus and
+scapula. Further flexion during repose is prevented chiefly by the
+glutens medius (maximus) muscle and its tendons. The larger tendon
+inserts to the summit of the trochanter major of the femur and
+corresponds to the biceps brachii in the action of the latter on the
+scapulohumeral joint, except that the gluteus medius, in attaching to
+the femoral trochanter, exerts its effect as a lever of the first class.
+Because of the relationship between the long axes of the femur and iliac
+shaft it is evident that the angle formed by these two bones is
+maintained chiefly by the gluteus muscles during weight bearing.
+Contraction of muscular fibers of the gluteus medius causes extension of
+the femur and muscular strain is prevented to a great degree by the
+inelastic portion of this muscle. The chief physiological antagonistics
+of the glutei are the quadriceps femoris and tensor fascia lata.</p>
+
+<p>While the leg is supporting weight the stifle joint is fixed in position
+mainly by the quadriceps femoris group of muscles which are attached to
+the patella. Tendinous fibres intersect this muscular mass and relieve
+muscular strain during weight bearing. Because of the manner in which
+the patella functionates with the trochlea of the femur, comparatively
+little energy is required to prevent further flexion of the stifle
+joint. The <a name="Page_193" id="Page_193"></a>patella, according to Strangeways, may be considered a
+sesamoid bone.</p>
+
+<p class="figcenter"><a name="image45" id="image45"></a>
+   <a href="./images/img45-full.jpg"><img src="./images/img45.jpg"
+   alt="Fig. 45&mdash;Left stifle joint; front view. The capsules are
+removed. 1. Middle patellar ligament. 2. Stump of fascia lata. 3. Stump
+of common tendon of extensor longus and peroneus tertius. (From Sisson's
+''Anatomy of Domestic Animals.'')"
+   title="Fig. 45&mdash;Left stifle joint; front view. The capsules are
+removed. 1. Middle patellar ligament. 2. Stump of fascia lata. 3. Stump
+of common tendon of extensor longus and peroneus tertius. (From Sisson's
+''Anatomy of Domestic Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 45&mdash;Left stifle joint; front view. The capsules are
+removed. 1.&nbsp;Middle patellar ligament. 2.&nbsp;Stump of fascia lata. 3.&nbsp;Stump
+of common tendon of extensor longus and peroneus tertius. (From Sisson's
+"Anatomy of Domestic Animals.")</p>
+
+
+<p>The quadriceps group of muscles is assisted by the anterior digital
+extensor (extensor pedis) peroneus tertius and tibialis anticus (flexor
+metatarsi) muscles. The latter pair (flexor metatarsi, muscular and
+tendinous portions, because of their attachment to the external condyle
+of the femur and to the metatarsal bone) are enabled to automatically
+flex the tarsal joint when the stifle is flexed.</p>
+<p><a name="Page_194" id="Page_194"></a></p>
+
+<p>The hock is kept fixed in position by the gastrocnemius and the
+superficial digital flexor (perforatus). The latter structure, which is
+chiefly tendinous, originates in the supracondyloid fossa of the femur
+and has an insertion to the summit of the fibular tarsal (calcis) bone.
+It relieves the gastrocnemius of muscular strain during weight bearing.</p>
+
+<p><span class="nowrap">Smith<a name="FNanchor_35_35" id="FNanchor_35_35"></a><a href="#Footnote_35_35" class="fnanchor">[35]</a></span> styles the function of the stifle and hock joints a
+reciprocating action, and we quote from this authority the following:</p>
+
+<div class="blockquot"><p>From what has been said, it is evident that flexion and extension
+of stifle and hock are identical in their action. When the stifle
+is extended, the hock is automatically extended, nor can it under
+any circumstances flex without the previous flexion of the stifle.
+There is no parallel to this in the body. The two joints, though
+far apart, act as one, and they are locked by the drawing up of the
+patella, and in no other way. The so-called dislocation of the
+stifle in the horse is a misnomer. That the patella is capable of
+being dislocated is beyond doubt, but the ordinary condition
+described under that term, when the stifle and hock are rigid while
+the foot is turned back with its wall on the ground, is nothing
+more than spasm of the muscles which keeps the patella drawn up.
+The moment they relax the previously immovable limb and useless
+foot have their function restored as if by magic, but are
+immediately thrown out of gear in the course of a few minutes as a
+recurrence of the tetanus of the petallar muscle takes place. The
+fascia of the thigh, like that of the arm, is a most potent factor
+in giving assistance to the constant strain imposed on the muscles
+of the limbs during standing.</p>
+
+<p>Below the hock the hind limb is arranged like that of the fore, the
+deep flexor (perforans) receiving its additional support from the
+"check ligament," as in the fore leg.</p>
+
+<p>The natural attitude of standing adopted by the horse is to rest on
+three legs&mdash;one hind and two fore. If he is alert, he stands on all
+four limbs; but if standing in the ordinary manner, he always rests
+on one hind leg. He does not remain long in this position without
+changing to the other. Hour by hour he stands, shifting his weight
+at intervals from one to the other hind leg, and resting its fellow
+by flexing the hock and standing on the toe. He never spares his
+fore-limbs in this manner in a state of health, but always stands
+squarely on them.</p></div>
+
+<p><a name="Page_195" id="Page_195"></a></p>
+
+
+<h3><a name="Hip_Lameness" id="Hip_Lameness"></a>Hip Lameness.</h3>
+
+<p>Fortunately, because of the heavy musculature which goes to form a part
+of the locomotive apparatus of the rear extremity, hip lameness is
+comparatively rare. While the term is in itself ambiguous and signifies
+nothing more definite than does "shoulder lameness," yet diagnosis of
+almost any condition that may be classed under the head of "hip
+lameness" is not easy except in cases where the cause is obvious, as in
+wounds of the musculature and certain fractures. To the complexity which
+the gait of the quadruped contributes, because of its being four-legged,
+there is added the complicated manner of articulation of the bones of
+the hind leg. This involves the hip in the manner of diagnostic problems
+and because of the inaccessibility of certain parts, owing to the bulk
+of the musculature of these parts, diagnosis of some hip ailments
+becomes an intricate problem. Consequently, in some instances, before
+one may arrive at definite and enlightening conclusions, repeated
+examinations are necessary as well as a knowledge of reliable history
+and recorded observations of the subject over a considerable period.</p>
+
+<p>Rheumatic affections, when present, usually cause recurrent attacks of
+lameness; myalgia, due to subsurface injury occasioned by contusion,
+generally produces an ephemeral disturbance; and while these are
+examples of cases where occult causes are active, they are by no means
+unprecedented. In cases where the cause of lameness is not definitely
+located, and when by the process of exclusion one is enabled to decide
+that the seat of trouble is in the hip, a tentative diagnosis of hip
+lameness is always appropriate.</p>
+
+<p>In one instance a Shetland pony evinced a peculiar form of intermittent
+lameness which affected the left hip, and repeated examinations did not
+disclose the cause of the trouble. After about a year there was
+established spontaneously an opening through the integument overlying
+the region of the attachment of the psoas major (magnus), through which
+pus discharged. With the occurrence of this fistula, lameness almost
+entirely disappeared, but the emission of a small amount of pus
+persisted for more than a year. The subject was not observed thereafter
+<a name="Page_196" id="Page_196"></a>and the outcome in this case is not a matter of record. Whether there
+existed a psoic phlegmon due to metastatic infection or necrosis of a
+part of a lumber or dorsal vertebra is a matter for speculation. Thus
+the presence of some anomalous conditions which affect the pelvic region
+and cause lameness may be discovered, yet both in hip and shoulder
+regions causes may not be definitely located by means of practical
+methods of examination.</p>
+
+<p>Injuries of all kinds are the more frequent causes of hip lameness. In
+such cases, lameness may result directly and resolution be prompt, or
+the claudication become aggravated in time, due to muscular atrophy or
+degenerative changes affecting the hip joint or nerves. Rheumatism or
+metastatic infection may be the cause of hip lameness as well as
+affections of the pelvic bones, lumbar and sacral vertebrae. Hip
+lameness may also be provoked by melanotic or other tumors.</p>
+
+<p>In the diagnosis of hip lameness, one is guided in a general way by the
+character of the impediment manifested. Swinging-leg lameness is often
+present and the impediment is more accentuated when the animal is caused
+to step backward. In many cases lameness is mixed, being about equally
+noticeable during weight bearing and while the member is being swung. By
+exclusion of causes which might affect other parts; one may definitely
+locate the cause of the trouble or determine that a certain region is
+affected.</p>
+
+<p>The sudden manifestation of lameness is indicative of injury; thermic
+disturbances may signalize metastatic infection; history, if dependable,
+is always helpful. Repeated observations, taking into account the course
+which the affection assumes during a period of a few days, often serve
+to afford a means of establishing a diagnosis in baffling cases.</p>
+
+
+<h3><a name="Fractures_of_the_Pelvic_Bones" id="Fractures_of_the_Pelvic_Bones"></a>Fractures of the Pelvic Bones.</h3>
+
+<p>The os innominatum may be so fractured that the pelvic girdle is broken,
+as in fracture of the iliac shaft, or in a manner that the girdling
+continuity of the innominate bones is not interrupted. It naturally
+follows that greater injury is done when the pelvic girdle is broken
+than when it is not, except in cases <a name="Page_197" id="Page_197"></a>where the acetabulum is involved
+and its brim not completely divided.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Pelvic fractures are usually caused by falls
+or other manner of contusion. Cases are reported where it would seem
+that fracture of the iliac angle resulted from muscular contraction, but
+it is certain that most fractures of this kind are due to collisions
+with door jambs or similar injuries. In old horses especially, fracture
+of pelvic bones occurs frequently. This form of injury is of more
+frequent occurrence in animals of all ages that work on paved streets.
+The country horse is not subjected to the uncertain footing of the
+slippery pavement, nor to injuries which compare with those caused by
+contusions sustained in falling upon asphalt or cobble-stones.</p>
+
+<p><b>Symptomatology.</b>&mdash;While in many cases of pelvic fracture lameness or
+abnormal decumbency are the salient manifestations, yet the pathognomic
+symptoms are crepitation or palpable evidence which may be obtained by
+rectal or vaginal examination. In fractures of the angle of the ilium
+and the ischial tuberosity, perceptible evidence always exists.</p>
+
+<p>In cases where fracture of some portion of the pelvic girdle is
+suspected and the subject is able to walk, crepitation is sought by
+placing one hand on an external angle of the ilium and the other on the
+ischial tuberosity and the animal is then made to walk. Or, by placing
+the hands as just directed, an assistant may grasp the horse's tail and
+by alternately exerting traction on the tail and pushing against the hip
+in such manner that weight is shifted from one leg to the other,
+crepitation may be detected.</p>
+
+<p>Fracture of the pubis near its symphysis constitutes a grave injury, as
+there is danger of the bladder becoming caught in the fissure and
+perforation of its wall may result. Such a case is reported by
+<span class="nowrap">Bauman<a name="FNanchor_36_36" id="FNanchor_36_36"></a><a href="#Footnote_36_36" class="fnanchor">[36]</a></span> wherein a three-year-old gelding bore the history of having
+been lame for ten days. Upon rectal examination the bladder was found to
+be hard and tumor-like and about the size of a baseball. The body of the
+ischium in this case <a name="Page_198" id="Page_198"></a>was fractured and a rent in the bladder was caused
+by a sharp projecting piece of bone. Autopsy revealed, in addition to
+the fracture and rent of the bladder wall, a large quantity of urine in
+the peritoneal cavity.</p>
+
+<p>In other instances hemorrhage caused death and not infrequently
+infection was responsible for a fatal issue. <span class="nowrap">Moller,<a name="FNanchor_37_37" id="FNanchor_37_37"></a><a href="#Footnote_37_37" class="fnanchor">[37]</a></span> quoting Nocard,
+describes a case where fracture occurred through the region of the
+foramen ovale and paralysis of the obturator nerve followed.</p>
+
+<p>Fractures which include the acetabular bones cause great pain. This is
+manifested by marked lameness, both during weight bearing and when the
+member is swung. Such cases terminate unfavorably&mdash;complete recovery is
+impossible.</p>
+
+<p>Where small portions of the angle of the ilium are broken, and the skin
+is left intact, there exists the least troublesome class of pelvic
+fracture. If large portions of the ilium are fractured, considerable
+disturbance results. There eventually occurs more or less displacement
+in such cases, if such displacement does not take place at the time of
+injury. The same may be said of fracture of the tuber ischii, but when
+these bones are fractured a more serious condition results.</p>
+
+<p><b>Treatment.</b>&mdash;When a case is found to be uncomplicated, that is, if the
+fracture is such that recovery seems possible and after having
+determined that treatment may be practicable, the first consideration is
+that of confining the subject in suitable slings. In many cases of
+pelvic fracture, the affected animal will need to be kept in slings from
+six weeks to three months, and it becomes a difficult problem to
+minimize the distress during this long period of confinement in the
+peculiar manner required for favorable outcome.</p>
+
+<p>The pattern of sling employed should be the best that is obtainable and
+the matter of its adjustment is quite important lest unnecessary chafing
+or even necrosis of skin result. Frequent readjustment may be necessary,
+and time is well spent in this manner since this contributes materially
+toward a favorable termination by encouraging the subject to remain
+quiet so that <a name="Page_199" id="Page_199"></a>coaptation of the broken bones may be maintained. Aside
+from slings, mechanical appliances that are helpful in the treatment of
+these cases are not yet in use.</p>
+
+<p>A regimen that is nutritive and at the same time laxative is essential
+and in some cases cathartics and enemata are necessary. Also, during the
+first few days, if there is retention of urine, catheterization is
+imperative. In a word, the handling of such cases consists largely in
+keeping the subject inactive, as comfortable as possible, and giving
+attention to suitable diet.</p>
+
+<p>Simple fracture of the external iliac angle needs no particular
+attention, except that the subject is kept quiet until lameness
+subsides. In all cases where much of the bone is broken, the animal is
+blemished, but interference with function does not follow. If infection
+results because of a compound fracture, loose pieces of bone must be
+removed surgically and drainage provided for.</p>
+
+<p>In fracture of the ischial tuberosity, infection is more apt to result
+than in like injury of the ilium, and greater displacement of bone
+occurs. This displacement, due to contraction of the attached muscles,
+is in some instances a contributing cause to the infection which often
+follows in these cases. In females where the body of the ischium is
+fractured, lacerations of the vagina may be present, and this
+constitutes a serious complication which usually terminates fatally.</p>
+
+<p>After-care in fracture of the pelvic girdle consists principally in
+allowing a protracted period of rest before subjects are put to work.</p>
+
+
+<h3><a name="Fractures_of_the_Femur" id="Fractures_of_the_Femur"></a>Fractures of the Femur.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This is a comparatively rare injury in the
+horse because of the protection afforded the femur by the heavy
+musculature. Fragilitas of the bone probably exists in many cases when
+fracture of its diaphysis occurs. It is generally conceded that the neck
+of the femur is rarely broken because of a lack of constriction in this
+part, but fracture of the trochanters has been recorded rather
+frequently. However, Lienaux and <span class="nowrap">Zwanenpoete<a name="FNanchor_38_38" id="FNanchor_38_38"></a><a href="#Footnote_38_38" class="fnanchor">[38]</a></span> state that fracture of
+the neck of the femur is of frequent occurrence in Belgian colts.
+<span class="nowrap">Tapley<a name="FNanchor_39_39" id="FNanchor_39_39"></a><a href="#Footnote_39_39" class="fnanchor">[39]</a></span><a name="Page_200" id="Page_200"></a> reports in the Veterinary Journal (English) fracture of the
+head and internal trochanter of the femur and patellar luxation
+occurring simultaneously affecting a mule. In this case the mule was
+found decumbent on a concrete floor. After three weeks, the subject was
+destroyed and autopsy revealed rupture of the left pubiofemoral
+ligament, tearing with it a portion of the articular surface of the
+femur. The internal trochanter was also fractured in four small pieces.
+In this case it is fair to suppose that the mule in trying to regain
+footing on a slippery floor violently abducted the legs and fracture
+resulted. It is possible also that a temporary luxation of the patella
+took place first and caused the animal to struggle in such manner that
+fracture followed.</p>
+
+<p class="figcenter"><a name="image46" id="image46"></a>
+   <a href="./images/img46-full.jpg"><img src="./images/img46.jpg"
+   alt="Fig. 46&mdash;Oblique fracture of the femur of a 1,500
+six-year-old draft horse. Showing shortening of bone, owing to a lateral
+approximation of the diaphysis because of muscular contraction. Photo by
+Dr. Edward Merillat."
+   title="Fig. 46&mdash;Oblique fracture of the femur of a 1,500
+six-year-old draft horse. Showing shortening of bone, owing to a lateral
+approximation of the diaphysis because of muscular contraction. Photo by
+Dr. Edward Merillat." /></a></p>
+<p class="captioncenter">Fig. 46&mdash;Oblique fracture of the femur of a 1,500
+six-year-old draft horse. Showing shortening of bone, owing to a lateral
+approximation of the diaphysis because of muscular contraction. Photo by
+Dr. Edward Merillat.</p>
+
+
+<p><b>Symptomatology.</b>&mdash;According to Cadiot and <span class="nowrap">Almy,<a name="FNanchor_40_40" id="FNanchor_40_40"></a><a href="#Footnote_40_40" class="fnanchor">[40]</a></span> "regardless of the
+location of femoral fractures, the subject is usually intensely lame,
+the animal frequently walking on three legs&mdash;fractures of the diaphysis
+are characterized by an abnormal mobility."</p>
+
+<p>As a rule, crepitation is to be recognized in fractures of the <a name="Page_201" id="Page_201"></a>shaft of
+the bone, by passively moving the leg to and from the medial plane
+(adduction and abduction).</p>
+
+<p>Fracture of the trochanter major is signalized by local swelling and
+evidence of pain; the forward stride is shortened because this movement
+tenses the tendon of the gluteus major (maximus) which is attached
+principally to the trochanter.</p>
+
+<p class="figcenter"><a name="image47" id="image47"></a>
+   <a href="./images/img47-full.jpg"><img src="./images/img47.jpg"
+   alt="Fig. 47&mdash;Same bone as in Fig. 46 after about six months'
+treatment. In this case Dr. Merillat employed a weight to counteract
+muscular contraction. It is noticeable that very little provisional
+callus has formed in this case, and in spite of unusual ingenuity and
+good facilities for caring for the subject, union of bone did not
+occur."
+   title="Fig. 47&mdash;Same bone as in Fig. 46 after about six months'
+treatment. In this case Dr. Merillat employed a weight to counteract
+muscular contraction. It is noticeable that very little provisional
+callus has formed in this case, and in spite of unusual ingenuity and
+good facilities for caring for the subject, union of bone did not
+occur." /></a></p>
+<p class="captioncenter">Fig. 47&mdash;Same bone as in <a href="#image46">Fig. 46</a> after about six months'
+treatment. In this case Dr. Merillat employed a weight to counteract
+muscular contraction. It is noticeable that very little provisional
+callus has formed in this case, and in spite of unusual ingenuity and
+good facilities for caring for the subject, union of bone did not
+occur.</p>
+
+
+<p><b>Treatment.</b>&mdash;Reduction of femoral fracture in the horse is practically
+impossible, and retaining the broken bones in coaptation is not possible
+by means of mechanical appliances. Consequently, prognosis is
+unfavorable in fracture of the body of the femur. When union of bone
+occurs, there results shortening of the leg and animals are rendered
+permanently lame. If the immediate region of the head of the bone is
+involved as well as in case of fracture of the condyles, an incurable
+arthritis ensues.</p>
+
+<p>Where the trochanters are broken, chronic lameness and muscular atrophy
+is the result. Therefore, it is evident that, because of the manner of
+function of the femur, the leverage afforded by its great trochanter and
+its heavy muscular attachments, fractures of this bone in the horse do
+not terminate favorably.</p>
+
+
+<h3><a name="Luxation_of_the_Femur" id="Luxation_of_the_Femur"></a>Luxation of the Femur.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Uncomplicated femoral luxation is of less
+frequent occurrence in the horse than in the other <a name="Page_202" id="Page_202"></a>domestic animals.
+The deep cotyloid cavity renders disarticulation difficult and luxation
+does not often take place. Complications that usually occur are rupture
+of the round (coxofemoral) ligament or fracture of the neck of the
+femur. Falls or violent strains are necessary to produce this luxation.
+Goubaux is quoted by Cadiot and <span class="nowrap">Almy<a name="FNanchor_41_41" id="FNanchor_41_41"></a><a href="#Footnote_41_41" class="fnanchor">[41]</a></span> as having observed the head of
+the femur in an instance wherein luxation had long existed. In this case
+autopsy revealed the fact that the inner portion (two-thirds) of the
+head of the femur had completely disappeared.</p>
+
+<p>Luxation of the femur is observed in old emaciated animals that are
+worked on slippery pavements. Occasionally, evidence of chronic luxation
+of the femur is observed in the anatomical laboratory. The chronicity of
+the condition is obvious when one notes the well formed articulation
+which Nature provides for the head of the femur, where fracture or other
+serious complications are not present.</p>
+
+<p><b>Symptomatology.</b>&mdash;In every case there must exist either restriction of
+movement or an evident abnormal position of the leg, or both conditions
+may exist at once. Also, the leg may be markedly shortened.
+Manifestation of this affection varies, depending upon the character of
+the luxation (position of the head of the humerus with relation to the
+acetabulum). <span class="nowrap">Lusk<a name="FNanchor_42_42" id="FNanchor_42_42"></a><a href="#Footnote_42_42" class="fnanchor">[42]</a></span> cites a case of a mule which had suffered femoral
+luxation. The animal was destroyed and on autopsy the head of the femur
+found to be contained within a false articular cavity situated about
+four inches above the acetabulum. In Dr. Lusk's case as he states it,
+the following symptoms were presented: "Limb shortened and fixed in a
+position of adduction. While standing the affected limb hung directly
+across and in front of the opposite one; upper trochanter very
+prominent; skin over hip joint very tense. The mobility of the limb was
+very limited, especially in the forward direction."</p>
+
+<p>Being very prominent when there is an upward luxation and less
+perceptible in downward displacement, the location of the trochanter
+major is an indicator of the character of the luxation with respect to
+the position of the head of the femur. This <a name="Page_203" id="Page_203"></a>variation of position
+causes abnormal tenseness or looseness of the skin over the region of
+the trochanter major. Rectal examination is of aid in locating the head
+of the humerus.</p>
+
+<p><b>Treatment.</b>&mdash;When it is evident that a subject should be given
+treatment and not destroyed, the animal must be cast and completely
+anesthetized. With complete relaxation thus secured by rotation of the
+limb, using the hip joint region as a pivot, reduction may be effected.
+Traction is exerted in the same direction from the acetabulum that the
+head of the femur is situated and by pressing over the joint, the
+displaced bone may be returned in position. If luxation is downward,
+traction on the extremity will tend to dislodge the head of the femur
+from the inferior acetabular margin making reduction possible.</p>
+
+<p>The same general plan which is ordinarily employed in correcting
+luxation is indicated here, but because of the heavy musculature of the
+hip, complete anesthesia is imperative in all such manipulations.</p>
+
+
+<h3><a name="Gluteal_Tendo-Synovitis" id="Gluteal_Tendo-Synovitis"></a>Gluteal Tendo-Synovitis.</h3>
+
+<p>The glutens medius (g. maximus) muscle is inserted chiefly by means of
+two tendons; one to the summit of the trochanter major of the femur and
+the other passing over the anterior part of the convexity of the
+trochanter, and being attached to the crest below it. The trochanter is
+covered with cartilage, and a bursa (the trochanteric) is interposed
+between the tendon and the cartilage.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This affection is probably caused in most
+instances by direct injury to the parts, such as may be occasioned by
+being kicked, falling on pavement, or being struck by the body of a
+heavy wagon. Strains in pulling or in slipping are undoubtedly causative
+factors and in draft horses such strains may result in involvement of
+this synovial apparatus.</p>
+
+<p><b>Symptomatology.</b>&mdash;If pain be severe and inflammation acute, weight may
+not be borne with the affected member. There is some local manifestation
+of the condition in acute cases. Swelling of the tissues contiguous to
+the bursa is present and <a name="Page_204" id="Page_204"></a>pain is evinced upon manipulation of the
+parts. A characteristic gait marks inflammation of the trochanteric
+bursa, and as Gunther has put it, the subject generally moves or trots
+as does the dog&mdash;the sound member being carried in advance of the
+affected one and the forward stride of the diseased leg is shortened. In
+some chronic cases crepitation is discernible by holding the hand on the
+trochanter while the subject walks.</p>
+
+<p><b>Treatment.</b>&mdash;In the first stages of an acute affection absolute quiet
+must be enforced; local antiphlogistic applications are beneficial.
+Later, vesication of a liberal area surrounding the trochanter major is
+indicated. Where the condition has become chronic in horses that are to
+be kept at heavy draft work there is little chance for complete
+recovery. And, naturally, one is not to expect resolution in cases where
+there exist erosion and ossification of cartilage&mdash;where crepitation is
+discernible.</p>
+
+
+<h3><a name="Paralysis_of_the_Hind_Leg" id="Paralysis_of_the_Hind_Leg"></a>Paralysis of the Hind Leg.</h3>
+
+<p>Aside from paraplegic conditions due to disease of the cord or the
+lumbosacral plexus, and monoplegic affections resultant from
+disturbances of this plexus, paralysis of certain nerves are
+occasionally encountered.</p>
+
+<p><b>Anatomy.</b>&mdash;The lumbosacral plexus results substantially from the union
+of the ventral branches of the last three lumbar and the first two
+sacral nerves, but it derives a small root from the third lumbar nerve
+also. The anterior part of the plexus lies in front of the internal
+iliac artery, between the lumbar transverse processes and the psoas
+minor. It supplies branches to the <span class="nowrap">iliopsoas<a name="FNanchor_43_43" id="FNanchor_43_43"></a><a href="#Footnote_43_43" class="fnanchor">[43]</a></span> (designated by Girard,
+the iliacomuscular nerves). The posterior part lies partly upon and
+partly in the texture of the sacrosciatic ligament. From the plexus are
+derived the nerves of the pelvic limb (Sisson).</p>
+
+
+<h3><a name="Paralysis_of_the_Femoral_Crural_Nerve" id="Paralysis_of_the_Femoral_Crural_Nerve"></a>Paralysis of the Femoral (Crural) Nerve.</h3>
+
+<p><b>Anatomy.</b>&mdash;The femoral nerve (crural) is derived chiefly from the
+fourth and fifth lumbar nerves. It runs ventrally <a name="Page_205" id="Page_205"></a>and backward, at
+first between the psoas major and minor, then crosses the deep face of
+the tendon of the latter and descends under cover of the sartorious over
+the terminal part of the iliopsoas. It innervates the psoas major
+(magnus), psoas minor (parvus), sartorious, rectus femoris, vastus
+lateralis (interims). Branches supply the stifle and the adductor and
+pectineus muscles.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;While paralysis of the femoral nerve, also
+known as "dropped stifle" occurs as a result of local injuries and
+melanotic tumors in gray horses, most cases are due to azoturia.
+So-called crural paralysis or "hip swinney" is occasionally observed but
+this is not a condition wherein the nerve is affected in the manner that
+characterizes the marked atrophy of quadriceps femoris (crural) muscles
+in some cases of hemaglobinuria. This form of paralysis according to
+Hutyra and Marek is due primarily to diffuse degeneration of the
+muscles.</p>
+
+<p><b>Symptomatology.</b>&mdash;When muscular atrophy is not extensive no particular
+evidence of this condition may be manifested while the subject is at
+rest, but where muscular waste has occurred, the nature of the ailment
+is at once recognized. Since the femoral nerve supplies the quadriceps
+femoris muscles, it follows that when the psoic portion of this nerve
+becomes diseased, the stifle loses its support, and in a unilateral
+involvement when the subject attempts to walk on the affected member,
+the stifle sinks down for want of support and the leg collapses unless
+weight is caught up with the other leg. Often, following azoturia, a
+bilateral affection is to be observed.</p>
+
+<p><b>Treatment.</b>&mdash;Horses may be restrained in the standing position, and in
+the average instance, a twitch and hood are all the restraining
+appliances necessary.</p>
+
+<p>In cases where the disease is unilateral and atrophy is not of too long
+standing, recovery is possible in vigorous subjects. All affections,
+however, wherein degenerative changes involve the nerve trunk, whether
+due to diffuse myositis or pressure from malignant tumors, will not
+yield to treatment.</p>
+
+<p>The same general plan of treatment is indicated that is described on
+page <a href="#Page_74">74</a> in the consideration of atrophy of the <a name="Page_206" id="Page_206"></a>scapular muscles. It is
+especially important to provide for the subject to be exercised when
+there is atrophy of the quadriceps muscles following azoturia.</p>
+
+<p>In addition to the foregoing, good results have attended the use of
+intramuscular injections of oxygen. The technic of the operation
+consists in preparing the area of skin which covers the atrophied
+muscles as for any operation. The hair is clipped over five or six or
+more circular areas of about an inch in diameter; the skin is cleansed
+and then painted with tincture of iodin.</p>
+
+<p>A long heavy sterile needle, which is connected with an oxygen tank by
+means of six feet of rubber tubing, is thrust into the depths of the
+affected muscles and the gas is gently introduced into the tissues. One
+needs exercise extreme care that the gas enter slowly because great pain
+is produced by the sudden injection of the oxygen. Likewise too much of
+the gas must not be introduced at one place. When the oxygen is slowly
+introduced it may be allowed to enter the tissues until the subject
+gives evidence of experiencing considerable pain, or if the parts are
+not particularly sensitive, a reasonable amount (enough to cause a mild
+degree of diffuse inflammation) is introduced at each one of five or six
+points. In large animals more points of injection may be used.</p>
+
+<p>No infection or other bad results will follow the execution of a good
+technic and the treatment may be repeated every three or four weeks
+until either marked regeneration of tissue is evident or the case is
+obviously proved hopeless.</p>
+
+
+<h3><a name="Paralysis_of_the_Obturator_Nerve" id="Paralysis_of_the_Obturator_Nerve"></a>Paralysis of the Obturator Nerve.</h3>
+
+<p><b>Anatomy.</b>&mdash;The obturator nerve, situated at first under the peritoneum,
+accompanies the obturator artery through the obturator foramen and
+gaining the muscles on the internal face of the thigh, terminates in the
+obturator externus, adductors, pectineus and gracilis, also giving twigs
+to the obturator internus (Strangeways).</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This condition occurs upon rare occasions as
+the result of injury such as falls which cause extreme abduction of the
+legs, or in pelvic fracture where the <a name="Page_207" id="Page_207"></a>nerve is directly injured, or
+when melanotic tumors or other new growths compress the nerve in such
+manner that its function is suspended. Paralysis of the obturator nerve
+or nerves is met with rather frequently, notwithstanding, in mares,
+following dystocia. The nerves (one or both) may become bruised at the
+brim of the obturator foramen by being caught between the pelvis and the
+body of the fetus in some cases of protracted labor.</p>
+
+<p><b>Symptomatology.</b>&mdash;In a unilateral affection there may be little
+evidence of the trouble while the subject is standing; or there is to be
+seen some abduction; or the affected member may present abduction of the
+stifle and stand "toe outward." If the animal is walked there will be
+manifested more or less abduction and the character of the impediment
+varies according to the nature of the involvement.</p>
+
+<p>Following protracted cases of labor in some instances where only a
+unilateral paralysis exists, walking is performed with difficulty; the
+subject may be unable to support weight with the affected member and is
+obliged to hop on the one sound hind leg. In bilateral affections, they
+are unable to rise. If the condition is severe the sling is required to
+keep the subject standing, and with this care, recovery will follow.</p>
+
+<p><b>Treatment.</b>&mdash;If new growths or callosities or similar conditions affect
+the nerve, little, if any, hope for recovery exists. In young and
+vigorous subjects where cause is not definitely known, a course of
+strychnin may be given. Good nursing, providing for the subject's
+comfort and allowing moderate exercise, constitute rational treatment.
+Stimulating embrocations on the abductor muscles resorted to in cases
+during the incipient stage may prove helpful.</p>
+
+<p>When paralysis of the obturator nerve occurs as a post-partum
+complication, and other conditions are favorable, the subject should be
+raised to its feet without unnecessary delay. If the mare is unable to
+assist in regaining her feet, a sling is required. Usually little else
+is necessary and after a few days in the sling the subject can get about
+unassisted. In the meanwhile the well-being of the affected animal is to
+be considered just as in any other case where the patient is so
+confined. The foal in <a name="Page_208" id="Page_208"></a>such instances constitutes a source of some
+trouble, but the average mare offers no serious resistance to the
+confinement occasioned by the sling.</p>
+
+<p>Good hygienic care, a suitable diet and full physiological doses of
+strychnin are indicated. Cadiot and Almy recommend vaginal douches of
+cold water and counterirritation of the region of the inner thigh in
+these cases.</p>
+
+
+<h3><a name="Paralysis_of_the_Sciatic_Nerve" id="Paralysis_of_the_Sciatic_Nerve"></a>Paralysis of the Sciatic Nerve.</h3>
+
+<p><b>Anatomy.</b>&mdash;The great sciatic nerve leaves the pelvis in company with
+the gluteal nerves, through the great sciatic foramen (notch), passing
+downward along the posterior face of the femur. Near the stifle it
+passes between the two heads of the gastrocnemius muscle and continues
+as the tibial. Branches supply the following muscles&mdash;obturator,
+semimembranosus (adductor magnus), biceps femoris (triceps abductor
+femoris), semitendinosus (biceps rotator tibialis), lateral extensor
+(peroneus) and the tibial nerve, its continuation, innervates the
+digital flexors.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Paralysis of the great sciatic nerve may be
+caused by central disorders, injury in falling, fractures and new
+growths. Because of its protected position, this nerve does not often
+suffer injury, and paralysis of the sciatic nerve is recorded in a few
+instances owing to its rarity.</p>
+
+<p><b>Symptomatology.</b>&mdash;When consideration is given the number of muscles
+that are supplied by the sciatic nerve and the function of these
+muscular structures, it is obvious that the leg cannot be used in
+sciatic paralysis. However, the limb is capable of sustaining weight
+when it is fixed in position, but this is done without exertion of
+muscular fibers which are supplied by the great sciatic nerve. Trotting
+is impossible and flexion of the affected member is also likewise
+precluded. The foot is dragged when the subject is caused to advance.</p>
+
+<p>Under the heading "sciatica," <span class="nowrap">Scott<a name="FNanchor_44_44" id="FNanchor_44_44"></a><a href="#Footnote_44_44" class="fnanchor">[44]</a></span> has described a case of acute
+sciatic affection wherein a pacing horse manifested evidence of great
+pain of a nervous character. There were muscular <a name="Page_209" id="Page_209"></a>twitchings and the leg
+was held off the floor and moved about convulsively. Breathing was very
+much accelerated, pulse 85 per minute, the temperature was 103&deg; and
+manipulation of the hips augmented the pain.</p>
+
+<p>This was not a paralytic condition and recovery resulted, yet
+undoubtedly this was a case which, if not properly cared for, might have
+terminated unfavorably.</p>
+
+<p><b>Treatment.</b>&mdash;Prognosis is decidedly unfavorable in paralysis of the
+great sciatic nerve. If treatment is attempted, it is to be conducted
+along the same general lines as in femoral paralysis. Particular
+attention should be given to conditions which will make for the
+patient's comfort, and as soon as it is evident that the affection is
+not progressing favorably, the subject should be humanely destroyed.</p>
+
+
+<h3><a name="Iliac_Thrombosis" id="Iliac_Thrombosis"></a>Iliac Thrombosis.</h3>
+
+<p>This condition is undoubtedly of more frequent occurrence than we are
+wont to grant when one considers the comparatively small number of cases
+that are actually recognized in practice. It does not follow, however,
+that iliac thrombosis rarely exists. Probably in the majority of
+instances there is insufficient obstruction of the lumina of vessels to
+provoke noticeable inconvenience. Or, if circulation is hampered to the
+extent that function is impaired and manifestations are observed by the
+driver, the subject may be permitted to rest a few days and partial
+resolution occurs, so that further trouble is not noticeable.</p>
+
+<p>As judged by lesions of the aorta and iliac arteries in dissecting
+subjects, the conclusion that arteritis and resultant disorders are of
+rather frequent occurrence, is logical.</p>
+
+<p><b>Etiology.</b>&mdash;Inflammation of the vessel walls and resultant
+prolifieration of tissue together with the accumulation of clotted blood
+becoming organized, serve to obstruct the lumen of the affected artery.
+The cause of arteritis is unknown in many instances, but parasitic
+invasion and contiguous involvement of vessels in some inflammatory
+injuries are etiological factors.</p>
+
+<p><b>Symptomatology.</b>&mdash;A characteristic type of lameness signalizes iliac
+thrombosis and the following brief abstract from a <a name="Page_210" id="Page_210"></a>contribution on this
+subject by Drs. <span class="nowrap">Merillat<a name="FNanchor_45_45" id="FNanchor_45_45"></a><a href="#Footnote_45_45" class="fnanchor">[45]</a>,</span> clearly portrays the chief symptoms:</p>
+
+<p class="figcenter"><a name="image48" id="image48"></a>
+   <a href="./images/img48-full.jpg"><img src="./images/img48.jpg"
+   alt="Fig. 48&mdash;Exposure of aorta and its branches, showing
+location of thrombi in numerous places. In this case (same as Fig. 49)
+Dr. L.A. and Dr. Edward Merillat found the cause of the condition to be
+due to sclerastomiasis."
+   title="Fig. 48&mdash;Exposure of aorta and its branches, showing
+location of thrombi in numerous places. In this case (same as Fig. 49)
+Dr. L.A. and Dr. Edward Merillat found the cause of the condition to be
+due to sclerastomiasis." /></a></p>
+<p class="captioncenter">Fig. 48&mdash;Exposure of aorta and its branches, showing
+location of thrombi in numerous places. In this case (same as Fig. 49)
+Dr. L.A. and Dr. Edward Merillat found the cause of the condition to be
+due to sclerastomiasis.</p>
+
+
+<div class="blockquot"><p>The seizures are accompanied with profuse sudation, tremors,
+dilated nostrils, accelerated respirations and other symptoms of
+pain and distress, all of which, together with the lameness,
+disappear as rapidly as they had developed, leaving the animal in
+<a name="Page_211" id="Page_211"></a>an apparently perfect state of health, ready to fall with another
+attack of precisely the same kind, as soon as enough exercise is
+forced upon it. The rectal explorations may reveal a pulseless
+state of one or more of the iliac arteries and a hardness and
+enlargement of the aortic quadrifurcation, but sometimes this
+palpation fails to disclose any <i>perceptible</i> diminution of the
+blood current of these vessels. The obturation being incomplete, it
+may be impossible by palpation to decide that thrombosis really
+exists. In this event and, in fact, in all eases, the clinical
+symptoms are sufficiently characteristic to make a diagnosis
+without reservation. It cannot be mistaken for any other disease,
+once properly investigated. Any given seizure may easily be
+mistaken for azoturia, at first, but a better examination soon
+excludes that disease.</p>
+
+<p class="figcenter"><a name="image49" id="image49"></a>
+   <a href="./images/img49-full.jpg"><img src="./images/img49.jpg"
+   alt="Fig. 49&mdash;Illustrative of thrombosis of the aorta,
+iliacs and branches. Photo by Dr. L.A. Merillat."
+   title="Fig. 49&mdash;Illustrative of thrombosis of the aorta,
+iliacs and branches. Photo by Dr. L.A. Merillat." /></a></p>
+<p class="captioncenter">Fig. 49&mdash;Illustrative of thrombosis of the aorta,
+iliacs and branches. Photo by Dr. L.A. Merillat.</p>
+
+
+<p><b>Prognosis and Treatment.</b>&mdash;In the majority of instances, when
+there is occasioned serious inconvenience, the outcome is not
+likely to be favorable, according to M&ouml;ller. Detachment of a
+portion of the thrombus, according to Hoare, may result in the
+lodgment of an embolus in the brain or kidneys. The latter
+authority also states that muscular atrophy may occur owing to lack
+of blood supply in some of these cases. M&ouml;ller states that
+<a name="Page_212" id="Page_212"></a>moderate exercise or work stimulates the establishment of
+collateral circulation. Massage per rectum is condemned as
+dangerous by Cadiot.</p></div>
+
+
+<h3><a name="Fracture_of_the_Patella" id="Fracture_of_the_Patella"></a>Fracture of the Patella.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Patellar fractures are rarely met with in
+the horse but may be caused by falls and heavy contusions. Violent
+muscular contraction, it is said, may also bring about the same
+condition.</p>
+
+<p><b>Symptomatology.</b>&mdash;Fracture may be transverse or vertical, and depending
+on the manner in which the bone is broken, prognosis is either at once
+rendered favorable or unfavorable. The patella performs a function which
+is in a way similar to that of the sesamoids and when fractured,
+complete recovery is improbable in the average instance. When complete,
+transverse fractures permit of separation of the parts of bone. Tension
+on the straight ligaments below and contraction of the quadriceps above
+usually cause insuperable difficulty in the handling of this type of
+fracture in the horse.</p>
+
+<p>Compound fractures as well as multiple or comminuted fractures
+occasionally occur and these constitute injuries which are generally
+considered fatal, although Andrien, according to Cadiot and Almy,
+succeeded in obtaining complete recovery in a case of compound fracture
+of the patella and the horse was in service and almost free from
+lameness two months after treatment was begun.</p>
+
+<p>No difficulty is encountered in recognizing the fracture of the patella
+because of the exposed position of the bone. Crepitation, and in some
+cases fissures, may be easily detected.</p>
+
+<p><b>Treatment.</b>&mdash;In simple fracture, when treatment is thought advisable,
+the subject is put in a sling and kept as nearly comfortable as
+possible. If little inflammation exists, the application of a vesicant
+two or three weeks after the injury has been inflicted will be helpful
+and serve to hasten repair.</p>
+
+<p>Bandages or mechanical appliances are of no practical use in the
+handling of these cases.</p>
+<p><a name="Page_213" id="Page_213"></a></p>
+
+
+<h3><a name="Luxation_of_the_Patella" id="Luxation_of_the_Patella"></a>Luxation of the Patella.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This, the most common luxation met with in
+the equine subject, has been described by writers as existing in many
+forms. Patellar disarticulation may be more practically considered as
+<i>momentary</i> and <i>fixed</i>, regardless of the position taken by the
+patella. Described under the title of false luxation are recorded cases
+wherein the quadriceps (crural) muscles become contracted in such manner
+that a condition simulating true disarticulation of the patella obtains.
+Also, some practictioners report cases of patellar luxation and refer to
+pseudo-luxations, without clearly defining the conditions which
+constitute pseudo-luxation. This has contributed to the extant cause of
+misconception as to actual differences between luxation and conditions
+simulating dislocation.</p>
+
+<p>Luxation of the patella is a condition wherein the articular portions of
+the femur and patella assume abnormal relations whether such
+displacement of the patella be momentary and capable of spontaneous
+reduction, or fixed and requiring corrective manipulation. Spasmodic
+contraction of the crural muscles which sometimes retains the patella in
+such position that the leg is rigidly extended, does not in itself
+constitute luxation of the patella; and unless this bone becomes lodged
+on the upper portion of a femoral condyle or laterally displaced out of
+its femoral groove, luxation cannot be said to exist in the horse. These
+are sub-luxations.</p>
+
+<p>Occasionally one may observe in suckling colts outward luxation of the
+patella wherein there is history of navel infection and no marked
+evidence of rachitis is present. Some of these cases recover. In a
+unilateral involvement of this kind in a three-month-old mule colt, the
+author observed a case wherein an unfavorable prognosis was given and
+destruction of the subject advised, because of the extreme dislocation
+of the patella. This colt, however, was not destroyed and in three weeks
+had apparently recovered. No treatment was given in this instance; the
+colt was allowed the run of a small pasture with its dam and in time it
+matured, becoming a sound and serviceable animal.</p>
+
+<p><b>Classification.</b>&mdash;Two forms of true patellar luxation in the <a name="Page_214" id="Page_214"></a>horse may
+be considered; one which is due to the patella becoming fixed upon the
+internal trochlear rim of the femur and the other when the patella slips
+over the outer rim of the trochlea.</p>
+
+<p>The first form is known as <i>upward</i> luxation and is made possible by
+rupture of the mesial (internal) femeropatellar ligament. According to
+Cadiot and Almy, it is only by the rupture of this ligament&mdash;the
+femeropatellar&mdash;that upward luxation may occur. This type of luxation is
+rarely observed and is usually due to violent strain and abnormal
+extension of the stifle joint.</p>
+
+<p>The second class, <i>outward</i> luxation, occurs in colts and is, in many
+instances, congenital. This form of luxation is also the one usually
+seen following debilitating diseases such as influenza and pneumonia.</p>
+
+<p><i>Upward luxation of the patella</i> is characterized by the stiff-extended
+position of the leg. When the patella is situated upon the inner
+trochlear rim, the tibia must be extended because of the traction
+exerted by the straight ligaments. Since the stifle and hock joints
+extend and flex in unison, there is presented also an extension of the
+tarsus. Extension of the stifle joint would increase the distance
+between the femoral origin of the gastrocnemius and its insertion to the
+summit of fibular tarsal bone (calcis) were it not for the gastrocnemius
+and superficial flexor (perforatus). Extension of the hock in upward
+luxation of the patella, permits of flexion of the phalanges. In upward
+luxation, then, the leg is extended as if too long, but the phalanges
+may be in a state of moderate flexion. If the foot rests on the ground
+when the extremity is not flexed, it is almost impossible for the
+subject to step backward. Because of immobilization of the stifle and
+hock joints in upward luxation, the subject can walk only by hopping on
+the sound leg and then the extremity is flexed, allowing the anterior
+portion of the fetlock to drag on the ground.</p>
+
+<p>In some cases practitioners are called to attend young animals that are
+reported to be "stifled" (often in young mules that have made a rapid
+growth) and upon arrival the only noticeable symptom of pre&euml;xisting
+luxation is the soiled condition of the anterior fetlock
+region&mdash;evidence of its having been dragged. Such cases may be styled
+momentary luxation, whether they are <a name="Page_215" id="Page_215"></a>due to a weakened condition of the
+patellar ligaments or spasmodic contraction of the crural muscles.</p>
+
+<p>In upward luxation, reduction is effected by attempting further
+extension of the stifle joint and at the same time the patella is pulled
+outward, off the internal rim of the trochlea. This is attempted by
+securing the subject in a standing position; the sound side is kept
+against a wall if possible and a rope is tied to the extremity of the
+affected leg. Traction is exerted upon the rope and at the same time
+force is directed against the stifle joint to produce further extension
+if possible, so that the straight patellar ligaments may relax
+sufficiently to allow the patella to be dislodged from its position upon
+the inner trochlear lip. Failing in this manner of procedure, the
+affected animal is to be cast and anesthetized with chloroform. The
+relaxation which attends surgical anesthesia will permit of reduction of
+the dislocated bone and manipulations such as have just been outlined
+may be employed.</p>
+
+<p>Following reduction in the average case it is essential that the subject
+be given vigorous exercise for a few minutes. Reduction having been
+affected, the application of a vesicant over the whole patellar region
+is customary.</p>
+
+<p>In cases of habitual luxation, unless the ligaments are so lax that the
+patella may be displaced laterally over the inner as well as the outer
+trochler rims, division of the inner straight patellar ligament will
+correct the condition. This desmotomy has been advocated by Bassi, and
+good results in appropriate cases have been reported by Cadiot, Merillat
+and Schumacher. This operation has been found a corrective in cases of
+outward luxation as well as those of upward dislocation of the patella
+when resorted to before the trochleae are worn from frequent luxation.</p>
+
+<p><i>Outward luxation of the patella</i> is occasioned by a lax condition of
+the internal femeropatellar ligament or a rupture of the same so that
+the patella slips over the outer femoral trochlear rim and permits of an
+abnormal flexion of the stifle joint. The outer trochlear rim being the
+smaller of the two, inward luxation does not occur in the horse. With
+the patella disarticulated in <a name="Page_216" id="Page_216"></a>this manner, the action of the quapriceps
+femoral group of muscles has no effect on the stifle joint and,
+therefore, flexion of this articulation occurs as soon as the subject
+attempts to sustain weight and the leg collapses unless weight is at
+once taken up by the other member if sound.</p>
+
+<p>As a rule, the reduction of this form of luxation is not difficult. The
+patella may be pushed inward and into position without manipulation of
+the leg. Retention of the patella in position is a difficult problem.
+Bandaging is considered impractical and is not ordinarily done in this
+country. Benard, according to Cadiot and Almy, recommends bandaging with
+a heavy piece of cloth in which an opening is made through which the
+patella is allowed to protrude, and by turning such a bandage snugly
+about the stifle several times, the patella is held in position. This
+bandage should be kept in place for about ten days.</p>
+
+<p>In young and rachitic animals outdoor exercise and a good nutritive
+ration for the subject are indicated. Hypophosphites in assimilable form
+may be beneficial, and vesication of the patellar region contributes to
+recovery.</p>
+
+<p>Where extreme luxation is present in both stifles, the prognosis is
+unfavorable. In such cases, degenerative changes may exist and in some
+instances the ligaments are so diseased and elongated that regeneration
+is impossible. <span class="nowrap">Williams<a name="FNanchor_46_46" id="FNanchor_46_46"></a><a href="#Footnote_46_46" class="fnanchor">[46]</a></span> reports a case where bilateral "floating"
+(outward) luxation was present and extensive degeneration changes
+affected the articulation.</p>
+
+<p>In subjects suffering frequent dislocation of the patella (habitual
+luxation) it is possible in some cases, to prevent its occurrence or at
+least to minimize the distress occasioned by momentary luxation, by
+keeping the animals in wide stalls so that "backing" is unnecessary. In
+some nervous subjects that seem to be suffering from cramp of the crural
+muscles, the difficulty and pain of their being backed out of narrow
+stalls, accentuates the nervousness. Sudation and restlessness are
+manifested and the subject presents a clinical picture of distress and
+fear of a painful ordeal. In some cases of this kind, complete recovery
+takes place by the time animals are five or six years of age. One should
+avoid keeping such subjects in narrow stalls. Pref<a name="Page_217" id="Page_217"></a>erably patellar
+desmotomy should be performed that relief may be obtained at once.</p>
+
+<p>Luxations attending some cases of influenza recover promptly when
+subjects are kept comfortably confined in roomy box-stalls. The
+administration of stimulative medicaments such as nux vomica and the
+application of an active blistering agent to the patella serve to hasten
+recovery. Dislocations in such cases are often bilateral and they are
+usually momentary. Reduction occurs spontaneously, as a rule, and the
+subjects are not occasioned much distress if they are kept quiet for a
+few days.</p>
+
+
+<h3><a name="Chronic_Gonitis" id="Chronic_Gonitis"></a>Chronic Gonitis.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Chronic inflammation of the stifle joint is
+met with following acute synovitis due to strains and concussion. It is
+an ailment which affects heavy horses and particularly animals that are
+kept at work on paved streets, but this does not explain its existence
+in animals that are not subjected to work likely to cause concussion.
+<span class="nowrap">Berns<a name="FNanchor_47_47" id="FNanchor_47_47"></a><a href="#Footnote_47_47" class="fnanchor">[47]</a></span> considers rheumatism a probable cause of gonitis and, as he
+states, the dropsical form of affection of this joint is not ordinarily
+attended with manifestations of inconvenience to the subject. Gonitis is
+often bilateral and its onset is insidious in many instances.</p>
+
+<p><b>Symptomatology.</b>&mdash;In unilateral gonitis weight is not borne by the
+affected member. There is noticeable distension of the joint capsule&mdash;a
+characteristic pendant pouching protrusion. When both stifles are
+affected the subject frequently shifts the weight from one limb to the
+other. Lameness comes on gradually and during the incipient stages may
+be intermittent but it progressively increases so that in time affected
+animals become useless. In bilateral affections animals drag the toes
+because of the pain incident to flexing the stifles. This is
+particularly evident when the subject is made to trot. As the disease
+progresses, atrophy of the quadriceps femoris muscles becomes pronounced
+and as destructive changes involving the articular cartilages take
+place. The subject becomes more lame and eventually is rendered
+incapable of service.</p>
+<p><a name="Page_218" id="Page_218"></a></p>
+
+<p>Upon manipulation of the patellar region, one is impressed with the fact
+that hyperesthesia does not exist in proportion to the pain manifested
+during locomotion. In some cases a gelatinous swelling is present and
+may be detected by palpating between the straight ligaments of the
+patella. Williams, Hughes, Merillat, Hadley and others have directed
+attention to the existence of floating masses (<i>corpora oryzoidea</i>) in
+the synovial capsule of this joint in gonitis, and as with all cases of
+arthritis, irreparable damage is often done the articular cartilages
+during the course of the ailment.</p>
+
+<p class="figcenter"><a name="image50" id="image50"></a>
+   <a href="./images/img50-full.jpg"><img src="./images/img50.jpg"
+   alt="Fig. 50&mdash;Chronic gonitis. The knuckling which results
+from long continued inactivity of the crural muscles in chronic cases is
+marked in this instance. Photo by Dr. L.A. Merillat."
+   title="Fig. 50&mdash;Chronic gonitis. The knuckling which results
+from long continued inactivity of the crural muscles in chronic cases is
+marked in this instance. Photo by Dr. L.A. Merillat." /></a></p>
+<p class="captioncenter">Fig. 50&mdash;Chronic gonitis. The knuckling which results
+from long continued inactivity of the crural muscles in chronic cases is
+marked in this instance. Photo by Dr. L.A. Merillat.</p>
+
+<p><a name="Page_219" id="Page_219"></a></p>
+
+<p><b>Treatment.</b>&mdash;No effective method is as yet known which will control
+this condition during its incipiency. The disease progresses, and more
+or less damage is done the affected parts in the course of months or
+even years in some cases before subjects are rendered hopelessly
+crippled. When recognized early (before chronic gonitis exists)
+aspiration of the synovia and the injection of diluted tincture of iodin
+might prove beneficial in cases of synovial distension. Chronic gonitis
+is considered an incurable affection and as soon as subjects manifest
+evidence of distress from this condition they should by all means be
+taken from work. Firing and vesication have not been productive of
+beneficial results.</p>
+
+<p class="figcenter"><a name="image51" id="image51"></a>
+   <a href="./images/img51-full.jpg"><img src="./images/img51.jpg"
+   alt="Fig. 51&mdash;Gonitis. Showing position assumed in such cases
+because of pain occasioned. Photo by Dr. C.A. McKillip."
+   title="Fig. 51&mdash;Gonitis. Showing position assumed in such cases
+because of pain occasioned. Photo by Dr. C.A. McKillip." /></a></p>
+<p class="captioncenter">Fig. 51&mdash;Gonitis. Showing position assumed in such cases
+because of pain occasioned. Photo by Dr. C.A. McKillip.</p>
+
+<p><a name="Page_220" id="Page_220"></a></p>
+
+
+<h3><a name="Open_Stifle_Joint" id="Open_Stifle_Joint"></a>Open Stifle Joint.</h3>
+
+<p><b>Anatomy of the Joint Capsule.</b>&mdash;This joint capsule is thin and very
+capacious. On the patella it is attached around the margin of the
+articular surface, but on the femur the line of attachment is at a
+varying distance from the articular surface. On the medial side it is an
+inch or more from the articular cartilage; on the lateral side and
+above, about half an inch. It pouches upward under the quadriceps
+femoris for a distance of two or three inches, a pad of fat separating
+the capsule from the muscle. Below the patella it is separated from the
+patellar ligaments by a thick pad of fat, but inferiorly it is in
+contact with the femerotibial capsules. The joint cavity is the most
+extensive in the body. It usually communicates with the medial sac of
+the femerotibial joint cavity by a slit-like opening situated at the
+lowest part of the medial ridge of the trochlea. A similar, usually
+smaller, communication with the lateral sac of the femerotibial capsule
+is often found at the lowest part of the lateral ridge. (Sisson's
+Anatomy.)</p>
+
+<p>Thus it is seen that because of its frequent communication with the
+other parts of this large synovial membrane, a wound which opens the
+external portion of the femerotibial capsule may be the cause of
+contamination and resultant infectious arthritis of the whole stifle
+joint. Because of the distance between the most dependent part of the
+femerotibial articulation and the summit of the patella, one may
+misjudge the exact location of the lowermost part of this portion of the
+capsular ligament of the stifle joint and thereby fail at once to
+appreciate the seriousness of calk wounds in this region.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Wounds to the patellar region are of rather
+frequent occurrence, and because of the comparatively unprotected
+position of these structures, the capsular ligaments of the stifle joint
+may be perforated as a result of violence in some form. Calk wounds
+which penetrate the tissues in the immediate region of the lower portion
+of the external part of the femerotibial capsule sometimes result in
+open joint because of tissue necrosis resulting from the introduction of
+infection. Contused wounds sometimes destroy the skin and fascia over
+<a name="Page_221" id="Page_221"></a>large areas on the lateral patellar region and because of subsequent
+sloughing of tissue due to infection as well as to the manner in which
+such wounds are inflicted, septic arthritis subsequently occurs.
+Penetrant wounds, such as may be caused by a fork tine may not result in
+infection; if infectious material is introduced an infectious arthritis
+does not necessarily follow, though such cases should be considered as
+serious from the outset.</p>
+
+<p><b>Symptomatology.</b>&mdash;The pathognomonic symptom of open stifle joint is the
+profuse escape of synovia, indicating perforation of the synovial
+capsule; by means of a probe the wound may be explored in a way that
+will clearly reveal the nature of the injury.</p>
+
+<p>After a few days have elapsed in cases where considerable infection has
+taken place, there is manifestation of pain as in all cases of infective
+arthritis. <span class="nowrap">Hughes<a name="FNanchor_48_48" id="FNanchor_48_48"></a><a href="#Footnote_48_48" class="fnanchor">[48]</a></span> gives an excellent description of the clinical
+aspect of arthritis which applies here:</p>
+
+<div class="blockquot"><p>Acute arthritis begins like an ordinary attack of synovitis. In
+joints other than the pedal and pastern, there is sudden and
+extensive swelling, which at first is intra-articular, succeeded by
+extra-articular tumefaction, and accompanied by violent lameness.
+The pain soon becomes intense and agonizing. There is severe
+constitutional disturbance, the temperature ranging from 104 to 106
+degrees and the pulse from 60 to 72. Painful convulsions of the
+limb occur, shown by involuntary spasmodic elevations due to reflex
+irritation of the muscles. There is loss of appetite, rapid
+emaciation, the flank is tucked up and the back arched. In from
+three to six days, the tumefaction around the joint tends to soften
+at a particular place, and bursts, and a discharge that is
+sometimes of a sanious character, mixed with synovia, escapes.
+Great exhaustion at times supervenes, and if the joint is an
+important one, the horse lies or falls and is unable to rise.</p></div>
+
+<p><b>Treatment.</b>&mdash;In small puncture wounds the immediate application of a
+vesicating ointment has given good results, but when infection has taken
+place to such extent that the animal manifests evidence of intense pain,
+and lameness is marked and local swelling and hyperesthesia are great,
+vesication is contraindi<a name="Page_222" id="Page_222"></a>cated. In such instances the exterior of the
+wound and its margins should be prepared as in similar affections of
+other joints. A quantity of synovia is then aspirated by means of a
+small trocar and care should be taken to observe all due aseptic
+precautions. Subsequently the injection of from four to six ounces of a
+mixture of tincture of iodin, one part to ten parts of glycerin, and
+gentle massage of the joint immediately after the injection has been
+made, serves to check the infective process in some cases.</p>
+
+<p>The subject should be cared for as has been previously suggested in
+arthritis proper provisions for comfort being made. Good nursing is
+always essential to a successful issue. However, the author cannot view
+cases of open stifle joint with the same optimism concerning their
+course and outcome that is expressed by a number of writers on this
+subject. It is a grave condition wherein the prognosis should be given
+advisedly.</p>
+
+
+<h3><a name="Fracture_of_the_Tibia" id="Fracture_of_the_Tibia"></a>Fracture of the Tibia.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Because of its exposed position to kicks,
+and its lack of protection by heavy musculature (especially on its inner
+surface), there is afforded ample opportunity for frequent injury to the
+tibia. Fractures are complete and varying as to nature, or incomplete.
+The heavy tibial fascia affords sufficient protection so that fissures
+without entire solution of continuity of the bone may occur from
+violence to which this part is often subjected. M&ouml;ller classes tibial
+fracture as ranking second in frequency&mdash;pelvic fracture being more
+often met with in horses. This does not apply in our country as
+phalangeal and metacarpal and even metatarsal fractures are observed in
+more instances than are such injuries to the tibia. The tibia is
+occasionally broken at its middle and lower thirds, but malleolar
+fractures are not common.</p>
+
+<p><b>Symptomatology.</b>&mdash;When fracture is complete and all support is removed,
+the leg dangles, and the nature of the injury is so obvious that there
+is no mistaking its identity. However, in case of incomplete fracture
+one needs to base all conclusions upon the history of the case, evidence
+of injury, or other knowl<a name="Page_223" id="Page_223"></a>edge of the character of violence to which
+this bone has been exposed. For without the presence of crepitation
+(even by excluding other possible causes for the pronounced lameness
+which characterizes some of these cases) we can only resort to the
+knowledge which experience has taught that fracture may be deemed
+probable in many injuries to the tibial region. Consequently, we are to
+look upon all injuries that affect the tibia as being fractures of some
+sort when there is either local evidence of the infliction of violence
+or whenever marked lameness attends such injuries, unless there is
+positive indication that no fractures exist.</p>
+
+<p>A careful examination of parts of the tibia, i.e., noting the amount and
+painfulness of swellings, exploration with the probe, and observations
+of the course taken in any given case, will determine the exact nature
+of injuries. Such examination needs to extend over a period of a week or
+in some instances two or three weeks may pass before the true state of
+affairs is apparent. In the meanwhile, cases are to be handled as though
+tibial fracture certainly existed.</p>
+
+<p><b>Prognosis.</b>&mdash;Prediction of the outcome in tibial fracture is somewhat
+presumptuous, but in the majority of cases in mature subjects fatality
+results. <span class="nowrap">Cadiot<a name="FNanchor_49_49" id="FNanchor_49_49"></a><a href="#Footnote_49_49" class="fnanchor">[49]</a>,</span> however, views this condition with more optimism
+than have American practitioners. While he considers the condition
+grave, in citing case reports of successful treatment by d'Arboval,
+Duchemin, Leblanc, and others, his conclusion is that many practitioners
+erroneously consider fractures of the tibia as incurable.</p>
+
+<p>The method of handling these cases by Leblanc is as follows: The subject
+is placed in a sling; a pit is excavated below the affected member so
+that a heavy weight may be attached to the extremity; splints are
+applied to each side of the leg, which is padded with oakum, and this is
+kept in position by means of bandages covered with pitch. The outer
+splint extends from the hoof to the stifle and the inner one from the
+hoof to the upper third of the leg. This method in the hands of Leblanc
+has been successful in several instances, according to Cadiot.</p>
+<p><a name="Page_224" id="Page_224"></a></p>
+
+<p>In a foal the author has in one instance succeeded in obtaining complete
+recovery in a simple fracture of the lower third of the tibia where the
+only support given the broken bone was a four-inch plaster-of-paris
+bandage which was adjusted above the hock. Below the tarsus a cotton and
+gauze bandage was applied to prevent swelling of the extremity. In this
+instance (an emergency case in which materials that are not to be
+recommended were necessarily employed) recovery took place within thirty
+days.</p>
+
+<p>As has been mentioned in the consideration of radial fractures, heavy
+leather is better suited for immobilization of these parts than a cast
+or other rigid splint materials. Mature animals may be expected to
+resist the immobilization of the hind legs because of the normal manner
+of flexion of the tarsal and stifle joints in unison. Therefore, the
+application of rigid splints to the leg and including the hock is
+productive of disastrous results in some cases.</p>
+
+<p>The application of cotton and bandages to pad the member and the
+adjusting of heavy leather splints on either side of the leg, and
+retaining them in position with four-inch gauze bandages will prove more
+nearly satisfactory than some other methods employed. Prognosis is
+unfavorable, however, in most cases of compound fracture and recovery is
+improbable when the upper portion of the tibia is broken.</p>
+
+
+<h3><a name="Rupture_and_Wounds_of_the_Tendo_Achillis" id="Rupture_and_Wounds_of_the_Tendo_Achillis"></a>Rupture and Wounds of the Tendo Achillis.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Cases are recorded by Uhlrich in which
+rupture has followed degenerative changes affecting the tendo Achillis.
+Not infrequently, the result of a trauma, division of the tendo Achillis
+occurs. M&ouml;ller states that rupture of this tendon may be due to jumping,
+in riding horses and in draught horses, in their efforts to avoid
+slipping. In runaways, it sometimes occurs where sharp-edged implements
+are bounced against the legs in such fashion that division of the tendon
+results.</p>
+
+<p><b>Symptomatology.</b>&mdash;With division of the tendo Achillis or of the
+musculature of the gastroenemii and the superficial flexor<a name="Page_225" id="Page_225"></a>
+(perforatus), there remains nothing to inhibit tarsal flexion except the
+deep flexor tendon (perforans) and this does not support the leg. When
+attempt is made to sustain weight with the affected member, abnormal
+flexion of the tarsus takes place and the hock sinks almost to the
+ground. The symptoms are so characteristic that recognition is always
+easy even in case no wound of the skin exists.</p>
+
+<p><b>Prognosis.</b>&mdash;Spontaneous recoveries occur and such cases are reported
+by Bouley who is quoted by Cadiot as having observed division of the
+tendo Achillis due to a sword wound wherein at the end of four months
+recovery was complete. Division of this tendon in brood mares has been
+practiced by the early settlers of parts of the United States for the
+purpose of preventing their straying too far from home. In such
+instances one leg only was so mutilated and in most instances, it is
+reported that spontaneous recovery took place.</p>
+
+<p>In unilateral involvement without complications, the prognosis is not
+unfavorable if provisions for giving necessary attention are available.</p>
+
+<p><b>Treatment.</b>&mdash;The subject is to be confined in a sling and the member
+bandaged and supported by means of leather splints. Immobilization as
+for fracture is not necessary but, nevertheless, movement is to be
+restricted as much as possible. In case of open wounds, the exposed
+tissues are cared for along general surgical lines. Where the divided
+parts of the tendon are maintained in fairly close and constant
+relation, granulation of tissue, sufficient to sustain weight takes
+place in from six weeks to three months.</p>
+
+
+<h3><a name="Spring-Halt_String-Halt" id="Spring-Halt_String-Halt"></a>Spring-Halt. (String-Halt.)</h3>
+
+<p><b>Occurrence.</b>&mdash;This condition is a myoclonic affection of the hind leg
+which is discussed in works on theory and practice under the head of
+neuroses, but the cause or causes have not been established. Theories
+that heredity is responsible have their supporters and advocates of
+hypotheses attributing it to disease of the sciatic nerve, patellar
+subluxation, fascial contraction of various muscles, "dry spavin"
+(tarsal arthritis), iliac exostoses, disease of the foot and contraction
+of the hoof, <a name="Page_226" id="Page_226"></a>are on record in veterinary literature. This ailment
+affects old horses more frequently than it does young and is seen in all
+breeds of animals including mules.</p>
+
+<p class="figcenter"><a name="image52" id="image52"></a>
+   <a href="./images/img52-full.jpg"><img src="./images/img52.jpg"
+   alt="Fig. 52&mdash;Spring-halt."
+   title="Fig. 52&mdash;Spring-halt." /></a><br />
+Fig. 52&mdash;Spring-halt.</p>
+
+
+<p><b>Symptomatology.</b>&mdash;This disease develops slowly, and progressively
+increases in severity as a rule, but does not ordinarily constitute
+cause for rendering an animal unserviceable. While the affection is
+sometimes bilateral (occasionally affections of the forelegs are
+reported) and the extreme flexion of the legs in the spasmodic manner
+which characterizes spring-halt, cause great waste of energy during
+locomotion, yet such cases are rare. Usually the ailment is markedly
+evinced when subjects are first taken from the stable, but as they are
+exercised the manifestation diminishes, and in many instances it
+completely subsides. The condition is generally more noticeable when the
+subject is made to step backward. In some animals there is <a name="Page_227" id="Page_227"></a>marked
+abduction at the time flexion occurs and in singular instances the
+spasmodic contraction is so violent that the subject falls to the ground
+as a result of the peculiar flexion of the leg.</p>
+
+<p>In severe cases of "scratches" or chemical irritation of the extremity,
+the legs are abnormally flexed in a manner which simulates spring-halt,
+but because of the evident injury of the parts this is not likely to
+confuse. Since all facts concerning etiological agencies are surrounded
+with so much obscurity, classification does not lend any particular
+assistance in the consideration of this ailment.</p>
+
+<p><b>Prognosis.</b>&mdash;One cannot intelligently give a prognosis in these cases
+if forecast is expected to state the exact course following treatment.
+However, in a general way, cases of recent affection are thought more
+favorable than are those of long standing or in old animals where
+myositis and other muscular and fascial affections exist owing to years
+of hard service.</p>
+
+<p><b>Treatment.</b>&mdash;No known line of medicinal treatment is of service, nor is
+any particular surgical operation to be considered dependable for
+obtaining relief. Operations of almost every conceivable nature have
+been tried with the hope of securing recovery in spring-halt but under
+no condition can the practitioner as yet be reasonably certain of
+effecting permanent relief in any case. Treatment is, therefore,
+entirely empirical.</p>
+
+<p>Neurectomies have been performed and recoveries following were
+attributed thereto; fascial divisions in the crural region have been
+done with good results and this manner of treatment has its favorers.
+Advocates of tenotomies, likewise, are to be found. Consequently, one
+may summarize thus: Spring-halt is a disease of unknown origin&mdash;the
+exact cause has not been determined; therefore, all treatment is, in a
+way, experimental. The recommendation of any given procedure in handling
+cases must then be a matter of opinion based either upon practical
+experience or knowledge of the experiences of others. Divisions of the
+lateral digital extensor (peroneus) below the tarsus near its point of
+insertion to the extensor of the digit is recommended here because it is
+followed by a percentage of recoveries that is as large as in any other
+method of treatment and the operation <a name="Page_228" id="Page_228"></a><a name="Page_229" id="Page_229"></a>is not difficult to perform nor
+is its performance fraught with any dangerous complications. In selected
+subjects about fifty per cent of cases recover in from two to six weeks
+following this operation.</p>
+
+<p class="figcenter"><a name="image53" id="image53"></a>
+   <a href="./images/img53-full.jpg"><img src="./images/img53.jpg"
+   alt="Fig. 53&mdash;Lateral (external) view of tarsus showing
+effects of generalized tarsitis."
+   title="Fig. 53&mdash;Lateral (external) view of tarsus showing
+effects of generalized tarsitis." /></a><br />
+Fig. 53&mdash;Lateral (external) view of tarsus showing
+effects of generalized tarsitis.</p>
+
+
+<h3><a name="Open_Tarsal_Joint" id="Open_Tarsal_Joint"></a>Open Tarsal Joint.</h3>
+
+<p>Like the tibia the hock is exposed to frequent injuries and in some
+cases wounds perforate the joint capsule. When due to calk wounds where
+horses are kicked, the injury is often on the side of the tarsus (medial
+or lateral) and such wounds not infrequently result in infectious
+arthritis. Horses sometimes jump over wire fences and wounds are
+inflicted which constitute extensive laceration of the joint capsule. In
+firing for bone spavin, where a deep puncture is made very near the
+tibial tarsal (tibioastragular) joint if infection gains entrance,
+serious and generalized infection of the open joint cavity supervenes in
+some cases.</p>
+
+<p><b>Symptomatology.</b>&mdash;There is no marked difference in the constitutional
+disturbances which are occasioned in this condition and those
+encountered in other cases of septic arthritis (previously considered
+herein) except that there is a difference in the degree of resultant
+derangement and local tissue changes. Chiefly, because of the difficulty
+encountered in keeping the hock joint in an aseptic condition or
+securely bandaged, open tarsal joint constitutes a more serious
+condition than a similar affection of the fetlock. Otherwise, a very
+similar condition obtains and the same diagnostic principles serve here
+that have been described on page <a href="#Page_110">110</a> in considering open fetlock joint.</p>
+
+<p><b>Treatment.</b>&mdash;The same plan that is described in detail for treatment of
+similar conditions affecting the fetlock joint is indicated in this
+affection. Exceeding care must be exercised in bandaging the hock,
+however, lest the animal be so irritated that in the extreme flexion of
+the tarsus which is often caused by bandaging, the wound dressings may
+be completely deranged. A wide gauze bandage material is most
+satisfactory; cotton of long fiber is separated in thin layers and wound
+about the hock, extending from the site of injury to a point about six
+inches proximal to the summit of the os calcis. By using an abundance
+<a name="Page_230" id="Page_230"></a>of cotton in this way, it will not be found necessary to apply the
+bandages very snugly; with a four-inch gauze bandage material, which is
+supported above the cap of the hock and brought across the anterior face
+of the tarsus in a diagonal manner, a comfortable and very serviceable
+protective dressing is provided for. Animals so treated will not
+ordinarily resist because of pressure from the bandages. Pressure is
+unavoidable in the use of adhesive dressings or where careful attention
+is not given the manner of applying cotton to the parts. Such methods
+are sure to result disastrously. But if subjects are kept quiet after
+the parts have been properly bandaged, no difficulty is encountered in
+maintaining asepsis in an uninfected wound. Recovery takes place in
+favorable cases in from three weeks to three months, depending on the
+nature and extent of injuries inflicted.</p>
+
+
+<h3><a name="Fracture_of_the_Fibular_Tarsal_Bone_Calcaneum" id="Fracture_of_the_Fibular_Tarsal_Bone_Calcaneum"></a>Fracture of the Fibular Tarsal Bone (Calcaneum.)</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;This condition though rarely met with in the
+horse, is the result of violent strain upon the os calcis by the
+gastrocnemius and superficial flexor tendons in efforts put forth by
+animals in attempts to regain a footing when the hind feet slip forward
+under the body, or in jumping and in falls or direct contusion by heavy
+bodies. <span class="nowrap">Hoare<a name="FNanchor_50_50" id="FNanchor_50_50"></a><a href="#Footnote_50_50" class="fnanchor">[50]</a></span> reports a case of a mare that had produced fracture in
+jumping.</p>
+
+<p>Fracture of the other tarsal bones are very seldom observed but may be
+occasioned by contusions wherein multiple or comminuted fractures are
+produced, such as are to be seen in small animals. Fracture of the
+tibial tarsal bone (astragalus) is to be observed as a complication in
+luxations of the tarsal joint and, according to Cadiot, the other tarsal
+bones may likewise suffer fracture in luxations of the hock.</p>
+
+<p><b>Symptomatology.</b>&mdash;Great pain attends this accident according to the
+observations given in recorded cases. In the case cited by Hoare the
+animal evinced great pain and uneasiness; the hock was unduly flexed;
+the calcaneum was displaced forward; and marked crepitation was present.
+A portion of the body of <a name="Page_231" id="Page_231"></a>the calcaneum was protruding through the
+perforated skin. The animal was destroyed and the bone was found broken
+in three pieces.</p>
+
+<p class="figcenter"><a name="image54" id="image54"></a>
+   <a href="./images/img54-full.jpg"><img src="./images/img54.jpg"
+   alt="Fig. 54&mdash;Right hock joint. Viewed from the front and
+slightly laterally after removal of joint capsule and long collateral
+ligaments. T.t., Tibial tarsal bone (distal tuberosity). T.c., central
+tarsal bone. T.3. Ridge of third tarsal bone. T.f. Fibular tarsal bone
+(distal end). T.4. Fourth tarsal bone. Mt. III, Mt. IV. Metatarsal
+bones. Arrow points to vascular canal. (From Sisson's ''Anatomy of the
+Domestic Animals.'')"
+   title="Fig. 54&mdash;Right hock joint. Viewed from the front and
+slightly laterally after removal of joint capsule and long collateral
+ligaments. T.t., Tibial tarsal bone (distal tuberosity). T.c., central
+tarsal bone. T.3. Ridge of third tarsal bone. T.f. Fibular tarsal bone
+(distal end). T.4. Fourth tarsal bone. Mt. III, Mt. IV. Metatarsal
+bones. Arrow points to vascular canal. (From Sisson's ''Anatomy of the
+Domestic Animals.'')" /></a></p>
+<p class="captioncenter">Fig. 54&mdash;Right hock joint. Viewed from the front and
+slightly laterally after removal of joint capsule and long collateral
+ligaments. T.&nbsp;t.,&nbsp;Tibial tarsal bone (distal tuberosity). T.&nbsp;c.,&nbsp;central
+tarsal bone. T.&nbsp;3.&nbsp;Ridge of third tarsal bone. T.&nbsp;f.&nbsp;Fibular tarsal bone
+(distal end). T.&nbsp;4.&nbsp;Fourth tarsal bone. Mt. III, Mt. IV. Metatarsal
+bones. Arrow points to vascular canal. (From Sisson's "Anatomy of the
+Domestic Animals.")</p>
+
+
+<p>Since the support for the tendo Achillis is removed in such fracture and
+no leverage on the metatarsus obtains, it naturally follows that any
+attempt to sustain weight must result in extreme flexion of the hock and
+descent of this part in a manner similar to cases of rupture or division
+of the Achilles' tendon. The two conditions should not be confused,
+however, as the parts may be <a name="Page_232" id="Page_232"></a>definitely outlined by palpation and the
+slack condition of the tendon and displaced summit of the calcaneum,
+which characterize fracture of the fibular tarsal bone, are easily
+recognized.</p>
+
+<p><b>Treatment.</b>&mdash;Prognosis is unfavorable in the majority of cases, but
+should attempts at treatment be undertaken in young and quiet mares
+which might prove valuable for breeding purposes in case of imperfect
+recovery, they should be put in slings and the member is to be
+immobilized as in tibial fracture. Authorities are agreed that prognosis
+is entirely unfavorable in mature animals, when the case is viewed from
+an economic standpoint.</p>
+
+
+<h3><a name="Tarsal_Sprains" id="Tarsal_Sprains"></a>Tarsal Sprains.</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;The hock joint is often subjected to great
+strain because of the structural nature of this part and its relation to
+the hip as well as the manner in which the tarsus functionates during
+locomotion. That ligamentous injuries owing to sprain frequently occur
+and attendant periarticular inflammations with subsequent hypertrophic
+changes follow, is a logical inference. Fibrillary fracture of the
+collateral ligaments may take place in falls or when animals make
+violent efforts to maintain their footing on slippery streets. In
+expressing opinions concerning the frequency with which the hock is
+found to be the seat of trouble in lameness of the pelvic members,
+different writers place the percentage of hock lameness at from
+seventy-five to ninety per cent. And when one considers the possibility
+that a goodly proportion of cases of tarsal exostis are the outcome of
+sprains, the occurrence of tarsal sprains may be more generally
+admitted.</p>
+
+<p><b>Symptomatology.</b>&mdash;A mixed type of lameness is present and the nature of
+the impediment varies, depending upon the location of the injury.
+Sprains of the mesial tarsal ligaments cause lameness somewhat similar
+to that of spavin. However, in establishing a diagnosis, local evidence
+in these cases is of greater significance than the manner of locomotion.
+During the acute stage of inflammation there is to be detected local
+hyperthermia, some hyperesthesia and a little swelling. Later, when
+resolution is not prompt, considerable swelling (or perhaps correctly
+speak<a name="Page_233" id="Page_233"></a>ing, an indurated enlargement) variable in size is developed. In
+some cases the entire tarsal region becomes greatly enlarged and this
+swelling is very slowly absorbed in part or completely. Such sub-acute
+cases are observed during the winter season and particularly where
+subjects are kept in tie stalls without exercise for weeks at a time.</p>
+
+<p><b>Treatment.</b>&mdash;Attention should be directed toward relief for the animal
+in all acute inflammations. Local applications of heat are helpful and,
+of course, rest is essential. Towels that are wrung out of hot water and
+held in position by means of a few turns of a loose bandage and this
+covered with an impervious rubber sheet, will serve as a practical means
+of application of hydrotherapy. Following this when conditions improve,
+as in the handling of all similar cases, counterirritation is indicated.</p>
+
+<p>When proper care is given at the onset and where injury does not involve
+too much ligamentous tissue, recovery takes place in a few weeks but in
+some cases which occur during the winter season in farm horses, complete
+recovery does not result until several months have passed.</p>
+
+
+<h3><a name="Curb" id="Curb"></a>Curb.</h3>
+
+<p>The hock is said to be curbed when the normal appearance, viewed from
+the side, is that of bulging posteriorly at any point between the summit
+of the calcaneum and the upper third of the metatarsus. Among some
+horsemen a hock is said to be "curby" whenever there exists an
+enlargement of any kind on the posterior face of the tarsus whether it
+be due to sprain, exostosis or proliferation of tissue as a result of
+contusion.</p>
+
+<p>French veterinarians consider under the title of "courbe," an exostosis
+situated on the mesial side of the distal end of the tibia. Cadiot and
+Almy state that this condition (courbe) is of rare occurrence. Percivall
+defines curb as "a prominence upon the back of the hind leg, a little
+below the hock, of a curvilinear shape, running in a direct line
+downwards and consisting of infusion into, or thickening of, the sheath
+of the flexor tendons." M&ouml;ller's version of true curb is a thickening of
+the plantar ligament (calcaneocuboid or calcaneometatarsal). Hughes and
+Mer<a name="Page_234" id="Page_234"></a>illat consider curb as a synovitis having for its seat the synovial
+bursa which is situated between the superficial flexor tendon
+(perforatus) and the plantar ligament.</p>
+
+<p><b>Occurrence.</b>&mdash;Certain predisposing factors seem to favor the occurrence
+of curb. A malformation of the inferior part of the tarsus so that its
+antero-posterior diameter is considerably less than normal is a
+contributing cause. Such hocks are known as "tied-in." Another fault in
+conformation is the existence of a weak hock that is set low down on a
+crooked leg, especially when such a member is heavily muscled at the
+hip. Given such conformation in an excitable horse, and curb is usually
+produced before the subject is old enough for service. It is certain
+that in cases where conformation is bad, greater strain is put upon the
+plantar ligament. This structure serves to bind the tibial tarsal
+(calcis) bone to the metatarsus; traction exerted upon its summit by the
+tendo Achillis is great when animals run, jump or rear and also at heavy
+pulling. In animals having curby hocks, sprain is likely to result and
+curb supervenes.</p>
+
+<p><b>Symptomatology.</b>&mdash;The characteristic swelling which marks curb may
+develop quickly and lameness occur suddenly or the enlargement comes on
+gradually and slowly, causing little lameness. Lameness is not
+proportionate to the size of the swelling and in all cases whether
+subacute or chronic, the condition improves with rest, but lameness is
+again manifested upon exertion. A horse which "throws a curb" will go
+lame until the acute inflammatory condition subsides and depending upon
+treatment received and conformation of the hock, this requires from
+three days to two or three weeks.</p>
+
+<p>The character of the swelling varies; in some cases it is not large but
+rather dense and lacking in evidence of heat and hyperesthesia; in other
+cases there is considerable swelling, which is hot and doughy, somewhat
+painful to the touch but not necessarily productive of much lameness. In
+any event, whether the swelling or enlargement is big or little, its
+location makes it conspicuous when viewed in profile.</p>
+
+<p>In most cases after the acute inflammatory period has passed, lameness
+is slight, if at all present, and in time no interference <a name="Page_235" id="Page_235"></a>with the
+subject's usefulness is occasioned because of the curb, but the animals
+often remain blemished&mdash;complete resorption of inflammatory products
+being unusual when much disturbance has existed.</p>
+
+<p><b>Treatment.</b>&mdash;The handling of curb during the acute inflammatory stage
+is along the same lines as in sprain&mdash;local applications of cold and
+heat. Subjects must be kept quiet until all inflammation has subsided,
+for there are no cases wherein a little brisk exercise is more likely to
+cause a recurrence of lameness before recovery is complete than in curb.
+Vesication is in order in a week or ten days after the affection has set
+in; in old stubborn cases that have resisted ordinary treatment for a
+few months, the use of the actual cautery (line firing) is to be
+recommended.</p>
+
+<p class="figcenter"><a name="image55" id="image55"></a>
+   <a href="./images/img55-full.jpg"><img src="./images/img55.jpg"
+   alt="Fig. 55&mdash;Spavin."
+   title="Fig. 55&mdash;Spavin." /></a><br />
+Fig. 55&mdash;Spavin.</p>
+
+
+<h3><a name="Spavin_Bone_Spavin" id="Spavin_Bone_Spavin"></a>Spavin. (Bone Spavin.)</h3>
+
+<p>This term is applied to an affection of the tarsus which is usually
+characterized by the existence of an exostosis on the mesial <a name="Page_236" id="Page_236"></a>and
+inferior portion of the hock. There is also included under this name,
+articular inflammation wherein no external evidence is shown. Spavin
+lameness has long been recognized and much has been written upon this
+subject. Since authorities are agreed that most cases of lameness in the
+hind leg are due to hock affection, and because the majority of cases of
+lameness which have the tarsal region as the seat of trouble are
+instances of spavin lameness, this disease merits all the attention it
+has received.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Causes may well be classified as
+predisposing and exciting, for there are many etiologic factors to be
+reckoned with in spavin, some of which are widely different in nature.</p>
+
+<p>Considered as predisposing causes, hereditary influences play an
+important r&ocirc;le and may, owing to faulty conformation, subject an animal
+to affections of this kind because of disproportionate development of
+parts (weak and small joints and heavy muscular hips); or as a
+consequence of inherited traits, a subject may manifest susceptibility
+to degenerative bone changes which are signalized by the formation of
+exostoses of different parts on one or more of the legs. Hereditary
+predispositions make for the presence of spavin in a large percentage of
+the progeny of sires so affected. This fact has been repeatedly
+demonstrated in this country as well as elsewhere according to Quitman,
+Dalrymple and <span class="nowrap">Merillat.<a name="FNanchor_51_51" id="FNanchor_51_51"></a><a href="#Footnote_51_51" class="fnanchor">[51]</a></span> A number of states have passed stallion
+inspection laws stipulating that animals having such exostoses as spavin
+and ringbone cannot be registered except as "unsound."</p>
+
+<p>Asymmetrical conformation, particularly where the hock is obviously
+small and weak as compared with other parts of the leg, constitutes a
+noteworthy predisposing cause.</p>
+
+<p>Peters' theory is plausible that the screw-like joint between the tibia
+and the tibial tarsal (astragulus) bones causes these structures to
+functionate in a manner not in harmony with the provisions allowed by
+the collateral ligaments of the tarsus, per<a name="Page_237" id="Page_237"></a>mitting movement only in a
+direction parallel with the long axis of the body.</p>
+
+<p>Because of the quality of their temperaments, nervous animals possessing
+no particular congenital structural defects of the hock and having no
+history of spavined progenitors, are subject to spavin when kept at work
+likely to produce tarsal sprain. Spavin usually develops early in such
+subjects and examples of this kind may be frequently observed in
+agricultural sections of the country. Where spavin develops in unshod
+colts at three and four years of age, shoeing is not an influencing
+agency when animals are not worked on pavements.</p>
+
+<p>Exciting causes of spavin are sprain and concussion. Various hypotheses
+are recorded as to how sprains are influenced and among others may be
+mentioned that of <span class="nowrap">McDonough<a name="FNanchor_52_52" id="FNanchor_52_52"></a><a href="#Footnote_52_52" class="fnanchor">[52]</a>,</span> which is that the foot is robbed of its
+normal manner of support by the ordinary three-calked shoe. With such a
+shoe, little support is given the sides of the foot; hence, undue strain
+is put upon the collateral ligaments of the tarsus. Moreover, the shoe
+with its calks increases the length of the leg and adds to the leverage
+on the hock, by virtue of such added length. This makes for greater
+strain upon the mesial or lateral tarsal ligaments whenever the foot
+bears upon a sloping ground surface, so that one side (inner or outer)
+is higher or lower than the other. But according to McDonough's theory
+(a good one concerning horses that work on pavements), the chief error
+in shoeing lies in that the foot is deprived of its normal base or
+support on the sides&mdash;the three-calked shoe being an unstable
+support&mdash;and that this manner of shoeing city horses working on
+pavements is an "inhumane" practice, a "diabolical method."</p>
+
+<p>Whether spavin has its point of origin within the articulation as a
+rarefying ostitis of the cancellated structure of the lower tarsal bones
+as suggested by Eberlein; or, as Diekerhoff asserts, that the cunean
+bursa may be the initial point of affection, is unsettled; but it is
+reasonable to consider occult spavin as having its origin within the
+articulation, and that cases readily yielding <a name="Page_238" id="Page_238"></a>to cunean tenotomy are
+primarily due to affection of the cunean bursa.</p>
+
+<p><b>Symptomatology.</b>&mdash;Where a visible exostosis exists, the presence of
+spavin is easily detected, yet exostoses that extend over large areas
+may constitute cause for serious trouble and still be difficult of
+detection. By observing the internal surface of the hock from various
+suitable angles, such as from between the forelegs or directly behind
+the subject, one may note the presence of any ordinary exostosis.</p>
+
+<p>The position assumed by the spavined horse is often characteristic. More
+or less knuckling is usually present (Liautard, McDonald). There is
+abduction of the stifle in some cases, or the toe may be worn in unshod
+horses so that it presents a straight line at the surface. This is
+manifested to a great degree in some animals and in others the foot is
+not dragged and there is no wearing of the hoof at the toe.</p>
+
+<p>Spavin lameness is so distinctive that one trained and experienced in
+the examination of horses that are spavined, should correctly diagnose
+the condition in practically every instance without recourse to other
+means than noting the peculiar character of the gait of the subject.
+Lameness develops gradually in the majority of instances, and an
+important feature in spavin lameness is that it disappears after the
+subject has gone a little way, to return again as soon as the animal has
+rested for a variable length of time&mdash;from a half hour to several hours.
+This "warming out" is marked during the incipient stage, but less
+pronounced in most chronic cases. A complete disappearance of lameness
+is observed in some instances, while in others only partial subsidence
+is evident. Because of the fact that pain is occasioned both during
+weight bearing and while the leg is being flexed and advanced, there is
+manifested the characteristic mixed lameness and exaggerated hip action
+which typifies spavin. By throwing the hips upward with the sound member
+it is possible to advance the affected leg with less flexion, hence less
+pain is experienced in this manner of locomotion. When made to step
+aside in the stall, a spavined horse will flex the affected member
+abruptly and when weight is taken on the diseased leg, symp<a name="Page_239" id="Page_239"></a>toms are
+evinced of pain, and weight is immediately shifted to the sound limb.
+This is marked during the incipient stages of spavin. Lameness usually
+precedes the formation of exostosis, though cases are observed wherein
+an exostosis is present and no lameness is manifested and no history of
+the previous existence of lameness is available.</p>
+
+<p>The "spavin test" is of value as a diagnostic measure when it is
+employed with other means of examination, though reaction to this test
+is seen in some cases in old "crampy" horses that have experienced hard
+service. The test consists in flexing the affected leg (elevating the
+foot from the ground twelve to twenty-four inches) and holding the
+member in this position for a minute, whereupon the animal is made to
+step away immediately at a trot. During the first few steps taken
+directly thereafter, the subject shows pronounced lameness and this
+constitutes a reaction to the spavin test.</p>
+
+<p>Where no exostosis is present it becomes necessary to exclude other
+causes for lameness but the characteristic spavin lameness is to be
+relied upon to a greater extent in such cases than are other means of
+examination. Such cases are known as occult spavin and may be present
+for months before any external changes in structure are observable. In
+some instances no extoses form even during the course of years. The
+spavin test is of aid in establishing a diagnosis here but the marked
+"warming out" peculiar to spavin is not so pronounced in such cases.</p>
+
+<p><b>Prognosis.</b>&mdash;An animal having hereditary predisposition to spavin is
+not likely to recover completely whether this predisposition be due to
+faulty conformation or susceptibility to bone changes. In predicting the
+outcome, the temperament of the subject is to be taken into account, as
+well as the character of service the animal is expected to perform. And
+finally, a very important feature to be noted, is the location of the
+exostosis. If situated rather high and extending anterior to the hock,
+there is less likelihood of recovery resulting than where an exostosis
+is confined to the lower row of tarsal bones. When situated anterior to
+the tarsus a large exostosis may by mechanical interference to function,
+cause lameness when all other causes are <a name="Page_240" id="Page_240"></a>absent. In making examinations
+one must not be deceived by the inconspicuous and seemingly
+insignificant exostosis which has a broad base. In some cases of this
+kind, dealers style the condition as "rough in the hock" when as a
+matter of fact, in some instances, incurable spavin lameness develops.</p>
+
+<p><b>Treatment.</b>&mdash;Many incipient cases of spavin yield to vesication and a
+protracted period of rest. Results depend primarily upon the nature of
+the affection. However, in every instance if there is involvement of the
+tibial tarsal (astragalus) bone, complete recovery is highly improbable.
+When the disease is confined to the lower tarsal bones, lameness
+subsides as soon as the degenerative changes are checked and ankylosis
+occurs.</p>
+
+<p>The use of the actual cautery when properly employed constitutes an
+excellent method of treatment. The "auto-cautery" when equipped with a
+point of about one-eighth of an inch in diameter and about three-fourths
+of an inch in length is well suited for this particular operation.
+Before deciding to cauterize, it is necessary to ascertain the extent of
+area affected. The nearness of the exostosis to the tibiotarsal
+articulation can be definitely determined by palpation. The hair over
+the entire surgical field is clipped and the cautery at white heat is
+pushed through the overlying soft tissues and into the central part of
+the exostosis. Care is taken to keep the cautery-point away from the
+articular margin of the tibial tarsal bone about three-fourths of an
+inch. No danger will result from cauterizing to a depth of three-fourths
+of an inch in the average case. Two or three (and not more) centrally
+located points for penetration with the cautery are sufficient.
+Experience has shown that several (five or six or more) punctures are
+not productive of good results. When considerable cicatricial tissue is
+present, due to the action of depilating vesicants or other chemicals,
+sloughing of tissue is very apt to follow deep cauterization, if one is
+not careful to keep the punctures at least one-half inch apart when
+three are made. It is best, in such cases, to make but two deep
+penetrations with the cautery but additional superficial punctures may
+be made if kept about three-fourths of an inch distant and not nearer
+than this to one another. Sloughing of tissue is not necessarily
+productive of bad results but there is occasioned an open <a name="Page_241" id="Page_241"></a>wound which
+usually becomes infected and necrosis of tissue may extend into the
+articulation. No benefit results from sloughing and it should be
+avoided. In small horses, one deep point of cauterization is sufficient
+if the osseous tissues are penetrated to a proper depth so that an
+active inflammation is induced. The cautery may, if necessary, be
+reintroduced several times. When the field of operation has been
+properly prepared and it is thought advisable (as where subjects are
+kept in the hospital for a time), the hock may be covered with cotton
+and bandaged and no chance for infection will occur.</p>
+
+<p>After cauterization the subject should be kept quiet in a comfortable
+stall for three weeks; thereafter, if the animal is not too playful, the
+run of a paddock may be allowed for about ten days and a protracted rest
+of a month or more at pasture is best. It is unwise in the average case
+to put an animal in service earlier than two months after having been
+"fired."</p>
+
+<p>Where cases progress favorably, lameness subsides in about three weeks
+after cauterization and little if any recurrence of the impediment is
+manifested thereafter. However, because of violent exercise taken in
+some instances when subjects are put out after being confined in the
+stall, a return of lameness occurs and it may remain for several days or
+in some cases become permanent. No good comes from the use of blistering
+ointments immediately after cauterization. The actual cautery is a means
+of producing all necessary inflammation and it should be so employed
+that sufficient reactionary inflammation succeeds such firing. The use
+of a vesicating ointment subsequent to cauterization invites infection
+because of the dust that is retained in contact with the wound. The
+employment of irritating chemicals in a liquid form following firing is
+needless and cruel.</p>
+
+<p>In many instances lameness is not relieved and subjects show no
+improvement at the end of six weeks time and it then becomes a question
+of whether or not recovery is to be expected even with continued rest
+and treatment. As a rule, such cases are unfavorable. In one instance
+the author employed the actual cautery three times during the course of
+six months and lameness gradually diminished for a year. In this case
+the spavin was of nearly one year's standing when treatment was
+instituted. The sub<a name="Page_242" id="Page_242"></a>ject was a nervous and restless but well-formed
+seven-year-old gelding. Recovery was not complete; recurrent intervals
+of lameness marked this case, but the horse limped so slightly that the
+average observer could not detect its existence after the animal had
+been driven a little way.</p>
+
+<p>Cunean tenotomy has been advocated and practiced by Abildgaard, Lafosse,
+Peters, Herring, Zuill and others and good results have followed in many
+cases so treated.</p>
+
+<p>Considering results, the employment of chemicals of various kinds for
+the purpose of relieving spavin lameness does not compare favorably with
+firing. Moreover, so many animals have been tortured and needlessly
+blemished in the attempted cure of spavin that agents which are not of
+known value, the use of which are likely to result in extensive injury
+to the tissues, are only to be condemned.</p>
+
+<p>When spavin is bilateral and lameness is likewise affecting both
+members, prognosis is at once unfavorable. Such cases are often
+benefited by cauterization but only one leg at a time should be treated.</p>
+
+<p>Bossi's double tarsal neurectomy (division of the anterior and posterior
+tibial nerves) has undoubtedly been of decided benefit in many cases,
+but is not at present a popular method of treatment in this country.
+This operation has its indications, however, and may be recommended in
+chronic lameness where no extensive exostosis exists which may
+mechanically interfere with function.</p>
+
+
+<h3><a name="Distension_of_the_Tarsal_Joint_Capsule_Bog_Spavin" id="Distension_of_the_Tarsal_Joint_Capsule_Bog_Spavin"></a>Distension of the Tarsal Joint Capsule. (Bog Spavin.)</h3>
+
+<p>Distension of the capsular ligament of the tibial tarsal
+(tibioastragular) joint with synovia is commonly known as bog spavin.
+This condition is separate and distinct from that of distension of the
+sheath of the deep flexor tendon (perforans) though not infrequently the
+two affections coexist.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Following strains from work in the harness
+or under the saddle, horses develop an acute synovitis of the hock
+joint, which often results in chronic synovial distension. Debilitating
+diseases favor the production of this <a name="Page_243" id="Page_243"></a>affection in some animals. It is
+also frequently observed in young horses and in draught colts of twelve
+to eighteen months of age. This condition occurs while the subjects are
+at pasture and often spontaneous recovery results by the time the
+animals are two years of age.</p>
+
+<p class="figcenter"><a name="image56" id="image56"></a>
+   <a href="./images/img56-full.jpg"><img src="./images/img56.jpg"
+   alt="Fig. 56&mdash;Bog spavin. Showing point of view which may be
+most advantageously taken by the diagnostician in examining for
+distension of the capsular ligament of the tarsal joint."
+   title="Fig. 56&mdash;Bog spavin. Showing point of view which may be
+most advantageously taken by the diagnostician in examining for
+distension of the capsular ligament of the tarsal joint." /></a></p>
+<p class="captioncenter">Fig. 56&mdash;Bog spavin. Showing point of view which may be
+most advantageously taken by the diagnostician in examining for
+distension of the capsular ligament of the tarsal joint.</p>
+
+
+<p><b>Symptomatology.</b>&mdash;Bog spavin is recognized by the distended condition
+of the joint capsule which is prominent just below the internal tibial
+malleolus and this affection is character<a name="Page_244" id="Page_244"></a>ized by a fluctuating swelling
+which varies considerably in size in different subjects. Except in cases
+of acute synovitis, lameness is not present and in chronic distension of
+the capsule of the tarsal joint, no interference with the subject's
+usefulness occurs. In the majority of instances, the disfigurement which
+attends bog spavin is the principal objectionable feature. The condition
+is bilateral in many instances, and in such cases the subjects have a
+predisposition to this condition or it follows attacks of strangles or
+other debilitating ailments. Because of a rapid and unusual growth,
+bilateral affections are of frequent occurrence in some animals.</p>
+
+<p><b>Treatment.</b>&mdash;The most practical method of handling bog spavin consists
+in aspiration of synovia and injection of tincture of iodin. Discretion
+should be employed in selecting subjects for treatment, regardless of
+the manner in which such cases are to be handled. Where there exists
+chronic distension of the joint capsule of several years' standing in
+old or weak subjects, needless to say, recovery is not likely to result.
+When animals are vigorous and two or three months' time is available,
+treatment may be begun with reasonable hope for success.</p>
+
+<p>The average subject is handled standing and can be restrained with a
+twitch, sideline and hood. Aspirating needles and all necessary
+equipment must be in readiness (sterile and wrapped in aseptic cotton or
+gauze) so that no delay will occur from this cause when the operation
+has been started. The central or most prominent part of the distended
+portion of the capsule is chosen for perforation and an area of an inch
+and a half in diameter is shaved. The skin is cleansed and then painted
+with tincture of iodin. The sterile aspirating needle is pushed through
+the tissues and into the capsule with a sudden thrust. With a large and
+sharp needle (fourteen gauge), synovia can be drawn from the cavity in
+most instances and the subject usually offers no resistance. By
+compressing the distended capsule and surrounding structures with the
+fingers, considerable synovia may be evacuated. In singular instances,
+no synovia is to be aspirated with the needle, and in such cases the
+amount of iodin injected needs be increased, possibly twenty-five per
+cent., as experience <a name="Page_245" id="Page_245"></a>will indicate. From two to five cubic centimeters
+of U.S.P. tincture of iodin is injected through the aspirating needle
+into the synovial cavity of the joint, and the exterior of the parts are
+vigorously massaged immediately after injection to stimulate
+distribution of the iodin throughout the synovial cavity. Where a
+bilateral affection exists, two or three weeks' time should intervene
+between the treatments of each leg. A sterile metal syringe equipped
+with a slip joint for the needle is well adapted to this operation.
+Lubrication of the plunger with heavy sterile vaseline or glycerin will
+prevent the syringe from being ruined by the iodin.</p>
+
+<p>Following the injection, the subject is kept in a stall or in a suitable
+paddock, so that conditions may be observed for four or five days. The
+object sought by the introduction of iodin is not only for a local
+effect upon the synovial membranes in checking secretions, but the
+production of an active inflammation and great swelling, which will
+remain from four weeks to three months subsequent to the injection. This
+periarticular swelling should produce and maintain a constant pressure
+over the entire affected parts for a sufficient length of time until
+normal tone is re-established.</p>
+
+<p>In some cases, swelling does not develop as the result of a single
+injection of iodin. When marked swelling has not taken place within five
+days, none will occur and a repetition of the injection may be made
+within ten days after the first treatment has been given. One may safely
+increase the amount of iodin at the second injection in such cases by
+one-fourth to one-third.</p>
+
+<p>In Europe this method of treating bog spavin has been employed by
+Leblanc, Abadie, Dupont and others according to Cadiot; but Bouley, Rey,
+Lafosse and Varrier used it with bad results. Where a perfect technic is
+executed (and no other is excusable in this operation), no infection
+will occur if a reasonable amount of iodin is injected. The dilution of
+iodin with an equal amount of alcohol has been practised by the author
+in many cases, but later this was found unnecessary.</p>
+
+<p>Other methods of treatment have been used with success. Perhaps the most
+heroic consists in opening the joint capsule with a <a name="Page_246" id="Page_246"></a>bistoury or with
+the actual cautery. Such practice is too hazardous for general use and
+is not to be recommended, although good results should follow the
+employment of such methods if infectious arthritis does not occur.</p>
+
+<p>Line firing over the distended capsule is a practical method of
+treatment. This is attended with good results in young animals in many
+cases, but considerable blemish is caused when sufficient irritation is
+produced to stimulate resolution.</p>
+
+<p>Vesication also is successfully employed in some instances. However,
+only cases of recent origin in young animals&mdash;colts of two years or
+younger&mdash;yield to blistering, and in some affected colts no doubt
+recovery would have been spontaneous had no treatment been instituted.</p>
+
+<p>Ligation of the saphenous vein at two points, one above and the other
+below the distended ligamentous capsule, is an old operation, which has
+undoubtedly given good results in some cases, although it does not seem
+to be a rational procedure.</p>
+
+<p><b>After-Care.</b>&mdash;After swelling has fully developed&mdash;which occurs within a
+week&mdash;the subject is turned to pasture and no attention is necessary
+thereafter. A gradual subsidence of the swelling occurs and in the
+average instance, this completely resolves within six or eight weeks.</p>
+
+<p>Complete recovery succeeds the aspiration-and-injection-treatment in
+about seventy-five per cent of cases as the result of one operation, and
+subjects may be gradually and carefully returned to work in about sixty
+days after treatment has been given.</p>
+
+
+<h3><a name="Distension_of_the_Tarsal_Sheath_of_the_Deep_Digital_Flexor" id="Distension_of_the_Tarsal_Sheath_of_the_Deep_Digital_Flexor"></a>Distension of the Tarsal Sheath of the Deep Digital Flexor.<br />
+(Thoroughpin.)</h3>
+
+<p>The terms "thoroughpin" or "throughpin" are translations from the French
+<i>vessignon chevill&eacute;</i> and have the same significance. They are so named
+because of the diametrically opposed distensions of the sheath of the
+deep flexor tendon in such manner that the distensions appear to be due
+to a supporting peg.</p>
+
+<p><b>Anatomy.</b>&mdash;The theca through which the deep digital flexor (perforans)
+plays in the tarsal region, begins about three inches <a name="Page_247" id="Page_247"></a>above the inner
+tibial malleolus and extends about one-fourth of the way down the
+metatarsus. The posterior part of the capsular ligament of the hock
+joint is very thick in its most dependent portions and is in part
+cartilaginous, forming a suitable groove for the passage of the deep
+flexor tendon.</p>
+
+<p class="figcenter"><a name="image57" id="image57"></a>
+   <a href="./images/img57-full.jpg"><img src="./images/img57.jpg"
+   alt="Fig. 57&mdash;Thoroughpin. Showing distension of the sheath of
+the deep flexor tendon as it protrudes antero-externally to the fibular
+tarsal bone (calcaneum)."
+   title="Fig. 57&mdash;Thoroughpin. Showing distension of the sheath of
+the deep flexor tendon as it protrudes antero-externally to the fibular
+tarsal bone (calcaneum)." /></a></p>
+<p class="captioncenter">Fig. 57&mdash;Thoroughpin. Showing distension of the sheath of
+the deep flexor tendon as it protrudes antero-externally to the fibular
+tarsal bone (calcaneum).</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Strains and sequellae to debilitating
+diseases constitute the usual causes of this affection. As a result of
+acute synovitis a chronic synovial distension of the tarsal sheath
+occurs. Bog spavin is often present in case of thoroughpin but the two
+conditions are separate and distinct excepting in that both may occur
+simultaneously and as the result of the same cause. Some animals are
+undoubtedly predisposed to disease of synovial structures. The average
+horse that has been subjected to hard service on pavements or hard roads
+at fast work suffers synovial distension of bursae, thecae or of joint
+capsules. Some of the well bred types such as the <a name="Page_248" id="Page_248"></a>thoroughbred horses
+may be subjected to years of hard service and still remain "clean
+limbed" and free from all blemishes. Thus it seems that subjects of
+rather faulty conformation, animals having lymphatic temperaments and
+the coarse-bred types, are prone to synovial disturbances such as
+thoroughpin, bog spavin, etc., sometimes having both legs affected.</p>
+
+<p class="figcenter"><a name="image58" id="image58"></a>
+   <a href="./images/img58-full.jpg"><img src="./images/img58.jpg"
+   alt="Fig. 58&mdash;Fibrosity of tarsus as a complication in chronic
+thoroughpin."
+   title="Fig. 58&mdash;Fibrosity of tarsus as a complication in chronic
+thoroughpin." /></a><br />
+Fig. 58&mdash;Fibrosity of tarsus as a complication in chronic
+thoroughpin.</p>
+
+
+<p><b>Symptomatology.</b>&mdash;Thoroughpin is characterized by a distended condition
+of the tarsal sheath which is manifested by protrusions anterior to the
+tendo Achillis. However, where but moderate distension of the sheath
+exists, there is little, if any, bulging on the mesial side of the hock
+and but a small hemispherical enlargement is presented on the outer side
+of the tarsus, anterior to the summit of the os calcis. In some
+instances the protruding parts assume large proportions, but always,
+because of the relationship between the fibular tarsal bone (calcaneum)
+and the tendon sheath, the larger protrusion is situated mesially.</p>
+
+<p><a name="Page_249" id="Page_249"></a></p>
+
+<p>During the acute inflammatory stage there is marked lameness present but
+this soon subsides when local antiphlogistic agents are applied to the
+parts. In fact, spontaneous relief from lameness usually results in the
+course of ten days' time following the appearance of thoroughpin. No
+lameness marks the advent of this affection when it develops as the
+result of continuous strain and concussion occasioned by hard service,
+and local changes tend to remain in <i>status quo</i>.</p>
+
+<p class="figcenter"><a name="image59" id="image59"></a>
+   <a href="./images/img59-full.jpg"><img src="./images/img59.jpg"
+   alt="Fig. 59&mdash;Another view of same case as illustrated in Fig.
+58."
+   title="Fig. 59&mdash;Another view of same case as illustrated in Fig.
+58." /></a><br />
+Fig. 59&mdash;Another view of same case as illustrated in <a href="#image58">Fig.
+58</a>.</p>
+
+
+<p><b>Treatment.</b>&mdash;Rest and the local application of heat or cold will
+suffice to promote resolution of acute inflammation and lameness when
+present will subside within two weeks. In chronic affections, however,
+the matter and manner of effecting a cor<a name="Page_250" id="Page_250"></a>rection of the
+condition&mdash;distended tarsal sheath&mdash;merit careful consideration. While
+drainage of distended thecae and bursae by means of openings made with
+hot irons was practiced by the Arabs, centuries ago, and good results
+have attended such heroic corrective measures, nevertheless the
+occasional serious complications which result from infection likely to
+be introduced in following such procedures, cause the prudent and
+skilful practitioner to employ safer methods of treatment.</p>
+
+<p>The application of blistering agents is of no value in stimulating
+resorption of an excessive amount of synovia in chronic cases and the
+actual cautery when employed without perforation of the synovial
+structure, is of little benefit. Trusses or mechanical appliances for
+the purpose of maintaining pressure upon the distended parts are of no
+practical value because of the great difficulty of keeping such
+contrivances in position. They usually cause so much discomfort to the
+subject that they are not tolerated.</p>
+
+<p>A very practical and fairly successful method of treatment consists in
+the aspiration of a quantity of synovia and injecting tincture of iodin.
+Cadiot recommends the drainage of synovia with a suitable trocar and
+cannula and injecting a mixture consisting of tincture of iodin, one
+part, to two parts of sterile water, to which is added a small quantity
+of potassium iodid. The latter agent is added to prevent precipitation
+of the iodin. This authority (Cadiot) further advocates the removal of
+practically all of the synovia that will run out through the cannula and
+the immediate introduction of as much as one hundred cubic centimeters
+of the above mentioned iodin solution. This solution is allowed to
+remain in the synovial cavity a few minutes and by compressing the
+tissues surrounding the tendon sheath, the evacuation of as much of the
+contents of the synovial cavity as is practicable, is effected.
+Subsequently the subject is allowed absolute rest and more or less
+inflammatory reaction follows. In some cases there occur marked lameness
+and some febrile disturbance, but where a good technic is carried out,
+no bad results follow. At the end of four weeks' time, horses so treated
+may be returned to service, but the full beneficial <a name="Page_251" id="Page_251"></a>effect of such
+treatment is not experienced until several months' time have elapsed.</p>
+
+<p>Where good facilities for executing a careful technic in every detail
+are at hand, incision of the tarsal sheath, evacuation of its contents
+and uniting its walls again by means of sutures and providing for
+drainage with a suitable drainage tube, may be practiced. This manner of
+treatment has been satisfactory in the hands of a number of surgeons.</p>
+
+
+<h3><a name="Capped_Hock" id="Capped_Hock"></a>Capped Hock.</h3>
+
+<p>Enlargements which occur upon the summit of the os calcis, whether
+hypertrophy of the skin and subcuticular fascia, the result of injury or
+repeated vesication, distension of the subcutaneous bursa or injury to
+the superficial flexor tendon (perforatus) or its sheath, are generally
+known as capped hock. However, the term should be restricted to use in
+reference to distensions of synovial structures of that region.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Usually there occurs a hygromatous
+involvement of the subcutaneous bursa due to contusion. As in bog
+spavin, following certain infectious diseases (influenza, purpura
+hemorrhagica, etc.) there remains a distended condition of the
+subcutaneous bursa, after swelling of the member has subsided. In
+feeding pens where numbers of young mules are kept in crowded quarters
+many cases may be observed. In some instances where violent contusions
+result from kicking cross-bars of wagon shafts (by nymphomaniacs or in
+habitual kickers where there is opportunity for doing such injury) the
+superficial flexor tendon and its synovial apparatus are injured and a
+more serious condition may result.</p>
+
+<p><b>Symptomatology.</b>&mdash;In acute and extensive inflammation of the parts,
+lameness is present, but in the average case no inconvenience to the
+subject results. The prominent site of the affection is cause for an
+unsightly blemish. This is undesirable, particularly in light-harness or
+saddle horses. These affections are characterized by a fluctuating mass
+which has a thin wall and in all cases of long standing the condition is
+painless.</p>
+<p><a name="Page_252" id="Page_252"></a></p>
+
+<p>By careful palpation one may readily distinguish between a hygromatous
+condition of the superficial bursa and involvement of the underlying
+structures. Affection of the expanded portion of the flexor tendon and
+contiguous structures makes for an organized mass of tissue which is
+somewhat dense and in some instances painful to the subject when
+manipulated. This is particularly noticeable in cases where the parts
+are regularly and repeatedly injured as in habitual kickers.</p>
+
+<p class="figcenter"><a name="image60" id="image60"></a>
+   <a href="./images/img60-full.jpg"><img src="./images/img60.jpg"
+   alt="Fig. 60&mdash;''Capped hock.'' Distension of the bursa over the
+summit of the os calcis."
+   title="Fig. 60&mdash;''Capped hock.'' Distension of the bursa over the
+summit of the os calcis." /></a><br />
+Fig. 60&mdash;"Capped hock." Distension of the bursa over the
+summit of the os calcis.</p>
+
+<p><b>Treatment.</b>&mdash;In acute inflammation, antiphlogistic applications are
+indicated and the subject must be kept quiet. The matter of bandaging
+the hock is a difficult problem in some cases and needs be done with
+care. As has been previously stated in this volume, the tarsus needs to
+be well padded with cotton before the bandages are applied and only a
+moderate degree of tension is employed in applying the bandages lest
+anemic-necrosis result from pressure. In distension of the superficial
+bursa, after clipping the hair over a liberal area and preparing the
+skin <a name="Page_253" id="Page_253"></a>by thoroughly cleansing and painting with tincture of iodin, the
+capsule is incised with a bistoury. An incision about an inch in length,
+situated low enough to provide drainage, is made through the tissues and
+the contents are evacuated. Tincture of iodin is injected into the
+cavity and the parts are covered with cotton and bandaged. No after-care
+is necessary except to retain the dressing in position, which is not
+difficult in the average case if the subject is kept tied. If much
+resistance is exhibited, such as extreme flexion of the bandaged hock,
+the animal may be put in a sling and little if any objection to the
+bandage will be offered thereafter. The wound may be dressed at the end
+of forty-eight hours and no redressing will be necessary in the average
+instance if infection is not present. But slight local disturbance and
+little distress to the subject result in cases so treated even when
+infection occurs, but a good technic is possible of execution in most
+instances and no infection should take place.</p>
+
+<p>The surgical wound heals in two or three weeks and inflammation
+gradually subsides. Bandages are retained one or two weeks, as the case
+may require, and subsequently a good wound lotion may be employed
+several times daily. A good lotion for such cases as well as in many
+others has long been employed with success by Dr. A. Trickett of Kansas
+City. It consists of approximately equal parts of glycerin, alcohol and
+distilled extract of witch hazel, to which is added liquor cresolis
+compositus, two percent, and coloring matter q.s.</p>
+
+<p>Complete resolution does not occur in the average case. There remains
+some hyperplastic tissue and even where the enlargement is slight, the
+prominent situation of the affection precludes its being unnoticed.</p>
+
+<p>In disease of the flexor tendon and its bursa where contiguous
+inflammation of tissue is present, the parts are blistered or fired.
+Line firing is beneficial in such instances but in all cases the cause
+is to be removed if possible.</p>
+
+
+<h3><a name="Rupture_and_Division_of_the_Long_Digital_Extensor" id="Rupture_and_Division_of_the_Long_Digital_Extensor"></a>Rupture and Division of the Long Digital Extensor<br />
+(Extensor Pedis).</h3>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Because of the fact that the long <a name="Page_254" id="Page_254"></a>digital
+extensor is the only extensor of the phalanges of the pelvic limb, its
+rupture or division constitutes a troublesome condition, which in some
+cases does not readily respond to treatment.</p>
+
+<p>Rupture of this tendon may occur during work on rough and uneven roads,
+particularly in range horses that are ridden over ground that is
+burrowed by gophers or prairie dogs; in such cases, horses are apt to
+suddenly and violently turn the foot in position of volar flexion,
+thereby causing undue strain to the digital extensor and its rupture
+sometimes follows. In foals of one or two days of age, this tendon is
+sometimes found parted or ruptured and the condition may be bilateral.</p>
+
+<p>As the result of accidents, the digital extensor may be divided and when
+the wound becomes contaminated, as it does because of the marked volar
+flexion (knuckling) which occurs during the course of this affection,
+regeneration of tissue is checked and recovery is tardy.</p>
+
+<p><b>Symptomatology.</b>&mdash;There is no interference with ability to sustain
+weight in such cases, when the foot is placed in normal position; but
+immediately upon attempting to walk, the toe is dragged, and if weight
+is borne with the affected member, it comes upon the anterior face of
+the fetlock. The flexors are not antagonized and if there be an open
+wound the parts soon become contaminated; or, in rupture, if animals
+travel about very much, there soon occurs necrosis of the tissues of the
+anterior fetlock region and the condition is rendered incurable. Cases
+are reported of animals that have suffered rupture of the long digital
+extensor and the subjects learned to throw the member forward during
+extension, substituting for the extensor tendon the pendulum-like
+momentum which the foot affords when so employed; and a walking and even
+a trotting pace was possible without doing injury to the fetlock region.</p>
+
+<p>Where a subcutaneous division exists as in rupture, the divided ends of
+the tendon may be definitely recognized by palpation.</p>
+
+<p><b>Treatment.</b>&mdash;Subjects are best put in slings and kept so confined until
+regeneration of tendinous structures has been com<a name="Page_255" id="Page_255"></a>pleted. This requires
+from six weeks to two months' time. In addition, the extremity is kept
+in a state of extension by means of suitable splints and shoes,&mdash;a shoe
+equipped with an extension at the toe and perforated so that a steel
+brace may be hooked into the perforation and the brace fashioned to be
+buckled to the upper metatarsal region. When braces are placed in front
+of the foot, great care is necessary in properly padding the member with
+cotton lest sloughing from pressure occurs at the coronet; but this does
+not apply in rupture of extensors so much as where flexors are ruptured.</p>
+
+<p>Open wounds are treated along general surgical lines, dressed as
+frequently as occasion demands, and recovery will be complete in a few
+months' time unless much of the tendon has been destroyed. In one
+instance, the author had occasion to observe such a condition, which,
+because of the extensive destruction of tendon and lack of facilities
+for giving proper attention to the subject, results were so unfavorable
+that it was deemed necessary to destroy the animal.</p>
+
+
+<h3><a name="Wounds_From_Interfering" id="Wounds_From_Interfering"></a>Wounds From Interfering.</h3>
+
+<p>When, during locomotion, injury is inflicted upon the mesial side of an
+extremity by the swinging foot of the other member, the condition is
+termed interfering.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Faulty conformation, bad shoeing and
+over-work are the principal causes of interfering. Horses that are "base
+narrow" or that have crooked legs are quite apt to interfere. Shoes that
+are put on a foot that is not level or applied in a twisted position, or
+shoes wide at the heel will often cause interfering and injury. Animals
+that are driven at fast work until they become nearly exhausted may be
+expected to interfere. Such cases are frequently observed in young
+horses that are driven over rough roads, particularly when so nearly
+exhausted or weakened from disease or inanition that the feet are
+dragged forward rather than picked up and advanced in the normal manner.</p>
+
+<p><b>Symptomatology.</b>&mdash;Wounds inflicted by striking the extremities in this
+manner present various appearances and occasion dis<a name="Page_256" id="Page_256"></a>similar
+manifestations. The hind legs are almost as frequently affected as the
+front and the fetlock region is most often injured, though wounds may be
+inflicted to the coronet. In front, the carpus is sometimes the site of
+injury.</p>
+
+<p>When only an abrasion is caused, little if any lameness occurs, but
+where interfering is continued and nerves are involved or subfascial
+infection and extensive inflammation succeed such abrasions, marked
+lameness and evidence of great pain are manifested. Frequently, in
+chronic cases affecting the hind leg, the fetlock assumes large
+proportions, and at times during the course of every drive the subject
+strikes the inflamed part, immediately flexing and abducting the injured
+member, and the victim hops on the other leg until pain has somewhat
+subsided.</p>
+
+<p>Interfering is much more serious in animals that are used at fast work
+than in draft horses. In light-harness or saddle horses, it may render
+the subject practically valueless or unserviceable if the condition
+cannot be corrected.</p>
+
+<p><b>Treatment.</b>&mdash;Wherever possible, cause is to be removed and if animals
+are properly used, ordinary interfering wounds will yield to treatment.
+If the shoeing is faulty, this should be corrected, the foot properly
+prepared and leveled before being shod and suitable shoes applied. In
+young animals that become "leg-weary" from constant overwork, rest and
+recuperation are necessary to enhance recovery. In such cases it will be
+found that very light shoes, frequently reset, will tend to prevent
+injury to the fetlock region such as characterizes these injuries of
+hind legs.</p>
+
+<p>Palliative measures of various kinds are employed where cause is not to
+be removed and a degree of success attends such effort. In draft horses
+or animals that are used at a slow pace, shields of various kinds are
+strapped to the extremity and protection is thus afforded. Or, large
+encircling pads of leather, variously constructed, serve to cause the
+subject to walk with the extremities apart.</p>
+
+<p>Interfering shoes of different types are of material benefit in many
+instances. Often the principle upon which corrective shoeing is based is
+that the mesial (inner) side of the foot is too low; the foot is
+consequently leveled and the inner branch of the <a name="Page_257" id="Page_257"></a>shoe is made thicker
+than the outer, altering the position of the foot in this way. This is
+productive of desirable results. However, much depends upon the manner
+in which the foot in motion strikes the weight-bearing member as to the
+corrective measures that are indicated. This belongs to the domain of
+pathological shoeing and the reader is referred to works on this subject
+for further study of this phase of lameness.</p>
+
+
+<h3><a name="Lymphangitis" id="Lymphangitis"></a>Lymphangitis.</h3>
+
+<p>Excluding glanders, in the majority of instances, lymphangitis in the
+horse, such as frequently affects the hind legs, is due to the local
+introduction of infectious material into the tissues as a result of
+wounds. However, one may observe in some instances an acute lymphangitis
+which affects the pelvic limbs of horses and no evidence of infection
+exists. Consequently, lymphangitis may be considered as <i>infectious</i> and
+<i>non-infectious</i>.</p>
+
+
+<p class="center">INFECTIOUS LYMPHANGITIS.</p>
+
+<p><b>Etiology and Occurrence.</b>&mdash;Traumatisms of the legs frequently result in
+infection and when such injuries are near lymph glands, even though the
+degree of infection be slight, more or less disturbance of function of
+the muscles in the vicinity of such glands occurs and lameness follows.</p>
+
+<p>The prescapular, axillary and cubital lymph glands when in a state of
+inflammation, cause lameness of the front leg, and the superficial
+inguinal and deep inguinal lymph glands not infrequently become involved
+also. Because of the location of these lymph glands, they are subject to
+comparatively frequent injury and inflammation, causing lameness more
+often than other lymph-gland-affections.</p>
+
+<p>Small puncture wounds in the region of the elbow are often met with.
+These may be inflicted when horses lie down upon sharp stumps of
+vegetation or shoe-calk injuries may be the means of introducing
+contagium, and an infectious inflammation results. Abscess formation,
+the result of strangles or other infection in the prescapular glands,
+may be observed at times. Following castration, the inguinal lymph
+glands may become involved in an infectious inflammation and locomotion
+is im<a name="Page_258" id="Page_258"></a>peded to a marked degree. Horses running at pasture sometimes
+become injured by trampling upon pieces of wood, causing one end of
+these or of various implements to become embedded in the soft earth and
+the other end to enter at the inguinal region and even penetrate the
+tissues to and through the skin and fascia just below the perineal
+region.</p>
+
+<p>Nail punctures resulting in infection frequently cause an infectious
+lymphangitis and a marked and painful swelling of the legs supervenes.</p>
+
+<p class="figcenter"><a name="image61" id="image61"></a>
+   <a href="./images/img61-full.jpg"><img src="./images/img61.jpg"
+   alt="Fig. 61&mdash;Chronic lymphangitis. Showing hypertrophy of the
+left hind leg, due to repeated inflammation."
+   title="Fig. 61&mdash;Chronic lymphangitis. Showing hypertrophy of the
+left hind leg, due to repeated inflammation." /></a><br />
+Fig. 61&mdash;Chronic lymphangitis. Showing hypertrophy of the
+left hind leg, due to repeated inflammation.</p>
+
+<p><b>Symptomatology.</b>&mdash;Lameness, mixed or swinging-leg, signalizes the
+presence of acute lymphangitis. There is always more or less swelling
+present and manipulation of the affected parts gives pain to the
+subject. Depending upon the character of the infection and its extent,
+there is presented a varying degree of constitutional disturbance. There
+may be a rise in temperature of from two to five degrees, and in such
+instances there is an accelerated pulse. Where much intoxication is
+present, anorexia and dipsosis are to be noticed.</p>
+<p><a name="Page_259" id="Page_259"></a></p>
+
+<p>Swelling may increase gradually and in time discharge of pus may take
+place spontaneously without drainage being provided for, if the
+character of the infection does not cause early death. In these cases
+lameness is pronounced and the cause of the disturbance is to be sought,
+particularly if the condition be due to a nail puncture.</p>
+
+<p class="figcenter"><a name="image62" id="image62"></a>
+   <a href="./images/img62-full.jpg"><img src="./images/img62.jpg"
+   alt="Fig. 62&mdash;Elephantiasis."
+   title="Fig. 62&mdash;Elephantiasis." /></a><br />
+Fig. 62&mdash;Elephantiasis.</p>
+
+
+<p><b>Treatment.</b>&mdash;Location of the site of injury is advisable in <a name="Page_260" id="Page_260"></a>all cases
+and in some instances provision for drainage, as in puncture wounds, is
+helpful. Locally, curettage and the application of suitable antiseptics
+are indicated. Hot fomentations are beneficial and should be continued
+for several days if necessary, to stimulate resolution. A brisk purge
+should be admintered at the onset and strychnin, because of its indirect
+stimulative effect upon the circulation together with its tonic effect
+upon the musculature, is beneficial.</p>
+
+<p>In all such cases rational treatment, good hygiene and careful nursing
+are the principal factors which stimulate recovery. Individual
+resistance or lowered vitality has a marked influence on the course of
+this affection.</p>
+
+
+<p class="center">NON-INFECTIOUS LYMPHANGITIS.</p>
+
+<p>This type of lymphangitis is associated with, or the result of, a
+derangement of digestion. It affects heavy draft horses, rarely other
+types of animals, and involves one or both hind legs.</p>
+
+<p><b>Occurrence.</b>&mdash;In healthy and well nourished horses irregularly used,
+this affection may suddenly manifest itself. It occurs in singular
+instances in mares that are in advanced pregnancy even when such animals
+are at pasture. Usually, however, this malady is found in heavy draft
+horses that have been kept stabled from one to three days.</p>
+
+<p><b>Symptomatology.</b>&mdash;At the outset in severe cases, there is elevation of
+temperature, labored breathing, accelerated pulse, anorexia and more or
+less swelling of the affected members. Swelling is very painful and when
+the affected legs are palpated, pain is manifested by flinching. The
+inguinal lymph glands are often swollen but in some cases they are not
+affected in any perceptible degree. In the average case suppuration does
+not occur and when conditions are favorable, resolution is complete
+within ten days. The extent of the involvement and the intensity of the
+affection vary materially in different cases and a chronic lymphangitis
+may succeed the acute attacks and finally in some instances,
+elephantiasis results.</p>
+
+<p><b>Treatment.</b>&mdash;An active purgative should be given at once and in the
+ordinary case, stimulants are indicated. If marked distress is present,
+morphin is given and where there is much <a name="Page_261" id="Page_261"></a>rise of temperature, cold
+drinking water is offered in abundance and catharsis is enhanced by
+enemata. Locally, hot applications are of benefit. Hot towels or cotton
+held in position by bandages and kept soaked with warm water will
+relieve pain and stimulate resolution. Diuretics may be of benefit and
+anodyne applications are to be employed with profit in some cases.
+Walking exercise, if not indulged in to excess, is helpful as soon as
+acute inflammation has subsided. By giving careful attention to the
+regimen and providing regular exercise for susceptible subjects, this
+type of lymphangitis is often forestalled.</p>
+<p><a name="Page_262" id="Page_262"></a></p>
+
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<p class="footnote"><a name="Footnote_34_34" id="Footnote_34_34"></a><a class="footnotea" href="#FNanchor_34_34">[34]</a>&nbsp;&nbsp;Manual of Veterinary Physiology. Page 610.</p>
+
+<p class="footnote"><a name="Footnote_35_35" id="Footnote_35_35"></a><a class="footnotea" href="#FNanchor_35_35">[35]</a>&nbsp;&nbsp;Manual of Veterinary Physiology, page 601.</p>
+
+<p class="footnote"><a name="Footnote_36_36" id="Footnote_36_36"></a><a class="footnotea" href="#FNanchor_36_36">[36]</a>&nbsp;&nbsp;Case report at meeting of the Iowa State Veterinary
+Medical Association, Jan., 1904, by Dr. S.H. Bauman, Birmingham, Ia.</p>
+
+<p class="footnote"><a name="Footnote_37_37" id="Footnote_37_37"></a><a class="footnotea" href="#FNanchor_37_37">[37]</a>&nbsp;&nbsp;Regional Veterinary Surgery and Operative Technique, by
+John A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 733.</p>
+
+<p class="footnote"><a name="Footnote_38_38" id="Footnote_38_38"></a><a class="footnotea" href="#FNanchor_38_38">[38]</a>&nbsp;&nbsp;As quoted by A. Liautard, M.D., V.M., American Veterinary
+Review, Vol. 37, page 667.</p>
+
+<p class="footnote"><a name="Footnote_39_39" id="Footnote_39_39"></a><a class="footnotea" href="#FNanchor_39_39">[39]</a>&nbsp;&nbsp;Quoted by Prof. Liautard, American Veterinary Review, Vol.
+33, page 190.</p>
+
+<p class="footnote"><a name="Footnote_40_40" id="Footnote_40_40"></a><a class="footnotea" href="#FNanchor_40_40">[40]</a>&nbsp;&nbsp;Traite de Th&eacute;rapeutique Chirurgical des Animaux Domestique
+par P.J. Cadiot et J. Almy, Tome second, page 460.</p>
+
+<p class="footnote"><a name="Footnote_41_41" id="Footnote_41_41"></a><a class="footnotea" href="#FNanchor_41_41">[41]</a>&nbsp;&nbsp;Traite de Th&eacute;rapeutique Chirurgical, Tome second, page
+465.</p>
+
+<p class="footnote"><a name="Footnote_42_42" id="Footnote_42_42"></a><a class="footnotea" href="#FNanchor_42_42">[42]</a>&nbsp;&nbsp;Luxation of the Femur, by Wm. V. Lusk, Veterinary Surgeon,
+U.S. Cavalry, American Veterinary Review, Vol. 21, page 254.</p>
+
+<p class="footnote"><a name="Footnote_43_43" id="Footnote_43_43"></a><a class="footnotea" href="#FNanchor_43_43">[43]</a>&nbsp;&nbsp;Because of the intimacy of the psoas major (p. magnus) and
+the iliacus they are sometimes called iliopsoas.</p>
+
+<p class="footnote"><a name="Footnote_44_44" id="Footnote_44_44"></a><a class="footnotea" href="#FNanchor_44_44">[44]</a>&nbsp;&nbsp;Dr. John Scott, Peoria, Ill., in The American Veterinary
+Review, Vol. 16, page 16.</p>
+
+<p class="footnote"><a name="Footnote_45_45" id="Footnote_45_45"></a><a class="footnotea" href="#FNanchor_45_45">[45]</a>&nbsp;&nbsp;Annotation on Surgical Items, by Drs. L.A. and Edward
+Merillat, American Veterinary Review, Vol. 31, page 358.</p>
+
+<p class="footnote"><a name="Footnote_46_46" id="Footnote_46_46"></a><a class="footnotea" href="#FNanchor_46_46">[46]</a>&nbsp;&nbsp;W.L. Williams in American Veterinary Review, Vol. 21, page
+452.</p>
+
+<p class="footnote"><a name="Footnote_47_47" id="Footnote_47_47"></a><a class="footnotea" href="#FNanchor_47_47">[47]</a>&nbsp;&nbsp;Geo. H. Berns, D.V.S., report, American Veterinary Medical
+Association, 1912, page 238.</p>
+
+<p class="footnote"><a name="Footnote_48_48" id="Footnote_48_48"></a><a class="footnotea" href="#FNanchor_48_48">[48]</a>&nbsp;&nbsp;Joseph Hughes, M.R.C.V.S., in the Chicago Veterinary
+College Quarterly Bulletin, Vol. 10, page 15.</p>
+
+<p class="footnote"><a name="Footnote_49_49" id="Footnote_49_49"></a><a class="footnotea" href="#FNanchor_49_49">[49]</a>&nbsp;&nbsp;Traite de Therap. Chir. Cadiot et Almy, Tome second, page
+480.</p>
+
+<p class="footnote"><a name="Footnote_50_50" id="Footnote_50_50"></a><a class="footnotea" href="#FNanchor_50_50">[50]</a>&nbsp;&nbsp;E. Wallis Hoare, F.R.C.V.S., American Veterinary Review,
+Vol. 27, page 1189.</p>
+
+<p class="footnote"><a name="Footnote_51_51" id="Footnote_51_51"></a><a class="footnotea" href="#FNanchor_51_51">[51]</a>&nbsp;&nbsp;Discussions on paper entitled "The Spavin Group of
+Lamenesses," by W.L. Williams, Carl W. Fisher and D.H. Udall,
+Proceedings of American Veterinary Medical Association, 1905.</p>
+
+<p class="footnote"><a name="Footnote_52_52" id="Footnote_52_52"></a><a class="footnotea" href="#FNanchor_52_52">[52]</a>&nbsp;&nbsp;"Hock-Joint Lameness," by Dr. James McDonough, Proceedings
+of the A.V.M.A., 1913, page 545.</p>
+</div>
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_263" id="Page_263"></a></p>
+
+<h2><a name="INDEX" id="INDEX"></a>INDEX</h2>
+
+
+<ul class="letters">
+<li><b>A</b></li>
+</ul>
+
+<div class="index">
+<ul class="IX">
+<li>Acetabulum, <a href="#Page_185">185</a></li>
+<li>Acute arthritis, <a href="#Page_65">65</a></li>
+<li>Acute laminitis, <a href="#Page_162">162</a></li>
+<li>Acute tendinitis, <a href="#Page_135">135</a></li>
+<li>Affections of blood vessels, <a href="#Page_31">31</a></li>
+<li>Affections of bursae and thecae, <a href="#Page_27">27</a></li>
+<li>Affections of the feet, <a href="#Page_34">34</a></li>
+<li>Affections of ligaments, <a href="#Page_20">20</a></li>
+<li>Affections of lymph vessels and glands, <a href="#Page_32">32</a></li>
+<li>Affections of muscles and tendons, <a href="#Page_28">28</a></li>
+<li>Affections of nerves, <a href="#Page_30">30</a></li>
+<li>Anamnesis, <a href="#Page_38">38</a></li>
+<li>Anatomo-physiological review of parts of fore leg, <a href="#Page_55">55</a></li>
+<li>Anatomo-physiological consideration of the pelvic limbs, <a href="#Page_185">185</a></li>
+<li>Anatomy of the joint capsule, <a href="#Page_220">220</a></li>
+<li>Annular ligament, <a href="#Page_58">58</a></li>
+<li>Antea-spinatus muscle, <a href="#Page_65">65</a></li>
+<li>Anterior brachial region, wounds of, <a href="#Page_90">90</a></li>
+<li>Anterior digital extensor muscle, <a href="#Page_193">193</a></li>
+<li>Arteritis, <a href="#Page_209">209</a></li>
+<li>Artery (brachial), thrombosis of the, <a href="#Page_81">81</a></li>
+<li>Arthritis, <a href="#Page_22">22</a>, <a href="#Page_84">84</a></li>
+<li>Arthritis, acute, <a href="#Page_65">65</a></li>
+<li>Arthritis, chronic, <a href="#Page_65">65</a></li>
+<li>Arthritis, infectious, <a href="#Page_66">66</a></li>
+<li>Arthritis, metastatic, <a href="#Page_25">25</a></li>
+<li>Arthritis of the fetlock joint, <a href="#Page_152">152</a></li>
+<li>Arthritis, rheumatic, <a href="#Page_26">26</a></li>
+<li>Arthritis, scapulohumeral, <a href="#Page_65">65</a></li>
+<li>Arthritis, tarsal, <a href="#Page_225">225</a></li>
+<li>Arthritis, traumatic, <a href="#Page_22">22</a></li>
+<li>Articular ringbone, <a href="#Page_121">121</a></li>
+<li>Articulation, femeropelvic, <a href="#Page_185">185</a></li>
+<li>Articulation, metacarpophalangeal, <a href="#Page_58">58</a></li>
+<li>Articulation, scapulohumeral, <a href="#Page_55">55</a></li>
+<li>Aspiration-and-injection treatment of bog spavin, <a href="#Page_244">244</a></li>
+<li>Aspiration-and-injection treatment of capped hock, <a href="#Page_252">252</a></li>
+<li>Aspiration-and-injection treatment of thoroughpin, <a href="#Page_250">250</a></li>
+<li>Astragalus, <a href="#Page_190">190</a></li>
+<li>Astragalus, fracture of the, <a href="#Page_230">230</a></li>
+<li>Attitude of the subject, <a href="#Page_41">41</a></li>
+<li>Atrophy of the quadriceps muscles, <a href="#Page_205">205</a></li>
+<li>Atrophy, shoulder, <a href="#Page_73">73</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>B</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Biceps brachii, <a href="#Page_58">58</a>, <a href="#Page_65">65</a>, <a href="#Page_68">68</a>, <a href="#Page_69">69</a></li>
+<li>Bicipital bursa, inflammation of, <a href="#Page_68">68</a></li>
+<li>Blood vessels, affections of, <a href="#Page_31">31</a></li>
+<li>Bog spavin, <a href="#Page_242">242</a></li>
+<li>Bog spavin, aspiration-and-injection treatment of, <a href="#Page_244">244</a></li>
+<li>Bog spavin, line firing for, <a href="#Page_246">246</a></li>
+<li>Bog spavin, vesication for, <a href="#Page_246">246</a></li>
+<li>Bone spavin, <a href="#Page_235">235</a></li>
+<li>Bones, degenerative changes in, <a href="#Page_16">16</a></li>
+<li>Bones, tarsal, <a href="#Page_190">190</a></li>
+<li>Bossi's double tarsal neurectomy, <a href="#Page_242">242</a></li>
+<li>Brachial artery, thrombosis of the, <a href="#Page_81">81</a></li>
+<li>Brachial paralysis, <a href="#Page_77">77</a></li>
+<li>Bursa intertubercularis, <a href="#Page_62">62</a>, <a href="#Page_69">69</a></li>
+<li>Bursa podotrochlearis, inflammation of the, <a href="#Page_157">157</a></li>
+<li>Bursae, affections of, <a href="#Page_27">27</a></li>
+<li><a name="Page_264" id="Page_264"></a>
+    Bursitis, <a href="#Page_27">27</a>, <a href="#Page_104">104</a></li>
+<li>Bursitis, infectious, <a href="#Page_28">28</a></li>
+<li>Bursitis in the fetlock region, <a href="#Page_150">150</a></li>
+<li>Bursitis intertubercularis, <a href="#Page_68">68</a></li>
+<li>Bursitis, noninfectious, <a href="#Page_28">28</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>C</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Calcaneo-cuboid ligaments, <a href="#Page_190">190</a></li>
+<li>Calcaneo-metatarsal ligaments, <a href="#Page_190">190</a></li>
+<li>Calcaneum, fracture of the, <a href="#Page_230">230</a></li>
+<li>Calk wounds, <a href="#Page_170">170</a></li>
+<li>Capped hock, <a href="#Page_251">251</a></li>
+<li>Capped hock, aspiration-and-injection treatment of, <a href="#Page_252">252</a></li>
+<li>Capsular ligament, <a href="#Page_190">190</a></li>
+<li>Caput muscles, <a href="#Page_71">71</a></li>
+<li>Carpal bones, fracture of the, <a href="#Page_96">96</a></li>
+<li>Carpal bones, luxation of the, <a href="#Page_96">96</a></li>
+<li>Carpal flexors, contraction of the, <a href="#Page_93">93</a></li>
+<li>Carpal flexors, inflammation of the, <a href="#Page_93">93</a></li>
+<li>Carpal joint, <a href="#Page_58">58</a></li>
+<li>Carpal joint, open, <a href="#Page_100">100</a></li>
+<li>Carpitis, <a href="#Page_98">98</a></li>
+<li>Carpus, inflammation of the, <a href="#Page_98">98</a></li>
+<li>Cartilage, lateral, inflammation of, <a href="#Page_174">174</a></li>
+<li>Cartilages of the third phalanx, ossification of the, <a href="#Page_155">155</a></li>
+<li>Chronic arthritis, <a href="#Page_65">65</a></li>
+<li>Chronic gonitis, <a href="#Page_217">217</a></li>
+<li>Chronic laminitis, <a href="#Page_164">164</a></li>
+<li>Chronic tendinitis, <a href="#Page_137">137</a></li>
+<li>Cochran shoe for dropped soles, <a href="#Page_169">169</a></li>
+<li>Collateral ligaments, <a href="#Page_190">190</a></li>
+<li>Comminuted fractures, <a href="#Page_17">17</a></li>
+<li>Compound fractures, <a href="#Page_17">17</a></li>
+<li>Contracted tendons of foals, <a href="#Page_143">143</a></li>
+<li>Contraction of the carpal flexors, <a href="#Page_93">93</a></li>
+<li>Contraction of the flexor tendons, <a href="#Page_137">137</a></li>
+<li>Contusions of the triceps brachii, <a href="#Page_71">71</a></li>
+<li>Contusive wounds, <a href="#Page_85">85</a></li>
+<li>Coracoradialis, <a href="#Page_58">58</a></li>
+<li>Corns, <a href="#Page_172">172</a></li>
+<li>Coronary region, wounds of the, <a href="#Page_170">170</a></li>
+<li>Corpora oryzoidea, <a href="#Page_218">218</a></li>
+<li>Cotyloid ligament, <a href="#Page_185">185</a></li>
+<li>Courbe, <a href="#Page_233">233</a></li>
+<li>Crepitation, false, <a href="#Page_48">48</a></li>
+<li>Crepitation, true, <a href="#Page_47">47</a></li>
+<li>Crucial ligaments, <a href="#Page_188">188</a></li>
+<li>Crural nerve, paralysis of the, <a href="#Page_204">204</a></li>
+<li>Cunean bursa, <a href="#Page_237">237</a></li>
+<li>Cunean tenotomy, <a href="#Page_242">242</a></li>
+<li>Cuneiform magnum, <a href="#Page_191">191</a></li>
+<li>Cuneiform medium, <a href="#Page_191">191</a></li>
+<li>Curb, <a href="#Page_233">233</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>D</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Deep digital flexor, distension of the tarsal sheath of, <a href="#Page_246">246</a></li>
+<li>Deep flexor tendon (perforans), <a href="#Page_60">60</a></li>
+<li>Degenerative changes in bones, <a href="#Page_16">16</a></li>
+<li>Diagnosis by exclusion, <a href="#Page_53">53</a></li>
+<li>Diagnosis by use of the X-ray, <a href="#Page_179">179</a></li>
+<li>Diagnostic principles, <a href="#Page_37">37</a></li>
+<li>Disease, navicular, <a href="#Page_157">157</a></li>
+<li>Dislocations, <a href="#Page_21">21</a></li>
+<li>Distension of the tarsal joint capsule, <a href="#Page_242">242</a></li>
+<li>Distension of the tarsal sheath of the deep digital flexor, <a href="#Page_246">246</a></li>
+<li>Division of long digital extensor, <a href="#Page_253">253</a></li>
+<li>Dorsal ligaments, <a href="#Page_190">190</a></li>
+<li>Dropped elbow, <a href="#Page_71">71</a>, <a href="#Page_80">80</a></li>
+<li>Dropped soles, shoe for, <a href="#Page_169">169</a></li>
+<li>Dropped stifle, <a href="#Page_205">205</a></li>
+<li>Dry spavin, <a href="#Page_225">225</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>E</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Elbow, dropped, <a href="#Page_71">71</a>, <a href="#Page_80">80</a></li>
+<li>Elbow, inflammation of the, <a href="#Page_84">84</a></li>
+<li><a name="Page_265" id="Page_265"></a>
+    Elbow joint, <a href="#Page_58">58</a></li>
+<li>Elephantiasis, <a href="#Page_34">34</a></li>
+<li>Etiology, general discussion of, <a href="#Page_15">15</a></li>
+<li>Examination by palpation, <a href="#Page_43">43</a></li>
+<li>Examination, special methods of, <a href="#Page_53">53</a></li>
+<li>Examination, visual, <a href="#Page_39">39</a></li>
+<li>Exclusion, diagnosis by, <a href="#Page_53">53</a></li>
+<li>Exostosis of splint bones, <a href="#Page_107">107</a></li>
+<li>Exostosis, phalangeal, <a href="#Page_118">118</a></li>
+<li>Extensor (long digital) rupture and division of, <a href="#Page_253">253</a></li>
+<li>Extensor of the digit, rupture of, <a href="#Page_145">145</a></li>
+<li>Extensor pedis, <a href="#Page_60">60</a></li>
+<li>Extensor pedis, rupture of, <a href="#Page_145">145</a></li>
+<li>Extensor pedis, rupture and division of, <a href="#Page_253">253</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>F</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>False crepitation, <a href="#Page_48">48</a></li>
+<li>Feet, affection of the, <a href="#Page_34">34</a></li>
+<li>Femoral nerve, paralysis of the, <a href="#Page_204">204</a></li>
+<li>Femeropatella ligaments, <a href="#Page_188">188</a></li>
+<li>Femeropelvic articulation, <a href="#Page_185">185</a></li>
+<li>Femur, <a href="#Page_185">185</a>, <a href="#Page_192">192</a></li>
+<li>Femur, fracture of the, <a href="#Page_199">199</a></li>
+<li>Femur, luxation of the, <a href="#Page_201">201</a></li>
+<li>Fetlock joint, <a href="#Page_58">58</a></li>
+<li>Fetlock joint, arthritis of the, <a href="#Page_152">152</a></li>
+<li>Fetlock joint, luxation of the, <a href="#Page_125">125</a></li>
+<li>Fetlock joint, open, <a href="#Page_110">110</a></li>
+<li>Fetlock region, thecitis and bursitis in, <a href="#Page_148">148</a></li>
+<li>Fetlock, shoe for bracing the, <a href="#Page_181">181</a></li>
+<li>Fibular tarsal bone, fracture of the, <a href="#Page_230">230</a></li>
+<li>Firing, treatment of ringbone by, <a href="#Page_123">123</a></li>
+<li>First phalanx, <a href="#Page_59">59</a></li>
+<li>"Fish knees", <a href="#Page_145">145</a></li>
+<li>Fixed luxations, <a href="#Page_21">21</a></li>
+<li>Fixed patellar disarticulation, <a href="#Page_213">213</a></li>
+<li>Flexor brachii, <a href="#Page_58">58</a>, <a href="#Page_68">68</a>, <a href="#Page_69">69</a></li>
+<li>Flexor carpiradialis, <a href="#Page_93">93</a></li>
+<li>Flexor carpiulnaris, <a href="#Page_93">93</a></li>
+<li>Flexor metacarpi externus, <a href="#Page_94">94</a></li>
+<li>Flexor metacarpi internus, <a href="#Page_93">93</a></li>
+<li>Flexor metacarpi medius, <a href="#Page_93">93</a></li>
+<li>Flexor metatarsi, <a href="#Page_193">193</a></li>
+<li>Flexor, superficial digital, <a href="#Page_194">194</a></li>
+<li>Flexor tendons, contraction of the, <a href="#Page_137">137</a></li>
+<li>Flexor tendons, inflammation of the, <a href="#Page_135">135</a></li>
+<li>Flexor tendons, rupture of, <a href="#Page_146">146</a></li>
+<li>Flexors of phalanges, open sheath of, <a href="#Page_124">124</a></li>
+<li>Foals, contracted tendons of, <a href="#Page_143">143</a></li>
+<li>Forearm, wounds of, <a href="#Page_90">90</a></li>
+<li>Fore leg, lameness in the, <a href="#Page_55">55</a></li>
+<li>Fracture of the carpal bones, <a href="#Page_96">96</a></li>
+<li>Fracture of the femur, <a href="#Page_199">199</a></li>
+<li>Fracture of the fibular tarsal bone, <a href="#Page_230">230</a></li>
+<li>Fracture of first and second phalanges, <a href="#Page_131">131</a></li>
+<li>Fracture of humerus, <a href="#Page_82">82</a></li>
+<li>Fracture of the ilium, <a href="#Page_198">198</a></li>
+<li>Fracture of the ischial tuberosity, <a href="#Page_199">199</a></li>
+<li>Fracture of the metacarpus, <a href="#Page_106">106</a></li>
+<li>Fracture of the patella, <a href="#Page_212">212</a></li>
+<li>Fractures of the pelvic bones, <a href="#Page_196">196</a></li>
+<li>Fracture of the proximal sesamoids, <a href="#Page_128">128</a></li>
+<li>Fracture of the pubis, <a href="#Page_197">197</a></li>
+<li>Fracture of the radius, <a href="#Page_87">87</a></li>
+<li>Fracture of the scapula, <a href="#Page_62">62</a></li>
+<li>Fracture of the tibia, <a href="#Page_222">222</a></li>
+<li>Fracture of the tibial tarsal bone, <a href="#Page_230">230</a></li>
+<li>Fracture of the ulna, <a href="#Page_86">86</a></li>
+<li>Fractures, <a href="#Page_16">16</a></li>
+<li>Fractures, comminuted, <a href="#Page_17">17</a></li>
+<li>Fractures, compound, <a href="#Page_17">17</a></li>
+<li>Fractures, green stick, <a href="#Page_18">18</a></li>
+<li>Fractures, impacted, <a href="#Page_19">19</a></li>
+<li>Fractures, longitudinal, <a href="#Page_18">18</a></li>
+<li><a name="Page_266" id="Page_266"></a>
+    Fractures, multiple, <a href="#Page_18">18</a></li>
+<li>Fractures, multiple longitudinal, <a href="#Page_19">19</a></li>
+<li>Fractures, oblique, <a href="#Page_18">18</a></li>
+<li>Fractures, simple, <a href="#Page_17">17</a></li>
+<li>Fractures, simple transverse, <a href="#Page_18">18</a></li>
+<li>Fractures, transverse, <a href="#Page_18">18</a></li>
+<li>Fragilitas, <a href="#Page_199">199</a></li>
+<li>Fragilitas osseum, <a href="#Page_128">128</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>G</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Gait, observing character of, <a href="#Page_48">48</a></li>
+<li>Gastrocnemius, <a href="#Page_194">194</a></li>
+<li>Gluteal tendo-synovitis, <a href="#Page_203">203</a></li>
+<li>Gluteus medius muscle, <a href="#Page_192">192</a>, <a href="#Page_203">203</a></li>
+<li>Gonitis, chronic, <a href="#Page_217">217</a></li>
+<li>Green stick fractures, <a href="#Page_18">18</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>H</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Hind leg, lameness in the, <a href="#Page_185">185</a></li>
+<li>Hind leg, paralysis of the, <a href="#Page_204">204</a></li>
+<li>Hip lameness, <a href="#Page_195">195</a></li>
+<li>Hip swinney, <a href="#Page_205">205</a></li>
+<li>Hock, capped, <a href="#Page_251">251</a></li>
+<li>Hock joint, <a href="#Page_188">188</a></li>
+<li>Hoof testers, <a href="#Page_53">53</a></li>
+<li>Humeroradioulnar joint, <a href="#Page_58">58</a></li>
+<li>Humerus, fracture of, <a href="#Page_82">82</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>I</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Iliac thrombosis, <a href="#Page_209">209</a></li>
+<li>Iliopsoas, <a href="#Page_204">204</a></li>
+<li>Ilium, fracture of the, <a href="#Page_198">198</a></li>
+<li>Impacted fractures, <a href="#Page_19">19</a></li>
+<li>Infectious arthritis, <a href="#Page_66">66</a></li>
+<li>Infectious bursitis, <a href="#Page_28">28</a></li>
+<li>Infectious inflammation of the lateral cartilage, <a href="#Page_173">173</a></li>
+<li>Infectious lymphangitis, <a href="#Page_257">257</a></li>
+<li>Infectious synovitis, <a href="#Page_124">124</a></li>
+<li>Inflammation of the bicipital bursa, <a href="#Page_68">68</a></li>
+<li>Inflammation of the bursa podotrochlearis, <a href="#Page_157">157</a></li>
+<li>Inflammation of the carpal flexors, <a href="#Page_93">93</a></li>
+<li>Inflammation of the carpus, <a href="#Page_98">98</a></li>
+<li>Inflammation of the elbow, <a href="#Page_84">84</a></li>
+<li>Inflammation of the flexor tendons, <a href="#Page_135">135</a></li>
+<li>Inflammation of posterior ligaments of pastern, <a href="#Page_129">129</a></li>
+<li>Inflammation of proximal sesamoid bones, <a href="#Page_127">127</a></li>
+<li>Inflammation of third sesamoid and deep flexor tendon, <a href="#Page_157">157</a></li>
+<li>Inflammation of the trochanteric bursa, <a href="#Page_204">204</a></li>
+<li>Infraspinatus muscle, <a href="#Page_65">65</a></li>
+<li>Injection of fluids for quittor, <a href="#Page_177">177</a></li>
+<li>Injuries to  scapulohumeral joint, <a href="#Page_66">66</a></li>
+<li>Interfering, shoeing for, <a href="#Page_256">256</a></li>
+<li>Interfering, wounds from, <a href="#Page_255">255</a></li>
+<li>Ischial tuberosity, fracture of the, <a href="#Page_199">199</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>J</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Joint capsule, anatomy of the, <a href="#Page_220">220</a></li>
+<li>Joint, carpal, <a href="#Page_58">58</a></li>
+<li>Joint, elbow, <a href="#Page_58">58</a></li>
+<li>Joint, fetlock, <a href="#Page_58">58</a></li>
+<li>Joint capsule, tarsal, distension of the, <a href="#Page_242">242</a></li>
+<li>Joint, fetlock, arthritis of the, <a href="#Page_152">152</a></li>
+<li>Joint, fetlock, luxation of, <a href="#Page_125">125</a></li>
+<li>Joint, hock, <a href="#Page_188">188</a></li>
+<li>Joint, humeroradioulnar, <a href="#Page_58">58</a></li>
+<li>Joint, open, <a href="#Page_67">67</a></li>
+<li>Joint, open carpal, <a href="#Page_100">100</a></li>
+<li>Joint, open fetlock, <a href="#Page_110">110</a></li>
+<li>Joint, pastern proximal interphalangeal, <a href="#Page_129">129</a></li>
+<li>Joint, shoulder, <a href="#Page_55">55</a></li>
+<li>Joint, stifle, open, <a href="#Page_220">220</a></li>
+<li>Joint, tarsal, open, <a href="#Page_229">229</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><a name="Page_267" id="Page_267"></a>
+    <b>L</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Lameness, hip, <a href="#Page_195">195</a></li>
+<li>Lameness, mixed, <a href="#Page_49">49</a></li>
+<li>Lameness in the fore leg, <a href="#Page_55">55</a></li>
+<li>Lameness in the hind leg, <a href="#Page_185">185</a></li>
+<li>Lameness, shoulder, <a href="#Page_61">61</a></li>
+<li>Lameness, supporting-leg, <a href="#Page_49">49</a></li>
+<li>Lameness, swinging-leg, <a href="#Page_49">49</a></li>
+<li>Laminitis, <a href="#Page_160">160</a></li>
+<li>Laminitis, acute, <a href="#Page_162">162</a></li>
+<li>Laminitis, chronic, <a href="#Page_164">164</a></li>
+<li>Lateral cartilage, infectious inflammation of the, <a href="#Page_174">174</a></li>
+<li>Lateral cartilages, ossification of, <a href="#Page_155">155</a></li>
+<li>Ligaments, affections of, <a href="#Page_20">20</a></li>
+<li>Ligament, capsular, <a href="#Page_190">190</a></li>
+<li>Ligaments, collateral, <a href="#Page_190">190</a></li>
+<li>Ligament, cotyloid, <a href="#Page_185">185</a></li>
+<li>Ligaments, crucial, <a href="#Page_188">188</a></li>
+<li>Ligaments, dorsal, <a href="#Page_190">190</a></li>
+<li>Ligaments, femeropatella, <a href="#Page_188">188</a></li>
+<li>Ligament, medial, <a href="#Page_190">190</a></li>
+<li>Ligaments, mesial tarsal, sprains of the, <a href="#Page_232">232</a></li>
+<li>Ligaments of pastern proximal interphalangeal joint, inflammation of, <a href="#Page_129">129</a></li>
+<li>Ligaments, patellar, <a href="#Page_188">188</a></li>
+<li>Ligaments, plantar, <a href="#Page_190">190</a></li>
+<li>Ligament, pubiofemoral, <a href="#Page_185">185</a></li>
+<li>Ligament, superior check, <a href="#Page_58">58</a></li>
+<li>Ligament, suspensory, rupture of, <a href="#Page_146">146</a></li>
+<li>Ligaments, volar, <a href="#Page_129">129</a></li>
+<li>Ligament, volar-carpal or annular, <a href="#Page_58">58</a></li>
+<li>Ligation of the saphenous vein, <a href="#Page_246">246</a></li>
+<li>Line firing for bog spavin, <a href="#Page_246">246</a></li>
+<li>Longitudinal fractures, <a href="#Page_18">18</a></li>
+<li>Lumbosacral plexus, <a href="#Page_204">204</a></li>
+<li>Luxation of the carpal bones, <a href="#Page_96">96</a></li>
+<li>Luxation of the femur, <a href="#Page_201">201</a></li>
+<li>Luxation of fetlock joint, <a href="#Page_125">125</a></li>
+<li>Luxation of the patella, <a href="#Page_213">213</a></li>
+<li>Luxation of the patella, outward, <a href="#Page_215">215</a></li>
+<li>Luxation of the patella, upward, <a href="#Page_214">214</a></li>
+<li>Luxation of scapulohumeral joint, <a href="#Page_67">67</a></li>
+<li>Luxations, <a href="#Page_21">21</a></li>
+<li>Luxations, fixed, <a href="#Page_21">21</a></li>
+<li>Luxations, temporary, <a href="#Page_21">21</a></li>
+<li>Lymph vessels and glands, affections of, <a href="#Page_32">32</a></li>
+<li>Lymphangitis, <a href="#Page_32">32</a></li>
+<li>Lymphangitis, infectious, <a href="#Page_257">257</a></li>
+<li>Lymphangitis, non-infectious, <a href="#Page_260">260</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>M</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Medial ligament, <a href="#Page_190">190</a></li>
+<li>Median neurectomy, <a href="#Page_124">124</a></li>
+<li>Mesial tarsal ligaments, sprains of the, <a href="#Page_232">232</a></li>
+<li>Metacarpophalangeal articulation, <a href="#Page_58">58</a></li>
+<li>Metacarpus, fracture of the, <a href="#Page_106">106</a></li>
+<li>Metastatic arthritis, <a href="#Page_25">25</a></li>
+<li>Mixed lameness, <a href="#Page_49">49</a></li>
+<li>Momentary patellar disarticulation, <a href="#Page_213">213</a></li>
+<li>Movements, passive, <a href="#Page_47">47</a></li>
+<li>Multiple fractures, <a href="#Page_18">18</a></li>
+<li>Multiple longitudinal fractures, <a href="#Page_19">19</a></li>
+<li>Muscles, affections of, <a href="#Page_28">28</a></li>
+<li>Muscle, antea-spinatus, <a href="#Page_65">65</a></li>
+<li>Muscle, anterior digital extensor, <a href="#Page_193">193</a></li>
+<li>Muscle, biceps brachii, <a href="#Page_58">58</a></li>
+<li>Muscle, caput, <a href="#Page_71">71</a></li>
+<li>Muscle, gluteus medium, <a href="#Page_192">192</a>, <a href="#Page_203">203</a></li>
+<li>Muscle, infraspinatus, <a href="#Page_65">65</a></li>
+<li>Muscle, peroneus tertius, <a href="#Page_193">193</a></li>
+<li>Muscle, postea-spinatus, <a href="#Page_65">65</a></li>
+<li>Muscles, quadriceps, <a href="#Page_193">193</a></li>
+<li>Muscles, quadriceps, atrophy of the, <a href="#Page_205">205</a></li>
+<li>Muscle, subscapularis, <a href="#Page_65">65</a></li>
+<li>Muscle, supraspinatus, <a href="#Page_65">65</a></li>
+<li><a name="Page_268" id="Page_268"></a>Muscle, supraspinatus, <a href="#Page_65">65</a></li>
+<li>Muscle, tibialis anticus, <a href="#Page_193">193</a></li>
+<li>Muscle, triceps brachii, <a href="#Page_58">58</a></li>
+<li>Myalgia, <a href="#Page_195">195</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>N</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Nail punctures, <a href="#Page_178">178</a></li>
+<li>Navicular disease, <a href="#Page_157">157</a></li>
+<li>Nerves, affections of, <a href="#Page_30">30</a></li>
+<li>Nerve, femoral, paralysis of the, <a href="#Page_204">204</a></li>
+<li>Nerve, obturator, paralysis of the, <a href="#Page_206">206</a></li>
+<li>Nerve, sciatic, paralysis of the, <a href="#Page_208">208</a></li>
+<li>Nerve, (suprascapular) paralysis of the, <a href="#Page_75">75</a></li>
+<li>Non-infectious lymphangitis, <a href="#Page_260">260</a></li>
+<li>Non-infectious bursitis, <a href="#Page_28">28</a></li>
+<li>Neurectomy, Bossi's double tarsal, <a href="#Page_242">242</a></li>
+<li>Neurectomy, median, <a href="#Page_124">124</a></li>
+<li>Neurectomy, plantar, <a href="#Page_124">124</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>O</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Oblique fractures, <a href="#Page_18">18</a></li>
+<li>Observing character of gait, <a href="#Page_48">48</a></li>
+<li>Obturator nerve, paralysis of the, <a href="#Page_206">206</a></li>
+<li>Occurrence, general discussion of, <a href="#Page_15">15</a></li>
+<li>Omphalophlebitis, <a href="#Page_25">25</a></li>
+<li>Open carpal joint, <a href="#Page_100">100</a></li>
+<li>Open fetlock joint, <a href="#Page_110">110</a></li>
+<li>Open joint, <a href="#Page_67">67</a></li>
+<li>Open sheath of flexors of phalanges, <a href="#Page_124">124</a></li>
+<li>Open stifle joint, <a href="#Page_220">220</a></li>
+<li>Open tarsal joint, <a href="#Page_229">229</a></li>
+<li>Os corona, <a href="#Page_60">60</a></li>
+<li>Ossification of cartilages of the third phalanx, <a href="#Page_155">155</a></li>
+<li>Ossification of the lateral cartilages, <a href="#Page_155">155</a></li>
+<li>Os innominatum, <a href="#Page_196">196</a></li>
+<li>Os suffraginis, <a href="#Page_59">59</a></li>
+<li>Osteitis, rarefying, <a href="#Page_16">16</a></li>
+<li>Outward luxation of the patella, <a href="#Page_215">215</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>P</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Palpation, examination by, <a href="#Page_43">43</a></li>
+<li>Paralysis, brachial, <a href="#Page_77">77</a></li>
+<li>Paralysis of the femoral nerve, <a href="#Page_204">204</a></li>
+<li>Paralysis of the hind leg, <a href="#Page_204">204</a></li>
+<li>Paralysis of the obturator nerve, <a href="#Page_206">206</a></li>
+<li>Paralysis of the sciatic nerve, <a href="#Page_208">208</a></li>
+<li>Paralysis of the suprascapular nerve, <a href="#Page_75">75</a></li>
+<li>Paralysis, radial, <a href="#Page_77">77</a></li>
+<li>Paronychia, <a href="#Page_170">170</a></li>
+<li>Passive movements, <a href="#Page_47">47</a></li>
+<li>Pastern proximal interphalangeal joint, inflammation of ligaments of, <a href="#Page_129">129</a></li>
+<li>Patella, <a href="#Page_188">188</a></li>
+<li>Patella, fracture of the, <a href="#Page_212">212</a></li>
+<li>Patella, luxation of the, <a href="#Page_213">213</a></li>
+<li>Patella, outward luxation of the, <a href="#Page_215">215</a></li>
+<li>Patella, upward luxation of the, <a href="#Page_214">214</a></li>
+<li>Patellar disarticulation, fixed, <a href="#Page_213">213</a></li>
+<li>Patellar disarticulation, momentary, <a href="#Page_213">213</a></li>
+<li>Patellar ligaments, <a href="#Page_188">188</a></li>
+<li>Pelvic bones, fractures of the, <a href="#Page_196">196</a></li>
+<li>Pelvic limbs, anatomo-physiological consideration of the, <a href="#Page_185">185</a></li>
+<li>Penetrative wounds, <a href="#Page_85">85</a></li>
+<li>Periarticular ringbone, <a href="#Page_122">122</a></li>
+<li>Peroneus tertius muscle, <a href="#Page_193">193</a></li>
+<li>Phalangeal exostosis, <a href="#Page_118">118</a></li>
+<li>Phalanges, fracture of first and second, <a href="#Page_131">131</a></li>
+<li>Phalanges, open sheath of flexors of, <a href="#Page_124">124</a></li>
+<li>Phalanx, first, <a href="#Page_59">59</a></li>
+<li>Phalanx, second, <a href="#Page_60">60</a></li>
+<li>Phalanx, third, ossification of cartilages of, <a href="#Page_155">155</a></li>
+<li><a name="Page_269" id="Page_269"></a>
+    Plantar ligaments, <a href="#Page_190">190</a></li>
+<li>Plantar neurectomy, <a href="#Page_124">124</a></li>
+<li>Polyarthritis, <a href="#Page_25">25</a></li>
+<li>Postea-spinatus muscle, <a href="#Page_65">65</a></li>
+<li>Principles, diagnostic, <a href="#Page_37">37</a></li>
+<li>Proximal sesamoid bones, inflammation of, <a href="#Page_127">127</a></li>
+<li>Proximal sesamoids, fracture of, <a href="#Page_128">128</a></li>
+<li>Pubiofemoral ligament, <a href="#Page_185">185</a></li>
+<li>Pubis, fracture of the, <a href="#Page_197">197</a></li>
+<li>Punctures, nail, <a href="#Page_178">178</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>Q</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Quadriceps muscles, <a href="#Page_193">193</a></li>
+<li>Quadriceps muscles, atrophy of the, <a href="#Page_205">205</a></li>
+<li>Quittor, <a href="#Page_174">174</a></li>
+<li>Quittor, injection of fluids for, <a href="#Page_177">177</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>R</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Rachitic ringbone, <a href="#Page_122">122</a></li>
+<li>Radial paralysis, <a href="#Page_77">77</a></li>
+<li>Radius, fracture of the, <a href="#Page_87">87</a></li>
+<li>Rarefying osteitis, <a href="#Page_16">16</a></li>
+<li>Rheumatic arthritis, <a href="#Page_26">26</a></li>
+<li>Rheumatism, <a href="#Page_196">196</a></li>
+<li>Ringbone, <a href="#Page_118">118</a></li>
+<li>Ringbone, articular, <a href="#Page_121">121</a></li>
+<li>Ringbone, periarticular, <a href="#Page_122">122</a></li>
+<li>Ringbone, rachitic, <a href="#Page_122">122</a></li>
+<li>Ringbone, traumatic, <a href="#Page_122">122</a></li>
+<li>Ringbone treated by firing, <a href="#Page_123">123</a></li>
+<li>Roberts shoe for bracing the fetlock, <a href="#Page_181">181</a></li>
+<li>Rupture of the extensor pedis, <a href="#Page_145">145</a></li>
+<li>Rupture of flexor tendons and suspensory ligament, <a href="#Page_146">146</a></li>
+<li>Rupture of long digital extensor, <a href="#Page_253">253</a></li>
+<li>Rupture of the tendo archillis, <a href="#Page_224">224</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>S</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Saphenous vein, ligation of the, <a href="#Page_246">246</a></li>
+<li>Scapula, fracture of the, <a href="#Page_62">62</a></li>
+<li>Scapulohumeral articulation, <a href="#Page_55">55</a></li>
+<li>Scapulohumeral joint, injuries to, <a href="#Page_66">66</a></li>
+<li>Scapulohumeral joint, luxation of, <a href="#Page_67">67</a></li>
+<li>Scapulohumeral joint, wounds of, <a href="#Page_67">67</a></li>
+<li>Scapulohumeral arthritis, <a href="#Page_65">65</a></li>
+<li>Sciatica, <a href="#Page_208">208</a></li>
+<li>Sciatic nerve, paralysis of the, <a href="#Page_208">208</a></li>
+<li>Second phalanx, <a href="#Page_60">60</a></li>
+<li>Sesamoid bones, <a href="#Page_59">59</a></li>
+<li>Sesamoid, third, inflammation of the, <a href="#Page_157">157</a></li>
+<li>Sesamoids, proximal, fracture of, <a href="#Page_128">128</a></li>
+<li>Sesamoiditis, <a href="#Page_127">127</a></li>
+<li>Setons, <a href="#Page_75">75</a></li>
+<li>Sheath of flexors of phalanges, open, <a href="#Page_124">124</a></li>
+<li>Sheath (tarsal) of the deep digital flexor, distension of the, <a href="#Page_246">246</a></li>
+<li>Shoe for dropped soles, <a href="#Page_169">169</a></li>
+<li>Shoeing for interfering, <a href="#Page_256">256</a></li>
+<li>Shoulder atrophy, <a href="#Page_73">73</a></li>
+<li>Shoulder joint, <a href="#Page_55">55</a></li>
+<li>Shoulder lameness, <a href="#Page_61">61</a></li>
+<li>Simple fractures, <a href="#Page_17">17</a></li>
+<li>Simple transverse fractures, <a href="#Page_18">18</a></li>
+<li>Soles, dropped, shoe for, <a href="#Page_169">169</a></li>
+<li>Spavin, bog, <a href="#Page_242">242</a></li>
+<li>Spavin, bone, <a href="#Page_235">235</a></li>
+<li>Spavin, dry, <a href="#Page_225">225</a></li>
+<li>Spavin test, <a href="#Page_239">239</a></li>
+<li>Special methods of examination, <a href="#Page_53">53</a></li>
+<li>Sprains of the mesial tarsal ligaments, <a href="#Page_232">232</a></li>
+<li>Sprains, tarsal, <a href="#Page_232">232</a></li>
+<li>Splints, <a href="#Page_107">107</a></li>
+<li>Spring-halt, <a href="#Page_225">225</a></li>
+<li>Stifle, dropped, <a href="#Page_205">205</a></li>
+<li>Stifle joint, open, <a href="#Page_220">220</a></li>
+<li><a name="Page_270" id="Page_270"></a>
+    Strangles, <a href="#Page_25">25</a></li>
+<li>Streptococcus equi, <a href="#Page_25">25</a></li>
+<li>String-halt, <a href="#Page_225">225</a></li>
+<li>Subject, attitude of the, <a href="#Page_41">41</a></li>
+<li>Subscapularis muscle, <a href="#Page_65">65</a></li>
+<li>Supporting-leg-lameness, <a href="#Page_49">49</a></li>
+<li>Suprascapular nerve, paralysis of the, <a href="#Page_75">75</a></li>
+<li>Supraspinatus muscle, <a href="#Page_65">65</a></li>
+<li>Superficial digital flexor, <a href="#Page_194">194</a></li>
+<li>Superior check ligament, <a href="#Page_58">58</a></li>
+<li>Suspensory ligament, rupture of, <a href="#Page_146">146</a></li>
+<li>Sweeny, <a href="#Page_73">73</a></li>
+<li>Swinging-leg-lameness, <a href="#Page_49">49</a></li>
+<li>Swinney, <a href="#Page_73">73</a></li>
+<li>Swinney, hip, <a href="#Page_205">205</a></li>
+<li>Synovial distension of tendon sheaths, <a href="#Page_104">104</a></li>
+<li>Synovitis, <a href="#Page_25">25</a></li>
+<li>Synovitis, infectious, <a href="#Page_124">124</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>T</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Tarsal arthritis, <a href="#Page_225">225</a></li>
+<li>Tarsal bones, <a href="#Page_190">190</a></li>
+<li>Tarsal joint capsule, distension of the, <a href="#Page_242">242</a></li>
+<li>Tarsal joint, open, <a href="#Page_229">229</a></li>
+<li>Tarsal sheath of the deep digital flexor, distension of the, <a href="#Page_246">246</a></li>
+<li>Tarsal sprains, <a href="#Page_232">232</a></li>
+<li>Tarsus, <a href="#Page_192">192</a></li>
+<li>Temporary luxations, <a href="#Page_21">21</a></li>
+<li>Tendinitis, <a href="#Page_135">135</a></li>
+<li>Tendinitis, acute, <a href="#Page_135">135</a></li>
+<li>Tendinitis, chronic, <a href="#Page_137">137</a></li>
+<li>Tendo achillis, rupture and wounds of the, <a href="#Page_224">224</a></li>
+<li>Tendon, deep flexor, inflammation of the, <a href="#Page_157">157</a></li>
+<li>Tendon, deep flexor (perforans), <a href="#Page_60">60</a></li>
+<li>Tendon, extensor, rupture of, <a href="#Page_145">145</a></li>
+<li>Tendon, flexor, rupture of, <a href="#Page_146">146</a></li>
+<li>Tendons of foals, contracted, <a href="#Page_143">143</a></li>
+<li>Tendon sheaths, synovial distension of, <a href="#Page_104">104</a></li>
+<li>Tendons, affections of, <a href="#Page_28">28</a></li>
+<li>Tendons, flexor, contraction of the, <a href="#Page_137">137</a></li>
+<li>Tendons, flexor, inflammation of the, <a href="#Page_135">135</a></li>
+<li>Tendo-synovitis, gluteal, <a href="#Page_203">203</a></li>
+<li>Tenotomy, cunean, <a href="#Page_242">242</a></li>
+<li>Tensor fascia lata, <a href="#Page_192">192</a></li>
+<li>Test, spavin, <a href="#Page_239">239</a></li>
+<li>Testers, hoof, <a href="#Page_53">53</a></li>
+<li>Thecae, affections of, <a href="#Page_27">27</a></li>
+<li>Thecitis, <a href="#Page_27">27</a>, <a href="#Page_104">104</a></li>
+<li>Thecitis in the fetlock region, <a href="#Page_150">150</a></li>
+<li>Thoroughpin, <a href="#Page_246">246</a></li>
+<li>Thoroughpin, aspiration-and-injection treatment of, <a href="#Page_250">250</a></li>
+<li>Thrombosis, iliac, <a href="#Page_209">209</a></li>
+<li>Thrombosis of the brachial artery, <a href="#Page_81">81</a></li>
+<li>Tibia, <a href="#Page_188">188</a></li>
+<li>Tibia, fracture of the, <a href="#Page_222">222</a></li>
+<li>Tibial tarsal bone, fracture of the, <a href="#Page_230">230</a></li>
+<li>Tibialis anticus muscle, <a href="#Page_193">193</a></li>
+<li>Tibioastragular joint, distension of the, <a href="#Page_242">242</a></li>
+<li>Transverse fractures, <a href="#Page_18">18</a></li>
+<li>Traumatic arthritis, <a href="#Page_22">22</a></li>
+<li>Traumatic ringbone, <a href="#Page_122">122</a></li>
+<li>Treatment of bog spavin by aspiration and injection, <a href="#Page_244">244</a></li>
+<li>Treatment of capped hock by aspiration and injection, <a href="#Page_252">252</a></li>
+<li>Treatment of ringbone by firing, <a href="#Page_123">123</a></li>
+<li>Treatment of thoroughpin by aspiration and injection, <a href="#Page_250">250</a></li>
+<li>Triceps brachii, <a href="#Page_58">58</a></li>
+<li>Triceps brachii, contusions of, <a href="#Page_71">71</a></li>
+<li>Triceps extensor brachii, <a href="#Page_71">71</a></li>
+<li><a name="Page_271" id="Page_271"></a>
+    Trochanteric bursa, inflammation of the, <a href="#Page_204">204</a></li>
+<li>True crepitation, <a href="#Page_47">47</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>U</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Ulna, fracture of the, <a href="#Page_86">86</a></li>
+<li>Ulnaris lateralis, <a href="#Page_94">94</a></li>
+<li>Upward luxation of the patella, <a href="#Page_214">214</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>V</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Vein, saphenous, ligation of the, <a href="#Page_246">246</a></li>
+<li>Vesication for bog spavin, <a href="#Page_246">246</a></li>
+<li>Vessignon chevill&eacute;, <a href="#Page_246">246</a></li>
+<li>Visual examination, <a href="#Page_39">39</a></li>
+<li>Volar-carpal ligament, <a href="#Page_58">58</a></li>
+<li>Volar ligaments, <a href="#Page_129">129</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>W</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>Wounds, calk, <a href="#Page_170">170</a></li>
+<li>Wounds, contusive, <a href="#Page_85">85</a></li>
+<li>Wounds from interfering, <a href="#Page_255">255</a></li>
+<li>Wounds of anterior brachial region, <a href="#Page_90">90</a></li>
+<li>Wounds of coronary region, <a href="#Page_170">170</a></li>
+<li>Wounds of scapulohumeral joint, <a href="#Page_67">67</a></li>
+<li>Wounds of tendo achillis, <a href="#Page_224">224</a></li>
+<li>Wounds, penetrative, <a href="#Page_85">85</a></li>
+</ul>
+</div>
+
+<ul class="letters">
+<li><b>X</b></li></ul>
+
+<div class="index">
+<ul class="IX">
+<li>X-ray diagnosis, <a href="#Page_179">179</a></li>
+</ul>
+</div>
+
+
+<hr style="width: 65%;" />
+
+<p><a name="Page_272" id="Page_272"></a></p>
+
+<p><a name="AUTHORITIES_CITED" id="AUTHORITIES_CITED"></a></p>
+
+<h2>AUTHORITIES CITED</h2>
+
+
+<div class="index">
+<ul class="IX">
+<li>Almy, J., <a href="#Page_141">141</a>, <a href="#Page_200">200</a>, <a href="#Page_202">202</a>, <a href="#Page_208">208</a>, <a href="#Page_212">212</a>, <a href="#Page_216">216</a>, <a href="#Page_214">214</a>, <a href="#Page_233">233</a></li>
+</ul>
+
+<ul class="IX">
+<li>Bassi, <a href="#Page_215">215</a></li>
+<li>Bauman, S.H., <a href="#Page_197">197</a></li>
+<li>Bell, Roscoe R., <a href="#Page_69">69</a></li>
+<li>Benard, <a href="#Page_216">216</a></li>
+<li>Berns, Geo. H., <a href="#Page_77">77</a>, <a href="#Page_218">218</a></li>
+<li>Bouley, <a href="#Page_225">225</a></li>
+<li>Bourdelle, <a href="#Page_147">147</a></li>
+</ul>
+
+<ul class="IX">
+<li>Cadiot, P.J., <a href="#Page_78">78</a>, <a href="#Page_141">141</a>, <a href="#Page_200">200</a>, <a href="#Page_202">202</a>, <a href="#Page_208">208</a>, <a href="#Page_212">212</a>, <a href="#Page_214">214</a>, <a href="#Page_216">216</a>, <a href="#Page_223">223</a>, <a href="#Page_225">225</a>, <a href="#Page_233">233</a>, <a href="#Page_245">245</a>, <a href="#Page_250">250</a></li>
+<li>Campbell, D.M., <a href="#Page_162">162</a>, <a href="#Page_166">166</a>, <a href="#Page_167">167</a></li>
+<li>Castagn&eacute;, <a href="#Page_84">84</a></li>
+<li>Cochran, David W., <a href="#Page_169">169</a>, <a href="#Page_170">170</a></li>
+</ul>
+
+<ul class="IX">
+<li>Diekerhoff, <a href="#Page_237">237</a></li>
+<li>Dollar, Jno. A.W., <a href="#Page_68">68</a>, <a href="#Page_198">198</a></li>
+</ul>
+
+<ul class="IX">
+<li>Eberlein, <a href="#Page_237">237</a></li>
+</ul>
+
+<ul class="IX">
+<li>Fisher, Carl W., <a href="#Page_236">236</a></li>
+<li>Frost, J.N., <a href="#Page_113">113</a></li>
+<li>Frost, R.F., <a href="#Page_128">128</a></li>
+</ul>
+
+<ul class="IX">
+<li>Greaves, Thomas, <a href="#Page_157">157</a></li>
+</ul>
+
+<ul class="IX">
+<li>Hoare, E. Wallis, <a href="#Page_25">25</a>, <a href="#Page_211">211</a>, <a href="#Page_230">230</a></li>
+<li>Hughes, Joseph, <a href="#Page_176">176</a>, <a href="#Page_221">221</a></li>
+<li>Hutyra and Marek, <a href="#Page_205">205</a></li>
+</ul>
+
+<ul class="IX">
+<li>Law, James, <a href="#Page_33">33</a></li>
+<li>Leblanc, <a href="#Page_223">223</a></li>
+<li>Liautard, A., <a href="#Page_84">84</a>, <a href="#Page_199">199</a>, <a href="#Page_238">238</a></li>
+<li>Lusk, Wm. V., <a href="#Page_203">203</a></li>
+</ul>
+
+<ul class="IX">
+<li>McDonough, James, <a href="#Page_237">237</a></li>
+<li>Merillat, Edward, <a href="#Page_210">210</a></li>
+<li>Merillat, L.A., <a href="#Page_80">80</a>, <a href="#Page_96">96</a>, <a href="#Page_175">175</a>, <a href="#Page_210">210</a></li>
+<li>Millar, Thomas, <a href="#Page_145">145</a></li>
+<li>M&ouml;ller, H., <a href="#Page_119">119</a>, <a href="#Page_156">156</a>, <a href="#Page_211">211</a>, <a href="#Page_222">222</a></li>
+<li>Montane, <a href="#Page_147">147</a></li>
+<li>Moore, R.C., <a href="#Page_162">162</a></li>
+</ul>
+
+<ul class="IX">
+<li>Roberts, G.H., <a href="#Page_181">181</a></li>
+</ul>
+
+<ul class="IX">
+<li>Schumacher, <a href="#Page_215">215</a></li>
+<li>Scott, John, <a href="#Page_208">208</a></li>
+<li>Seeley, J.T., <a href="#Page_176">176</a></li>
+<li>Sisson, Septimus, <a href="#Page_129">129</a>, <a href="#Page_204">204</a>, <a href="#Page_220">220</a></li>
+<li>Smith, F., Major General, <a href="#Page_56">56</a>, <a href="#Page_60">60</a>, <a href="#Page_155">155</a>, <a href="#Page_188">188</a>, <a href="#Page_194">194</a></li>
+<li>Strangeways, <a href="#Page_193">193</a></li>
+</ul>
+
+<ul class="IX">
+<li>Taylor, Henry, <a href="#Page_71">71</a></li>
+<li>Thompson, H., <a href="#Page_83">83</a>, <a href="#Page_87">87</a></li>
+<li>Trickett, A., <a href="#Page_253">253</a></li>
+</ul>
+
+<ul class="IX">
+<li>Udall, D.H., <a href="#Page_236">236</a></li>
+<li>Uhlrich, <a href="#Page_224">224</a></li>
+</ul>
+
+<ul class="IX">
+<li>Walters, Wilfred, <a href="#Page_83">83</a>, <a href="#Page_97">97</a></li>
+<li>Williams, W.L., <a href="#Page_217">217</a>, <a href="#Page_236">236</a></li>
+</ul>
+</div>
+
+<hr style='width: 65%' />
+
+<p><b>Transcriber's Notes:</b></p>
+
+<p><b>Accented words:</b> The following spelling differences have been
+maintained:</p>
+
+<p>Moller / Möller<br />
+Montane / Montané<br />
+Traite / Traité</p>
+
+<p><b>Hyphenation:</b> The following hyphenation differences have been
+maintained:</p>
+
+<p>bilateral / bi-lateral<br />
+calcaneocuboid / calcaneo-cuboid<br />
+calcaneometatarsal / calcaneo-metatarsal<br />
+counterirritation / counter-irritation<br />
+counterirritating / counter-irritating<br />
+foreleg / fore-leg<br />
+interphalangeal / inter-phalangeal<br />
+noninfectious / non-infectious<br />
+nonsensitive / non-sensitive<br />
+overwork / over-work<br />
+posteaspinatus / postea-spinatus<br />
+ringbone / ring-bone<br />
+subacute / sub-acute<br />
+subcoronary / sub-coronary<br />
+subfascial / sub-fascial<br />
+subperiosteal / sub-periosteal</p>
+
+<p><b>Typographical errors:</b></p>
+
+<p>sub-facial <i>for</i> sub-fascial<br />
+"At two-year-old" <i>for</i> "A two-year-old"<br />
+Ameircan <i>for</i> American<br />
+Symtomatology <i>for</i> Symptomatology<br />
+extoses <i>for</i> exostoses<br />
+admintered <i>for</i> administered</p>
+
+
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<hr class="full" />
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+The Project Gutenberg eBook, Lameness of the Horse, by John Victor Lacroix
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: Lameness of the Horse
+       Veterinary Practitioners' Series, No. 1
+
+
+Author: John Victor Lacroix
+
+
+
+Release Date: July 27, 2005  [eBook #16370]
+
+Language: English
+
+Character set encoding: ISO-646-US (US-ASCII)
+
+
+***START OF THE PROJECT GUTENBERG EBOOK LAMENESS OF THE HORSE***
+
+
+E-text prepared by Juliet Sutherland, Julia Miller, and the Project
+Gutenberg Online Distributed Proofreading Team (https://www.pgdp.net)
+
+
+
+Note: Project Gutenberg also has an HTML version of this
+      file which includes the original illustrations.
+      See 16370-h.htm or 16370-h.zip:
+      (https://www.gutenberg.org/dirs/1/6/3/7/16370/16370-h/16370-h.htm)
+      or
+      (https://www.gutenberg.org/dirs/1/6/3/7/16370/16370-h.zip)
+
+Transcriber's Note:
+
+      The original text was inconsistent in the use of accents and
+      hyphenation. These variants and a small number of typographical
+      errors were maintained in this transcription. A complete list
+      of the variant spellings is found at the end of the book along
+      with the list of typographical errors.
+
+      The Table of Contents lists the Authorities Cited section as
+      preceding the Index, but it was printed following the Index.
+      This order has been retained in this transcription.
+
+
+
+
+
+Veterinary Practitioners' Series
+
+No. 1
+
+LAMENESS OF THE HORSE
+
+by
+
+J. V. Lacroix, D.V.S.
+
+Professor of Surgery, The Kansas City Veterinary College
+Author of "Animal Castration"
+
+Illustrated
+
+Chicago
+American Journal Of Veterinary Medicine
+
+1916
+
+
+
+
+
+
+
+PREFACE
+
+
+All that can be known on the subject of lameness, is founded on a
+knowledge of anatomy and of the physiology of locomotion. Without such
+knowledge, no one can master the principles of the diagnosis of
+lameness. However, it must be assumed that the readers are informed on
+these subjects, as it is impossible to include this fundamental
+instruction in a work so brief as this one.
+
+The technic of certain operative or corrective procedures, has been
+described at length only where such methods are not generally employed.
+Where there is no departure from the usual methods, treatment that is
+essentially within the domain of surgery or practice is not given in
+specific detail.
+
+Realizing the need for a treatise in the English language dealing with
+diagnosis and treatment of lameness, the author undertook the
+preparation of this manuscript. That the difficulties of depicting by
+means of word-pictures, the symptoms evinced in baffling cases of
+lameness, presented themselves in due course of writing, it is needless
+to say.
+
+It is hoped that this volume will serve its readers to the end that the
+handling of cases of lameness will become a more satisfactory and
+successful part of their work; that both the practitioner and his
+clients may profit thereby; and last but by no means least, that the
+horse, which has given such incalculable service to mankind and is
+deserving of a more concrete reward, will be benefited by the
+application of the principles herein outlined.
+
+In addition to the consultation of standard works bearing on various
+phases of the subject of lameness, the author wishes to thankfully
+acknowledge helpful advice and assistance received from the publisher,
+Dr. D.M. Campbell; to appreciatively credit Drs. L.A. Merillat, A.
+Trickett and F.F. Brown for valuable suggestions given from time to
+time. Particular acknowledgment is made to Dr. Septimus Sisson, author,
+and W.B. Saunders & Co., publishers of The Anatomy of Domestic Animals,
+for permission to use a number of illustrations from that work.
+
+                                                             J.V.L.
+
+Chicago, Illinois, October, 1916.
+
+
+
+
+_Justice shows a triumphant face at the works of humane practitioners,
+who give serious thought and expend honest effort, for the alleviation
+of animal suffering._
+
+
+
+
+TABLE OF CONTENTS
+
+
+                                                             Page
+Illustrations                                                   7
+Introduction                                                   11
+
+                            SECTION I
+
+Etiology and Occurrence                                        15
+Affections of Bones                                            15
+Rarefying Osteitis, or Degenerative Changes                    16
+Fractures                                                      16
+Affections of Ligaments                                        20
+Luxations--Dislocations                                        21
+Arthritis                                                      22
+Affections of Bursae and Thecae                                27
+Affections of Muscles and Tendons                              28
+Affections of Nerves                                           30
+Affections of Blood Vessels                                    31
+Affections of Lymph Vessels and Glands                         32
+Affections of the Feet                                         34
+
+                            SECTION II
+
+Diagnostic Principles                                          37
+Anamnesis                                                      38
+Visual Examination                                             39
+Attitude of the Subject                                        41
+Examination by Palpation                                       43
+Passive Movements                                              47
+Observing the Character of the Gait                            48
+Special Methods of Examination                                 53
+
+                           SECTION III
+                    Lameness in the Fore Leg
+
+Anatomo-Physiological Review of Parts of the Fore Leg          55
+Shoulder Lameness                                              61
+Fracture of the Scapula                                        62
+Scapulohumeral Arthritis                                       65
+Infectious Arthritis                                           66
+Injuries                                                       66
+Wounds                                                         67
+Luxation of the Scapulohumeral Joint                           67
+Inflammation of the Bicipital Bursa                            68
+Contusions of the Triceps Brachii                              71
+Shoulder Atrophy (Sweeny)                                      73
+Paralysis of the Suprascapular Nerve                           75
+Radial Paralysis                                               77
+Thrombosis of the Brachial Artery                              81
+Fracture of the Humerus                                        82
+Inflammation of the Elbow                                      84
+Fracture of the Ulna                                           86
+Fracture of the Radius                                         87
+Wounds of the Anterior Brachial Region                         90
+Inflammation and Contraction of the Carpal Flexors             93
+Fracture and Luxation of the Carpal Bones                      96
+Carpitis                                                       98
+Open Carpal Joint                                             100
+Thecitis and Bursitis                                         104
+Fracture of the Metacarpus                                    106
+Splints                                                       107
+Open Fetlock Joint                                            110
+Phalangeal Exostosis (Ringbone)                               118
+Open Sheath of the Flexors of the Phalanges                   124
+Luxation of the Fetlock Joint                                 125
+Sesamoiditis                                                  127
+Fracture of the Proximal Sesamoids                            128
+Inflammation of the Posterior Ligaments of the Pastern
+    Proximal Interphalangeal Joint                            129
+Fracture of the First and Second Phalanges                    131
+Tendinitis (Inflammation of the Flexor Tendons)               135
+Chronic Tendinitis and Contraction of the Flexor Tendons      137
+Contracted Tendons of Foals                                   143
+Rupture of the Flexor Tendons and Suspensory Ligament         146
+Thecitis and Bursitis in the Fetlock Region                   150
+Arthritis of the Fetlock Joint                                152
+Ossification of the Cartilages of the Third Phalanx           155
+Navicular Disease                                             157
+Laminitis                                                     160
+Calk Wounds (Paronychia)                                      170
+Corns                                                         172
+Quittor                                                       174
+Nail Punctures                                                178
+
+                           SECTION IV
+                    Lameness in the Hind Leg
+
+Anatomo-Physiological Consideration of the Pelvic Limbs       185
+Hip Lameness                                                  195
+Fractures of the Pelvic Bones                                 196
+Fractures of the Femur                                        199
+Luxation of the Femur                                         201
+Gluteal Tendo-Synovitis                                       203
+Paralysis of the Hind Leg                                     204
+Paralysis of the Femoral (Crural) Nerve                       204
+Paralysis of the Obturator Nerve                              206
+Paralysis of the Sciatic Nerve                                208
+Iliac Thrombosis                                              209
+Fracture of the Patella                                       212
+Luxation of the Patella                                       213
+Chronic Gonitis                                               217
+Open Stifle Joint                                             220
+Fracture of the Tibia                                         222
+Rupture and Wounds of the Tendo Achillis                      224
+Spring-Halt (String-Halt)                                     225
+Open Tarsal Joint                                             229
+Fracture of the Fibular Tarsal Bone (Calcaneum)               230
+Tarsal Sprains                                                232
+Curb                                                          233
+Spavin (Bone Spavin)                                          235
+Distension of the Tarsal Joint Capsule (Bog Spavin)           242
+Distension of the Tarsal Sheath of the Deep Digital Flexor
+    (Thoroughpin)                                             246
+Capped Hock                                                   251
+Rupture and Division of the Long Digital Extensor (Extensor
+    Pedis)                                                    253
+Wounds from Interfering                                       255
+Lymphangitis                                                  257
+Authorities Cited                                             265
+Index                                                         267
+
+
+
+
+ILLUSTRATIONS
+
+                                                             Page
+Fig.  1--Hoof Testers                                          53
+Fig.  2--Muscles of Left Thoracic Limb, Lateral View           56
+Fig.  3--Muscles of Left Thoracic Limb, Medial View            57
+Fig.  4--Sagital Section of Digit and Distal Part of
+         Metacarpus                                            59
+Fig.  5--Ordinary Type of Heavy Sling                          62
+Fig.  6--A Sling Made in Two Parts                             63
+Fig.  7--Paralysis of the Suprascapular Nerve of Left
+         Shoulder                                              76
+Fig.  8--Radial Paralysis                                      78
+Fig.  9--Merillat's Method of Fixing Carpus in Radial
+         Paralysis                                             79
+Fig. 10--Contraction of Carpal Flexors, "Knee Sprung"          95
+Fig. 11--Pericarpal Inflammation and Enlargement Due to
+         Injury                                                99
+Fig. 12--Hygromatous Condition of the Right Carpus            100
+Fig. 13--Carpal Exostosis in Aged Horse                       101
+Fig. 14--Exostosis of Carpus Resultant from Carpitis          102
+Fig. 15--Distal End of Radius, Illustrating Effects of
+         Carpitis                                             102
+Fig. 16--Posterior View of Radius, Illustrating Effects of
+         Splint                                               108
+Fig. 17--Phalangeal Exosteses                                 120
+Fig. 18--Rarefying Osteitis in Chronic Ringbone               121
+Fig. 19--Phalangeal Exostoses in Chronic Ringbone             122
+Fig. 20--Contraction of Superficial Digital Flexor Tendon
+         Due to Tendinitis                                    138
+Fig. 21--Contraction of Deep Flexor Tendon Due to
+         Tendinitis                                           139
+Fig. 22--Chronic Case of Contraction of Both Flexor Tendons
+         of the Phalanges                                     140
+Fig. 23--Contraction of Superficial and Deep Flexor
+         Tendons                                              141
+Fig. 24--Contraction of Superficial Digital Flexor and
+         Slight Contraction of Deep Flexor Tendon             142
+Fig. 25--"Fish Knees"                                         145
+Fig. 26--Extreme Dorsal Flexion                               146
+Fig. 27--A Good Style of Shoe for Bracing the Fetlock         148
+Fig. 28--The Roberts Brace in Operation                       149
+Fig. 29--Distension of Theca of Extensor of the Digit         151
+Fig. 30--Rarefying Osteitis Wherein Articular Cartilage
+         Was Destroyed                                        153
+Fig. 31--Ringbone and Sidebone                                156
+Fig. 32--Position Assumed by Horse Having Unilateral
+         Navicular Disease                                    159
+Fig. 33--The Hoof in Chronic Laminitis                        165
+Fig. 34--Effects of Laminitis                                 166
+Fig. 35--Cochran Shoe, Inferior Surface                       168
+Fig. 36--Cochran Shoe, Superior Surface                       169
+Fig. 37--Hyperplasia of Eight Forefoot Due to Chronic
+         Quittor                                              176
+Fig. 38--Chronic Quittor, Left Hind Foot                      177
+Fig. 39--Skiagraph of Foot                                    179
+Fig. 40--Sagital Section of Eight Hock                        186
+Fig. 41--Muscles of Right Leg; Front View                     187
+Fig. 42--Muscles of Lower Part of Thigh, Leg and Foot         189
+Fig. 43--Right Stifle Joint; Lateral View                     190
+Fig. 44--Left Stifle Joint; Medial View                       191
+Fig. 45--Left Stifle Joint; Front View                        193
+Fig. 46--Oblique Fracture of the Femur                        200
+Fig. 47--Fracture of Femur After Six Months' Treatment        201
+Fig. 48--Aorta and Its Branches Showing Location of
+         Thrombi                                              210
+Fig. 49--Thrombosis of the Aorta, Iliacs and Branches         211
+Fig. 50--Chronic Gonitis                                      218
+Fig. 51--Position Assumed in Gonitis                          219
+Fig. 52--Spring-halt                                          226
+Fig. 53--Lateral View of Tarsus Showing Effects of Tarsitis   228
+Fig. 54--Right Hock Joint                                     231
+Fig. 55--Spavin                                               235
+Fig. 56--Bog Spavin                                           243
+Fig. 57--Thoroughpin                                          247
+Fig. 58--Fibrosity of Tarsus in Chronic Thoroughpin           248
+Fig. 59--Another View of Case Shown in Fig. 58                249
+Fig. 60--"Capped Hock"                                        252
+Fig. 61--Chronic Lymphangitis                                 258
+Fig. 62--Elephantiasis                                        259
+
+
+
+
+INTRODUCTION
+
+
+Lameness is a symptom of an ailment or affection and is not to be
+considered in itself as an anomalous condition. It is the manifestation
+of a structural or functional disorder of some part of the locomotory
+apparatus, characterized by a limping or halting gait. Therefore, any
+affection causing a sensation and sign of pain which is increased by the
+bearing of weight upon the affected member, or by the moving of such a
+distressed part, results in an irregularity in locomotion, which is
+known as lameness or claudication. A halting gait may also be produced
+by the abnormal development of a member, or by the shortening of the leg
+occasioned by the loss of a shoe.
+
+For descriptive purposes lameness may be classified as _true_ and
+_false_. _True lameness_ is such as is occasioned by structural or
+functional defects of some part of the apparatus of locomotion, such as
+would be caused by spavin, ring-bone, or tendinitis. _False lameness_ is
+an impediment in the gait not caused by structural or functional
+disturbances, but is brought on by conditions such as may result from
+the too rapid driving of an unbridle-wise colt over an irregular road
+surface, or by urging a horse to trot at a pace exceeding the normal
+gait of the animal's capacity, causing it to "crow-hop" or to lose
+balance in the stride. The latter manifestation might, to the
+inexperienced eye, simulate _true lameness_ of the hind legs, but in
+reality, is merely the result of the animal having been forced to assume
+an abnormal pace and a lack of balance in locomotion is the consequence.
+
+The degree of lameness, though variable in different instances, is in
+most cases proportionate to the causative factor, and this fact serves
+as a helpful indicator in the matter of establishing a diagnosis and
+giving the prognosis, especially in cases of somewhat unusual character.
+An animal may be slightly lame and the exhibition of lameness be such as
+to render the cause bafflingly obscure. Cases of this nature are
+sometimes quite difficult to classify and in occasional instances a
+positive diagnosis is impossible. Subjects of this kind may not be
+sufficiently inconvenienced to warrant their being taken out of
+service, yet a lame horse, no matter how slightly affected, should not
+be continued in service unless it can be positively established that the
+degree of discomfort occasioned by the claudication is small and the
+work to be done by the animal, of the sort that will not aggravate the
+condition.
+
+Subjects that are very lame--so lame that little weight is borne by the
+affected member--are, of course, unfit for service and as a rule are not
+difficult of diagnosis. For instance, a fracture of the second phalanx
+would cause much more lameness than an injury to the lateral ligament of
+the coronary joint wherein there had occurred only a slight sprain, and
+though crepitation is not recognized, the diagnostician is not justified
+in excluding the possibility of fracture, if the lameness seems
+disproportionate to the apparent first cause.
+
+The course taken by cases of lameness is as variable as the degree of
+its manifestation, and no one can definitely predict the duration of any
+given cause of claudication.
+
+Because of the fact that horses are not often good self-nurses at best,
+and that it is difficult to enforce proper care for the parts affected,
+one can not wisely state that resolution will promptly follow in an
+acute involvement, nor can he predict that the case will or will not
+become chronic. Experience has proved that complete or partial recovery
+may result, or again, that no change may occur in any given case, and
+that in some instances even where rational treatment is early
+administered, a decided aggravation of the condition may follow
+unaccountably.
+
+However, because of the economic element to be reckoned with, it is of
+some value to be able to give a fairly accurate prognosis in the
+handling of cases of lameness, as in the majority of instances the
+treatment and manner of after-care are determined largely by the expense
+that any prescribed line of attention will occasion.
+
+A case of acute bone spavin in a horse of little value is not generally
+treated in a manner that will incur an expense equivalent to one-half
+the value of the subject. The fact is always to be considered in such
+cases, that even where ideal conditions favor proper treatment, the
+outcome is uncertain. Where less than six weeks of rest can be allowed
+the animal, one affected with bone spavin would therefore not be treated
+with the expectation of obtaining good results, as six weeks' time, at
+least, is necessary for a successful outcome. If the cost attending the
+enforced idleness of an animal of this kind is considered prohibitive
+for the employment of proper measures to affect a cure, and if lameness
+is slight, the animal should be given suitable work, but in cases of
+articular spavin in aged subjects, they should be humanely destroyed and
+not subjected to prolonged misery.
+
+A thorough knowledge of the structure and functions of the affected
+parts is necessary to proceed in cases of lameness; likewise, the age,
+conformation and temperament of the subject need to be taken into
+consideration; the presence or absence of complications demand the
+attention; the kind of care the subject will probably receive directly
+influences the outcome; and the character of service expected of the
+subject, too, needs to be carefully considered before the ultimate
+outcome may reasonably be foretold.
+
+The practitioner is often confronted with the problem of how best to
+handle certain cases. Will they do better under conditions where
+absolute quiet is enforced, or is it preferable to allow exercise at
+will? The temperament of the animal must be considered in such cases,
+and if a lame horse is too active and playful when given his freedom,
+exercise must be restricted or prevented, as the case may require. In
+cases of strains of tendons, during the acute stage, immobilization of
+the affected parts is in order. In certain sub-acute inflammatory
+processes or in instances of paralytic disturbance where convalescence
+is in progress, moderate exercise is highly beneficial.
+
+Consequently, each case in itself presents an individual problem to be
+judged and handled in the manner experience has taught to be most
+effective, appropriate and practical, and the veterinarian should give
+due consideration to the comfort and welfare of the crippled animal as
+well as to the interests of the owner.
+
+
+
+
+SECTION I.
+
+ETIOLOGY AND OCCURRENCE.
+
+
+In discussions of pathological conditions contributing to lameness in
+the horse, cause is generally classified under two heads--_predisposing_
+and _exciting_. It becomes necessary, however, to adopt a more general
+and comprehensive method of classification, herein, which will enable
+the reader to obtain a better conception of the subject and to more
+clearly associate the parts so grouped descriptively.
+
+Though _predisposing_ factors, such as faulty conformation, are often to
+be reckoned with, _exciting_ causes predominate more frequently in any
+given number of cases. The noble tendency of the horse to serve its
+master under the stress of pain, even to the point of complete
+exhaustion and sudden death, should win for these willing servants a
+deeper consideration of their welfare. Too frequently are their
+manifestations of discomfort allowed to pass unheeded by careless,
+incompetent drivers lacking in a sense of compassion. Symptoms of
+malaise should never be ignored in any case; the humane and economic
+features should be realized by any owner of animals.
+
+In the consideration of group causes, lameness may be said to originate
+from affections of bones, ligaments, thecae and bursae, muscles and
+tendons, nerves, lymph vessels and glands, and blood vessels, and may
+also result from an involvement of one or several of the aforementioned
+tissues, caused by rheumatism. Further, affections of the feet merit
+separate consideration, and, finally, a miscellaneous grouping of
+various dissimilar ailments, which for the most part, do not directly
+involve the locomotory apparatus but do, by their nature, impede normal
+movement.
+
+
+AFFECTIONS OF BONES.
+
+The bony column serving as the framework and support of the legs,
+probably constitutes the most vital element having to do with weight
+bearing and locomotion, and therefore during the acute and painful stage
+of bone affections, the pain becomes more intense in the process and
+pressure of standing than when the member is swung or advanced.
+
+Certain bones are so well protected by muscular structures that they are
+not frequently injured except as a result of violence which may produce
+fracture. However, there are certain bones which receive the constant
+shock of concussion when the animal is subjected to daily, rapid work on
+hard road surfaces. Splints, ringbones and spavins are the most general
+examples produced by these conditions.
+
+Varying pathological developments often result from concussion,
+contusion or other violent shocks to the bony structures. In such cases
+there either follows a simple periostitis which may resolve
+spontaneously with no obvious outward symptom, or osteitis, which may
+occur with tissue changes, as in exostosis; or the case may produce any
+degree of reaction between these two possible extremes.
+
+
+Rarefying Osteitis, or Degenerative Changes.
+
+Certain bone affections, such as osteomalacia or osteoporosis, are in
+the main, responsible for distortions and morphological changes of bone,
+causing lameness, permanent blemish and even resulting in death of the
+affected animal. The climatic conditions in some localities favor these
+occurrences but they may also be ascribed to improper food constituents
+and to possible infective agencies.
+
+Rarefying degenerative changes manifested by exostosis involving the
+phalanges of the young, causing ringbone, are fairly common in
+occurrence throughout this country. This is due, supposedly, to a lack
+of mineral substance in the bony structure of the affected animals, and
+is known as rachitis--commonly called rickets. Since the affected
+subjects suffer involvement of several of the extremities at the same
+time, the theory of rachitic origin seems well supported.
+
+
+Fractures.
+
+Fractures of bones constitute serious conditions and are always
+manifested by lameness. A sub-classification is essential here for the
+student of veterinary medicine who would comprehend the technic of
+reduction and subsequent treatment in such cases.
+
+Fractures are classified by many authorities as being _simple_,
+_compound_, and _comminuted_. This method is practical because it
+separates dissimilar conditions. There are also grouped fractures, the
+pathologic anatomy of which is similar. Classification on an etiological
+basis would attempt to associate conditions, the morbid anatomy and
+gravity of which would justly preclude their being combined.
+
+Simple Fracture is a condition where the continuity of the bone has
+been broken without serious destruction of the soft structures adjacent,
+and where no opening has been made to the surface of the flesh. Such
+fractures do not reduce the bone to fragments. Long bones are frequently
+subjected to simple fracture, while short thick bones, such as the
+second phalanx, may suffer multiple or comminuted fractures.
+
+Compound Fracture designates a break of bone with the destruction of
+the soft tissues covering it, making an open wound to the surface of the
+skin. This form of fracture is serious because of the attendant danger
+of infection, and in treatment, necessitates special precaution being
+taken in the application of splints that the wound may be cared for
+without infection of the tissues. These fractures generally occur as a
+result of some forceful impact through the flesh to the bone, or where
+the bones are driven outward by the blow. Common examples are in
+fractures of the metacarpus and metatarsus of the first phalanx. This
+kind of injury in mature horses usually produces an irreparable
+condition, and viewed economically, is generally considered fatal.
+
+Comminuted Fractures, as the term implies, are those cases wherein the
+bone is reduced to a number of small pieces. This kind of break may be
+classified as simple-comminuted fracture when the skin is unbroken, and
+when the bone is exposed as a result of the injury, it is known as a
+compound-comminuted fracture. Such fractures are caused by violent
+contusion or where the member is caught between two objects and
+crushed.
+
+
+Multiple Fractures.
+
+Fractures are called _multiple_ when the bone is reduced to a number of
+pieces of large size. This condition differs from a comminuted fracture
+in that the multiple fracture may break the bone into several pieces
+without the pieces being ground or crushed, and the affected bone may
+still retain its normal shape.
+
+Further classification is of value in describing fractures of bone with
+respect to the manner in which the bone is broken--the direction of the
+fissure or fissures in relation to its long axis.
+
+A fracture is _transverse_ when the bone is broken at a right angle from
+its long axis. Such breaks when simple, are the least trouble to care
+for because there is little likelihood that the broken ends of bone will
+become so displaced that they will not remain in apposition. _Simple
+transverse_ fracture of the metacarpus, for instance, constitutes a
+favorable case for treatment if other conditions are favorable.
+
+_Oblique fractures_, as may be surmised, are solutions of continuity of
+bone in such manner that the fissure crosses the long axis of a bone at
+an acute or obtuse angle. These fractures are prone to injure the soft
+structures adjacent, and are frequently compound, as well. Moreover,
+because of the fact that the apposing pieces of bone are beveled, the
+broken ends of bone are likely to pass one another in such a way as to
+shorten the distance between the extremities of the injured member.
+Contraction of muscles also tends to exert traction upon a bone so
+fractured, resulting in a lateral approximation of the diaphysis and
+thus preventing union because the broken surfaces are not in proper
+contact.
+
+Fractures are _longitudinal_ when the fissure is parallel with the long
+axis of the bone. This variety of break is not infrequent in the first
+phalanx; and a vertical fracture of the second phalanx is also said to
+be longitudinal, however, there is little difference (if any, in some
+subjects) between the vertical and transverse diameters of this
+particular bone.
+
+_Green stick fractures_ are essentially those resulting from falls to
+young animals. They are usually sub-periosteal and when the periosteum
+is left intact or nearly so, no crepitation is discernible. If this
+fracture is _simple_, prompt recovery may be expected. Bones of young
+animals, because they do not contain proportionately as much mineral
+substance as do bones of adults, are more resilient and less apt to
+become completely fractured. They are, however, subject to what is known
+as green stick fracture.
+
+_Impacted fractures_ are usually occasioned by falls. When the weight of
+the body is suddenly caught by a member in such manner as to forcefully
+drive the epiphyseal portions of bone into and against the diaphysis,
+_multiple longitudinal_ fractures occur at the point of least
+resistance. Parts so affected undergo a fibrillary separation,
+increasing the transverse diameter of the bone; or if the impact has
+been sufficiently violent, the portion becomes an amorphous mass.
+
+In a treatise on the subject of lameness, the bones chiefly concerned
+and most often affected must be especially considered. The shape and
+size of a bone when injured, determines in a measure, the course and
+probable outcome in most cases, but of first and greater importance is
+the function of the bone. A fracture of the fibula in the horse need not
+incapacitate the subject, but a tibial fracture is serious and generally
+proves cause for fatal termination. The body of the scapula may be
+completely fractured and recovery will probably result in most cases
+without much attention being given to the subject, yet a fracture of the
+neck of this same bone constitutes an injury of serious consequence. The
+difference in the function of different parts of this same bone, as well
+as its shape and mode of attachment, determine the gravity of the case;
+so it is in fractures of other bones with respect to the course and
+prognosis of the case--function is the important factor to be
+considered.
+
+Next in importance is the age of the animal suffering fracture of the
+bone. Capacity for regeneration is naturally greater in a vigorous,
+young animal than in aged or even middle-aged subjects. A healthy
+condition of the bone and the body favor the process of repair in case
+of fracture, and prognosis may be favorable or unfavorable, depending
+upon these factors mentioned for consideration. Individuals of the same
+species, differing in temperament, may comport themselves in a manner
+that is conductive to prompt recovery, or to early destruction. This
+feature cannot be overestimated in importance, as it is sometimes a
+decisive element, regardless of other conditions. A horse suffering from
+an otherwise remediable pelvic fracture may be so worried and tortured
+by being confined in a sling that the case calls for special attention
+and care because of the animal's temperament. Sometimes, the constant
+presence of a kind attendant will so reassure the subject that it will
+become resigned to unnatural confinement, in a day or two. This
+precaution may, in itself, determine the outcome, and the wise
+veterinarian will not overlook this feature or fail to deviate from the
+usual rote in the handling of average cases. Recovery may be brought
+about in irritable subjects by this concession to the individual
+idiosyncrasies of such animals.
+
+
+AFFECTIONS OF LIGAMENTS.
+
+Ligaments which have to do with the locomotory apparatus are, for the
+most part, inelastic structures which are composed of white fibrous
+tissue and serve to join together the articular ends of bones; to bind
+down tendons; and to act as sheathes or grooves through which tendons
+pass, and as capsular membranes for retention of synovia in contact with
+articular surfaces of bones.
+
+Ligaments are injured less frequently than are bones. Because of their
+flexibility they escape fracture in the manner that bones suffer. They
+are, however, completely severed by being cut or ruptured, though
+fibrillary fracture the result of constant or intermittent tensile
+strain is of more frequent occurrence.
+
+Simple inflammation of ligaments is of occasional occurrence but, unless
+considerable injury is done this tissue, no perceptible manifestation of
+injury results. No doubt many cases wherein fibrillary fracture of
+ligaments (sprain) takes place some lameness is caused, but because of
+the dense, comparatively nonvascular nature of these structures, little
+if any manifestation, except lameness, is evident. And such cases, if
+recognized are usually diagnosed by excluding the existence of other
+possible causes and conditions which might also cause lameness.
+
+Certain ligaments are subjected to strain more than are others and
+therefore, when so involved, frequently cause lameness. Examples of this
+kind are affections of the collateral (lateral) ligaments of the
+phalanges. Because of the leverage afforded by the transverse diameter
+of the foot, when an animal is made to travel over uneven road surfaces,
+considerable strain is brought to bear on the collateral ligaments of
+the phalanges. A sequel to this form of injury is a circumscribed
+periostitis at the site of attachment of the ligaments and frequently
+the formation of an exostosis--ringbone--results.
+
+Where sudden and violent strain is placed upon a ligament and rupture
+occurs, the division is usually effected by the ligament being torn from
+its attachment to the bone. In such cases, a portion of periosteum and
+bone is usually detached and the condition may then properly be called
+one of fracture. In some cases of this kind recovery is tardy, because
+of the difficulty in maintaining perfect apposition of the divided
+structures, and reactionary inflammation is not of sufficient extent to
+enhance prompt repair. In fact, some cases of this kind seem to progress
+more favorably, when no attempt at immobilization of the affected member
+is attempted.
+
+If some freedom of movement is allowed, acute inflammation resulting in
+nature's provisional swelling soon develops and repair is hastened
+because of increased vascularity. But where luxation of phalanges
+accompanies sprain, reposition and immobilization are necessary--that is
+if cases are thought likely to benefit by any treatment.
+
+
+Luxations--Dislocations.
+
+Luxation or dislocation is a condition where the normal relation between
+articular ends of bones has been deranged to the extent that partial or
+complete loss of function results. When a bone is luxated (out of
+joint), there has occurred a partial or complete rupture of certain
+ligaments or tendons; or a bone may be luxated when an abnormal or
+unusual elasticity of inhibitory ligaments or tendons obtains.
+
+Luxations may be practically classified as _temporary_ and _fixed_. In
+temporary luxations, disarticulation is but momentary and spontaneous
+reposition always results; while a fixed luxation does not reduce
+spontaneously but remains luxated until reposition is effected by proper
+manipulation and treatment. Fixed luxation may be of such character as
+to be practically irreducible because of extensive damage done to
+ligaments or cartilage. Where a complete luxation of the
+metacarpophalangeal joint exists, it is probable that in most cases
+sufficient injury to collateral and capsular ligaments has been done to
+render complete recovery improbable, if not impossible.
+
+Temporary luxation of the patella is a common affection of the horse and
+fixed luxation of this bone also occurs. As a matter of fact, in the
+horse, patellar luxation is the one frequent affection of this kind.
+
+As a rule, complete disarticulation immobilizes the affected joint and
+in most instances there is noticeable an abnormal prominence in the
+immediate vicinity--in patellar luxation, the whole bone. In other
+instances the articular portion only, of the affected bone is
+malpositioned. Usually, luxation and fracture may be differentiated in
+that there is no crepitation in luxation and more or less crepitation
+exists in fracture.
+
+It is evident, when one considers the symptomatology and nature of the
+affection, that fixed luxation is usually caused by undue strain or
+violent and abnormal movement of a part. Joints having the greater
+freedom of movement are apt to suffer luxation more frequently.
+
+
+Arthritis.
+
+The study of arthritis in the horse is limited to a consideration of
+joint inflammations which, for the most part, are of traumatic origin.
+Unlike the human, the horse is not subject to many forms of specific
+arthritis--tubercular, gonorrheal, syphilitic, etc.
+
+A practical manner of classification of arthritis is _traumatic_ and
+_metastatic_.
+
+_Traumatic arthritis_ may result from all sorts of accidents wherein
+joints are contused. Such cases may be considered as being caused by
+direct injuries. Instances of this kind, depending on the degree of
+insult, manifest evidence of injury which ranges from a simple
+synovitis to the most active inflammatory involvement of the entire
+structure and adjacent tissues.
+
+The reactionary inflammation which attends a case of tarsitis caused by
+a horse being kicked is a good example of the result of direct injury.
+Such cases, if the contusion is of sufficient violence, result in
+arthritis and periarthritis. In inactive farm horses, during cold
+weather, this condition becomes chronic, swelling remains for weeks
+after all lameness and pain have subsided and occasionally hyperthrophy
+is permanent.
+
+Arthritis occasioned by indirect injury, such as characterizes joint
+inflammation from continuous concussion, is seen in horses that are
+worked at a rapid pace on city streets or other hard road surfaces. Such
+affections may be acute, as in some cases of spavin, but are usually
+inflammatory conditions that do not occasion serious disturbance when
+these affections become chronic. If the involvement persists with
+sufficient active inflammation, there may follow erosion of cartilage
+and incurable lameness. If extensive necrosis of cartilage takes place,
+the attendant pain will be sufficient to cause the animal to favor the
+diseased part and such immobilization enhances early ankylosis--nature's
+substitute for resolution in this disease.
+
+Wounds invading the tissues adjacent to joints, when these wounds are of
+considerable extent, cause inflammation of such articulations by
+contiguous extension of inflammation. As long as an injury remains
+practically aseptic, or if infected and the septic process does not
+involve the joint proper by direct extension, no more serious
+disturbance than a simple synovitis will result. If, instead, a
+periarthritic inflammation is serious or destructive in character, the
+type of arthritis will be grave--even though due to an indirect cause.
+
+Where a vulnerant body penetrates all structures and invades the
+interior of the joint capsule the result is that a more or less active
+disturbance is incited. The introduction of a sterile instrument into a
+joint cavity, under strict asepsis, where a perfect technic is executed,
+does not cause perceptible manifestation of the injury, if the opening
+so made is small--such as a suitable exploratory trocar makes. But a
+puncture made in a similar manner and with the same instrument without
+due regard to asepsis is likely to cause an infectious synovitis and
+arthritis usually follows.
+
+A larger opening than is produced by means of an exploratory trochar may
+be made into a joint cavity, causing escape of synovia as it is secreted
+for days and even for weeks and no serious or permanent trouble is
+experienced in some cases. If the synovitis or arthritis remains
+non-infected and the wound, traumatic or surgical, is not too large,
+healing by granulation occurs, and the discharge of synovia ceases.
+However, if synovial discharge persists too long because of tardy
+closure of an open joint, there is great danger of infection gaining
+entrance into the synovial cavity, or in some instances, desiccation of
+endothelial cells of the articulation occurs, in areas, and the
+reactionary inflammation eventually results in ankylosis.
+
+A small puncture which introduces into the synovial cavity infectious
+material of active virulence will cause an arthritis that is more
+serious, much more painful and more difficult to handle than is
+occasioned by a wound of moderate size, that affords ready escape of
+synovia even through the virulence of the infection be the same.
+
+Synovia is a good culture medium and the environment is ideal for
+multiplication of bacteria; consequently, the grave disturbances which
+may attend the introduction of pathogenic organisms into a synovial
+cavity as the result of a puncture wound are not to be forgotten. The
+veterinarian is in no position to estimate the virulency of organisms so
+introduced; neither can he determine the exact degree of resistance
+possessed by the subject in any given case. Therefore, he is uncertain
+as to the best method of handling such cases where an injury has been
+recently inflicted and positive evidence of the existence of an
+infectious synovitis is not present. If one could determine in advance
+the degree of infection and injury that is to follow small penetrant
+wounds of joint capsules, it would then be possible to select certain
+cases and immediately drain away all synovia and fill the cavity by
+injection with suitable antiseptic solutions.
+
+This offers a broad field for experimentation which will in time be
+productive of a radical change in the manner of treating such cases.
+
+_Metastatic arthritis_ is seen more frequently in colts or young animals
+than in mature horses and we here take the liberty of classifying with
+the arthritis of omphalophlebitis and strangles the so-called rheumatic
+variety.
+
+A specific polyarthritis or synovitis which attends navel infection of
+foals is perhaps the most frequent form of arthritis that is to be
+considered metastatic. This condition is truly a disease of young
+animals and, while it is a specific arthritis, the cause is yet to be
+attributed to any definite pathogenic organism with certainty. This
+condition is well defined by Bollinger as quoted by Hoare,[1] when he
+calls it a purulent omphalophlebitis due to local infection of the
+umbilicus and umbilical vessels, by pyogenic organisms, causing a
+metastatic pyemia.
+
+This affection is grave; its course is comparatively brief; the
+prognosis is usually unfavorable; and omphalophlebitis occasions a form
+of lameness which at once impresses the practitioner that serious
+constitutional disturbance exists. Its consideration properly belongs to
+discussions on practice or obstetrics and diseases of the new born, and
+it has received careful attention and is discussed at length in these
+works.
+
+A second form of metastatic arthritis is met with in strangles.
+Strangles occurs in the young principally and is not a frequent cause of
+synovitis or arthritis in the adult animal.
+
+Strangles or distemper is, according to most pathologists, due to the
+Streptococcus equi. Hoare[2] states that in this type of specific
+arthritis the contagium is probably carried by the blood. He gives it as
+his opinion that even laminitis has occurred as a result of the
+streptococcus-equi. This, indeed, would point toward probable extension
+by the blood as well as by way of lymph vessels.
+
+Septic synovitis and infectious arthritis are always serious affections
+even in young animals and much depends upon individual resistance and
+early rational treatment in such cases, if recovery is to follow.
+
+The same general plan of treatment is indicated in this kind of septic
+synovitis as is employed in all cases of infective synovitis and septic
+infection in open joints. There is to be considered, however, the fact
+that the young animal is more agile, a better self-nurse, and in a
+general way more apt to recover than is the adult, under similar
+conditions.
+
+_Rheumatic arthritis_, if one is justified in classifying rheumatic
+inflammation of joints as a metastatic form of arthritis, is not a
+common condition, though seen in mature and aged animals. Cases that may
+be diagnosed with certainty are usually advanced affections wherein
+dependable history is obtainable and the symptoms are well marked.
+
+Rheumatism may be thought of, with respect to arthritic inflammation
+caused thereby, as a sort of pyemia. Undoubtedly, exposure to wet and
+cold weather is an active factor, but probably a predisposing one only.
+Likewise a member that suffers from chronic inflammation due to
+recurrent injury or to constant or repeated strain is less able to
+resist the vicissitudes of climate and work.
+
+Consequently, rheumatic arthritis is to be seen affecting horses that
+are in service, more often at heavy draft work where they are exposed to
+severe straining of joints; where stabling is insanitary; and where they
+are obliged to lie down (if they do not remain standing) upon cold and
+wet ground or upon hard unbedded floors or paving.
+
+Where such inhumane and cruel treatment is given animals those
+responsible ought to be impressed with the unfairness to the animal as
+well as the economic loss occasioned by inflicting such unnecessary and
+merciless treatment upon their helpless and uncomplaining subjects. The
+very nature of the veterinarian's work affords him constant and frequent
+opportunity to convince those who are responsible for keeping animals in
+this manner, that it is inhumane and unprofitable.
+
+Cases of this kind are not uncommon about some grading and lumbering
+camps and in contract work where, often, shelter for animals is given
+little thought; the result is a cruel waste of horseflesh.
+
+Chronic articular rheumatism is occasionally observed in young animals
+that have never been in service. In these cases it seems that there
+exists an individual susceptibility and in some instances the condition
+is recurrent. Each attack is of longer duration, and eventually death
+results from continued suffering, emaciation and intoxication.
+
+
+AFFECTIONS OF BURSAE AND THECAE.
+
+Acute bursitis and thecitis is of frequent occurrence in horses because
+of direct injury from contusion, punctures and other forms of
+traumatism. These synovial membranes, with few exceptions, when inflamed
+occasion a synovitis that may be very acute, yet there is less
+manifestation of pain than in arthritis.
+
+It is only in structures such as the bursa intertubercularis or in the
+sheath of the deep digital flexor that an inflammation causes much pain
+and is apt to result in permanent lameness. This is due to the peculiar
+character of the function of such structures.
+
+An acute inflammation of a small bursa may even result in the
+destruction of such synovial apparatus without serious inconvenience to
+the subject, either at the time of destruction or thereafter.
+Obliteration of the superficial bursa over the summit of the os calcis
+is not likely to cause serious inconvenience or distress to the subject
+unless it be due to an infected wound. Even then, with reasonably good
+care given the animal, recovery is almost certain. Complete return of
+function of the member and cessation of lameness takes place within a
+few weeks in the average case.
+
+Where an infectious synovitis involves a structure such as the sheath of
+the tendon of the deep digital flexor (perforans) the condition is grave
+and because of the location of this theca the prognosis is not much more
+favorable than in an articular synovitis.
+
+Inflammation of bursae and thecae may be classified on a chronological
+basis with propriety because the duration of such affections, in many
+cases, materially modifies the result. A chronic inflammatory
+involvement of a theca through which an important tendon plays may cause
+adhesions to form. Or there may occur erosions of the parts with
+eventual hypertrophy and loss of function, partial or complete.
+
+However, in general practice a classification on an etiological basis
+is probably more practical and we shall consider inflammation of bursae
+and thecae as _infectious_ and _noninfectious_.
+
+_Infectious_ bursitis and thecitis is usually the result of direct
+introduction of septic material into the synovial structure by means of
+injuries. Infection by contiguous extension occurs and also metastatic
+involvement is met with occasionally.
+
+The noninfectious inflammation of bursae and thecae usually result from
+contusions or strains and generally run their course without becoming
+infective in character, where vitality and resistance of the subject are
+normal.
+
+In a general way, inflammation and other affections of bursae and thecae
+are considered very similar to like affections of joints.
+
+
+AFFECTIONS OF MUSCLES AND TENDONS.
+
+Muscles and tendons having to do with locomotion are more frequently
+injured than are any of the other structures whose function is to propel
+the body or sustain weight. This is due in part to the exposed position
+of muscles and tendons. They serve as a protection to the underlying
+structures and in this manner receive many blows the force and violence
+of which are spent before injury extends beyond these tissues.
+
+Muscles of the breast, shoulder and rump are most frequently the
+recipient of injuries of various kinds. The abductors of the thigh are
+subjected to bruising when horses are thrown astride of wagon poles or
+similar objects. Thus in one way or another muscle injuries are
+occasioned and cause lameness.
+
+Traumatic affection of muscles of locomotion may be surface or
+subsurface--subsurface with little injury done the skin and fascia, but
+with subsurface extravasation of blood and masceration of tissue.
+Puncture wounds wherein the vulnerant body is of small diameter, are
+observed, and they occasion deep seated infectious inflammation of the
+parts affected, with surface wounds that are often unnoticeable. Such
+injuries--puncture wounds--are always serious, and because of the fact
+that, there exists little evidence of injury at the time of their
+infliction, treatment is usually deferred several days and often
+infection has become quite extensive when the practitioner is consulted.
+
+Where infective wounds of muscles of locomotion occur, the course and
+gravity of the affection are directly influenced by the proximity of the
+injury to lymph plexuses. For instance, injuries causing an infectious
+inflammatory involvement of the adductors of the thigh may result in a
+generalization of the infection by way of the inguinal lymph glands.
+
+Large open wounds that extend deep into muscles, render inactive such
+structures, and even where division is not complete, the pain occasioned
+causes the subject to favor the part in every way possible. Contraction
+of muscular fibers of such parts increases pain and because of this fact
+groups of muscles are at times disabled because of injury done to one
+muscle. Instances of this kind are frequently seen where shoulder
+injuries, which affect but one muscle, exist; yet because of such injury
+a marked swinging-leg lameness is present.
+
+Tendons, because of their inelasticity, are subjected to injuries
+peculiar to themselves. In addition to being affected as are muscles,
+wounds of many kinds are found to affect tendons--contusions,
+interference wounds, penetrant wounds, incised wounds and lacerations.
+
+However, the commoner form of injury done tendons, is strain or sprain.
+Because of the sudden tensile strain brought to bear upon tendons in the
+shocks of concussion, as well as in propulsion of the body, there
+frequently occurs a rupture of fibers and this we know as sprain.
+
+Sprains may be considered as fibrillary fractures of soft structures and
+since this form of injury is subsurface, and limited to fractional
+portions of tendons, the inflammation occasioned usually remains an
+aseptic one. Reaction to this form of injury is characterized by
+inflammation, the course of which is erratic and variable. In chronic
+inflammation of tendons, where animals are continued in service, the
+usual sequel is contraction, or shortening of these structures.
+
+The degree of contraction as well as its import varies in different
+subjects and in the various tendons which may be affected. Contraction
+is a slow-going process that is progressive, gradually causing a
+decrease in the length of the affected structure and eventually
+rendering the animal useless.
+
+The practice of applying shoes with extended toe-calks for the purpose
+of "stretching" contracted deep digital flexor tendons (flexor pedis
+perforans) cannot be too strongly condemned. While the addition of an
+extension such as is ordinarily employed to the toe of a shoe of this
+kind, prevents for a time, frequent stumbling in such cases, the
+increased tensile strain which is thus occasioned hastens further
+contraction and subjects animals so shod to much unnecessary pain.
+
+
+AFFECTIONS OF NERVES.
+
+Because of their being protected by other structures, nerve trunks,
+which supply muscles of locomotion, are not subjected to frequent
+injuries such as contusions. However, they do become injured at times
+and the result is lameness, more or less severe.
+
+Lameness originating from nerve affection, may involve central
+structures as, for example, the spinal cord, medulla oblongata or parts
+of the brain. In making an examination of some lame animals it is
+necessary to distinguish between cases of lameness that are of central
+origin and marked by incooerdination of movement, and disturbances caused
+by other affections. Tetanus in its incipiency should not be confused
+with laminitis involving all four feet, or with certain forms of
+pleuritis, when careful examination is made, yet, in a way, to one not
+trained, the clinical symptoms are similar.
+
+Disturbances of nerve function are caused in a variety of ways. It is
+not within the scope of this work to discuss central nervous
+disturbances caused by ingestion of mouldy provender, or disturbances of
+the brain or cord occasioned by infectious diseases, but mention of the
+existence of such conditions is appropriate.
+
+By direct injury the result of blows, certain nerves are injured and
+muscles supplied by such nerves are rendered inactive. Depending upon
+the nature and extent of an injury thus inflicted, so the manner in
+which the affection is manifested varies. The suprascapular nerve is
+rather frequently injured causing partial or complete loss of function
+of the structures supplied by this nerve, and abduction of the
+scapulohumeral joint naturally results.
+
+In some cases of dystocia the obturator nerve, (or nerves, if the
+involvement is bilateral), becomes injured by being caught between the
+maternal pelvis and some dense part of the fetus. This results in
+paralysis of the adductors of the thigh if sufficient injury is done.
+
+It is said that nerves become over-stretched and held tense, in certain
+positions in which animals are obliged to remain while cast in
+confinement such as in some instances where unusual methods of restraint
+are employed. When the fore feet are drawn backward in such manner that
+great strain is put upon the radial nerve, it suffers more or less
+injury, and this is followed by partial or complete paralysis which may
+be temporary or permanent.
+
+Degenerative changes affecting nerves, as in other tissues, occur and
+more or less locomotory impediment will follow--this depending upon the
+nerve or nerves affected and the nature of such involvement. Tumors may
+surround nerves and eventually the nerve so exposed becomes implicated
+in the destructive process. Before degenerative changes take place in
+the nerve substance, in such cases, pressure may completely paralyze a
+nerve when it is so situated. Melanotic tumors in the paraproctal tissue
+in some cases, because of the large size of the new-growths, cause
+paralysis of the sciatic nerve. The author has seen one case of brachial
+paralysis occasioned by an enormous development of fibrous tissue
+involving the structures about the ulna.
+
+
+AFFECTIONS OF BLOOD VESSELS.
+
+Lameness caused by disturbances of circulation may be due to structural
+affection of vessels, or functional disorders of the heart, and in some
+instances, a combination of these causes may be active.
+
+Direct involvement of vessels is the commoner form of circulatory
+disturbance which occasions lameness, and the most frequent cause is of
+parasitic origin. Sclerostomiasis with attendant arteritis, thrombus
+formation and subsequent lodgement of emboli in the iliac, femoral, or
+other arteries, causes sufficient obstruction to prevent free
+circulation of blood, and the characteristic lameness of thrombosis
+results.
+
+Indirect injury to vessels may occur because of contused wounds and
+subsequent inflammation of tissues supplied by such vessels. If the
+injury be of sufficient extent, considerable extravasation of blood will
+take place and the painfully swollen parts necessarily impair
+locomotion. In such instances lymph vessels participate in the
+disturbance, and the condition then becomes one wherein lymphangitis is
+the predominant disturbing element.
+
+Angiomatous tumors are occasionally found affecting horses'
+legs--usually the result of some injury; and because of their size or
+position, they mechanically interfere with function. Furthermore, when
+such tumors are located on the inner or flexor side of joints, enough
+pain is occasioned that affected animals show evidence of distress,
+usually by intermittent lameness.
+
+Horses do not suffer from distension of veins as does man, that is,
+there is rarely to be seen a case wherein much disturbance from this
+source exists.
+
+
+AFFECTIONS OF LYMPH VESSELS AND GLANDS.
+
+Inflamed lymph vessels and glands, the result of various causes, is a
+rather common source of lameness of horses. When one considers the
+proportion of tissue that is composed of lymph vessels and glands, it is
+then obvious that inflammation of these structures should cause a
+painful affection of members, when so affected, and that marked lameness
+and, in some instances, general constitutional disturbance such as
+anorexia, hyperthermia and general circulatory disorder are to follow.
+
+Lymphangitis is most frequently occasioned by the introduction of septic
+material into the tissues; consequently, infectious lymphangitis is more
+frequently observed than the non-infectious type.
+
+Specific infectious forms of lymphangitis are seen in glanders and in
+strangles; infectious types of this disturbance are found in many
+instances where, initially, a localized or circumscribed infection has
+occurred--the contagium having been introduced by way of an injury. An
+example of this kind is to be seen in a wound perforating the tibial
+fascia, where the injury is inflicted by means of a horse being kicked
+by another animal shod with sharp shoe-calks. Cases of this kind
+invariably result in a septic lymphangitis, and frequently lymphadenitis
+also occurs, for the inguinal lymph glands are so situated that their
+becoming contaminated is almost certain.
+
+The trite phrase that "the tissues are bathed in lymph" should make
+clear the reason for the frequent occurrence of infectious lymphangitis
+and lymphadenitis. Foreign substances, bacteria and their products,
+inorganic material and in fact, anything that is introduced into the
+tissues, if soluble or miscible, will be taken up and conveyed by the
+afferent lymph vessels and disseminated throughout the system--hence the
+constitutional disturbances so frequently thus caused.
+
+A non-infectious type of lymphangitis is frequently seen in the heavy
+draft breeds of horses and in such cases one or both hind legs are
+involved--it is very seldom that the thoracic limbs become so affected.
+Law[3] refers to this ailment as "Acute Lymphangitis of Plethora in
+Horse." When one takes into consideration that these cases so frequently
+occur in heavy draft animals that are not worked regularly, that the
+pelvic limbs are the ones involved, and that the disorder often runs a
+short course (recovery often taking place within two or three days, with
+no treatment given other than a purge, circulatory stimulants and
+walking exercise) it is plausible to ascribe the condition to idiopathic
+factors.
+
+Admitting the frequency of non-infectious lymphangitis, the practitioner
+must not confuse this type with similar lymphatic inflammation
+occasioned by nail punctures of the foot. It is very embarrassing indeed
+to make a diagnosis of lymphangitis--expecting that the disturbance will
+terminate favorably and uneventually--and later to discover a sub-solar
+abscess caused by a nail prick in the region of the heel.
+
+Recurrent attacks of this disturbance cause hypertrophy of the lymph
+vessels and in some cases lymphangiectasis. In old subjects used for
+dissection or surgical purposes, it is very evident that in the ones
+which have suffered from chronic lymphangitis there exists an excessive
+amount of sub-facial connective tissue, making subcutaneous neurectomies
+quite difficult in some instances.
+
+A sequel of chronic lymphangitis is a condition known as elephantiasis.
+In such cases there occurs a hyperplasia of the skin and subcutaneous
+tissues, resulting in some instances, in the affected member attaining
+an enormous size. Sporadic cases of this kind are to be seen
+occasionally, and are apparently caused by repeated attacks of
+lymphangitis. The affection is not benefited by treatment, and while a
+horse's leg may become so heavy and cumbersome as to mechanically impede
+its gait, as well as to fatigue the subject when made to do service even
+at a slow pace, elephantiasis causes no constitutional derangement. The
+hind legs, in elephantiasis, are affected and a unilateral involvement
+is more often seen than a bilateral one. The legs may be enlarged from
+the extremity to the body, but ordinarily the affection does not extend
+higher than the hock or the mid-tibial region.
+
+A chronic, progressive, hyperplastic-degeneration exists in some cases
+and the subjects are in time rendered unserviceable because of the
+burden of getting about encumbered by the affected extremity. In other
+animals hyperplasia progresses for a time--until the parts become
+greatly enlarged and conditions apparently attain an immutable state.
+Nevertheless animals so affected may continue in service for years
+without being distressed.
+
+
+AFFECTIONS OF THE FEET.
+
+Lameness is very often due to affections of the feet, and in all foot
+diseases probably the most constant cause is injury inflicted in some
+manner. Resultant from injury, there frequently develops complications
+and the one most often seen is infection.
+
+Because of the fact that the feet are constantly exposed to germ-laden
+soil and filth, if not actually bathed in such infectious materials, it
+naturally follows that septic infection of some part of the feet must be
+of frequent occurrence.
+
+Subsequent to being obliged to stand in mud and other damp or wet media,
+exposure to desiccating influences such as stabling upon dry floors, or
+at service on hot and dry road surfaces causes the insensitive parts of
+the feet to become dry, hard and brittle. This favors "checking" of the
+protecting structures and it frequently results in the formation of
+large fissures which expose the underlying sensitive parts of the feet
+and lameness is the inevitable outcome.
+
+The function of the feet--bearing the weight of the animal at all times
+when the subject is not recumbent, and in addition to this, the
+increased strain put upon them at heavy draft work, together with the
+concussion and buffeting occasioned by locomotion, make the feet
+susceptible to frequent affections of various kinds.
+
+Being almost completely encased by a somewhat inexpansible and
+insensitive wall and sole, renders the foot subject to pathologic
+changes peculiar to itself. The very nature of the structure of the foot
+together with the function of the sensitive lamina is sufficient cause
+for an affection unlike that seen involving other tissues--laminitis.
+
+An exhaustive consideration of foot affections is a study in itself and
+one that comes within the realm of pathologic shoeing; nevertheless, a
+practical knowledge of diseases of the foot is indispensable in the
+diagnosis of lameness wherein the foot may be at fault.
+
+The peculiar nature of foot affections renders them difficult of
+classification on any sort of basis that is helpful in the consideration
+of this subject. Injuries are the most constant cause of foot lameness,
+yet one must admit that there results complications because of infection
+in most instances; and that in some cases the injury is slight--just
+enough to permit the introduction of vulnerant organisms into the
+tissues. Therefore, one might well classify affections of the feet as
+infectious and non-infectious. There can be grouped in the class of
+infectious affections such conditions as nail pricks, calk wounds and
+canker. In the class of non-infectious affections one may consider
+conditions such as laminitis, strain and fractures.
+
+FOOTNOTES:
+
+[Footnote 1: A System of Veterinary Medicine by E. Wallis Hoare,
+F.R.C.V.S., Vol. I, page 519.]
+
+[Footnote 2: Ibid, page 807.]
+
+[Footnote 3: Vol. I, page 534, Veterinary Medicine, by James Law,
+F.R.C.V.S.]
+
+
+
+
+SECTION II.
+
+DIAGNOSTIC PRINCIPLES.
+
+
+_To observe attentively is to remember distinctly._--_Poe_.
+
+Before treatment is administered in constitutional disturbances
+resulting in disease, _cause_ is logically sought; so, in order to
+handle effectively any case of lameness, it is necessary first to
+discover the source of the trouble and contributing conditions affecting
+the structures. Hence, diagnostic ability is the prime requisite; and a
+thorough knowledge of pathologic anatomy or of surgical technic is of
+little value if this knowledge is not applied with the insight of the
+trained diagnostician.
+
+The cruel and unnecessary methods employed by those untrained for
+diagnostics, cannot be too vigorously condemned. For instance, the
+application of an active and depilating vesicant upon a large area on
+the gluteal or crural region, in a case where the practitioner "guesses"
+the condition to be one of "hip lameness," constitutes an exposition of
+gross ignorance, and at once stamps the perpetrator as a crude bungler
+without scientific insight whose works are no credit to his profession.
+How much better it would be, if the practitioner does not see fit to
+call in a competent consultant, to prescribe a suitable agent to be
+given internally, and to recommend complete rest for the subject.
+
+In establishing a diagnosis in such cases, the student or practitioner
+seldom has recourse to laboratory assistance, and his work is done by
+means of physical examination; therefore, a thorough knowledge and a
+clear conception of the physiology of locomotion are essential.
+Memorizing nosological facts without an understanding of underlying
+principles is of no more practical benefit for qualification as a
+diagnostician in cases of lameness, than is the employment of similar
+methods in the study of theory and practice. A knowledge of the dosage
+of drugs does not in itself qualify one as being competent to administer
+such therapeutic agents to a proper effect. How much is a practitioner
+benefited by the knowledge that a high temperature is usually present in
+septic intoxication, if he is not possessed of a scientific
+understanding of anatomy, physiology, bacteriology and pathology, as
+well as the principles of clinical diagnosis?
+
+In order to determine the reasons for certain symptoms manifested by the
+subject, an analysis of these symptoms is the proper method of
+procedure, insofar as this is possible. If one may reason that an animal
+assumes a certain position while at rest to allow relaxation of an
+inflamed tendon or ligament, such a fact enables the diagnostician to
+recall that this is indicative of some specific ailment. In acute
+tendinitis, the subject while at rest, maintains the affected member in
+volar flexion because this position permits relaxation of the inhibitory
+apparatus, including the inflamed tendon. Likewise, the various abnormal
+positions assumed,--adduction, abduction, undue flexion or
+pointing--have their own significance and are taken into account by the
+trained diagnostician in the course of an examination.
+
+In the examination of lame subjects, where the cause is not obvious, a
+systematic method of diagnosis is pursued even by the most expert
+practitioners. In all obscure cases of lameness a methodical and
+thoroughly practical examination of the animal according to an
+established procedure is necessary to determine the nature and source of
+the affliction.
+
+
+Anamnesis.
+
+The first thing to be given consideration in diagnosis is the fact that
+related history of the case is not always dependable, because of lack of
+accurate observation or wilful deceit on the part of the owner or
+attendant. The successful veterinarian soon acquires the faculty of
+obtaining information in a manner best adapted to his client,--either by
+direct interrogation or by subtle means of suggestion, and in this way
+he draws out evaded facts essential to his diagnosis. In time he learns
+to make allowance for misstatements made to shield the owner or driver
+and to hide the facts of apparent neglect or abuse that the subject may
+have experienced. A suppurating cartilaginous quittor, complicated by
+the presence of a large amount of hyperplastic tissue, cannot be
+successfully represented to be an acute and recently developed
+affection, where a trained practitioner is left to judge the validity of
+the statement.
+
+In complicated conditions, where there is evident a chronic disturbance
+which could not be conceived as sufficient cause for a marked
+manifestation of lameness, accurate history of the case may be of great
+aid in arriving at a diagnosis. An aged animal, having recently become
+very lame, showing a small exostosis on the first phalanx, and with the
+history given that the osseous deposit was of long standing, should at
+once lead the veterinarian to seek the source of trouble elsewhere.
+
+
+Visual Examination.
+
+As in all diagnostic work, a careful visual examination of the subject
+should be made before it is approached. The novice is given to hasty
+examination by palpation, not realizing how much may be revealed by a
+careful scrutiny of the subject. In this way he is led to erroneous
+conclusions which the skilled diagnostician has learned from experience
+to avoid. _Too much emphasis cannot be placed on the importance of
+making a thoughtful visual examination in every instance before the
+subject is approached._ In this examination, type, conformation and
+temperament are taken into account at once, for each of these qualities
+is in itself, a determining factor in predisposing a subject to certain
+ailments or inherent attributes, which may exert a favorable or
+unfavorable influence upon existing conditions and thus make recovery
+probable or otherwise.
+
+Draft animals are less likely to be permanently incapacitated as a
+result of tendinitis, than are thoroughbreds. Likewise, one would not
+expect to find this affection present in heavy harness horses as
+frequently as in light harness animals.
+
+Mal-formation of a part, or an asymmetrical development of the body as a
+whole, may render an animal susceptible to certain affections which
+cause lameness. A "tied in" hock predisposes the subject to curb, and an
+animal having powerful and well-developed hips and imperfectly formed
+hocks, will, if subjected to heavy work, be a favorable subject for bone
+spavin.
+
+The matter of temperament cannot be disregarded in diagnosis, for in
+some instances, it is the chief determining factor which materially
+influences the outcome of the case. A nervous, excitable animal, that is
+kept at hard work, may, under some conditions, be expected to experience
+disturbances which more lethargic subjects escape. Nervous subjects, it
+is known, are more prone to azoturia than are those of lymphatic
+temperament. Furthermore, the lymphatic subject often recovers from
+certain bone fractures which are successfully treated only when the
+animal is sufficiently resigned by nature to remain confined in a sling
+for weeks without resistance.
+
+The physiognomy of a subject is often indicative of the gravity of its
+condition. The facial expression of an animal suffering the throes of
+tetanus, azoturia, or acute synovitis, is readily recognized by the
+experienced eye, and upon physiognomy alone, in many instances, may the
+opinions regarding prognosis be based. Particularly is this true where
+death is a matter of minutes, or at most is only a few hours distant.
+
+Due allowance should be made for restiveness manifested by some more
+nervous animals when the surroundings are strange and unusual. In such
+instances, even pathognomic symptoms may be masked to the extent that
+little, if any, sign of pain or malaise is evinced. In these cases the
+subject should be given sufficient time to adjust itself to the new
+environment, or it should be removed to a more suitable place for
+examination. Animals quickly detect the note of friendly reassurance in
+the human voice and can very often be calmed by being spoken to.
+
+By visual examination one may detect the presence of various swellings
+or enlargements, such as characterize bruises and strains of tendons
+where inflammation is acute. Inflammation of the plantar
+(calcaneocuboid) ligament in curb is readily detected when the affected
+member is viewed in profile. Spavin, ringbone, splints, quittor and many
+other anomalous conditions may all be observed from certain proper
+angles.
+
+The fact that the skins of most animals are pigmented and covered with
+hair, precludes the easy detection of erythema by visual examination,
+consequently this indicator of possible inflammation is not often made
+use of in the examination of equine subjects.
+
+
+Attitude of the Subject.
+
+The position assumed while the subject is in repose, is often
+characteristic of certain affections and this, of course, is noted at
+once. The manner in which the weight is borne by the animal at rest,
+should attract the attention of the diagnostician and if the attitude of
+the subject is abnormal or peculiar, the examiner tries to determine the
+reason for it. If weight-bearing causes symptoms of pain, the affected
+member will invariably be favored and held in some one of a number of
+positions. The foot may contact the ground squarely and yet the leg may
+remain relaxed and free from pressure; volar flexion, in such cases, is
+indicative of inflammation of a part of the flexor apparatus. If the
+condition be very painful, position of the afflicted member is
+frequently shifted, but in all cases where the pain is not so keenly
+felt, the inflamed member is held in a state of relaxation. There is
+need then, for a knowledge of anatomy and certain principles in physics
+to enable the observer to determine just which structures are purposely
+eased in this manner. Where palpation of parts is possible, one does not
+need to depend on visual examination alone, and it is always wise to
+take into consideration every factor that may influence conditions.
+Manipulation or palpation of the structures thought to be involved,
+should not be resorted to until a careful and thorough observation of
+the subject has revealed all that it can reveal to the diagnostician.
+
+In all conditions where extreme pain is manifested by the constant
+desire of the animal to keep its foot in motion off the ground,
+examination should be made for local cause. This is seen in certain
+septic inflammations of the feet such as those caused by nail punctures
+invading the navicular joint, or in newly made wounds where nerves have
+been divided and the proximal end of such a nerve is exposed to pressure
+or irritation.
+
+"Pointing" affords a comfortable position in some cases of navicular
+disease, and in a unilateral affection, one may observe the subject
+bearing weight with one sound member, while the affected foot is planted
+well ahead of the sound one. In a bilateral involvement of this kind,
+weight may be frequently shifted from one foot to the other, or in
+chronic cases, where no marked pain is experienced, the subject stands
+squarely upon both front feet and no peculiar shifting of weight or
+pointing is evident.
+
+In some cases of hip or shoulder involvement, complete relaxation of all
+parts of the affected member may be noticed. In brachial paralysis, the
+pectoral member is held limply; if the patient is made to move, it is
+evident there is lack of innervation to the afflicted part. In some
+cases where contusion has caused acute inflammation of the member, the
+subject instinctively tries to keep it inactive to relieve the pain
+which movement occasions.
+
+Where there is an active and painful inflammation of the prescapular
+lymph glands and contiguous structures, in some cases of "levator-humeri
+abscess," the scapulohumeral joint is extended. This is brought about by
+flexion of the elbow and carpal joints.
+
+There are some cases of bi-lateral affections which occasion such pain
+during weight-bearing that the subject shifts its weight from one
+affected leg to the other; an example of this condition may be observed
+in any acute case of gonitis which affects both patellar regions, making
+it equally painful to bear the weight on either member.
+
+A peculiar characteristic position is assumed in acute laminitis of the
+fore feet. In such instances, the hind feet are brought forward under
+the body sufficiently to relieve the front feet of the weight, insofar
+as is possible by the abnormal position taken in cases of acute
+laminitis.
+
+So in each position that is abnormal to any degree, assumed by a
+suffering animal, there may be deduced, the fact that the subject is
+attempting to relieve the affected structures, and in each clinical
+picture of this kind, the trained diagnostician sees some index to the
+nature and source of the trouble. Further examination is rendered more
+effective because of this preliminary visual examination which has
+precluded the unnecessary annoyance of the animal by manipulating
+unaffected structures.
+
+It has been presupposed in the foregoing, that the one making visual
+examination of a lame animal for diagnostic purposes, will remember that
+with the normal animal the weight is borne equally well with both fore
+legs; and that this is done without shifting from one to the other; and
+that the pelvic limbs do not support the body in this manner. Normal
+subjects shift their weight from one hind leg to the other and the one
+relaxed, rests in a state of flexion with the toe on the ground and the
+heel raised.
+
+
+Examination by Palpation.
+
+In nearly every case where lameness exists an examination of the
+affected parts, by palpation or by digital manipulation, is necessary
+before an accurate conclusion may be drawn; but in making this kind of
+an examination one needs to exercise good judgment lest he fail to
+acquire a correct impression of the actual existent conditions. There is
+need for the diagnostician, here, as well as in other conditions where
+physical examination is made, to approach the subject in a manner that
+will not excite or disturb to the extent that the animal will, in one
+way or another, resist or object to the approach of the diagnostician,
+thereby masking the symptoms sought. The practitioner would best acquire
+skill as a horseman--if he is not possessed of such--and handle each
+individual subject in the manner calculated to best suit the temperament
+of the animal examined. The unbroken subject is not handled as
+satisfactorily as is the intelligent family horse; in the former, in
+some cases, little dependence is placed upon digital examination.
+
+By palpation one is enabled to recognize hyperthermia and this, _in
+lieu_ of dependable history, is at times sufficient evidence upon which
+to determine the duration of any given inflammatory affection.
+
+By comparison of different parts of the same member or with an analogous
+portion of another member any marked increase in the apparently normal
+temperature of a part at once signalizes inflammation. In this manner,
+in examining a case where laminitis or other inflammation of the feet is
+suspected, one may arrive at a fairly accurate conclusion without the
+employment of other means. Throbbing vessels are not always easily
+recognized if the subject is a victim of chronic lymphangitis.
+
+In some instances, where a moderate degree of lameness exists and cause
+is apparently obscure, the recognition of hyperthermia may be the
+deciding factor in establishing a diagnosis. In cases of sprained
+ligaments in the phalangeal region, because of the dense character of
+the structures involved, little if any evidence of the cause of
+lameness, other than local heat, may be found twenty-four hours after
+the injury has been inflicted.
+
+In order to determine the amount or extent of hyperthermia with a fair
+degree of accuracy in any given case, one must make due allowance for
+external conditions affecting temperature; also the effect of a
+considerable amount of hair covering an area, as well as any possible
+dirt contacting the surface of the skin must be taken into account. All
+dirt should be removed if practicable, so that the diagnostician's palms
+may come as nearly in contact with the inflamed structures as possible.
+Then, too, the sense of touch if the operator's hands are chilled, is
+not dependable. In such instances the novice will need to be deliberate
+as to his findings--whether or not hyperthermia really exists. Such an
+examination is of little value where the subject's feet are wet and an
+examination is hurriedly made, as in cases of suspected laminitis.
+
+Often, before being able to distinguish the presence of a hyperthermic
+condition, one is impressed with the fact that an animal manifests
+evidence of being supersensitive. In fact, some animals in the
+anticipation of pain at the touch of an injured part, will instinctively
+withdraw--in self-protection--such an ailing member or resist the
+approach of the practitioner. This sensitiveness is more apparent in
+animals that have been subjected to previous manipulation or treatment
+which has occasioned pain, and consequently, allowance must be made for
+this exhibition of fear. No better example of this condition can be
+imagined than is present in cases of "shoe boil," where there exists an
+extensive area of acute inflammation of the elbow. There is always more
+or less surface disturbance wherever vesication has been produced, and
+in cases where irritants of any kind have been employed for several days
+or a week previous to an examination, more or less supersensitiveness is
+to be expected.
+
+One must not lose sight of the fact that unscrupulous
+dealers,--"traders"--make use of their knowledge of this principle in
+various way usually for the purpose of attracting attention to a part,
+which, presumably might have been blistered in order to intentionally
+produce inflammation of tissues, in this way, causing lameness which is
+not manifested until an animal has been kept by its new owner for
+twenty-four hours or more. This, to be sure, usually makes a
+dissatisfied purchaser who is willing to dispose of his newly acquired
+animal at a sacrifice, thus enabling the original owner or his agent to
+regain possession of the victimized animal at less than its real value.
+
+Some nervous animals, because of the manner of approach of the
+practitioner, are wont to flinch, and there is manifested a
+pseudo-supersensitiveness. Young animals not accustomed to being handled
+are likely to be timorous, and one must not hastily conclude that a part
+is painful to the touch because the subject resents even gentle digital
+manipulation of such parts. In instances of this kind, one needs to
+compare sensibility by manipulation of different parts of the subject's
+body in a careful and gentle manner; and by exercising patience and good
+judgment in such work, it is possible to actually distinguish between
+normal sensibility and abnormal sensitiveness, in most cases. Here,
+again, the diagnostician needs to possess skill as a horseman and good
+judgment as to individual temperament of different animals, under any
+condition which may exist at the time he makes his examination.
+
+By palpation alone, one can recognize the presence of fluctuating
+enlargements; one may not only recognize such conditions, but
+distinguish between a fluctuating mass such as exists in
+non-strangulated hernia and a large fibrous tumor. By palpation, for the
+recognition of density and for determining the presence or absence of
+hyperthermia, one may decide that there exists an abscess and not a
+tumor. Edematous swellings are recognized by palpation,--the
+characteristic indentations which may be made in dropsical swellings are
+pathognomonic indicators. In this manner it is easy to differentiate
+post-operative or post-traumatic edemas which may or may not cause
+lameness. At any rate, it is essential to take into account all
+determinate conditions that may assist in the prognosis of any given
+case, for the purpose of being able to outline rational remedial
+measures. To be able to distinguish between the generalization of a
+septic infection in its incipiency, and a more or less benign edema, is
+largely possible by digital manipulation alone. An extremity may be
+greatly swollen because of the existence of chronic lymphangitis,
+influenza, or an acute septic infection occasioned by the introduction
+of pathogenic and aerogenic organisms. Since the effect produced by
+these dissimilar ailments are productive of conditions that may
+terminate favorably or unfavorably, it becomes necessary for the
+diagnostician to develop a trained, discriminating, tactile-digital
+sense, in order to correctly interpret existing conditions, and handle
+cases in a rational and skillful manner.
+
+In order to ascertain the extent and exact location of a tumor, an
+exostosis, or other enlargements, the diagnostician, here also, needs to
+be in possession of a trained tactile sense and in addition if he be
+fortified with an accurate knowledge of normal anatomy and pathology, he
+is able to arrive at proper conclusions, when digital manipulations have
+been employed. Fibrous tumors are sometimes located in the inferior part
+of the medial side of the tarsus--exactly over the seat of bone-spavin.
+Such tumors, when the affected member is supporting weight, are not to
+be distinguished from exostoses; but as soon as the affected leg ceases
+to bear weight, it may be passively flexed and the nature of the
+enlargement recognized because it may be slightly displaced by digital
+manipulation. Displacement, of course, is not possible with an
+exostosis.
+
+A necessary qualification, which the diagnostician must possess, is that
+of being able to judge carefully the nearness of any given exostosis to
+articular structures. Also, the extent or area of the base of an
+exostosis as well as its exact position, needs be determined before one
+may estimate the probable outcome in any case,--whether treatment should
+be encouraged or discouraged by the practitioner. Periarticular ringbone
+may, because of the size and location of the exostosis, constitute a
+condition which cannot be relieved in any way in one case, and in
+another, because of the manner of distribution of such osseous
+deposits, the condition may be such that prompt recovery will follow
+proper treatment. In the examination of an exostosis of the tarsus, it
+is particularly important to determine the exact location of the
+exostosis--whether or not the spavin involves the tibial tarsal
+(astragulus) bone very near its tibial articular portions. Obviously, if
+articular surfaces of joints are involved, complete recovery cannot
+result despite the most skillful attention given the subject.
+
+
+Passive Movements.
+
+Wherever it is possible to gain the confidence of a tractable animal to
+the extent that it will relax the structures sufficiently to make
+possible passive movement of affected parts, much is to be learned as a
+result of such manipulation. By this method one may differentiate true
+crepitation, false crepitation, luxation and inflammation of ligaments
+that have been injured, as in sprains of such structures in the
+phalangeal region.
+
+_True crepitation_ is recognizable by the characteristic vibration which
+is interpreted by tactile sense. It is possible to recognize fracture by
+the use of other methods--auscultation, tuning fork tests, etc., but in
+ordinary veterinary practice one must rely upon the sense of touch for
+recognition of crepitation.
+
+Where pain is not so great that relaxation of parts does not occur, one
+can, by gently moving an extremity in various directions--as in flexion,
+extension and lateral motion as well as by rotation--cause to be
+manifested this peculiar grating,--the friction of newly broken bone.
+This is known as _true crepitation_. Where the subject, suffering
+phalangeal fracture, manifests evidence of pain due to tensing the
+structures about a fractured part, one may anesthetize the parts by
+using about two cubic centimeters of a two per cent. solution of cocain
+upon the plantar nerves, proximal to the fracture. It is perhaps best to
+deposit the cocain solution by means of two hypodermic punctures at
+different points along the course of each nerve, though closely situated
+to one another, thereby making more sure of the solution actually
+contacting the nerve. In some multiple fractures of the first or second
+phalanx this is quite necessary; otherwise, pain produced by passive
+manipulation causes the subject to keep the tendons so tense that
+crepitation may not be detected. The unnecessary infliction of pain is
+always to be avoided.
+
+We know as _false crepitation_ a vibrating impulse occasioned by normal
+contact of articular portions of bones such as in the metacarpophalangeal
+joint when this structure is passively moved, where the subject permits
+the parts to remain in a state of complete relaxation.
+
+Attempts to recognize supersensitiveness or inflammation by means of
+passive movement of the shoulder or hip, whether gently or forcefully,
+is not productive of good, in any case, in large animals. Because of the
+bulk and weight of parts so manipulated, as well as the resistance the
+subject offers even in normal cases, no accurate conclusion is to be
+arrived at in this manner in the average instance. Animals nearly always
+resist the placing of members in any position that is so unusual and
+uncomfortable as that which is required to materially displace the
+component tissues of the shoulder or hip; therefore, such practice is
+useless because one can not distinguish between normal resistance and
+flinching caused by painful sensations in injured parts. Such
+manipulations are practical in small animals.
+
+
+Observing the Character of the Gait.
+
+In order to determine the degree of lameness as well as its character,
+it is necessary to cause the subject which is being examined, to move in
+some manner. The degree of inconvenience or distress experienced by a
+lame animal that is being so examined is manifested by the character of
+the claudication; and where much pain is occasioned in locomotion there
+is disturbance of respiration; perspiration may be noticeable and in
+some instances manifestation of nervous shock are very evident--this in
+timid, nervous animals that anticipate being punished when approached
+and, consequently, make every effort possible to move when urged to do
+so. An animal, then, should be moved only sufficiently to cause it to
+exhibit the degree of lameness present in any given case, and if a
+marked impediment is manifested it is not necessary to cause the subject
+to be exerted to the extent of inflicting, in such manner, unnecessary
+punishment. Further or conclusive examination is made by palpation. To
+cause the subject to move, an assistant may simply lead the animal with
+a halter and compel it to walk a few steps. In this way, lameness,
+whether manifested during the weight-bearing period of an affected
+member, or when such a member is being advanced, or whether a
+combination of the two conditions exists, is made apparent. In the words
+of Dollar, one is thus enabled to recognize the existence of
+"supporting-leg-lameness," "swinging-leg-lameness" or "mixed lameness."
+
+When the cause of lameness is not strikingly apparent it becomes
+necessary to have the subject moved farther than a few steps and at
+different paces. Depending then, upon the character of lameness
+manifested, as well as upon its degree of intensity, one needs to
+exercise the subject in various ways, but this should not be overdone.
+
+The first thing apparent in the lame subject in action, is the lame leg.
+If this is not readily determinable, as in some complicated cases, the
+leg or legs which are at fault are to be discovered by further
+examination, and to do this,--word-pictures convey little that is
+helpful in difficult cases,--long practice is the one route by which one
+may become efficient; that is, by experience gained after fundamental
+principles in the diagnosis of lameness have been mastered.
+
+For a careful study of supporting-leg-lameness involving a fore limb,
+the subject is driven or led _toward_ the one making such examination.
+If a hind leg is to be observed, the animal is made to travel _away
+from_ the examiner. Where there exists swinging-leg-lameness, the
+subject should be caused to move past the diagnostician, so that he may
+get a side view of the subject while it is in motion.
+
+In every case such examinations are made to the best advantage if the
+practitioner can view his patient from a little distance. Here, again, a
+visual examination is made but this cannot be successfully executed, in
+difficult cases, if the practitioner is stationed at too close range.
+
+The average subject is best observed by being led, rather than being
+ridden, and in so doing the animal should be given moderately free
+rein. A close grasp on the lead may interfere somewhat with head
+movements. Nodding of the head with the catching up of weight by a sound
+member in supporting-leg-lameness of a fore leg, constitutes the chief
+symptom considered in detecting the lame leg.
+
+Where supporting-leg-lameness affects a hind limb the head is raised at
+the time weight is caught by the sound member--here the long axis of the
+subject's body may be likened unto a lever of the first class. The
+posterior part of the body, at the time weight is taken upon the sound
+leg, is as the long arm: the fore limbs the fulcrum, and the subject's
+head the weight, which is lifted. The head movements of a horse at a
+trot, in supporting-leg-lameness of a front leg, synchronize with the
+discharge of weight from a lame leg to the opposite one if sound; but in
+pelvic limb affections, the head is thrown or jerked upward as weight is
+caught by the sound member,--this peculiar nodding movement is
+_opposite_ in the two instances.
+
+In pacing horses, since front and hind legs of the same side are
+advanced at the same time, there occurs in supporting-leg-lameness, a
+nodding of the head with discharge of weight from the lame leg, and a
+dropping of the hip as weight is caught by the sound pelvic member. In
+observing animals that are limping, (as in supporting-leg-lameness) one
+notices particularly the sacro-iliac region in hind leg affections and
+the occipital region in lameness of the front legs.
+
+Where there exists a bilateral affection, (such as characterizes some cases
+of navicular disease or other affections causing supporting-leg-lameness)
+there occurs no nodding of the head; weight is supported for an equal
+length of time upon each one of the two legs, but the stride[4] is
+shortened. The gait, in such cases, is peculiar, animals appearing stiff
+and they are said, by horsemen, to have a "choppy" gait.
+
+It is desirable, in some cases, to cause an animal to move from side to
+side; in other instances the subject is best made to walk or trot in a
+circle, and if the circle be very small the animal then particularly
+employs the inner fore leg as a pivotal supporting member. To augment
+the manifestation of certain affections, it is necessary to cause the
+patient to walk backward, and each one of these tests of locomotion
+serves to point out in a more or less characteristic manner, the site of
+the affection which is causing lameness in different cases.
+
+Sprains or injuries of lateral ligaments of the extremities, ringbone
+and certain foot affections, are made manifest by a side to side
+movement or a pivotal movement. In fact, wherever it is possible to
+cause undue or unusual tension to be exerted upon an inflamed structure,
+manifestation of pain is the response. In an inflamed condition of the
+lateral side of the phalanges, unequal weight-bearing such as a rough
+road surface will, by virtue of the leverage which the solar surface of
+the foot affords, cause undue strain upon such inflamed parts, and
+increased lameness is evident.
+
+When an animal is made to travel in a circle, when a member affected
+with supporting-leg-lameness is on the inner side of the circle,
+lameness is accentuated because weight is borne by the lame leg for a
+greater length of time, the result of such circuitous manner of
+locomotion. In swinging-leg-lameness, on the other hand, because pain is
+increased at the time an affected member is being advanced, lameness is
+increased when the subject is made to travel in a circle, with the lame
+leg on the outside of a circle thus described.
+
+In supporting-leg-lameness, the transientness of the weight-bearing
+period upon the affected member is the determining factor in the
+production of lameness. This unequal period of weight-bearing upon the
+front legs, for instance, causes an acceleration in the advancement of
+the sound member, in order to relieve the diseased one which is bearing
+weight. In other words, when an animal that is affected with
+supporting-leg-lameness travels in a straight line, since weight is
+borne by the diseased leg for an abnormally short period of time, the
+sound member needs be in the act of advancement a correspondingly short
+period. The result is then, an unequal division of stride; a nodding of
+the head with the catching up of weight by the sound leg,--in front leg
+affections--and this is termed _limping_.
+
+With continuous exertion as in travel for a considerable distance, in
+some cases, lameness becomes less evident--as in spavin. This "warming
+out" process is due in a measure to the parts becoming less sensitive
+upon exertion, and is to be seen, to a limited extent, in all
+inflammatory affections that are not too severe; consequently, in some
+cases, examination of a lame animal should begin in the stall, for in
+instances where the impediment is not marked, there may be no evidence
+of lameness after the subject has walked a few steps. In other cases,
+lameness increases as the subject continues to travel, and often to the
+extent that the impediment becomes too severe to allow the animal being
+serviceable. Therefore, one can not, in every case of lameness observed,
+positively determine the gravity of the situation, without having seen
+the affected animal in action for a sufficient length of time to
+understand the nature of the condition existing. This necessitates
+driving the animal for several miles in certain cases.
+
+Sometimes it is impossible to arrive at any definite conclusion, as the
+result of a single examination, and it then becomes necessary to see the
+subject again at a later date, or under more favorable circumstances.
+This is to be expected in some conditions where there exists rheumatic
+affections, and also in some foot diseases.
+
+In the examination of young animals, unused to harness and to other
+strange incumbrances, one is obliged to make allowance for impediments
+of gait, which are not occasioned by diseased conditions. Such
+affections have been termed "false lameness." Young mules that are not
+well broken to harness, are difficult subjects for examination and in
+some cases it is necessary to have them led or driven for a considerable
+distance before one can definitely interpret the nature of the
+impediment in the gait when lameness is not pronounced. It is especially
+difficult to satisfactorily examine such subjects, for the reason that
+their normal rebellious temperaments cause resistance whenever a strange
+person approaches them, as it is necessary to do for an examination by
+palpation. In such cases--if an examination does not reveal the cause of
+trouble, rest must be recommended and further examination made at a
+later date, whereupon any new developments may be noted, if such changes
+exist.
+
+
+Special Methods of Examination.
+
+After having completed a general examination of a lame animal--obtaining
+the history of the case, noting its temperament, type, size,
+conformation, position assumed while at repose, swellings or
+enlargements if present, causing the subject to move to note the degree
+and character of lameness manifested; palpating and manipulating the
+parts affected to acquire a fairly definite notion of the nature of an
+inflammation or to recognize crepitation it becomes necessary in some
+cases to employ peculiar means of examination in singular instances.
+This may be done by making use of cocain in solution for the production
+of local anesthesia as in lameness of the phalanges. Such means are not,
+in themselves, dependable but are valuable when used in conjunction with
+all other available and practical methods.
+
+Trial use of various shoes in order to shift the weight from one part of
+the foot to another or to cause an animal to "break over" in a different
+manner so that the gait may be changed, constitutes a special test
+procedure. The use of hoof testers or of a hammer to note the degree or
+presence of supersensitiveness is another means that is of practical
+service. No examination, in any case of lameness, is complete without
+having removed the shoe and scrutinized the solar surface of the foot.
+
+[Illustration: Fig. 1--Hoof testers with special jaws of sufficient size
+to grasp the largest foot.]
+
+Diagnosis by exclusion, finally, is resorted to, and, as in any other
+case where the recognition of cause is difficult, exclusion of the
+existence of conditions,--one at a time, by an analysis of
+symptoms--generally enables the practictioner to eliminate all but the
+disturbing element.
+
+FOOTNOTES:
+
+[Footnote 4: By stride is meant the distance between two successive
+imprints of the same foot. The term is not used in this work as being
+synonymous with step.]
+
+
+
+
+SECTION III.
+
+LAMENESS IN THE FORE LEG.
+
+
+Anatomo-Physiological Review of parts of the Fore Leg.
+
+For supporting weight, whether the subject is at rest or in motion, the
+bony column of the leg, together with attached ligaments, tendons and
+muscles, is wonderfully well adapted by nature for the function which
+they perform. The several bones which go to make up the supportive
+portion of the leg, are so joined at their points of articulation, that
+a minimum degree of strain is put upon each attachment.
+
+The upper third of the scapula, with its cartilage of prolongation, is
+sufficiently broad and flattened that it fits snugly against the thorax
+without necessity for a complicated method of attachment--the clavicle
+being absent, attachment is muscular.
+
+Smith[5] has very aptly stated that:
+
+"It seems quite legitimate to regard the muscular union between the
+thorax and forelimb as a joint. There are no bones resting on each
+other, no synovia; but where the scapula has its largest range of
+movement there is a remarkable amount of areolar tissue, which renders
+movement easy. The whole central area beneath the scapula and humerus
+not occupied by muscular attachment, is filled with this easy-moving,
+apparently gaseously distended, crepitant, areolar tissue over which the
+fore legs glide on the chest wall as freely as if the parts were a
+large, well lubricated joint."
+
+The scapulohumeral articulation (shoulder joint) is an enarthrodial
+(ball and socket) joint but because of its being held more or less
+firmly against the thoracic wall by muscular and tendinous attachment,
+and because a part of this attachment affords a means of support for the
+body itself, there is no need for binding ligaments and movement is
+possible in all directions even though restricted as to extent.
+
+[Illustration: Fig. 2--Muscles of Left Thoracic Limb from Elbow
+Downward; Lateral (External) View.
+
+a, Extensor carpi radialis; g, brachialis; g', anterior superficial
+pectoral; c, common digital extensor; e, ulnaris lateralis. (After
+Ellenberger-Baum, Anat. fuer Kuenstler.) (From Sisson's "Anatomy of the
+Domestic Animals").]
+
+[Illustration: Fig. 3--Muscles of Left Thoracic Limb from Elbow
+Downward; Medial (Internal) View.
+
+The fascia and the ulnar head of the flexor carpi ulnaris have been
+removed. 1, Distal end of humerus; 2, median vessels and nerve. (From
+Sisson's "Anatomy of the Domestic Animals").]
+
+Undue extension, (by extension is meant such movement as will cause the
+long axis of two articulating bones to assume a position which
+approaches or forms a straight line--opposite to flexion), of the
+scapulohumeral joint is impossible while weight is borne, because of the
+normally flexed position of the humerus on the scapula; whereas flexion,
+beyond desirable limits, is inhibited by the biceps brachii (flexor
+brachii or coracoradialis) muscle.
+
+The distal end of the humerus, however, articulating with the radius and
+ulna in a fashion that no support is lent by any sort of contact with
+the body, is a ginglymus (hinge) joint and lateral motion, because of
+the long transverse diameter of its articular portions, is easily
+prevented by the medial and lateral ligaments (internal and external
+ligaments). Flexion of this, the humeroradioulnar joint (elbow), is
+restrained by the triceps brachii and extension is checked by the biceps
+brachii (flexor brachii).
+
+The carpal joint (erroneously called the knee joint), is composed of the
+several carpal bones which interarticulate and, when taken as a group,
+serve as a means of attachment and articulation for the radius and
+metacarpal bones.
+
+The transverse diameter of this joint is long, thus giving it contacting
+surfaces that are sufficiently extensive to minimize the strain upon the
+mesial and lateral ligaments (internal and external lateral common
+ligaments). Motion is that of flexion and extension; slight rotation is
+possible when the position is that of flexion. While supporting weight
+the carpus is fixed in position by a slight dorsal flexion, but undue
+dorsal flexion is prevented by the flexor muscles and tendons and
+volar-carpal or annular ligament, together with the superior check
+ligament.
+
+The metacarpophalangeal articulation (fetlock joint), is a hinge joint
+and its articular surfaces contact one another, with respect to their
+having a long bearing surface from side to side, as do all ginglymus
+(hinge) joints. Two common lateral ligaments bind the bones together.
+While bearing weight, there is assumed a position of slight dorsal
+flexion, undue flexion being checked by the inhibitory apparatus of the
+joint--check ligaments, and their tendons and the suspensory ligament.
+The inhibitory apparatus of the fetlock joint is materially reinforced
+by the proximal sesamoid bones. Situated as they are, between the
+bifurcating portions of the suspensory ligament and the posterior part
+of the distal end of the metacarpus--with which they articulate--the
+sesamoid bones serve to change the course of the branches of the
+suspensory ligament in a manner that they give firm support to this
+joint. Volar flexion is limited by the extensors of the phalanges.
+
+[Illustration: Fig. 4--Sagital Section of Digit and Distal Part of
+Metacarpus.
+
+A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third
+phalanx; E, distal sesamoid bone; 1, volar pouch of capsule of fetlock
+joint; 2, inter-sesamoidean ligament; 3, 4, proximal end of digital
+synovial sheath; 5, ring formed by superficial flexor tendon; 6, fibrous
+tissue underlying ergot; 7, ergot; 8, 9, 9', branches of digital
+vessels; 10, distal ligament of distal sesamoid bone; 11, suspensory
+ligament of distal sesamoid bone; 12, 12', proximal and distal ends of
+bursa podotrochlearis. (From Sisson's "Anatomy of the Domestic
+Animals").]
+
+The first phalanx (os suffraginis) normally sets at an angle of about
+50 to 55 degrees from a horizontal plane while weight is being
+supported. Its distal end articulates with the second or median phalanx
+(os corona) and forms the proximal interphalangeal (pastern or
+suffraginocoronary) joint. This also, is a ginglymus joint, having but
+slight lateral motion, and that only when it is in a state of flexion. A
+rather broad articular surface--from side to side--exists here,
+lessening the strain on the collateral ligaments somewhat. Dorsal
+flexion is checked by the flexor tendons and dorsal ligaments. Volar
+flexion is restrained by the extensor tendons.
+
+The distal end of the second phalanx (os corona) has but slight lateral
+motion and this is manifested principally when it is in a state of volar
+flexion. Undue dorsal flexion is prevented by the deep flexor tendon
+(perforans) and volar flexion is inhibited by the extensor of the digit
+(extensor pedis). Thus it is seen, that when the leg is a weight-bearing
+member, weight is supported by the bony framework whose constituent
+parts are joined together by ligaments and tendons and each one of the
+several bones articulates in such manner that the joint is locked. The
+articular parts of bones rest upon or against an inhibitory apparatus,
+and are slightly flexed, as in the carpus, or considerably flexed such
+as in the fetlock joint when weight is being supported. In the first
+instance, for example, the flexors of the carpus and the superior check
+ligament assisted by the flexors of the phalanges constitute the
+inhibitory apparatus.
+
+It will be noted that provision for weight bearing is so arranged that
+muscular energy is not required except in the matter of suspension of
+the body between the scapulae and here tonic impulses only are necessary
+to maintain an equilibrium[6], yet in every instance where weight is not
+supported by bones, inelastic ligaments or tendinous structures relieve
+the musculature of this constant strain. This explains the fact that
+some horses do not lie in the stall, yet in spite of their constant
+standing position, they are able to rest and sleep.
+
+The student of lameness is interested in the function of the legs in the
+role of supporting weight and as propelling parts, and not particularly
+in the capacity of these members for inflicting offense or as weapons
+of defense. Yet, in the exercise of their functions other than that of
+locomotive appliances, injury often results, but usually it is the
+recipient of a blow that suffers the injury, such as an animal may
+receive upon being kicked. Therefore, we do not often concern ourselves
+with strains or other injuries that the subject experiences as the
+result of efforts put forth in kicking or striking. Where such injuries
+occur, however, a diagnosis is established by making use of the
+principles heretofore discussed.
+
+As propelling members the front legs bear weight and are advanced
+alternately when the horse is walking or trotting--in cantering this is
+not so. When the normal subject travels in a straight line, at a walk or
+a trot, the length of the stride is the same with the right and left
+members. The stride of the right foot then, for example, is equally
+divided by the imprint of the left foot, in the normal horse, when
+traveling at a walk and in a straight line.
+
+
+Shoulder Lameness.
+
+This enigmatical term is frequently employed by the diagnostician when
+he is baffled in the matter of definitely locating the cause of
+lameness; when he has by exclusion and otherwise arrived at a decision
+that lameness is "high up." Shoulder lameness may be caused by any one
+or several of a number of conditions, e.g., fractures of the scapula or
+humerus; arthritis of the shoulder or elbow joint; luxation of the
+shoulder or elbow joint (rarely); injuries of muscles and tendons of the
+region due to strains, contusions or penetrant wounds; paralysis of the
+brachial plexus or of the prescapular nerve; involvement of lymph
+glands; arterial thrombosis; metastatic infections; rheumatic
+disturbances; and as the result of inflammation, infectious or
+non-infectious occasioned by collar bruises. In some instances such
+inflammation is due to the manner of treatment of collar injuries.
+Therefore, when one considers the numerous and dissimilar possible
+causes of shoulder lameness, it behooves the practitioner to become
+proficient in diagnostic principles.
+
+A principle which is elemental in the diagnosis of locomotory
+impediment, is that lameness of the shoulder or hip is usually
+manifested by more or less difficulty in swinging the affected member.
+Swinging-leg-lameness, then, is usually present in shoulder affections.
+In some instances lameness is mixed as in joint ailments, involvement of
+the bicipital bursa (bursa intertubercularis), etc. In affections of the
+extremity there exists supporting leg lameness. Consequently, we employ
+this elemental principle, and, by a visual examination of the subject,
+which is being made to travel suitably, one may decide that lameness is
+either "high up"--shoulder lameness or, "low down"--of the extremity.
+
+[Illustration: Fig. 5--Ordinary type of heavy sling.]
+
+To make practical use of this principle, the examiner must be thoroughly
+familiar with the anatomy of the various structures concerned in
+advancing the leg--those which support weight as well as those concerned
+both in weight bearing and swinging the member.
+
+
+Fracture of the Scapula.
+
+Etiology and Occurrence.--Fractures of the body of the scapula are of
+infrequent occurrence in horses for the reason that protection is
+afforded this bone because of its position. Its function, too, is such
+that very unusual conditions are necessary to subject it to fracture.
+The spine is occasionally broken due to blows such as kicks, etc., and
+here frequently a compound fracture exists.
+
+[Illustration: Fig. 6--A sling made in two parts so that horses may be
+supported without use of central part or bodice. This sling is more
+comfortable than is the ordinary style and is particularly useful in
+cases that require a long period of this manner of confinement.]
+
+Where fractures of the body of the scapula occur, heavy contusions have
+been the cause as a rule, and serious injury is done the subject;
+consequently, treatment of fracture of the body of the scapula is seldom
+successfully practised. Fractures of the body of this bone resulting
+from accidents not involving internal injury or other disturbances and
+which would not seriously interfere with the vitality of the subject,
+are not necessarily serious unless compound.
+
+Fractures of the neck of the scapula are serious because of the fact
+that there occurs displacement of the broken parts and perfect
+apposition of the fractured ends is difficult, if not impossible.
+
+Fractures that extend to the articular surface are very serious, and
+complete recovery in such instances is practically impossible. The
+cartilage of prolongation of the scapula is sometimes seriously involved
+in certain cases of fistulous withers, and in some instances it has been
+separated from its attachment to the rhomboidea muscles, and lameness
+has resulted. In such instances, the upper portion of the scapula is
+disjoined from all attachment, and with every movement the animal makes,
+the scapula is moved back and forth. Complete recovery in such cases
+does not occur.
+
+Symptomatology.--Fractures of the scapular spine are ordinarily
+readily recognized because there is usually visible displacement of the
+broken part. Crepitation is also detected without difficulty.
+
+In fractures of the body of the scapula where an examination may be made
+before much swelling has taken place, and in subjects that are not
+heavily muscled, one should have no difficulty in recognizing the
+crepitation.
+
+Fractures of the neck of the scapula are recognized by crepitation, by
+passively moving the leg, but it is necessary to exclude fractures of
+the humerus when one depends upon the finding of crepitation by this
+means. However, unless undue swelling exists, the exact location of the
+crepitation is recognized without serious difficulty.
+
+Treatment.--The treatment of compound fractures of the scapular spine
+consists in the removal of the broken piece of bone by way of a
+cutaneous incision so situated that good drainage of the wound will
+follow.
+
+Simple fractures of the body of the scapula are best treated by placing
+the subject in a sling, if the animal is halter broken, and enforcing
+absolute quiet for a period of from three to six weeks. Splints or
+similar appliances are not of practical value in scapular fractures.
+
+Compound fractures of the scapula usually result from violence, which at
+the same time does serious injury to adjacent structures, and it then
+becomes necessary to administer an expectant treatment, observing
+general surgical principles and providing in so far as possible for the
+comfort of the patient.
+
+
+Scapulohumeral Arthritis.
+
+Anatomy.--The scapulohumeral joint is an enarthrodial (ball and
+socket) joint wherein the ball or humeral articulating head greatly
+exceeds in size the socket or glenoid cavity of the scapula. The
+capsular ligament surrounding this joint is very large and admits of
+free and extensive movement of the articulation. There exist no lateral
+or common ligaments jointing the scapula and humerus as in other joints,
+but instead the tendinous portions of muscles perform this function. The
+principal ones which are attached to the scapula and humerus that act as
+ligaments are the supraspinatus (antea-spinatus), infraspinatus
+(postea-spinatus) biceps-brachii (flexor brachii) and subscapularis
+muscles.
+
+Etiology and Occurrence.--Inflammation of the scapulohumeral
+articulation results from injuries of various kinds, including punctures
+which perforate the joint capsule, bruises from collars, metastatic
+infections and involvement as a result of direct extension of infectious
+conditions situated near the joint.
+
+Classification.--Acute arthritis may be septic or aseptic, and there
+seems to be a remarkable tendency for recovery in cases of septic
+arthritis involving this joint in the horse.
+
+Chronic arthritis with destruction of articular surfaces and ankylosis,
+is seldom observed. It is only in cases of severe injury, where the
+articular portions of the bones are damaged at the time of infliction of
+the injury, and where the articulation remains exposed for weeks at a
+time, together with immobility of the parts because of attending pain,
+that permanent ankylosis results.
+
+Scapulohumeral arthritis may result then from _infections_, local or
+metastatic; from _injuries_, such as contusions of various kinds; from
+_wounds_, which break the surface structure or perforate the joint
+capsule; or from _luxations_.
+
+
+Infectious Arthritis.
+
+Infectious arthritis of the scapulohumeral joint the result of local
+causes other than produced by septic wounds, seldom causes serious
+inconvenience to the subject. Where such occurs, however, there is
+manifested mixed lameness and complete extension of the extremity is
+impossible. Local swelling is present and manifestations of pain are
+evident upon palpation of the affected area.
+
+Treatment.--During the first stage of the infection, local
+applications, hot or cold, are indicated. A hot poultice of bran or
+other suitable material contained within a muslin sack, may be supported
+by means of cords or tapes which are passed over the withers and tied
+around the opposite fore leg. Such an appliance may be held in position
+more securely by attaching it to the affected member. Following the
+acute stage of such an infection, any local counter-irritating
+application or even a vesicant is in order.
+
+Where abatement of the infectious process does not take place, and
+suppuration of the structures in the vicinity of the joint occurs, it is
+necessary to provide drainage for pus. In some cases of strangles, for
+instance, large pus cavities are formed and drainage is imperative.
+However, metastatic inflammation of this joint is seldom observed except
+in cases of strangles. The animal should be kept perfectly quiet until
+recovery has taken place.
+
+
+Injuries.
+
+Injuries to the scapulohumeral joint may be the result of kicks, runaway
+accidents or bruises from the collar, and there may result, because of
+such injuries, reactionary inflammation which will vary in intensity
+from the mildest synovitis to the most severe arthritis, causing more or
+less lameness.
+
+Treatment.--The general plan of treatment in this form of arthritis is
+the same as has been outlined under the head of infectious arthritis,
+with the exception that there is seldom occasion to provide for drainage
+of pus.
+
+
+Wounds.
+
+Wounds which cause a break of the skin and fascia overlying the
+scapulohumeral joint are usually of little consequence, unless the blow
+is of sufficient force to directly injure the articulation, and in such
+cases, the treatment of the injury along general surgical principles,
+such as cleansing the area, providing drainage for wound secretion, and
+the administration of suitable dressing materials such as antiseptic
+dusting powder, is all that is required for the wound. The symptoms
+manifested by the subject in such cases are the same as have been
+discussed heretofore and merit no special consideration.
+
+Prognosis.--Unless very serious injury be done the articular portions
+of the scapula or the humerus, resulting in the destruction of the
+capsular ligament, prognosis is entirely favorable.
+
+Open Joint.--Where the capsular ligament is perforated and the
+condition becomes one of open joint, then a special wound treatment
+becomes necessary. The surface of the skin is first freed from all hair
+and filth in the vicinity of the wound. The wound proper is cleared of
+all foreign material either by clipping with the scissors, curetting or
+mopping with cotton or gauze pledgets. The whole exposed wound surface
+as well as the interior of the joint cavity, if much exposed, is
+moistened with tincture of iodin. Subsequent treatment consists in a
+local application of a desiccant dusting powder, which should be applied
+five or six times daily. The composition of the powder should be such as
+to permit of its liberal use, thereby affording mechanical protection to
+the wound as well as exerting a desiccative effect. Equal parts of boric
+acid and exsiccated alum serve very well in such cases.
+
+Animals suffering from open joints of this kind should be confined in a
+standing position, preferably in slings, and kept so confined for three
+or four weeks. Since they usually bear weight upon the affected member,
+there is no danger of laminitis resulting.
+
+
+Luxation of the Scapulohumeral Joint.
+
+Because of the large humeral head articulating as it does with a
+glenoid cavity, scapulohumeral luxations are very rare in the horse.
+According to Moller[7], luxation is generally due to excessive flexion
+of the scapulohumeral joint. In such cases the head of the humerus is
+displaced anterior to the articular portion of the scapula and remains
+so fixed.
+
+Symptoms.--Complete luxation of the scapula is recognized because of
+immobility of the scapulohumeral joint and of the abnormal position of
+the head of the humerus, which can be recognized by palpation, unless
+the swelling be excessive. Immobility of the scapulohumeral joint is
+noticeable when one attempts to passively move the parts.
+
+Treatment.--Reduction of the luxation is effected by making use of the
+same general principles that are employed in the reduction of all
+luxations, and they are--the control of the animal so that the
+manipulations of the operator are not antagonized by muscular
+contraction, which is best accomplished by anesthesia; placing the
+luxated bones in the position which they have taken to become unjointed;
+and then making use of force which is directed in a manner opposite to
+that which has effected the luxation.
+
+In a forward luxation of this kind, the operator should further flex the
+humerus, and while it is in this flexed position, force is exerted upon
+the articular head of this bone, and it is pushed downward and backward
+into its normal position.
+
+After-care consists in restriction of exercise and, if necessary,
+confining the subject in a sling and the application of a vesicant over
+the scapulohumeral region.
+
+
+Inflammation of the Bicipital Bursa.
+(Bursitis Intertubercularis.)
+
+Anatomy.--There is interposed between the tendon of the biceps brachii
+(flexor brachii) and the intertubercular or bicipital groove a heavy
+cartilaginous pad, which is a part of the bursa of the biceps brachii.
+This synovial bursa forms a smooth groove through which the biceps
+brachii glides in the anterior scapulohumeral region. Great strain is
+put upon these parts because the biceps brachii is the chief inhibiting
+structure of the scapulohumeral articulation--the one which prevents
+further flexion of the humerus during weight bearing. Passing, as it
+does, over two articulations, the biceps brachii has a somewhat
+complicated function, being a flexor of the radius and an extensor of
+the humerus. Thus it is seen, the biceps brachii is a weight bearing
+structure, as well as one that has to do with swinging the leg.
+
+Etiology and Occurrence.--Because of the exposed position of the
+bicipital bursa (bursa-intertubercularis) it is occasionally injured.
+Blows and injuries received in runaway accidents do serious injury to
+the bursa and because of the peculiar and important part it plays during
+locomotion, serious injuries are not likely to resolve, and too often
+chronic lameness results. It is to be noted that the tendon of the
+biceps brachii (flexor brachii) is always involved in cases of
+inflammation of the bicipital bursa, and according to the late Dr.
+Bell[8] strain of the biceps brachii is a frequent cause of lameness in
+city horses, more frequent than is generally supposed.
+
+Pathological Anatomy.--More or less destruction of the cartilaginous
+portion of the bursa, sometimes involving the tendinous portion of the
+biceps, takes place and, according to Moller, in some instances there
+occurs ossification of the tendon. Autopsies in some old horses reveal
+the presence of erosions of cartilage and hyperthrophy of the inflamed
+parts.
+
+Symptoms.--In acute inflammations, there is always marked lameness.
+This is manifested to a greater degree when the subject advances the
+affected leg. There is incomplete advancement of the member; the toe is
+dragged when the horse is made to walk and the foot kept in a position
+posterior to the opposite or weight bearing foot while the subject is at
+rest. Lameness is disproportionate to the amount of local manifestation
+in the way of heat, swelling and pain that is to be recognized on
+palpation. In fact, in some cases so much pain attends the condition
+that no weight is borne by the affected member, and when compelled to
+walk, the subject hops on the sound leg.
+
+Chronic inflammation of the bicipital bursa is occasionally met with
+wherein both members are affected. Because of the nature of the
+structures involved, when inflamed, chronic inflammation is a more
+frequent termination than is complete recovery. Bilateral affections are
+seen in horses that are driven for years, regularly at a fast pace on
+paved streets. In such cases, the gait is stilted, that is, there is
+incomplete advancement of both members and, of course, the period of
+weight bearing is correspondingly shortened; hence the short strides.
+
+In chronic cases, little if any evidence of inflammation is to be
+detected by digital manipulation of the parts. If flinching occurs, one
+is often unable to interpret the manifestation as to whether it is due
+to inflammation or not.
+
+There is no marked "warming out" in this condition, and animals are
+nearly as lame after having been driven a considerable distance as when
+started, although the lameness is not as a rule very great.
+
+Treatment.--In very painful cases acute inflammation is treated by
+employing cold applications during the initial stage. Cracked ice when
+contained in a suitable sack may be held in contact with the affected
+part and the pack is supported by means of cords or tapes as suggested
+in the discussion on treatment of scapulohumeral arthritis on page 66.
+Later, hot applications may be employed to good advantage.
+
+In the course of ten days or two weeks, if the acute painful condition
+has entirely subsided, vesication is indicated. The ordinary mercury and
+cantharides combination does very well. Depending upon the course taken
+in any given case, one is guided in the treatment employed. If prompt
+resolution comes to pass, the subject may be given free run at pasture
+after three or four weeks confinement in a box stall. If, however, the
+case does not progress in a prompt and satisfactory manner, absolute
+quiet must be enforced for six weeks or more. Repeated blistering is
+beneficial, although it is doubtful if firing is of sufficient benefit
+in the average chronic case of intertubercular bursitis to justify the
+punishment which this form of treatment inflicts, unless infliction of
+pain is the thing sought, to enforce repose in restless subjects.
+Patients are best given a long rest at pasture and returned to work for
+two or three months after an acute attack of inflammation of the bursa,
+lest the condition become chronic. When due consideration is given the
+pathology of such cases, the frequent unsatisfactory termination under
+the most careful treatment, is readily understood.
+
+
+Contusions of the Triceps Brachii.
+(Triceps Extensor Brachii: Caput Muscles.)
+
+Anatomy.--The triceps brachii is the principal structure which fills
+the space between the posterior border of the scapula and the humerus.
+The several heads originate for the most part on the border of the
+scapula, the deltoid tuberosity of the humerus and the shaft of the
+humerus. Insertion of this large muscular mass is effected by means of
+several tendons to the olecranon. A synovial bursa is situated
+underneath the tendinous attachment of the posterior portion of the
+triceps brachii--the long head or caput magnum.
+
+The function of the triceps as a whole is to flex the shoulder joint and
+extend the forearm. The triceps brachii is the chief antagonist of the
+biceps brachii.
+
+Etiology and Occurrence.--Owing to the exposed position of this
+structure, it is not infrequently contused, the result of falls, kicks
+and other injuries. The function of the triceps is such that it becomes
+strained upon rare occasions when a horse resists confinement of
+restraint in such manner that the parts are unduly tensed in
+contraction. This sort of resistance may stretch the radial nerve or its
+branches in a way that paralysis results. A condition known as "dropped
+elbow" is described by Henry Taylor, F.R.C.V.S., in the Veterinary
+Record[9], wherein a two-year-old colt while resisting confinement was
+so injured.
+
+The triceps group because of its convenient location, constitutes the
+site for hypodermic injection of drugs and biologic agents, with some
+practitioners; and as a result, more or less inflammation may occur. The
+author has observed and treated some twenty cases where an intensely
+painful infectious inflammation of the triceps brachii was caused by
+the intramuscular injection of a caustic solution by a cruel and
+unscrupulous empiric, whose object was to increase his practice.
+
+Symptomatology.--As the triceps brachii is not particularly taxed
+during weight bearing in the subject at rest, there may be no unnatural
+position assumed during inflammation of the triceps. More or less
+swelling and supersensitiveness is always present, however, and great
+care and discrimination must be exercised in digital manipulation of the
+triceps region because many animals are normally sensitive to palpation
+of these parts. It is sometimes difficult to correctly interpret the
+true state of conditions because of this peculiarity.
+
+There is always swinging-leg-lameness, which is accentuated when the
+subject is urged to trot. Where symptoms are pronounced, it is
+unnecessary to cause the subject to move at a faster pace than at a walk
+to recognize the condition. The forward stride is shortened and in
+extremley painful conditions, no attempt is made to extend the leg. It
+is simply carried _en une piece_--flexion of the shoulder and elbow
+joints is carefully avoided.
+
+Treatment.--During the early stage of inflammation, hot or cold
+applications are beneficial. Long continued use of moist
+heat--fomentations--allays pain and stimulates resolution. Keeping in
+contact with the painfully swollen parts a suitable bag filled with
+bran, which can be moistened at intervals with warm water, constitutes a
+practical and easy means of treatment. By employing this method, one is
+more likely to succeed in having his patient properly cared for, in that
+less work is entailed than if hot fomentations are prescribed.
+
+After the acute and painful stage has subsided, a stimulating liniment
+is of benefit. The subject should be kept within a comfortable and roomy
+box stall for a sufficient length of time to favor prompt resolution.
+Wild and nervous subjects, if not so confined, will probably overexert
+the affected parts if allowed the freedom of a paddock or pasture.
+
+Where the inflammation becomes infective, surgical interference is
+necessary. The prompt evacuation of pus, with adequate provision for
+wound discharge, should be attended to before extensive destruction of
+tissue takes place. Resolution is prompt as a rule in such cases because
+of the vascularity of the structures and the ease with which proper
+drainage may be effected. No special after-care is necessary if drainage
+is perfect, except that one should avoid injecting the wound cavity with
+aqueous solutions unless it be absolutely necessary to cleanse such
+cavity, and then it is best to swab the wound rather than to irrigate it
+freely.
+
+
+Shoulder Atrophy.
+(Sweeny or Swinney)
+
+No satisfactory consideration of the pathogeny of this condition is
+recorded, but practitioners have long distinguished between muscular
+atrophies which are apparently caused without doing serious injury to
+nerves and muscular atrophy which seems to be due to nerve affection. In
+the first instance, recovery when proper attention is given, is prompt;
+whereas, in the latter, regeneration of the wasted tissues requires
+months in spite of the best sort of treatment.
+
+The parts more frequently affected are the supra- and infrascapularis
+(antea- and posteaspinatus) muscles. But in some cases the triceps group
+is involved; however, this occurs in unusual and chronic affections. No
+doubt, these chronic cases are due to suspended innervation and are not
+to be classed with the ordinary case of atrophy of the abductor muscles
+of the humerus (supra- and infraspinatus) as in the usual case of
+"sweeny."
+
+Occurrence.--Shoulder atrophy such as the general practitioner
+commonly meets with, is an affection, more often seen in young animals
+and it seems to be due to injuries of various kinds which contuse the
+muscles of the shoulder. Ill-fitting collars and pulling in a manner
+that there occurs side draft with unusual strain on the muscles of one
+side of the neck and shoulder, seem to be the more frequent causes of
+this trouble. Blows such as are occasioned by kicks and falls frequently
+result in atrophy of shoulder muscles.
+
+Course.--In some cases a rapidly progressive atrophy characterizes the
+case and lameness and atrophy appear at about the same time. The
+affection in such instances does not recover spontaneously but
+constitutes a condition which requires prompt and rational treatment so
+that function may be fully restored to the parts involved.
+
+Occasionally one may observe cases where there is but slight atrophy;
+where the disease progresses slowly and atrophy is not extensive or
+marked. In vigorous young animals that are left to run at pasture when
+so mildly affected, spontaneous recovery occurs.
+
+Symptomatology.--Lameness is the first manifestation of shoulder
+atrophy, and in many cases where lameness is slight, the veterinarian
+may fail to discover the exact nature of the trouble if he is not very
+proficient as a diagnostician of lameness or if he is careless in taking
+into consideration obtainable history, age of the subject, etc. Because
+of the fact that the average layman believes that practically every case
+of fore-leg lameness wherein it is not obvious that the cause is
+elsewhere, is due to a shoulder affection of some kind, we may be too
+hasty in giving the client assurance that no "sweeny" exists. In some of
+these cases where a diagnosis of "shoulder lameness" has been made and
+the client has been assured that no sweeny exists, the patient is
+returned in about a week and there is then marked atrophy of one or both
+of the spinatus muscles.
+
+A mixed type of lameness characterizes this affection, and in the
+average case there exists little evidence of local pain. The salient
+points in recognizing the condition are a consideration of history if
+obtainable; age of the subject; finding slight local soreness, by
+carefully manipulating the muscles which are usually involved; noting
+the character of the lameness if any is present; and where atrophy is
+evident, of course, the true condition is obvious.
+
+Treatment.--Subcutaneous injections of equal parts of refined oil of
+turpentine and alcohol, with a suitable hypodermic syringe, is a
+practical and ordinarily effective treatment. From five to fifteen cubic
+centimeters (the quantity varies with the size of the animal), of this
+mixture is injected into the atrophied parts at different points, taking
+care to introduce only about one to two cubic centimeters at each point
+of injection. The syringe should be sterile and, needless to say, the
+site of injections must be surgically clean.
+
+Other agents, such as tincture of iodin, solutions of silver nitrate,
+saline solutions and various more or less irritating preparations have
+been employed; but in the use of these preparations one may either fail
+to stimulate sufficient inflammation to cause regeneration to take
+place, or infection is apt to occur. Where suppuration results, surgical
+evacuation of pus must be promptly effected else large suppurating
+cavities form.
+
+The employment of setons constitutes a dependable method of treatment of
+shoulder atrophy, but because of the attendant suppurative process which
+inevitably results, this method is not popular with modern surgeons and
+is a last resort procedure.
+
+After-care.--Regular exercise such as the horse usually takes when at
+pasture, is very helpful in treating atrophy, and in some cases it has
+been found that no reasonable amount of irritation would stimulate
+muscular regeneration; but by later allowing patients to exercise at
+will, recovery took place in a satisfactory manner. No special attention
+is ordinarily necessary.
+
+
+Paralysis of the Suprascapular Nerve.
+
+Anatomy.--The suprascapular (anterior scapular) nerve, a small branch
+of the brachial plexus, is given off from the anterior portion of this
+plexus. The nerve rounds the anterior border of the neck of the scapula,
+passing upward and backward under the supraspinatus (antea-spinatus)
+muscle and terminating in the infraspinatus (postea-spinatus) muscle.
+
+Etiology and Occurrence.--As the result of direct injury to this nerve
+by contusion such as may be received in runaway accidents, collar
+bruises, especially collar bruises in young horses that are not
+accustomed to pulling and that walk in a manner to cause side draft,
+injury to the nerve occurs, and partial or complete paralysis
+supervenes. Some writers state that it may be produced by confining an
+animal in recumbency, with the casting harness. The common cause of
+paralysis or paresis of this nerve in cases such as one observes in
+country practice, is bruises from the collar in colts that are put to
+heavy farm work or where ill fitting collars are used.
+
+Symptomatology.--With partial or complete suspension of function of
+the suprascapular nerve there results enervation of the supraspinatus
+and infraspinatus muscles. Since these muscles act as external lateral
+ligaments of the scapulohumeral joint, when they are incapacitated,
+there naturally follows more or less abduction of the shoulder when
+weight is borne.
+
+In extreme cases, as soon as the ailing animal is caused to support
+weight with the affected member, the joint is suddenly thrown outward in
+a manner that the average layman at once concludes that there must be
+scapulohumeral luxation, and the veterinarian receives a call to see a
+case wherein the "shoulder is out of place." There exists, however, no
+luxation in such cases.
+
+If serious injury is done the nerve so that it undergoes degenerative
+changes, there will result atrophy of the muscles that derive their
+nerve supply from the suprascapular nerve.
+
+[Illustration: Fig. 7--Paralysis of the suprascapular nerve of the left
+shoulder]
+
+Treatment.--During the first few days following injuries which result
+in this form of paralysis, it is well to keep the subject inactive, and
+if much inflammation of the injured structures contiguous to the nerve
+exists, the application of cold packs is beneficial. Later, as soon as
+acute inflammation has subsided, vesication of a liberal area around the
+anteroexternal part of the scapulohumeral joint and over the course of
+the suprascapular nerve, will stimulate recovery in favorable cases. As
+a rule, in mild cases, the subject is in a condition to return to work
+in two or three weeks.
+
+
+Radial Paralysis.
+
+Described under the titles of "Radial Paralysis" and "Brachial
+Paralysis," there is to be found in veterinary literature a discussion
+of conditions which vary in character from the almost insignificant form
+of paresis to the incurably affected conditions wherein the whole
+shoulder is completely paralyzed.
+
+When one considers the anatomy of the brachial nerve plexus and the
+distribution of its various branches, the location of this plexus and
+its proximity to the first rib, and the inevitable injury it must suffer
+in fracture of this bone, together with the inaccessibility of the
+plexus, it is not strange that a correct diagnosis of the various
+affections of the brachial plexus and the radial nerve is often
+impossible until several days or weeks have passed. And, in some
+instances, diagnosis is not established until an autopsy has been
+performed. Here, too, we fail to find cause for paralysis in some rare
+instances.
+
+Anatomy.--The radial nerve is a large branch of the brachial plexus
+and is chiefly derived from the first thoracic root of the plexus and is
+here situated posterior to the deep brachial artery. It is directed
+downward and backward under the subscapularis and teres major muscles,
+rounding the posterior part of the humerus, and passing to the anterior
+and distal end of the humerus, it finally terminates in the anterior
+carpal region. The radial nerve supplies branches to the three heads of
+the triceps brachii, to the common and lateral extensors of the digit
+and also to the skin covering the forearm.
+
+Etiology and Occurrence.--Nothing definite is known about the cause of
+some forms of radial paralysis. However, radial paralysis is encountered
+following injury to the nerve occasioned by its being stretched, as in
+cases where the triceps brachii is unduly extended in restraining
+subjects by means of a casting harness. Berns[10] states that in
+confining horses on an old operating table where it was necessary to
+draw the affected foot forward twenty-four to thirty-six inches in
+advance of its fellow, which was secured in a natural vertical
+position, radial paralysis of a mild form was of frequent occurrence.
+Country practitioners, in restraining colts by casting with harness or
+ropes, occasionally observe a form of paresis wherein the radial nerve
+suffers sufficient injury that there is caused a temporary loss of
+function of the triceps brachii. Such cases recover within three or four
+days and are not a true paralysis, but nevertheless constitute
+conditions wherein normal nerve function is temporarily suspended.
+
+[Illustration: Fig. 8--Radial paralysis.]
+
+Symptoms.--Immediately subsequent to injuries which involve the radial
+nerve, there is manifested more or less impairment of function.
+Remembering the structures supplied by the radial nerve and its
+branches, one can readily understand that there should occur as
+Cadiot[11] has stated:
+
+     In complete paralysis, the joints of the affected limb with the
+     exception of the shoulder are usually flexed when the horse is
+     resting. In consequence of loss of power in the triceps and
+     anterior brachial muscles, the arm is extended and straightened on
+     the shoulder, the scapulohumeral angle is open, and the elbow
+     depressed. The forearm is flexed on the arm by the contraction of
+     the coracoradialis (biceps brachii), while the metacarpus and
+     phalanges are bent by the action of the posterior antibrachial
+     muscles. The knee is carried in advance, level with, or in front
+     of, a vertical line dropped from the point of the shoulder. The
+     hoof is usually rested on the toe, but when advanced beyond the
+     above mentioned vertical line, it may be placed flat on the ground,
+     the joints then being less markedly bent. When the limb as a whole
+     is flexed, it may be brought into normal position by thrusting back
+     the knee with sufficient force to counteract the action of the
+     flexor muscles.
+
+[Illustration: Fig. 9--Merillat's method of fixing carpus in radial
+paralysis. Courtesy, Alex. Eger.]
+
+When made to walk, the animal being unable to exert muscular action with
+the paralyzed structures, limply carries the member as a whole, and
+there is shortening of the anterior portion of the stride. There being
+loss of function of the triceps brachii, it is impossible for the
+subject to straighten the leg in the normal position for supporting
+weight; therefore, any attempt to bear weight results in further
+flexion of the affected member and the animal will fall if the body is
+not suddenly caught up with the sound leg.
+
+Differential Diagnosis.--In making examination of these cases, one can
+exclude fracture by absence of crepitation and usually, also, swelling
+is absent in radial paralysis. In a typical case of radial paralysis,
+the affected leg can sustain its normal share of weight if placed in
+position, that is, if the carpal joint is extended in such manner that
+the leg is positioned as in its normal weight-bearing attitude. In
+brachial paralysis, whether due to fracture of the first rib or to other
+serious injury, it is impossible for the subject to support weight with
+the affected member even when it is passively placed in position.
+
+No difficulty is ordinarily experienced in differentiating radial
+paralysis from muscular injuries to the triceps; yet, in some cases of
+"dropped elbow," it is necessary to observe the progress of the case for
+ten days or two weeks before one can positively establish a diagnosis.
+
+     Quoting Merillat[12]: "When, after four weeks, there is no
+     amelioration of the paralysis, the muscles have atrophied, and the
+     patient has become emaciated from pain and discomfort, the
+     diagnosis of brachial paralysis with fracture of the first rib may
+     then be announced."
+
+Prognosis.--When no complete paralysis of the brachial plexus or no
+fracture of the first rib exists, the majority of cases recover
+completely in from ten days to six weeks. Some writers claim that
+recoveries occur in ninety per cent of cases when conditions are
+favorable.
+
+Treatment.--When incomplete radial paralysis exists, little needs be
+done except to allow the subject moderate exercise and to provide for
+its comfort. Local applications, stimulative in character, are
+beneficial, and the internal administration of strychnin is indicated.
+
+In the cases where weight is not supported without the affected leg
+being passively placed in position, it is necessary to provide for the
+subject's comfort in several ways.
+
+Mechanical appliances such as braces of some kind in order to keep the
+affected leg in a position of carpal extension, constitute the essential
+part of treatment. The leg is supported in such a manner that flexion of
+the carpus is impossible. Due regard is given to prevent chafing or
+pressure necrosis by contact of the skin with the braces--this may be
+done by bandaging with cotton. The supportive appliance is kept in
+position for ten days or two weeks. At the end of this time the brace
+may be removed and the subject given a chance to walk, and improvement,
+if any exists, will be evident. When there is manifested an amelioration
+of the condition, moderate daily exercise and massage of the affected
+parts are helpful.
+
+Should the subject be seriously inconvenienced by the application of a
+brace or other supportive appliances, it is necessary to employ slings.
+Further, if weight is supported entirely by the unaffected member,
+laminitis may supervene if a sling is not used.
+
+
+Thrombosis of the Brachial Artery.
+
+Thrombosis of the brachial artery or of its principal branches is of
+very rare occurrence in horses.
+
+Etiology.--Partial or complete obstruction of arteries (brachial or
+others) occurs as the result of direct injury to the vessel wall from
+compression and tension of muscles and resultant arteritis; lodging of
+emboli; and parasitic invasion of vessel walls causing internal
+arteritis.
+
+Symptomatology.--If sufficient collateral circulation exists to supply
+the parts with blood, no inconvenience is manifested while the subject
+is at rest. Where the lumen of the affected vessel is not completely
+occluded, there may be no manifestation of lameness when the ailing
+animal is moderately exercised. Consequently, the degree of lameness
+depends upon the extent of the obstruction to circulation; and,
+likewise, the course and prognosis depend upon the character and extent
+of such obstruction.
+
+In severe cases, lameness is markedly increased by causing the animal to
+travel at a fast pace for only a short distance. There are evinced
+symptoms of pain, muscular tremors and sudation, but the affected member
+remains dry and there is a marked difference of temperature between the
+normal areas and the cool anemic parts. When the subject is allowed to
+rest, circulation is not taxed, and there is a return to the original
+and apparently normal condition, only to recur again with exertion. This
+condition characterizes thrombosis.
+
+Treatment.--In these cases, little if any good directly results from
+any sort of treatment in the way of medication. Absolute rest is thought
+to be helpful. Potassium iodid, alkaline agents such as ammonium
+carbonate and potassium carbonate, have been administered. Circulatory
+stimulants also have been given, but it is doubtful if any good has come
+from medication.
+
+
+Fracture of Humerus.
+
+The shaft of the humerus, protected as it is by heavy muscles, is not
+frequently fractured; and fractures of its less protected parts, as for
+example, the head, are complicated in such manner that resultant
+arthritis soon constitutes the more serious condition.
+
+As a result of falls on frozen ground, kicks or any other form of heavy
+contusion, the humerus is occasionally broken. It is rarely fractured
+otherwise. Because of the force of contusions usually required to effect
+humeral fracture, the manner in which the bone is broken, with respect
+to direction, is variable. Often oblique fractures exist and
+occasionally there occurs multiple fracture. In addition to the
+ordinarily serious nature of the fracture itself, there is always much
+injury done the adjoining structures.
+
+Symptomatology.--Mixed lameness and manifestation of severe pain
+characterize this affection. Considerable swelling which increases, in
+some cases for a week or more, is to be observed. Crepitation is readily
+detected, if pain and swelling is not too great to prevent passive
+movement of the member. Where intense pain is not manifested, because of
+manipulation, one may abduct the extremity and thereby occasion distinct
+crepitation; but when it is possible to recognize crepitation by holding
+the hand in contact with the olecranon while the animal is made to walk,
+this method is to be preferred, if the subject can move without serious
+difficulty. The pathognomonic symptom here is recognition of
+crepitation, but this may be very difficult to recognize in fracture of
+condyles, and in such instances, a careful examination is necessary.
+Gentle manipulation in a manner that pain is not aggravated will tend to
+inspire confidence on the part of the subject and relaxation of muscles
+will enable the operator to detect crepitation.
+
+Course and Prognosis.--Because of the direction of the long axis of
+the humerus, with relation to the bony column of the extremity, it is
+obvious that any lateral movement of the leg tends to rotate the shaft
+of this bone. In fractures of the shaft of the humerus, then, it is
+apparent that immobilization is very difficult if at all possible.
+
+The proximity to the axillary lymph glands makes for easy dissemination
+of infection when the contused musculature becomes infected. The
+adjacent brachial nerve plexus is so very apt to become involved, if not
+actually injured at the time fracture occurs, that paralysis is a
+probable complication. Consequently, it is logical to reason that
+because of the many possible serious complications, such as shock,
+occasioned by the injury and the distress and pain which this accident
+produces, recovery must be the exception in fracture of the humerus.
+However, recoveries do take place and in addition to the reported
+recoveries by Liautard, Moller, Stockfleth, Lafosse, Frohner and others,
+we have instances cited by American practitioners where cases resulted
+in recovery. Thompson[13] reports a good recovery in a 1600-pound mare
+where there existed an oblique fracture of the humerus. This mare was
+kept in slings for eight weeks. Walters[14] reports complete recovery in
+humeral fracture in a foal three days old. The only treatment given was
+the application of a pitch plaster from the top of the scapula to the
+radius. The colt was kept in a comfortable box stall and in about four
+weeks regained use of the leg. Complete recovery eventually resulted. In
+the experience of the author, recovery has not occurred in humeral
+fractures.
+
+Treatment.--When animals are not aged and of sufficient value to
+justify treatment, they are best supported in a sling, if halter broken.
+If subjects are nervous, wild and unbroken, it is possible to employ the
+sling, if care is given to train the animal to this manner of restraint.
+The presence of an attendant for a day or two will reassure such
+subjects so that even in these cases it may be practicable to employ the
+sling.
+
+Braces and other mechanical appliances intended to immobilize the parts
+are not of practical benefit in the horse. Unlike the dog, the horse as
+yet has not been successfully subjected to tolerating rigid braces for
+the shoulder and hip.
+
+Everything possible must be done that will make for the patient's
+comfort. If the subject turns out to be a good self nurse, and the
+nature of the fracture is such that practical apposition of the broken
+ends of bone may be maintained, recovery will occur in some cases.
+
+
+Inflammation of the Elbow.
+(Arthritis.)
+
+Affections of this articulation other than those which are produced by
+traumatism are rare. This joint has wide articular surfaces, and
+securely joined as they are by the heavy medial and lateral ligaments
+(internal and external lateral ligaments), luxation is practically
+impossible. When luxation does occur, irreparable injury is usually
+done. Castagne as quoted by Liautard[15], reports a case of true
+luxation of the elbow joint in a horse where reduction was effected and
+complete recovery took place at the end of twenty-five days. This is an
+unusual case. The average practitioner does not meet with such
+instances.
+
+Anatomy.--The condyles of the humerus articulate with the glenoid
+cavities of the radius and a portion of the ulna. Two strong collateral
+ligaments pass from the distal end of the humerus to the head of the
+radius. The capsular ligament is a large, loose membrane which encloses
+the articular portion of the humerus with the radius and ulna and also
+the radioulnar articulation. It is attached anteriorly to the tendon of
+the biceps brachii (flexor brachii). The capsule extends downward
+beneath the origin of these digital flexors. This fact should be
+remembered in dealing with puncture wounds in the region, lest an error
+be made in estimating their extent and an open joint be overlooked at
+the initial examination.
+
+Etiology and Occurrence.--Exclusive of specific or metastatic
+arthritis, which is seldom observed except in young animals,
+inflammation of the elbow joint is usually caused by injury. This
+articulation is not subject to pathologic changes due to concussion or
+sprains as occasioned by ordinary service, but is frequently injured by
+contusion from falls, blows from the wagon-pole and kicks. Wounds which
+affect the elbow joint, then, may be thought of in most cases, as
+resultant from external violence. They may be contused wounds or
+penetrant wounds. Sharp shoe-calks afford a means of infliction of
+penetrant wounds which may occasion open joint and infectious arthritis.
+
+Classification.--A practical manner of classifying inflammation of the
+elbow is on an etiological basis. Eliminating the forms of elbow
+inflammation, such as are caused by metastatic infection and other
+conditions which properly belong to the domain of theory of practice, we
+may consider this affection under the classification of _contusive
+wounds_ and _penetrative wounds_.
+
+Symptomatology.--Any injury which is of sufficient violence to
+occasion inflammation of the elbow causes marked lameness and
+manifestation of pain. The degree of lameness and distress manifested by
+the subject, depends upon the nature and extent of the involvement. A
+contusion suffered as the result of a fall, which occasions a
+circumscribed inflammation of the structures covering this joint and
+where little inflammation of the articulating parts exists, marked
+evidence of pain and lameness might be absent. On the other hand, if a
+true arthritis is incited, there will be evident distress manifested,
+such as hurried respiration, accelerated pulse, inappetence, mixed
+lameness, local evidence of inflammation and particularly marked
+supersensitiveness of the affected parts. Considering these two extremes
+of manifested distress and injury, one may readily conclude that in the
+frequently seen case, wherein contusion has occasioned a moderate
+degree of injury, prognosis is favorable and recovery ordinarily
+follows in the course of a few weeks' treatment.
+
+In cases of arthritis due to penetrative wounds (because of the
+important function of this joint and its large capsule, which when
+inflamed discharges synovia in a manner that closure of such an open
+joint is seldom possible) a very grave condition results.
+
+Treatment.--Inflammation of the elbow, such as is frequently seen in
+general practice where horses are turned out together and exposed to
+kicks and other injuries, yields to treatment readily, if an open joint
+does not exist.
+
+Hot packs supported in contact with the elbow and kept around the
+inflamed articulation for a few days, materially decrease pain and tend
+to reduce inflammation. The subject must be kept quiet in a comfortable
+stall and, if necessary, a sling used. Where it is impossible for the
+animal to support much weight with the injured member the sling should
+be employed.
+
+As inflammation abates, which it does in the course of from one to three
+weeks in uncomplicated cases, the subject may be allowed the freedom of
+a comfortable box stall. Vesication of the parts is in order, and this
+may be repeated in the course of two weeks, if it is deemed necessary.
+
+Penetrative wounds resulting in open joint are not treated with success
+as a rule, and because of the handicap under which veterinarians labor,
+methods of handling such cases, where large, important articulations are
+affected, are not being rapidly improved. Prognosis is usually
+unfavorable, and for humane and economic reasons, animals so affected
+should be destroyed.
+
+Ordinary wounds of the region of the elbow are treated along general
+lines usually employed. They merit no special consideration, except that
+it may be mentioned that with such injuries concomitant contusion of the
+parts occasions injury that does not recover quickly.
+
+
+Fracture of the Ulna.
+
+Etiology and Occurrence.--Fractures of the ulna in the horse are not
+common in spite of the exposed position of the olecranon. This bone when
+broken, is usually fractured by heavy blows and any form of ulnar
+fracture is serious because of its function and position in relation to
+the joint capsule. Transverse fractures do not readily unite because of
+the tension of the triceps muscles, which prevent close approximation of
+the broken ends of the bone.
+
+Thompson[16], however, reports a case of transverse simple fracture of
+the ulna in a mare, the result of a kick, in which complete recovery
+took place. He kept the subject in a sling for six weeks and then
+allowed six months rest.
+
+Symptomatology.--The position assumed by a horse suffering from a
+transverse fracture of the ulna, is similar to that in radial paralysis.
+Crepitation may be detected by manipulating the parts, and in some
+instances of fracture of the olecranon, there occurs marked displacement
+of the broken portions of the bone. Lameness is intense and the parts
+are swollen and supersensitive. The capsular ligament of the elbow joint
+is usually involved in the injury because fracture of the ulna may
+directly extend within the capsular ligament. In such cases, there is
+synovitis, and later arthritis causes a fatal termination.
+
+Treatment.--The impossibility of applying a bandage in any way to
+practically immobilize these parts in fracture of the ulna, prevents our
+employing bandages and splints. Therefore, one can do little else than
+to put the patient in a sling and try to keep it quiet and as nearly
+comfortable as circumstances allow.
+
+
+Fracture of the Radius.
+
+Etiology and Occurrence.--From heavy blows received such as kicks,
+collision with trees or in falls in runaway accidents, the radius is
+occasionally fractured. In very young foals, fracture of the radius, as
+well as of the tibia and other bones, results from their being trampled
+upon by the mother.
+
+Symptomatology.--Excepting in some cases of radial fracture of foals
+where considerable swelling has taken place, there is no difficulty in
+readily recognizing this condition. The heavy brachial fascia materially
+contributes to the support of the radius, and in cases where swelling
+is marked, crepitation may not be readily detected. In fact, a
+sub-periosteal fracture may exist for several days or a week or more and
+then, with subsequent fracture of the periosteum, crepitation and
+abnormal mobility of the member are to be recognized. In such cases, the
+subject will bear some weight upon the affected member, but this causes
+much distress. In one instance the author observed a transverse fracture
+of the lower third of the radius which was not positively diagnosed
+until about ten days after injury was inflicted. In this case, without
+doubt, the subject originally suffered a sub-periosteal fracture of the
+bone and because the animal was a good self nurse, the brachial fascia
+supported the radius until the periosteum gave way and the leg dangled.
+In this instance infection took place and suppuration resulted. It was
+deemed advisable to destroy this animal.
+
+Prognosis.--In adult animals, radial fracture constitutes a grave
+condition; generally speaking, prognosis, in such cases, is unfavorable.
+Because of the leverage afforded by the extremity, immobilization of the
+radius is difficult. Any sort of mechanical appliance, which will
+immobilize these parts, is likely to produce pressure-necrosis of the
+soft structures so contacted. There is occasioned thereby much pain and
+the subject becomes restive, unmanageable and sometimes the splints are
+completely deranged because of the animal's struggles, and much
+additional injury to the leg is done. Occasionally, an otherwise
+favorable case is thus rendered hopelessly impossible to handle, and the
+subject must be destroyed several days after treatment has been
+instituted.
+
+Consequently, unless all conditions are good, and the affected animal a
+favorable subject, young, of good disposition, and the fracture a simple
+transverse one, complete recovery is not likely to result from any
+practical means of handling.
+
+Treatment.--Mature subjects ought to be put in slings and kept so
+restrained throughout the entire time of treatment. Immobilization of
+the broken parts of the bone is the object sought. This is attempted by
+practitioners who employ various methods, and each method has its
+advocates.
+
+Casts are used by some and serve very well in many cases; but because of
+their bulk and unyielding and rigid nature, they are not well adapted to
+use on fractures of bones proximal to the carpus and tarsus. This is in
+reference to plaster-of-paris casts or those of any similar material.
+
+Appliances which depend on glue or other adhesive substances combined
+with leather, wood or fiber for their support, are efficacious but not
+comfortable.
+
+The use of heavy leather when the member has been suitably padded with
+cotton and bandages, constitutes a very good manner of reducing fracture
+of the radius or of the tibia. Leather when cut to fit both the medial
+and lateral sides of a leg, and firmly held with bandages, will form a
+firm support that yields slightly to changes of position, thus making
+for comfort of the subject.
+
+Such a splint or support should extend from the fetlock region to the
+elbow, but the cotton and bandages are to reach to the foot. When one
+considers that, with the supportive appliance placed on each side of the
+affected member, rigidity is accomplished as much from tensile strain
+put upon the leather as from its own stiffness, it is seen that the
+leather need not be of the heaviest--sole leather is unnecessary.
+Because of the more comfortable immobilizing appliance, the subject is
+less restive, and chances for a successful outcome are materially
+increased thereby.
+
+In the mature subject, six or eight weeks' time is required for union of
+the parts to occur sufficiently so that splints may be dispensed with.
+Rearrangement of the supportive apparatus, however, is possible and
+usually necessary during the first few weeks of treatment. By employing
+care in handling the parts, the subject will be unlikely to do itself
+injury at the time readjustment of splints is being effected.
+
+In foals, it is best to give them the run of a box stall with the
+mother. Being agile, they get up and lie at will without doing injury to
+the fractured member. The splints (leather is preferable in these cases
+also) are looked after and readjusted as necessity demands.
+
+Three or four weeks time is all that is required for the average young
+colt to be kept in splints when suffering from simple transverse
+fracture of the radius.
+
+Compound fractures are necessarily more difficult to treat than are the
+simple variety, but even in such cases recovery results sometimes, and
+the practitioner is justified in attempting treatment after having
+explained the situation to his client.
+
+Oblique fractures, even when simple, do not completely recover. Muscular
+and tendinous contraction, together with the natural tendency for the
+beveled contacting parts of the broken bone to pass one another in
+oblique fracture, results in shortening of the leg and, if union
+results, a large callus usually forms. Where shortening of bones occur,
+necessarily, permanent lameness follows.
+
+
+Wounds of the Anterior Brachial Region.
+
+Etiology and Occurrence.--Contusions and lacerations of the forearm
+are of frequent occurrence in horses and are troublesome cases to
+handle; particularly is this noticeable where extensive laceration of
+the parts occurs. These injuries are caused by animals being kicked; by
+striking the forearm against bars in jumping; and in sections of the
+country where barbed wire is used to enclose pastures, extensive
+lacerated wounds are met with when horses jump into such fences.
+
+Symptomatology.--Any wound which causes inflammation of the structures
+of the anterior half of the forearm, is characterized by
+swinging-leg-lameness. Depending upon the nature and extent of the
+injury, manifestation varies. In cases where laceration has practically
+divided all of the substance of the extensor tendons, it is, of course,
+impossible for the subject to advance the leg; but where lacerated
+wounds involve only a part of the extensor apparatus of the foreleg, not
+so much inconvenience is evident, unless the wound is seriously infected
+and inflammation involves contiguous structures. Therefore, in many
+instances, lameness is more pronounced in contusions of the anterior
+brachial region than where tissues have been divided more or less
+keenly.
+
+In every instance diagnosis is easily established. The injury is quite
+evident, and the manner of locomotion is not in itself an essential
+feature to be considered in a discussion of symptoms. Where a contusion
+of the anterior brachial structures occurs, there is, in addition to
+lameness, swelling which is painful because of the pressure occasioned
+by the heavy non-yielding brachial fascia. And where suppuration occurs,
+there is then an intensely painful condition which is not relieved until
+pus has been evacuated. Rather frequently, drainage for wound secretions
+is a difficult problem, and approximation of the divided ends of muscles
+is always difficult to maintain.
+
+Treatment.--Contused wounds of the anterior brachial region are
+treated along usual lines; that is, attempt is made to stimulate prompt
+resolution. Hot or cold applications are employed throughout the acute
+stage of the affection. Complete rest is provided for until all pain has
+subsided. Later, stimulating liniments are beneficial.
+
+Where no injury is done the periosteum or bone, complete resorption of
+all products of inflammation usually occurs, though in many instances,
+this is tardy--six weeks or more are sometimes required for recovery to
+take place.
+
+If suppuration occurs, it is necessary to provide for drainage as soon
+as it is possible to distinguish the presence of pus. Due regard is
+given the manner of establishing drainage because of the usual existence
+of sub-fascial fistulae. In these cases, one avoids injecting solutions
+of aqueous antiseptics. By gently compressing the parts, pus is caused
+to drain out and in enforcing a moderate amount of exercise at a walk,
+when lameness is not intense, drainage is maintained. Cotton packs,
+moistened with hot antiseptic solutions, and kept around the forearm for
+several hours daily, are helpful because drainage is facilitated, and
+resolution is stimulated by the increase of blood thus attracted to the
+parts, and pain materially diminishes.
+
+In lacerated wounds of the anterior brachial region, after having
+controlled hemorrhage, an area around the wound margin is freed of hair
+by clipping or shaving. The wound is carefully examined, and the best
+site for drainage is selected and a suitable opening for wound discharge
+is provided for. Where the extensor carpiradialis (metacarpi magnus)
+with other structures, is divided and the distal portion is torn
+downward, as frequently is the case in barbed wire cuts, it is
+necessary to make careful provision for drainage. The wound is
+thoroughly cleansed by means of ablutions if necessary; but preferably
+by swabbing with pledgets of cotton or gauze which are moistened in
+antiseptic solutions. All shreds of macerated tissue are clipped with
+scissors and finally the whole wound surface is painted with tincture of
+iodin.
+
+If drainage is made by cutting through the tissues in the median portion
+of the structures that have been displaced, the opening should be packed
+with gauze so that it may remain patent after swelling has occurred.
+Such packing is left _in situ_ for twenty-four hours.
+
+The pendant muscular portions of tissues are sutured up by means of
+tapes and, while perfect apposition is not ordinarily possible, it is
+very essential to train the pendant tissues in their normal position
+even if they require resuturing within a week. This minimizes
+granulation of tissue, and there results less scar if the detached
+portions are kept near, even if not in contact with the proximal wound
+margins. The skin together with subcutaneous fascia is sutured on either
+side unless drainage is to be provided for on one side, and the
+lowermost part of that side is left unsutured.
+
+After-care.--Where extensive suturing of tissues has been necessary,
+subjects must be kept quiet. They are best confined in box stalls and
+not taken out for several weeks. Particularly is this true where
+transverse division of extensors has taken place. Sutures are removed at
+the end of from ten days to three weeks as cases permit. Drainage of
+wound secretions, which usually become infected, is necessary, because
+with obstructed drainage in an infected wound of this kind, there will
+result an early destruction of tissue at some point sutured. Daily
+irrigation done in a manner that practical asepsis is carried out, is
+necessary for about a week. All irrigation is done by way of the
+drainage opening, and this with warm aqueous solutions of suitable
+antiseptics. After a week or ten days' time, the wound should not be
+dressed more frequently than twice weekly.
+
+If it is necessary to leave a portion of the wound uncovered, as in
+cases where skin is destroyed, the frequent (three or four daily)
+application of a suitable antiseptic powder is necessary to check
+exuberant granulation. This may be directly effected by the use of an
+astringent or desiccant preparation, and such dressing serves as a
+mechanical protection as well.
+
+When such wounds are kept clean, where drainage is properly maintained,
+and the subject kept quiet, no particular attention other than the local
+application of an astringent lotion (such as the zinc and lead lotion)
+is necessary after the first three or four weeks. Usually, if the animal
+gnaws at the parts or otherwise manifests evidence of discomfort, it is
+an indication that new areas of infection are being established because
+of obstructed drainage or retained eschars. A thorough cleansing of the
+wound with a two per cent solution of Liquor Cresolis Compositus and
+this followed by moistening every part of the wound with tincture of
+iodin, will check all such disturbance if done promptly.
+
+Where practically all of the anterior surface of the radius has been
+denuded, recovery is tardy and there is in some cases imperfect
+extension of the leg for months after the wound has healed. But in such
+instances, animals gradually regain complete use of the affected member
+and in the course of a year function is fully restored.
+
+
+Inflammation and Contraction of the Carpal Flexors.
+
+Anatomy.--The structures which are usually considered as true flexors
+of the carpus are a group of three muscles, which have separate heads of
+origin and different points of tendinous insertion.
+
+The _flexor carpiradialis_ (flexor metacarpi internus) originates from
+the medial epicondyle of the humerus. It is inserted to the proximal end
+of the medial metacarpal (inner metacarpal or splint) bone. This muscle
+is the smaller of the three and is not usually divided in doing carpal
+tenotomy.
+
+The _flexor carpiulnaris_ (flexor metacarpi medius) has two heads of
+origin; one, the larger, originates from the epicondyle of the humerus
+and the other from the posterior surface of the olecranon. The two
+heads unite at the upper third of the radius and the muscle, becoming
+tendinous, as is the case with the other carpal flexors, is attached by
+one point of insertion to the accessory carpal bone (trapezum). The
+other blends with the posterior annular ligament of the carpus.
+
+The _ulnaris lateralis_ (flexor metacarpi externus) has its origin from
+the lateral epicondyle of the humerus and inserts to the proximal
+extremity of the fourth metacarpal (outer splint) bone and by another
+attachment to the accessory carpal bone (trapezium) with the tendon of
+the flexor carpiulnaris (flexor metacarpi medius).
+
+Acting together, these muscles flex the carpus or extend the elbow and
+this action is antagonized by the biceps brachii (flexor brachii) and
+extensors of the carpus and phalanges.
+
+Etiology and Occurrence.--Inflammation of the muscular or tendinous
+parts of the carpal flexors, does not occur as frequently as does
+inflammation of the flexors of the extremity. They are subject to injury
+such as is occasioned by hard work and concussion and contract as a
+result; but, more frequently a congenital malformation of the leg is
+responsible for undue strain upon these parts. Horses that are "knee
+sprung" or that have a congenital condition where in the anterior line,
+as formed by the radius, carpal and metacarpal bones, is bent forward at
+the carpus, are subject to inflammation and contraction of the carpal
+flexors. When these flexors are contracted, the condition is commonly
+known among horsemen as "buck knee." In itself, inflammation of the
+carpal flexors is not a condition which is likely to prove troublesome,
+but because of carpal involvement (which is often present) the cause of
+the trouble remains, and inflammation of the carpal flexors recurs or
+becomes chronic and contraction of tendons results.
+
+Symptomatology.--Inflammation of the carpal flexors, when acute and
+uncomplicated, is characterized by a painfully swollen condition of the
+affected tendons. No weight is borne upon the affected leg and the
+carpal joint is flexed. Mixed lameness is present. There is no
+difficulty encountered in arriving at a diagnosis because of the very
+noticeably inflamed parts.
+
+Many fully developed cases of contraction of the tendons of the carpal
+flexors are observed where the condition has become established
+gradually and no lameness has resulted from tendinitis or carpitis. In
+some of these cases, subjects are stumblers and when they are carelessly
+handled or kept at fast work over irregular or hard roads, chronic
+carpitis with hyperplasia of the structures of the anterior carpal
+region results, owing to frequent bruising from falls.
+
+[Illustration: Fig. 10--Contraction of carpal flexors, "knee sprung."]
+
+Where inflammation is caused by a puncture wound and subfascial
+infection occurs, there is evident manifestation of pain. No weight is
+supported by the affected member and because of the pressure, occasioned
+by the swollen muscles confined within the non-yielding brachial fascia,
+there exists marked supersensitiveness of the affected parts. Flexion of
+the elbow is avoided because contraction of the biceps brachii (flexor
+brachii) or the extensors, which are antagonists of the flexors of the
+carpus, tenses the carpal flexors and pain is thereby increased.
+
+However, in most instances, the practitioner's attention is not directed
+to typical and uncomplicated cases, but to subacute or chronic
+inflammations which are often attended with contraction of the tendinous
+parts of the carpal flexors, and in such cases carpitis is present.
+Animals so affected have lost the rigidity which characterizes the
+normal carpal joint when the leg is a weight bearing member, and because
+of its sprung condition, the leg trembles when supporting weight.
+
+Treatment.--Acute inflammation is treated by means of local
+application of cold or hot packs until the pain and acute stage of
+inflammation has subsided and later stimulating liniments are indicated.
+Absolute quiet must be enforced. Especially where the carpus is involved
+must the subject be kept quiet until all evidence of inflammation has
+subsided.
+
+The application of vesicants or line-firing is beneficial in subacute
+inflammation of the tendons of the carpal flexors. Where contraction of
+tendons exists and no osseous or ligamentous change prevents correction
+of the condition, tenotomy is necessary. The reader is referred to
+Merillat's "Veterinary Surgery"[17] for a good description of the
+technic of this operation.
+
+In all serious cases of inflammation of the carpal flexors, whether
+tenotomy has been performed or not, the subject needs a long period of
+rest subsequent to treatment. In fact, three or four months at pasture
+is necessary to permit of recovery and this where no congenital
+deformity has predisposed the subject to such affection of the flexors.
+Return to work must be gradual and the character of the work such as to
+enable the animal to become inured to service without a recurrence of
+the trouble if possible.
+
+It follows then, that tenotomy, here as in other cases, is not practical
+from an economic viewpoint, unless the animal be of sufficient value to
+justify the long period of rest for recovery. Tenotomy is not of
+practical benefit unless ample time is allowed for regeneration of
+divided tendinous tissue.
+
+
+Fracture and Luxation of the Carpal Bones.
+
+Etiology and Occurrence.--Fracture of the carpal bones is of
+infrequent occurrence in horses and, when it does occur, it is usually
+due to injuries, and because of their nature (resulting as they
+generally do from heavy falls or in being run over by street cars or
+wagons), a comminuted fracture of one or more bones exists. The
+accessory carpal bone (trapezium) is said to be fractured at times
+without being subjected to blows or like injuries, but this is
+exceptional.
+
+Luxations of the carpal joint are of rare occurrence, and very few cases
+of this kind are on record. Walters[18] reports a case of
+carpometacarpal luxation in a pony wherein reduction was spontaneous and
+an uneventful recovery followed. His reason for reporting the case, as
+he states, is its rarity.
+
+Symptomatology.--Fractures of the carpal bones as they usually take
+place are diagnosed without difficulty. Because of their usually being
+comminuted, abnormal movement of the joint is possible. Such movement is
+not restricted and flexion of the leg at the carpus in any direction is
+possible. Crepitation is readily detected and frequently these fractures
+are of the compound-comminuted variety.
+
+In fracture of the accessory carpal bone (trapezium) or in fracture of
+any other single bone when such exists, there is no increase in the
+movement of the joint. The accessory carpal bone may be readily
+manipulated and when fractured, its parts are more or less displaced.
+Recognition of fracture of any other single carpal bone must be done by
+detecting crepitation unless it be a compound fracture, whereupon
+probing is of aid in establishing a diagnosis.
+
+Carpal luxation when present is to be recognized by finding the apposing
+carpal bones joined in an abnormal manner--that is, out of position.
+There is restricted or suspended function of the joint, and in the cases
+recorded, no difficulty has been experienced in making a diagnosis. The
+carpometacarpal portion of the articulation is the part which is usually
+affected.
+
+Prognosis and Treatment.--There is no chance for complete recovery in
+the usual case of carpal fracture because of the fact that there results
+sufficient arthritis to destroy articular cartilage beyond repair. In
+the average instance, because of arthritis which persists for a
+considerable length of time, more or less ankylosis results. At best,
+one can only hope for partial recovery, that is to say, the member may
+regain its usefulness as a weight-supporting part, but because of
+restricted or abolished joint function, locomotion is more or less
+difficult. Exostoses, articular and periarticular, occur and the carpus
+usually becomes a large immobile articulation. There is danger of
+infection resulting in simple carpal fractures and, needless to say, in
+a compound-comminuted fracture of the carpus, infection usually occurs
+and a fatal outcome is probable.
+
+When treatment is instituted, antiseptic precautions are taken in
+handling the compound fractures, and in any case immobilization of the
+parts is sought. Here, as has been previously pointed out, it is best to
+employ leather splints, so that a maximum degree of rigidity with a
+minimum of distress and inconvenience to the patient will result. The
+leg must be bandaged from the hoof upward, making use of a sufficient
+amount of cotton to ensure against pressure-necrosis. The leather
+splints are placed mesially and laterally and, of course, need to extend
+as high as the proximal end of the radius. Subjects must be kept in
+slings until union of bones has become established, and as a rule there
+will then exist marked ankylosis.
+
+There is no particular difference in the handling of carpal luxation and
+dislocation of other bones. Where ligaments have not been destroyed to
+the extent that reduction is of no practical use, the parts are kept
+immobilized, if thought necessary. Later, vesication of the whole
+pericarpal region is done and the subject allowed exercise at will.
+
+
+Carpitis.
+
+Etiology and Occurrence.--Inflammation of the carpus is caused by
+contusions, such as are occasioned in falling, by kicks by striking the
+carpus against objects in jumping and sometimes by striking it against
+the manger in pawing. The condition is of rather frequent occurrence.
+
+Symptomatology.--Evident symptoms of inflammation in carpitis are
+always present--hyperthermia, supersensitiveness and swelling. Also,
+there exists lameness which is characterized by an apparent inability to
+flex the leg, and there is circumduction of the leg as it is advanced
+because in this way little if any flexion of the carpus (which increases
+pain) is necessary.
+
+Depending upon the nature of the cause, there occurs a marked difference
+in the character and amount of swelling.
+
+[Illustration: Fig. 11--Pericarpal inflammation and enlargement due to
+injury.]
+
+Naturally, when much extravasation of serum and blood takes place, there
+is occasioned a fluctuating swelling which is usually less painful to
+the subject upon manipulation than is a dense inflammatory change
+without marked extravasation.
+
+In acute carpitis, there is present, then, a very painful condition
+which involves the articulation, causing marked lameness, disturbance of
+appetite and some elevation of temperature.
+
+Chronic cases do not occasion serious pain or constitutional
+disturbances, but do interfere with locomotion in direct proportion to
+the existing articular inflammation and periarticular hypertrophy of
+ligamentous and tendinous structures.
+
+Treatment.--If possible, keep the subject absolutely quiet, employing
+the sling if necessary. During the first stages of inflammation, the
+application of ice packs to the affected parts, is of marked benefit.
+At the end of forty-eight hours, hot applications may be used and this
+treatment continued throughout several days. Anodyne liniments are of
+service and should be employed throughout the acute stage of
+inflammation during intervals between the hydrotherapeutic treatments.
+
+As inflammation subsides, a counterirritating application such as a
+suitable liniment and later blistering or line-firing is helpful in
+stimulating resolution.
+
+[Illustration: Fig. 12--Hygromatous condition of the right carpus, also
+distension of sheaths of extensor tendons of both fore legs.]
+
+
+Open Carpal Joint.
+
+Anatomy.--The carpal bones as they articulate with one another and
+with the radius and metacarpal bones, as classed by anatomists, form
+three distinct articular parts of the joint as a whole and are known as
+radiocarpal, intercarpal and carpometacarpal. These three pairs of
+articulating surfaces are all enclosed within one capsular ligament. On
+the anterior face of the bones, the capsular ligament is attached to the
+carpal bones in such manner that an imperfect partitioning of the three
+joint compartments is formed. Posteriorly, the capsule is very heavy and
+forms a sort of padding over the irregular surfaces of the bones, and
+also its reflexions constitute the sheaths of the flexor tendons. The
+anterior portion of the capsular ligament forms sheaths for the extensor
+tendons, and both portions of the joint have an attachment around the
+distal end of the radius and another at the proximal end of the
+metacarpal bones.
+
+[Illustration: Fig. 13--Carpal exostosis in aged horse.]
+
+Etiology and Occurrence.--Puncture wounds of any kind may serve to
+perforate the joint capsule and such traumatisms are occasioned by
+falls, kicks and in various ways in runaway accidents, and open carpal
+joint may follow.
+
+Symptomatology.--The pathognomonic symptoms of the existence of an
+open joint is the exposure to view of articular surfaces of bones or
+noting the escape of synovia from the joint capsule. As has been
+previously referred to, there always exists a peculiar suspension of
+carpal flexion in all cases of carpitis.
+
+Non-infective wounds which may cause open joint are not necessarily
+productive of an active carpitis--a synovitis may be the extent of the
+disturbance. Unlike synovitis, which may characterize a non-infectious
+penetrative wound of the capsular ligament, septic arthritis which may
+supervene is a very painful inflammatory disturbance. It is
+characterized by all of the symptoms which attend the case of open joint
+and synovitis plus the obvious manifestation of great pain. There is an
+elevation of temperature of from two to five degrees above normal;
+circulation is accelerated; the pulse is bounding; respiration is
+hurried; there is an expression of pain as indicated by the physiognomy;
+and because of rapid erosive changes of cartilages which take place,
+there is soon so much of the articulation destroyed that death is
+inevitable. Death is usually due to generalization of the arthritic
+infection.
+
+[Illustration: Fig. 14--Exostosis of carpus resultant from carpitis.]
+
+[Illustration: Fig. 15--Distal end of radius. Illustrating the effects
+of chronic carpitis.]
+
+In the meanwhile, if the character of the infectious material is not so
+virulent, the disease will take on a slower course and the subject may
+experience laminitis from supporting weight upon the sound member, or
+because of continued recumbency, decubital gangrene and emaciation
+sometimes cause death. If the subject does not soon succumb, it is
+compelled to undergo days or even weeks of unnecessary suffering, and
+too often in such cases, it is later deemed advisable to destroy the
+animal because of the cost of continuing treatment until the horse is
+serviceable. Therefore, it is evident that when such joints as the
+carpus or tarsus are open and infection exists, if they are not promptly
+treated and the infectious process checked, it is neither humane nor
+practical to prolong treatment.
+
+Distinction must be made between the different joints when infected as
+the condition is much more serious in some cases than in others. All
+things considered, perhaps open joints rank, with respect to being
+serious cases as follows: elbow, navicular, stifle, tarsus, carpus,
+fetlock and pastern. This, of course, is restricted to articulations of
+the locomotory apparatus.
+
+Treatment.--Preliminary care in the treatment of an open carpal joint,
+is the same as has been described in this condition as it affects the
+scapulohumeral articulation described on page 65. Likewise the further
+treatment of such cases is along the same lines except that where it is
+possible, the parts are kept covered with cotton and bandages. However,
+in some cases, animals have been successfully treated without bandaging
+and by keeping the patient in a standing position and on pillar reins
+until recovery resulted. Such cases were of the non-infectious type and
+recovery was possible within three or four weeks. Further, the condition
+is not sufficiently painful in such instances as to prevent the subjects
+bearing weight with the affected member; hence, no danger of resulting
+laminitis is incurred. And finally, where bandages are not employed, the
+frequent use of antiseptic dusting powders is substituted for cotton as
+a protector.
+
+When bandaged, such wounds need dressing more or less frequently, as
+individual instances demand. The purulent infective inflammation of a
+carpal joint will require daily dressing; whereas, in other cases
+(non-infective), semi-weekly change of bandages is sufficient. Equal
+parts of boric acid and exsiccated alum constitute a suitable
+combination for the treatment of these cases, and this powder should be
+liberally employed. Tincture of iodin may be injected into the joint
+capsule where there is provision for its ready evacuation, as
+conditions seem to require. Daily injections for three, four or five
+days, are not harmful and will control infection in many instances.
+
+
+Thecitis and Bursitis.
+
+Etiology and Occurrence.--The thecae and bursae of the leg are several
+in number. In the carpal region, the flexors of the phalanges are
+contained together in the carpal sheath, and this is the principal theca
+in the carpal region. Each of the tendons is provided with synovial
+sheaths which are subject to inflammation and occasionally synovitis and
+distension of these synovial sheaths occur.
+
+Because of faulty conformation, some animals are subject to inflammation
+of these sheaths, and all forms of strenuous work which taxes the
+tendons greatly is apt to result in synovitis. Direct injury such as
+blows may be the cause of synovial distension of thecae and the
+affection is to be seen in all horses that have done much fast work on
+hard road surfaces or pavements.
+
+The usual case as it occurs in practice is a non-infective synovitis,
+but where puncture wounds cause the trouble, an infectious inflammation
+obtains.
+
+Symptomatology.--No trouble is experienced in diagnosing distension of
+tendon sheaths, for the affection is very palpable. During acute
+inflammatory stages of this affection, some lameness is present--in
+infectious inflammation lameness is intense. Local heat and pain upon
+manipulation are readily discernible in all acute cases. And finally,
+where there is reason for doubt, an aseptic exploratory puncture of the
+wall of the fluctuating enlargement may be made with a suitable trocar,
+and the discharging synovia will be proof of the existence of synovial
+distension.
+
+After the affection becomes subacute or chronic, no lameness or
+inconvenience is manifested, and the condition is undesirable only
+because of its being a blemish.
+
+Treatment.--Acute non-infectious synovial distension of tendon sheaths
+is treated by aspirating as much synovia as possible from the affected
+theca (this is, of course, done under strict asepsis) and by means of
+bandages, a uniform degree of pressure is kept over the parts for ten
+days or two weeks. The patient is kept quiet and in the course of two
+weeks an active blistering agent is employed over the region affected.
+Usually, at the end of a month's time, complete recovery has taken place
+and the subject may be gradually returned to work.
+
+When synovial distensions are of long standing, it is necessary to take
+special precautions to check excessive secretion of synovial fluid, and,
+also because of the atonic condition of the tissues affected, resolution
+is tardy. In addition to aspirating synovia, the introduction of equal
+parts of alcohol and tincture of iodin into the theca is necessary. The
+quantity of this combination injected, depends upon the size of the
+sheath affected and the amount of synovia retained at the time injection
+is made. Experience is necessary to judge as to this part of the work,
+but one may consider that a quantity between three and ten cubic
+centimeters of equal parts of tincture of iodin and alcohol constitutes
+the proper amount to employ. Where much synovia is contained within the
+sheath at the time of injection, there occurs great dilution of the
+agent injected and consequently less irritation results.
+
+The object of such injections is to check synovial secretion, and this
+is sought by the local effect of iodin in contact with the secreting
+cells together with the reactionary swelling which occasions pressure.
+An increase in the local blood supply also follows. In all cases where
+it is possible to employ suitable bandages, this should be done. The
+ordinary derby bandages serve well and if their use is continued for a
+sufficient length of time, good results follow.
+
+There are other methods of treating these affections, and each has its
+advantages and disadvantages. Line-firing, instead of the vesicant is
+made use of by some, but the object desired is the same and results
+obtained are similar.
+
+Sheaths may be opened surgically by means of a knife, and the removal of
+a portion of the wall of distended and atonic tendon sheaths is
+possible. These operations belong to the realm of surgery and are not
+properly a part of this treatise. However, in passing, it may be said
+that if a perfect technic is possible in doing the last named
+operation, a permanent recovery is the outcome.
+
+
+Fracture of the Metacarpus.
+
+Etiology and Occurrence.--As the result of all sorts of violence, such
+as falls and injuries in accidents of various kinds wherein the
+metacarpals are subjected to contusions, fractures may result. In the
+horse it is unusual for fracture of one of the small metacarpal bones to
+take place without there being at the same time a fracture of the third
+(large) metacarpal bone.
+
+Classification.--Fractures of the metacarpal bones as they occur, are
+as likely to be compound as simple, and the multiple and comminuted
+varieties are occasionally observed. The manner in which the third
+(large) metacarpus is fractured, largely determines the outcome in any
+given case.
+
+Symptomatology.--Abnormal mobility of the broken parts of bone and
+crepitation mark fracture of the metacarpus, and the condition is easily
+diagnosed. In many instances, when compound fracture exists, broken ends
+of bone are protruding through the skin. No weight is borne upon the
+fractured member ordinarily, although during the excitement occasioned
+by runaways, horses are sometimes seen to support weight with a broken
+leg even when the protruding bone is sunk into the ground in so doing.
+
+Prognosis.--Generally speaking, fractures other than the
+simple-transverse in young animals, are considered unfavorable cases.
+With the metacarpus, however, there are instances where compound
+fracture occurs in colts that justify treatment. But in all cases of
+compound fracture, the element of infection in addition to the increased
+difficulty in maintaining immobility of the broken bone, creates almost
+insuperable difficulties in the average instance. And unless the
+practitioner distinctly explains to his client the various reasons which
+make treatment an economic impracticability, dissatisfaction is likely
+to follow if treatment is instituted without such an understanding.
+
+Treatment.--Perfect apposition of the broken ends of bone is easily
+effected and less difficulty is encountered in maintaining such
+relations in metacarpal fractures than in fractures of the radius.
+However, reduction and immobilization of this as in all fractures, must
+be done without delay. In simple fracture, the metacarpus is covered
+with enough cotton to pad the parts, and this is retained in position by
+bandages. Splints of heavy leather or of thin pieces of tough flexible
+wood are placed on each side of the leg and firmly held in position with
+bandages. Bandages may be put on in layers and a coating of glue applied
+over each layer if this is thought necessary. The advantage gained in
+using glue or other adhesive materials is that the cast thus formed is
+more rigid than where such material is not employed. On the other hand,
+all elasticity is lost as soon as the cast adapts itself to the contour
+of the extremity, and because of this rigidity, it is doubtful if
+anything is gained by the incorporation of glue, except in the way of
+added strength of the cast. Since the animal does not walk upon the
+broken leg, it is possible to employ splints of suitable materials which
+are retained in position without glue and frequent readjustment of a
+part of the immobilizing apparatus is possible. This is impossible with
+casts.
+
+In compound fractures, provision ought to be made for dressing the wound
+of the soft structures. This entails adjusting the splints in such
+manner that one splint may be retained and others removed for dressing
+the wound and readjusted as often as wound dressing is necessary.
+
+
+Splints.
+
+By this term is meant a condition where there exists an exostosis which
+involves usually the second (inner small) and third (large) metacarpal
+bones. While an exostosis involving any one of the splint bones, even
+when directly caused by an injury, is called a "splint," the term is
+employed here, in reference to exostoses not due to direct injury such
+as in contusions.
+
+Etiology and Occurrence.--This condition is one wherein there is
+osseous formation following a periostitis and the region of the upper
+portion of the second (inner small) metacarpal bone is the usual site of
+the exostosis. There is incited an inflammation of the periosteum at
+the site of the interosseous ligament which attaches the small to the
+large metacarpal bone. This ligament is involved in the inflammatory
+process, and according to Havemann, whose view is supported by Moller,
+this inflammation is the origin of the trouble.
+
+Various theories attempting an explanation of the frequent affection of
+this one certain part so regularly involved have been offered, but no
+proof of the correctness of any exists. It follows, however, that
+splints occur in young animals; that the affection seldom starts in
+subjects that are ten years of age or older, and that when the exostosis
+has formed, lameness usually subsides. Anything which will cause undue
+strain or irritation of the metacarpal bones in young animals, is quite
+apt to result in a splint being formed. Concussion such as is caused by
+fast work on hard roads, or work on rough or irregular road surfaces
+which cause unequal distribution of weight, will cause splint lameness
+and exostosis follows.
+
+[Illustration: Fig. 16--Posterior view of radius (right) illustrative of
+effects of splint. Note the extent of exostosis.]
+
+Course.--Because of the peculiar manner in which the second and third
+metacarpal bones articulate in young animals, until the bones become
+ossified and permanently joined, the inflammation which attends the
+acute stage of this affection, causes lameness. Later, unless an
+unusually large exostosis is formed, which may cause a constant
+irritation due to its size and juxtaposition to the carpus, lameness is
+discontinued.
+
+Symptomatology.--Lameness is usually the first manifestation of this
+disorder, and the thing which characterizes splint lameness is its
+peculiar intermittence. There is a mixed form of lameness which may not
+be in evidence when an affected animal is started on a drive, but which
+is marked after the subject has gone some distance. The animal may,
+however, go lame throughout the whole of a drive and continue to be lame
+for several days or weeks in some cases. It is noticeable that lameness
+is augmented or produced when the subject travels on rough road surfaces
+and that little or no difficulty is encountered when roads are smooth.
+
+The heavy brachial fascia is inserted in part to the head of the second
+metacarpal (inner small) bone together with the oblique digital extensor
+(extensor metacarpi obliquus) and this explains the reason for pain
+being manifested during extension of the member.
+
+Before there is a visible exostosis, supersensitiveness is readily
+recognized upon palpation of the parts, if careful comparison is made
+between the sound and unsound members. However, frequently splints occur
+on both forelegs at the same time and in some instances exostoses are
+several in number upon each member affected. In some instances, the
+affection involves the outer splint bone and no evident involvement of
+the inner one exists.
+
+Treatment.--At the onset complete rest should be provided and the
+local application of some good cataplasm is in order. A stimulating
+liniment is beneficial when employed several times daily and massage is
+also quite helpful. Later, the application of a blistering ointment is
+good treatment. The use of the actual cautery stimulates prompt
+resolution, but there is seldom any resorption of products of
+inflammation following firing. Whereas, in cases where other treatment
+is begun early, there usually follows considerable diminution in the
+size of the exostosis. A rest of four or five weeks is necessary and
+very young animals should not be put to work too soon, if the character
+of the work is such as to induce a recurrence of the trouble.
+
+Many cases are treated successfully in draft types of animals (where the
+subjects are not kept at work that occasions serious irritation to the
+affected parts) by blistering the exostosis repeatedly and allowing the
+animals to continue in service. In such cases, it is unreasonable to
+expect to check the size of the exostosis and, of course, such methods
+are not employed where lameness causes distress to the subject.
+
+Firing usually causes prompt recovery from lameness and is a dependable
+manner of treating such cases but there remains more blemish following
+cauterization than where vesication is done.
+
+
+OPEN FETLOCK JOINT.
+
+This condition, because of the frequency with which it occurs may be
+taken as typal, from the standpoint of treatment and results obtained
+therefrom. While it serves to constitute a basis from which other
+joints, when open, are to be considered, due allowance must be made for
+the fact that, as has been previously mentioned, some articulations when
+open constitute cause for grave consequences; while with others an open
+capsule, even when infected, does not cause disturbance enough to be
+classed as difficult to handle. Moreover, the fetlock joint is admirably
+suited, anatomically, to bandaging; and when wounded, is easily kept
+protected by means of surgical dressings. This fact is of great
+importance in influencing the course and termination in any given case
+of open fetlock joint and should not be forgotten.
+
+There is no logical reason for comparing the pedal joint with the
+pastern on the basis that it may also be completely and securely
+bandaged. Open navicular joint does not occur, as a rule, except by way
+of the solar surface of the foot, and the introduction of active and
+virulent contagium is certain to happen; consequently, an acute
+synovitis quickly resulting in an intensely septic and progressively
+destructive arthritis soon follows in perforation of the capsule of the
+distal interphalangeal articulation.
+
+Etiology and Occurrence.--Wounds of the fetlock region resulting in
+perforation or destruction of a part of the capsular ligament are caused
+by all sorts of accidents, such as wire cuts, incised wounds occasioned
+by plowshares, disc harrows, stalk cutters and other farming implements.
+In runaways the joint capsule is sometimes punctured by sharp pieces of
+wood or other objects. In horses driven on unpaved country roads the
+fetlock is occasionally wounded by being struck against the sharp end of
+some object, the other end of which is firmly embedded in the ground. In
+one instance the author treated a case wherein the fetlock joint was
+perforated by the sickle-guard of a self-binder. In this case there
+occurred complete perforation causing two openings through the
+_cul-de-sac_ of the joint. Such wounds are produced by implements which
+are, to say the least, non-sterile, and this perforation of the
+uncleansed skin conveys infectious material into the joint capsule. Yet
+in many instances, especially in country practice, no infectious
+arthritis results where cases are promptly cared for.
+
+Symptomatology.--A difference in the character of symptoms is
+evidenced when dissimilar causes exist. Small penetrant wounds which
+infect the synovial membranes cause infectious arthritis in some cases,
+whereas a wound of sufficient size to produce evacuation of all synovia
+will, in many instances, cause no serious distress to the subject, even
+when not treated for several days. If it is not evident that an open
+joint exists and the articular cavity is not exposed to view a positive
+diagnosis may be early established by carefully probing the wound. In
+some cases where a small wound has perforated the joint capsule,
+swelling and slight change of relation of the overlying tissues may
+preclude all successful exploratory probing. In such instances it is
+necessary to await development of symptoms. Twenty-four hours after
+injury has been inflicted, there is noticeable discharge of synovia
+which coagulates about the margin of the orifice, where synovial
+discharge is possible. Particularly evident is this accumulation of
+coagulated synovia where wounds have been bandaged--there is no
+mistaking the characteristic straw-colored coagulum which, in such
+cases, is somewhat tenacious.
+
+No difference exists between other symptoms in infectious arthritis
+caused by punctures, and non-infectious arthritis, excepting the
+intensity of the pain occasioned, the rise in temperature, circulatory
+disturbances, etc.; all of which have been previously mentioned.
+
+Treatment.--Just as has been stated in discussions on the subject of
+open joint, probing or other instrumentation is to be avoided until the
+exterior of the wound and a liberal area surrounding has been thoroughly
+cleansed--too much importance can not be placed on this preliminary
+measure. In cases of open joint where ragged wound margins exist and the
+interior of the joint capsule is contaminated, much time is required to
+thoroughly cleanse all soiled parts. In some instances an hour's time is
+required for this cleansing process after the subject has been
+restrained and prepared. In order to thoroughly cleanse these delicate
+structures without doing them serious injury, one ought to be skillful
+and careful in all manipulations of the exposed parts of the joint
+capsule.
+
+The general plan of treatment, after preliminary cleansing has been
+accomplished, has been outlined on page 66 in the consideration of
+scapulohumeral joint affections. The injection of undiluted tincture of
+iodin in ounce quantities, it must be remembered, is not to be done
+unless there is provision for its free exit. Where good drainage from
+the joint cavity exists all infected wounds should be thus treated, and
+this treatment may be repeated as conditions seem to require--until
+infection is checked.
+
+If daily injections are necessary, dilution of the tincture of iodin
+with an equal amount of alcohol is advisable in order to avoid doing
+irreparable damage to the articular cartilages and synovial membranes.
+
+An antiseptic powder composed of equal parts of boric acid and
+exsiccated alum is employed to protect the wound surfaces and the
+margins, and the parts are then bandaged. In bandaging wounds of this
+kind a liberal amount of cotton should be employed, and after a large
+surface surrounding the wound has been thoroughly cleansed, it must be
+so kept thereafter. This is impossible, if one uses a small amount of
+cotton, particularly if such meager quantity of dressing material is
+carelessly wrapped in position with an insufficient amount of bandage
+material. Mention, without description of the elemental problem of
+applying cotton and bandages to a wound, would be sufficient, were it
+not that this is a very important part of the handling of such cases,
+and many practitioners are not only thoughtless in this part of their
+work, but also apparently careless. What does it profit to prepare a
+part and cleanse a wound with painstaking care and then neglect to take
+every possible precaution to prevent its subsequent contamination?
+
+In the handling of open joint capsules where the perforation of the
+capsular ligament is small and discharge of synovia does not immediately
+follow, there is presented a problem which is difficult to decide upon
+and that is the manner in which such wounds are to be handled. One
+hesitates to enlarge such openings to drain or irrigate the capsule when
+there is no proof that serious trouble will follow because of infectious
+material which has probably been introduced at the time the wound was
+inflicted. It is especially difficult to decide upon the manner of
+handling such cases where the tarsal joint is wounded, although one
+hesitates to invade any joint to the extent of incising its capsule,
+unless there is urgent need of so doing.
+
+Frost[19] offers the following suggestion in such instances:
+
+     The treatment recommended by us for open joints, in which we wish
+     to prevent ankylosis, is, first, to shave all hair from the area
+     surrounding the wound, following with a thorough cleansing of the
+     skin and disinfection of the wound, and then to inject a twenty per
+     cent Lugol's solution in glycerin into the wound. This should be
+     repeated two or three times a day, each time enough of the solution
+     being injected to fill the joint capsule, thereby securing the
+     flushing effect. As this solution does not cause irritation to the
+     tissue and yet is a strong antiseptic, it serves to shorten the
+     period of congestion and inflammation and to overcome the infection
+     without causing a destruction of the secreting membrane until the
+     external wound has had time to heal. The injection of this solution
+     seems to retard the excessive secretion of synovia. The larger the
+     joint capsule and the smaller the external wound, the longer our
+     antiseptic will remain in contact with the inflamed tissues as the
+     glycerin, being thick, does not flow through a small opening.
+
+After-care.--Following the initial cleansing and treatment of open
+joint, subsequent dressing is necessary as frequently as conditions
+demand. If the parts are badly infected and profuse discharge of pus
+exists a daily change of dressings is necessary. In the average
+instance, however, semi-weekly treatments are sufficient. And in many
+instances where one is obliged to travel a considerable distance to
+handle the affected animal one weekly dressing of the wound will suffice
+after the second treatment.
+
+The same general plan of treatment concerning the subject's comfort that
+has been previously mentioned in arthritis, is carried out here. A
+further and detailed consideration of the subject of handling of open
+joints follows.[20]
+
+     * * * Such wounds may be classified in two general groups as
+     follows: First, wounds in which the trauma has exposed the
+     articulation to view, and second, those the result of punctures, in
+     which the external wound is small and free drainage is lacking.
+
+     Wounds in which the articulation is exposed to view have drainage
+     either all ready provided for, or it is established without
+     hesitancy surgically. With free drainage thus established there is
+     little or no chance for the adjacent tissues to become infiltrated
+     with infected wound discharge. This prevents an extension of the
+     injury and the establishment of a good field for the growth of
+     anaerobic bacteria.
+
+     Open joints caused by punctures, unless the puncture is aseptic,
+     produce a swelling which is more painful than is the open wound
+     which exposes the joint to view. Especially is this true if the
+     puncture is of small diameter, allowing the tissues to partially
+     close the opening immediately after the wound has been made. Where
+     drainage is lacking there follows an exudation which congests the
+     tissues surrounding the injury and all factors favoring germ growth
+     are present. It is perhaps advisable to establish good drainage in
+     such cases as soon as a diagnosis is made.
+
+     It is not always an easy matter to recognize an open-joint, when
+     first made, but twelve to twenty-four hours later there is no cause
+     for doubt. The condition is then a very painful one; lameness is
+     excessive; there is rise in temperature; acceleration of the pulse
+     and manipulation or palpation of the region affected, occasions
+     great pain.
+
+     The treatment of open joints must be varied to suit the disposition
+     of the animal, the nature and location of the injury, the length of
+     time intervening between the infliction of the wound and the first
+     attention given, and the surroundings in which the patient is kept.
+
+     In each and every case in which there exists an open wound the
+     surface surrounding the wound is cleansed thoroughly, the hair is
+     shaved if possible, and the margin of the wound is curretted and
+     cleansed thoroughly with antiseptic solutions.
+
+     If there is evidence that the articulation contains infective
+     material, it is washed out with copious quantities of peroxide of
+     hydrogen--usually as much as six or eight ounces. This is followed
+     by injection of an ounce or two of tincture of iodin. Even though
+     the joint appears to be clean some tincture of iodin is used, as it
+     checks the secretion of synovia and is, in every way, beneficial.
+     Care is taken to apply the iodin also to the surface immediately
+     surrounding the wound. The entire wound is then covered with a
+     dusting powder composed of zinc oxide, boric acid, exsiccated alum,
+     phenol and camphor.
+
+     This powder is used in abundance and the wound is then covered with
+     a heavy layer of absorbent cotton and well bandaged. This bandage
+     is not disturbed for at least three days and may be left in place
+     for a week. In cases in which it is necessary to keep the dressing
+     on for a week, or in cases where the patient is, through necessity,
+     kept in quarters that are wet or unclean, the first bandage is
+     covered with a layer of oakum which has been saturated in oil of
+     tar and this in turn is held in place by means of several layers of
+     bandages. The bandages are also saturated with oil of tar.
+
+     In from one to two months wounds so treated, unless they are
+     foot-wounds, will be ready to dress without being bandaged. It is
+     ordinarily unnecessary to dress foot-wounds oftener than every
+     second week after the discharge of synovia has ceased. When the
+     wound has filled with granulation, a protective dressing is applied
+     which is rendered water proof by the use of bandages covered with
+     oil of tar. The patient can now be turned out for a month or six
+     weeks without disturbing the dressing. After the removal of the
+     bandages, the only treatment necessary is an occasional application
+     of some mildly antiseptic ointment.
+
+     Except in nail pricks of the foot, occasioned by punctures, a five
+     per cent tincture of iodin is injected into open joints, if the
+     wound remains sufficiently open, and this treatment is continued so
+     long as there is a discharge of synovia. Surgical drainage is
+     established if it is considered practicable and the remainder of
+     the treatment is about the same as for wounds which are open.
+
+     Open joints occur in horses at pasture and are sometimes not
+     discovered until several days or a week after the injury, and in
+     some instances the wounds are filled with maggots. The only
+     difference in the treatment of these cases is that more time and
+     care is taken in cleansing the wound, more curetting is necessary,
+     and after cleansing the wound with peroxide of hydrogen, the joint
+     is thoroughly washed out with equal parts of tincture of iodin and
+     chloroform. This is followed by the injection of a quantity of
+     seventy-five percent alcohol and the wound is dressed and bandaged
+     as already described. At each subsequent dressing of infected
+     wounds so treated less suppuration is noticed and the synovial
+     discharge usually ceases in from one to two months.
+
+     About _ninety percent of all cases of open joint make complete
+     recoveries_, about four per cent partially recover and six per cent
+     are fatal. Among the fatal cases are the open joints with
+     complications as severed tendons, those occasioned by calk wounds
+     in horses that are stabled, and nail punctures of the feet. The
+     following report of twelve favorable cases is taken from a record
+     of sixty-two cases. The favorable ones are reported, chiefly
+     because there are now enough reports on record of such cases which
+     have terminated fatally.
+
+     Case 1.--A gray gelding used as a saddle pony received a
+     horizontal wire cut laying completely bare the scapulohumeral
+     articulation. The margins of the wound were cleansed as heretofore
+     described, a drainage was provided surgically, tincture of iodin
+     was injected and the wound was covered with equal parts of boric
+     acid and exsiccated alum. The horse was kept tied and a diluted
+     tincture of iodin was injected into the wound once daily and the
+     powder applied often enough to keep the wound covered. The case
+     made a complete recovery and the pony was again in service within
+     sixty days.
+
+     Case 2.--A twelve-hundred-pound bay mare with an open carpal
+     joint. The wound was an open one about two and one-half inches in
+     length, and made transversely and when the member was flexed the
+     articular surface of the carpal bones were presented to view. An
+     ounce of tincture of iodin was injected into this joint after
+     having cleansed the margin of the wound and the mare was cross-tied
+     in a single stall to keep her from lying down. The owner was
+     instructed to keep the outside of the wound powdered with air
+     slaked lime and a very unfavorable prognosis was given.
+
+     I heard nothing further from this case until fifty-nine days from
+     the date of the injury, when I met the owner driving this mare to a
+     buggy. The wound had healed by first intention and at that time so
+     little cicatrix remained that it was difficult to find it.
+
+     Case 3.--A brown mare with an open fetlock joint due to a
+     spike-nail puncture. Lameness was excessive, and joint greatly
+     swollen. Tincture of iodin was injected into the wound and towels
+     dipped in hot antiseptic solutions were applied for several hours
+     daily until the acute stage had passed. Later the mare was turned
+     out to pasture and a vesicant was applied once or twice a month
+     until recovery was complete which was in about six months.
+
+     Case 4.--A four-year-old bay mare having a wire-cut which opened
+     the tarsus joint was treated as heretofore described. The wound was
+     kept bandaged for about two weeks and later it was dressed without
+     being bandaged. In ninety days she had completely recovered.
+
+     Case 5.--A twelve-year-old mare with an open fetlock joint due to
+     a puncture wound. The margins of the wound were cleansed and the
+     external wound enlarged to facilitate drainage. Tincture of iodin
+     was injected; the wound was bandaged and dressed for a month in the
+     manner heretofore described, when all discharge had stopped. A
+     vesicant was applied; the mare was put to pasture and within sixty
+     days from the date of the injury she was being driven on short
+     trips.
+
+     Case 6.--A two-year-old brown gelding with a wire-cut on the left
+     front foot. The wound extended down through the sole and opened the
+     navicular joint. This colt was very wild and it was necessary to
+     tie it down each time the wound was dressed. The wound was dressed
+     weekly for a month and less frequently thereafter. It was handled
+     eight times; the last dressing was left in place until worn out.
+     Six months later the colt was practically well, a very little
+     lameness being shown when walking on frozen ground.
+
+     Case 7.--A seven-year-old saddle-horse weighing eleven hundred
+     and fifty pounds received a wound of the tarsus, laying bare the
+     articular surfaces of a part of the joint. It was impossible to
+     keep this wound bandaged because of the restless disposition of the
+     subject. Injections of a dilute tincture of iodin were employed
+     every second or third day for a month and the wound was kept
+     covered with the antiseptic dusting powder referred to heretofore.
+     In five months complete recovery had taken place, with the
+     exception of a stubborn skin disturbance which was successfully
+     treated six months after the wound was inflicted. The horse is
+     still in use and is absolutely free from lameness.
+
+     Case 8.--A two-year-old brown gelding with a wire-wound opening
+     the scapulohumeral joint. This wound was large enough to expose to
+     view the articular portion of the humerus. The same treatment as
+     that given case No. one was instituted and in ninety days the colt
+     was practically well.
+
+     Case 9.--A three-year-old bay filly was found at pasture with one
+     fore foot badly injured. The owner intended to destroy her, but a
+     neighbor prevailed upon him to have her treated. Apparently the
+     wound was of about a week's standing and in a very bad condition,
+     filled with maggots and dirt. Both the navicular and coronary
+     articulations were open. This wound was cleansed in the usual
+     manner and the owner cared for the case the balance of the time
+     because the distance from my office was too great to give her
+     personal attention. She made an almost complete recovery in five
+     months.
+
+     Case 10.--At two-year-old mule with an open navicular joint due
+     to a barbed wire wound. Usual care was given this case and in five
+     months recovery was complete and little scar is to be seen. This
+     case received seven treatments.
+
+     Case 11.--An eighteen-months-old colt at pasture was found down
+     and unable to rise without help. In addition to several wounds of
+     lesser importance there was a large wound on the inner side of the
+     elbow, the joint was open and the entire leg was greatly swollen
+     and in a state of acute infectious inflammation. The colt could not
+     walk, its temperature was 105 deg., pulse was rapid and respiration was
+     a little hurried. After advising the owner to put the poor animal
+     out of its misery I left the place. Four days later the owner came
+     to my office and asked if he could borrow some old shears to "trim
+     off some loose hide from that colt." He left the colt in the
+     pasture and all the care it received was the regular application of
+     a proprietary dusting powder. It made a complete recovery.
+
+     Case 12.--A family mare, heavy in foal, received a vertical wound
+     of the fetlock joint inflicted by a disc-harrow. The _cul-de-sac_
+     of the ligament of this joint was opened freely. The wound was
+     dressed in the usual manner and again three days later when no
+     suppuration had taken place. Four days later the patient gave birth
+     to a colt and suckled it right along through her convalescence.
+     This wound healed by first intention and seventy-nine days from the
+     date of the injury the mare was driven to town, two and one-half
+     miles distant, and showed but little lameness.
+
+
+Phalangeal Exostosis (Ringbone)
+
+This term is applied to exostoses involving the first and second
+phalanges (suffraginis and corona), regardless of their size, extent or
+location. It is a misnomer, in a sense, and the veterinarian is
+frequently obliged to spend considerable time with his clients in order
+to convince them that a spherodial exostosis of the proximal phalanx, in
+certain cases, is in reality "ringbone," even though there exists no
+exostosis which completely encircles the affected bone.
+
+Etiology and Occurrence.--Exostosis of the first and second phalanges
+is usually due to some form of injury, whether it be a contusion, a
+lacerated wound which damages the periosteum, or periostititis and
+osteitis incited by concussions of locomotion, or ligamentous strain.
+Practically the only exception is in the rachitic form of ringbone which
+affects young animals.
+
+There are predisposing causes that merit consideration, chief among
+which is the normal conformation of the coronet joint. This proclivity
+is constant; the normal interphalangeal articulation is an incomplete
+ginglymoid joint and while its dorso-volar diameter is great, this in no
+wise compensates for its disproportionately narrow transverse diameter.
+The pivotal strain which is sometimes thrown upon this articulation when
+an animal turns on one foot, as well as the tension which is put on the
+collateral ligaments when the inner or the outer quarter of the foot
+rests in a depression of the road surface, tends to detach the insertion
+of these ligaments or to cause fibrillary fractures of their substance.
+
+Short, upright, pasterns receive greater concussion during fast travel
+on hard roads than do the longer more sloping and well formed
+extremities. Those who are advocates of the theory that this type of
+osteitis with its complications has its origin in the articular portion
+of the joint, claim that the upright pastern constitutes an important
+tendency toward ringbone. Howbeit, ringbone is an active, serious and
+frequent cause of lameness and it affects animals of all ages and occurs
+under various conditions. Horses having good conformation and kept at
+work wherein no great amount of strain is put upon these parts, are
+occasionally victims of this affection.
+
+Classification.--The arrangement employed by Moller[21] is intensely
+practical and logical. He considers ringbone as _articular_,
+_periarticular_, _rachitic_ and _traumatic_. A mode of classification
+that is common and in a practical way, good, is, high and low ringbone.
+When prognosis is considered, for instance, it is very convenient to
+state that the chances for recovery are much better in high ringbone
+than in low ringbone. The classification of Moeller will be followed
+here.
+
+[Illustration: Fig. 17--Phalangeal exostoses.]
+
+Symptomatology.--In all forms of incipient ringbone except rachitic,
+the first manifestation of its existence, or of injury to the ligaments
+in the region of the pastern joint which causes periostitis, or
+affections of the articular portions of the proximal inter-phalangeal
+joint, is lameness. Lameness which typifies ringbone is of the
+supporting-leg variety and by compelling the subject to step from side
+to side, marked flinching is observed, especially in periarticular
+ringbone; causing the affected animal to turn abruptly on the diseased
+member, using it as a pivot, likewise accentuates the manifestation. In
+fact, many subjects that exhibit no evidence of locomotory impediment
+while walking or trotting in a straight line on a smooth road surface,
+will manifest the characteristic form of lameness from ringbone when the
+aforementioned side to side movement is performed.
+
+When the manner in which pain is occasioned is considered, it will be
+understood why lameness is intermittent in the early stages of this
+affection and may even be unnoticed by the driver. An animal may travel
+on a smooth road without giving evidence of any inconvenience, but as
+soon as a rough and irregular pavement or road surface is reached, will
+limp. As the subject is driven farther on level streets the lameness may
+disappear. This intermittent type of lameness may continue until there
+is developed a large exostosis, or until articular involvement causes so
+much distress during locomotion that lameness is constant. On the other
+hand, resolution may occur during the stage of periosteal inflammation,
+or, an exostosis forms which causes no interference with function.
+
+[Illustration: Fig. 18--Rarefying osteitis in chronic ringbone and
+ossification of lateral cartilages.]
+
+Before there is evidence of an exostosis, diagnosis of ringbone is not
+easy, for it is then a problem of detecting the presence of a
+ligamentous sprain, periostitis, or osteitis. The diagnostician should
+take note of local manifestations of hypersensitiveness, or heat if such
+exist, and, in addition, other conditions must be excluded before
+definite conclusions are possible.
+
+In _articular_ ringbone as soon as there is developed an exostosis, it
+occupies a position on the dorsal (anterior) part of the articulation
+and extends around the sides of the joint.
+
+_Periarticular_ ringbone is characterized by exostoses which are
+situated on the sides of the phalanges and not extending around to the
+anterior part of the joint. This type of ringbone as well as the
+articular may occur "high" or "low."
+
+[Illustration: Fig. 19--Phalangeal exostoses in chronic ringbone. Museum
+specimen of the Kansas City Veterinary College.]
+
+With the _traumatic_ form of ringbone, all consequences, as to the size
+and form the exostosis is to assume, depend upon the nature and extent
+of the injury.
+
+_Rachitic_ ringbone is frequently observed in some sections of the
+country and does not ordinarily cause much if any lameness. It is a
+disease of colts and may affect one or all of the phalanges at the same
+time. As the subject advances in age there is more or less diminution in
+the size of the enlargements.
+
+Treatment.--Rest is essential in the treatment of ringbone. If
+diagnosed during its incipiency, remedial measures such as are usually
+employed to treat sprains, are indicated and later the parts should be
+blistered. When an exostosis has developed puncture firing is the remedy
+_par excellence_. Not that this method of treatment is infallible, for
+to any thinking one who takes into consideration the pathological
+anatomy of this condition, it is evident that no manner of treatment is
+beneficial in some cases. If the exostosis is so situated that it does
+not mechanically interfere with function, and is not so large that it
+may inhibit flexion and extension, and where the articular portions of
+the joint are not eroded, good results attend the use of the actual
+cautery.
+
+In firing, after having anesthetized the extremity, and prepared the
+surgical area, the cautery is deeply inserted in numerous places, taking
+care, however, not to open the joint. The parts are immediately covered
+with aseptic absorbent cotton and this dressing is left in position for
+forty-eight hours and if perchance there is evidence of synovial
+discharge, the parts are again aseptically dressed in order to prevent
+infection of the articulation. If, as is the case usually, no
+perforation of the joint capsule exists, the openings made by the
+cautery have been closed by the coagulation of serum and there is then
+little chance of infection causing trouble, even though the member is
+left unbandaged.
+
+In several instances, the author has treated ringbone by this method
+where the periarticular type existed and lameness was marked, and in
+three weeks the subjects were in service and not lame--this, in one
+instance in a valuable polo pony where the subject continued in service
+for more than a year without any evidence of recurrence of the lameness.
+The production of a deep-seated and acute inflammation with the actual
+cautery is preferable to any sort of counter-irritation which may be
+produced by vesicants.
+
+There is no occasion for any difference in the treatment of either of
+the first three classes of ringbone, but in the rachitic type where
+treatment is given, the application of a vesicant is all that is
+required. In most instances treatment is not necessary.
+
+The affected animals require a month to three months' time for recovery
+to take place in the average favorable cases of ringbone.
+
+Median neurectomy is of service in many instances where lameness is not
+completely relieved by the use of the actual cautery and no bad results
+attend the performance of this operation even though no benefit is
+derived thereby. Plantar neurectomy is contraindicated in all cases
+where there exists much lameness. If lameness is due to acute
+inflammation bad results such as sloughing and loss of the hoof may
+follow; and if large exostoses mechanically interfere with function of
+the joint, or where articular erosions exist, no possible good can come
+from neurectomy. Careful discrimination should be employed in selecting
+cases for neurectomy for this operation; otherwise, it is very likely to
+prove disappointing.
+
+
+Open Sheath of the Flexors of the Phalanges.
+
+This condition does not differ from a like affection involving other
+tendons except that the function of these tendons is such that large
+synovial sheaths are necessary, and when synovitis exists, the condition
+then becomes more serious.
+
+Infectious synovitis involving these tendons in the fetlock region is of
+more frequent occurrence than a like affection of carpal or tarsal
+sheaths. With the exception of the extent of the involvement and
+distress occasioned thereby, synovitis the result of open tendon
+sheaths, is similar wherever it occurs.
+
+Etiology.--The same conditions which are responsible for open fetlock
+joint and other wounds of the pastern region, cause open tendon sheaths
+of the flexor tendons.
+
+Symptomatology.--Because of the size and extent of this sheath and the
+different manner in which it is opened, there is manifested dissimilar
+symptoms in different cases. A nail puncture which perforates the sheath
+in the pastern region and at the same time produces an infectious
+synovitis, will cause a markedly different manifestation than will a
+wound which freely opens the sheath above the fetlock. In the first
+instance, the condition is much more painful; swelling is intense in
+some cases; and if the subject does not possess sufficient resistance so
+that spontaneous resolution promptly occurs, surgical evacuation of pus
+is usually necessary. When these tendon sheaths are opened, there
+follows a reaction which is quite analogous to that which exists in
+arthritic synovitis, but instead of ankylosis, adhesions with thecal
+obliteration occur. Rarely there result cartilaginous and osseous
+formations.
+
+The constitutional disturbances which characterize this condition vary
+with the degree of distress occasioned. As the infection is virulent and
+causes serious destruction of the affected parts, so does evidence of
+malaise and finally distress appear. Detailed discussions of
+symptomatology in similar conditions have heretofore been given, and
+further repetition is unnecessary.
+
+Treatment.--The same general plan of treatment which is employed for
+handling open joint is put in practice in these cases. Following the
+preoperative cleansing of the external wound and adjacent surfaces,
+where liberal drainage exists, tincture of iodin is injected into the
+sheath, the parts covered with a suitable dressing powder, and the
+entire member is carefully dressed with cotton and bandages.
+
+Subsequent treatment is the same as has been outlined in the discussion
+of open fetlock joint on page 112. The same general plan of after-care
+is necessary. Recovery, however, does not require so much time
+ordinarily, yet punctures of the sheath occasioned by nails or other
+small implements make for long drawn out cases of infective synovitis.
+
+
+Luxation of the Fetlock Joint.
+
+Etiology and Occurrence.--The manner of construction of the fetlock
+joint is such that disarticulation without irreparable injury resulting,
+is practically impossible. Logically, this joint in the fore legs (not
+so in the pelvic limbs) should disarticulate in such manner that either
+all of the inhibitory apparatus (flexor tendons and suspensory ligament)
+must rupture or a lateral luxation is necessary. Lateral disarticulation
+must necessarily sever the attachment of one of the common collateral
+ligaments. Because of the width (transverse diameter) of the
+articulating surfaces of this joint, lateral luxation requires a great
+strain; and a force that is sufficient to occasion this trauma usually
+causes serious additional injury. Therefore, the condition is considered
+one wherein prognosis is always unfavorable in so far as practical
+methods of treatment are concerned.
+
+Mr. A. Barbier[22] reports a case of bilateral luxation of the fetlock
+joints of the hind legs in a horse. This was done in jumping, and the
+extensor tendon of each leg was ruptured and the anterior portion of the
+metatarsus was protruding through the skin. Profuse hemorrhage had taken
+place due to tearing of the blood vessels.
+
+Symptomatology.--Entire luxation of this joint when present is so
+evident that one cannot fail to recognize the condition. Complete
+disarrangement of normal relation occurs and there is either a breaking
+down of the inhibitory apparatus, or if a lateral disarticulation
+exists, the normally straight line formed by the bones of the front leg,
+as viewed from the front or rear, is broken at the fetlock.
+
+Often fracture of bones are concomitant and then, of course, mobility is
+increased and not decreased as is the case in uncomplicated luxation.
+
+Such violence occurs at times, when this joint is disarticulated, that
+the joint capsule is also completely ruptured and the articular portion
+of the bones is exposed to view.
+
+Treatment.--The condition being practically a hopeless one,
+destruction of the subject is the thing which should be promptly done.
+In valuable breeding animals, owners may prefer that treatment be
+attempted when a lateral luxation and detachment of but one common
+ligament have permitted luxation without complete disarticulation and
+rupture of the joint capsule. In such cases, by immobilizing the
+affected parts as in fracture, and confining the subject in a sling for
+about sixty days, partial recovery may occur in some instances.
+
+Experience has shown that where luxation with detachment of a
+collateral ligament occurs, recovery is slow and incomplete--there
+always results considerable exostosis at the site of injury.
+
+
+Sesamoiditis.
+
+Etiology and Occurrence.--Inflammation of the proximal sesamoid bones
+is caused by any kind of irritation which may involve this part of the
+inhibitory apparatus. Positioned as they are, between the bifurcations
+of the suspensory ligament and the pastern joint, they serve as fulcra
+and effectively assist in minimizing concussion which is received by the
+suspensory ligament. The flexor tendons also, in contracting, exert
+strain upon the inter-sesamoidean ligament, which has a similar effect
+upon the sesamoid bones as that which is produced by the suspensory
+ligament.
+
+The condition occurs quite frequently, and because of the important
+function performed by these bones, active inflammation of the sesamoids
+constitutes a serious affection. Because of the fact that these bones
+have proportionately large articular surfaces, when they are inflamed to
+the extent that degenerative changes affect the articular cartilage,
+complete recovery seldom results.
+
+The same pathological changes occur here that are to be seen in any case
+of arthritis. No special pathological condition characterizes
+sesamoiditis but this condition causes incurable lameness when the
+sesamoid bones are much inflamed.
+
+Symptomatology.--In acute inflammation, there exist all the symptoms
+which portray any arthritic inflammation of like character. The parts
+are readily palpable and are found to be hot, supersensitive, and more
+or less infiltration of the tissues contiguous to the joint causes
+swelling. There is volar flexion of the phalanges when the subject is at
+rest. Lameness is intense; in some acute inflammatory disturbances the
+subject is unable to bear weight on the affected member.
+
+In chronic sesamoiditis, constant lameness is the one salient feature
+which marks the condition. While it is possible for one sesamoid bone to
+become involved without its fellow being affected, this is not usual.
+Considerable organization of tissue surrounding the joint is present and
+no particular evidence of supersensitiveness exists. However,
+supporting weight brings sufficient pressure to bear upon the inflamed
+and more or less eroded bones so that pain is occasioned and lameness
+results.
+
+Treatment.--During acute inflammation, absolute quiet is, of course,
+of first consideration. Cold packs are to be kept in contact with the
+parts until acute inflammatory symptoms subside. The fetlock region is
+then enveloped with a poultice or an iodin and glycerin combination
+(iodin one part to seven parts of glycerin) is applied and a dressing of
+cotton is kept in contact with the inflamed region. Following this, a
+vesicant is employed and the subject is allowed a month's rest.
+
+In sub-acute cases, the entire region surrounding the pastern is
+blistered or the actual cautery is used. Line-firing is preferable. The
+subject is given a month or six weeks rest and one may be guided by the
+presence or absence of lameness as to whether improvement or recovery is
+taking place.
+
+Old chronic cases, and particularly those where there are considerable
+induration and fibrous organization of tissue surrounding the joint, are
+not to be benefited by treatment.
+
+The chief consideration in handling sesamoiditis is checking
+inflammation as early as possible and preventing, if this can be done,
+the erosion of articular surfaces. If destruction of any part of the
+articular surfaces can be prevented and the patient allowed ample time
+for complete resolution of the affected parts to occur, permanent relief
+is possible.
+
+
+Fracture of the Proximal Sesamoids.
+
+Etiology and Occurrence.--Fracture of the proximal sesamoid bones is
+caused by violent strain when there exists _fragilitas osseum_, or by
+contusions. The author treated a case where fracture of one sesamoid was
+occasioned by a horse receiving a puncture wound wherein the sharp end
+of a steel bar was protruding from the ground where it was firmly
+embedded. The subject in this case was injured while being driven along
+a country road. Frost[23] reports simultaneous fracture of all of the
+proximal sesamoids occurring in a sixteen-year-old pony. The condition
+is of rather common occurrence in some countries because of the fragile
+condition of horses' bones.
+
+Symptomatology.--If the parts can be examined before extravasation of
+blood and swelling mask the condition, crepitation may be detected. In
+other instances, it is possible to note a displacement of parts of the
+sesamoid bones--this in horizontal fracture. There occurs more or less
+descent of the fetlock which must not be attributed to rupture of the
+superficial flexor tendon (perforatus). By outlining the course of this
+tendon with the fingers, when it is passively tensed sufficiently to
+follow its course, one may exclude rupture of the superficial flexor.
+Finding the suspensory ligament intact from its origin to the sesamoid
+attachments, one may also eliminate rupture of this structure as a cause
+of the trouble. Needless to say, marked lameness and swelling of the
+fetlock soon take place. The condition is painful, and ordinarily,
+recovery is impossible.
+
+Treatment.--Where treatment is attempted, immobilization as in
+luxation is in order. The patient's comfort is sought, and if the
+fractured parts can be kept in close proximity, their union may occur in
+time. However, chances for partial recovery (which is the best to be
+hoped for) are so remote that early destruction of the subject is the
+humane and economical thing to do.
+
+Where treatment is instituted, it is found that there is required a long
+time for union of the fractured bones to occur (where union does take
+place) and the cost of treatment together with the uncertainty of even
+partial recovery, makes for an unfavorable outcome. When the best
+possible results succeed treatment, a large callosity is formed and
+movement of the pastern joint is restricted. Lameness, though not
+intense, in the case referred to, where one bone was broken, was
+permanent and the subject was out of service for nearly a year.
+
+
+Inflammation of the Posterior Ligaments of the Pastern (Proximal
+Interphalangeal) Joint.
+
+Anatomy.--The ligaments here involved are the four volar ligaments
+described by Sisson[24] as follows: "The _volar ligaments_ (Ligg
+Volaria) consist of a central pair and a lateral and medial bands which
+are attached below to the posterior margin of the proximal end of the
+second phalanx and its complementary fibro-cartilage. The lateral and
+medial ligaments are attached above to the middle of the borders of the
+first phalanx, the central pair lower down and on the margin of the
+triangular rough area."
+
+This portion of the inhibitory apparatus is described by Strangeways'
+Anatomy as two posterior ligaments which run each from three points on
+the sides of the os suffraginis to a piece of fibro cartilage, described
+as the glenoid cartilage, and attached to the postero-superior edge of
+the os coronae; between them is the insertion of the inferior
+sesamoidean ligament.
+
+Etiology and Occurrence.--Everything tending to increase strain upon
+these ligaments is contributory to possible fibrillary fracture of these
+structures. Excessive leverage as furnished by long toes, long toe-calks
+and low heels increases the normal tension on the posterior ligaments of
+the pastern joint. Faulty conformation, which throws an abnormal strain
+on these ligaments, is a predisposing cause of inflammation of these
+structures. Hard pulling upon slippery and rough or frozen roads is a
+common exciting cause of this injury. The condition is of comparatively
+frequent occurrence and is seen affecting draft horses frequently, in
+the hind legs.
+
+Symptomatology.--Lameness is the first manifestation of this affection
+and weight bearing is painful in direct proportion to the extent of
+injury present. Volar flexion of the phalanges relieves tension on the
+parts; therefore, this position is assumed while the subject is at rest.
+When considerable tissue has been ruptured, and the condition is very
+painful, the foot is held off the ground as in all painful affections of
+the extremity.
+
+By palpation evidence of pain is discernible, though very little
+swelling occurs. Pain is increased by manual tension of the parts which
+is done by grasping the toe of the foot and exerting traction on the
+flexor apparatus. Care must be taken in executing such manipulations,
+and it is only by comparison of the affected member with the sound one
+and noting the difference in the manifestations of discomfort that we
+may arrive at the proper conclusion.
+
+Some hyperthermia is to be recognized in acute inflammation, by
+comparing the extremities. In the fore legs, navicular disease is
+differentiated by noting absence of contraction at the heel. By use of
+the hoof testers one may recognize evidence of inflammation of the
+navicular apparatus. In inflammation of the posterior ligaments of the
+pastern joint, there is also absence of the characteristic stumbling
+which is seen in navicular disease.
+
+Treatment.--Rest is the first requisite, and in addition every
+mechanical means possible to change the center of gravity in the
+phalangeal region, is to be employed. This is best accomplished by
+shortening the toe and paring the sole at the toe as much as conditions
+will permit. The heel is raised by means of a shoe with moderately high
+heel calks.
+
+The iodin-glycerin combination heretofore mentioned may be applied and
+the parts covered with cotton and bandage. Subjects require from three
+weeks to several months' rest and must be returned to work carefully,
+lest the incompletely regenerated tissues suffer injury.
+
+Regeneration of tissue in such cases, as has been pointed out, is slow
+and sufficient time for complete recovery must be allowed or relapses
+will occur.
+
+
+Fracture of the First and Second Phalanges.
+
+Etiology and Occurrence.--Fractures of the first phalanx (suffraginis)
+occur with respect to frequency, second to pelvic fractures. Often,
+almost insignificant injuries cause phalangeal fractures. On city
+streets, horses shod with shoes having long calks get caught in frogs of
+street railways or by slipping on rails, and phalangeal bones are often
+broken. The author observed a case of comminuted fracture of both the
+first and second phalanges (suffraginis and corona) in a polo pony
+caused by making a sudden turn while in action in a contest on the turf.
+
+Symptomatology.--Fracture of the phalanges is nearly always signalized
+by lameness, and this is marked during the period of weight bearing.
+Lameness is usually intense and where the pathognomonic symptom
+(crepitation) is not recognized, the intensity of the claudication, when
+other causes are absent, is indicative of fracture. The subject does not
+bear weight upon the affected member and where pain is intense, the foot
+is held in an elevated position and swung back and forth. In hind legs
+the member is often flexed in abduction and held in this position for
+several minutes, being rested on the ground only during short intervals.
+When compelled to walk, if pain is excruciating, the animal hops with
+the sound leg, no weight being supported by the fractured member.
+
+When an examination of the subject is possible before the extremity is
+swollen, crepitation is usually found without great difficulty, except
+in a subperiosteal break or in some cases of vertical or oblique
+fracture. Great care is necessary in handling the injured extremity in
+these cases, and particularly in nervous subjects or in excited animals
+that have been recently injured in runaways, is it necessary to be
+gentle in manipulating the extremity, if definite deductions are to be
+made. As has been mentioned in the chapter on diagnostic principles, if
+the condition is so painful that the subject does not relax the parts
+and crepitation is masked, local anesthesia is necessary. An anesthetic
+solution of cocain or novocain may be applied to the metacarpal or
+metatarsal nerves and an entirely satisfactory examination is then
+possible.
+
+Passive movement of the phalanges in all directions is practised in
+order to produce crepitation. When rotation of the parts does not
+occasion crepitation, gentle flexion and extension may do so. And in
+many instances, considerable manipulation of the phalanges is necessary
+before the pathognomonic symptom is to be recognized.
+
+In cases where crepitation is not found and lameness is pronounced, out
+of proportion with other possible existing causes, one may by exclusion
+of other causes establish a diagnosis of fracture in the course of
+forty-eight hours. In the meanwhile, support is given the affected
+member by applying an effective leather splint, so that pain may be
+diminished. To combat inflammation, a suitable cataplasm may be applied
+directly to the skin, the extremity bandaged, and the temporary
+immobilizing appliance may be secured over all. In this manner one may
+make repeated examinations of the subject, and if slings are used and
+every other necessary precaution taken to promote comfort for the
+subject, no harm will result in delaying for several days the
+application of permanent immobilization--bandages and splints or casts.
+In fact, where much swelling exists at the time one is called to treat
+such cases, it is advisable to delay the application of a permanent
+dressing or cast until inflammation has somewhat subsided.
+
+Course and Prognosis.--Where conditions are favorable, the nature of
+the fracture one that will yield to treatment, the subject not aged, and
+facilities for giving good attention to the affected animal are ample,
+fractures of the first and second phalanges recover completely in from
+six weeks to four months. Only simple fractures are considered curable
+from a practical and economical point of view, excepting in foals, where
+compound, and even comminuted, fractures may be so handled that animals
+may eventually become serviceable though blemished.
+
+Age retards the process of osseous regeneration, but in one instance at
+the Kansas City Veterinary College, a very aged mare suffering from a
+multiple fracture of the first phalanx was treated and at the end of
+sixty days was able to walk into an ambulance. Large exostoses had
+developed and the subject remained lame, but union of the broken bone
+took place in a surprisingly prompt and effective manner, when age of
+the subject and nature of the fracture are considered.
+
+As a rule, one is loath to recommend treatment, even in a simple
+transverse fracture of the first phalanx, in animals ten years of age or
+older. The conditions which exist in any given locality that regulate
+the expense of caring for an animal during the period of treatment,
+especially influence the course to be pursued in treating fractures.
+
+Treatment.--For permanent immobilization of the phalanges in fracture,
+materials which might adapt themselves to the irregular contour of the
+member and at the same time contribute sufficient rigidity to the parts
+without doing injury to the soft structures, would constitute ideal
+means of treatment; but no such materials have yet been devised, and
+opinions are various as to the most efficient and practical method to
+employ.
+
+After the fetlock has been shorn of hair and the ergot trimmed, the skin
+is thoroughly cleansed and allowed to dry. Several thin layers of long
+fiber cotton are then wrapped around the extremity--enough to pad well
+the member--and this is retained in position with a wide bandage. Gauze
+bandages are preferable to heavier bandages of cotton fabric because
+they are somewhat more elastic and yield to the irregular contour of the
+parts to a better advantage. Layers of three inch gauze bandages, which
+are soaked with a cold starch paste are wound about the extremity.
+Strips of leather that are flexible and not more than an inch in width
+are placed in a vertical position around the leg and these are also
+covered with the starch and securely held in position with the bandages.
+In this way, one is able to provide a sufficient degree of rigidity and
+at the same time, where the cast is carefully applied, little if any
+injury is done the skin. Such a cast is not difficult to remove and is
+so inexpensive that it may be removed and reapplied at any time it
+should be thought preferable to do so. Of course, this does not
+constitute an effective means of support if the parts are to be
+frequently and thoroughly soaked with water, but animals undergoing this
+sort of treatment are usually kept sheltered.
+
+The same after-care is necessary in such cases as is given in fractures
+of other bones. Two months after the injury has been done, the
+application of a blistering ointment to the entire region is of benefit.
+
+Results.--Much depends on the nature of fractures as to the success
+one may attain in approximating the parts of a broken bone, and in some
+cases of oblique fracture for instance, complete recovery is impossible,
+despite the most skillful and painstaking attention given. On the other
+hand, cases of simple transverse fractures make perfect recoveries in
+some instances. All fractures are serious, and in every instance the
+practitioner would best be careful to impress his client with the many
+difficulties which usually attend the treatment of fracture in horses.
+
+
+Tendinitis.
+
+Inflammation of the Flexor Tendons.
+
+One of the most common causes of lameness in light harness and saddle
+horses is tendinitis, and because of the character of the structure of
+tendons and because of their function, an active inflammation of these
+parts is always serious.
+
+Being almost inelastic and not well supplied with blood, tendinous
+tissue is slowly regenerated, and so much time is required for complete
+recovery to take place in tendinitis, that affected animals seldom fully
+recover before they are in service or vigorously exercising at will. As
+a result, complete recovery is delayed or prevented.
+
+The extensor tendons, because of the nature of their function, are very
+seldom strained; they are often bruised and occasionally divided, but
+unlike this condition in the flexors, tendinitis of the extensors is of
+rare occurrence.
+
+For a concise discussion of this subject the most practical
+classification is one made on a chronological basis and we may then
+consider tendinitis as _acute_ and _chronic_.
+
+
+ACUTE TENDINITIS.
+
+Etiology and Occurrence.--Causes of tendinitis, as in almost all
+diseases, may be considered under the heads of predisposing and
+exciting. Among the predisposing causes of tendinitis may be mentioned,
+faulty conformation. Everything which has to do with increasing the
+strain upon tendons adds to the probability of their being over-taxed.
+Long, sloping, pastern bones; disproportionate development of parts,
+such as a heavy body and small, weak tendons and long hoofs, are the
+principal factors which usually predispose to tendinous sprains.
+Degenerative changes which take place in tendons following
+constitutional diseases such as influenza may also be classed as a
+predisposing cause.
+
+Excessive strain when put upon tendons in any possible manner, such as
+is occasioned in running and jumping; making missteps and catching up
+the weight of the body with one foot, when the force thus thrown upon
+the supporting structure is great because of momentum gained at a rapid
+pace, are exciting causes of tendinitis.
+
+Symptomatology.--In all cases of acute tendinitis there is presented a
+characteristic attitude by the subject. Volar flexion in a sufficient
+degree to relax the inflamed structures is always evident. The foot may
+be rested on the toe or placed slightly in advance of the one supporting
+weight, but the fetlock is always thrown forward. More or less swelling
+of the inflamed tendons is present. Where the deep flexor (perforans) is
+involved swelling is marked and with swelling there is present the other
+symptoms of inflammation--heat and supersensitiveness.
+
+In manipulating tendons for the purpose of detecting supersensitiveness,
+care must be taken so that no false conclusion be drawn, because of the
+aversion many horses have to submitting to palpation of the tendons even
+when they are in a normal condition.
+
+Supporting-leg-lameness is present and varies in degree with the
+intensity of the pain caused by weight bearing. In many instances, as
+soon as the subject has traveled a considerable distance, lameness
+diminishes or discontinues. As soon as the affected animal is permitted
+to stand long enough to "cool out" there is a return of the lameness,
+which is then marked.
+
+No difficulty is encountered in making a practical diagnosis in
+tendinitis; that is, one may fail to readily recognize the extent of the
+involvement as it affects the superficial flexor tendon, for instance,
+but this has no practical bearing on the prognosis and treatment, when
+existing inflammation of the deep flexor is recognized.
+
+The course of each tendon is readily outlined by palpation; all parts
+are easily manipulated; and with experience one may readily recognize
+the extent and degree of the inflammation.
+
+Treatment.--In some cases of acute tendinitis, pain is intense and the
+application of cold packs during this stage is very beneficial in that
+pain is controlled and inflammation subsides. The extremity may be
+bandaged with a liberal quantity of absorbent cotton or with woolen
+material. Ice water is then poured around the bandaged member every
+fifteen minutes and this should be continued for about forty-eight
+hours. In some cases this treatment is not necessary for more than
+twelve hours; at the end of this length of time, pain has subsided and
+the acute stage of inflammation has passed or its intensity has been
+diminished.
+
+Following the application of cold packs, the use of a poultice such as
+some of the sterile, medicated muds, is of marked benefit. The author
+has made use of tincture of iodin and glycerin in the proportion of one
+part of iodin to seven parts glycerin, with very satisfactory results.
+This combination is hygroscopic, anodyne and antiseptic and is easily
+applied. A liberal quantity is directly applied all around the affected
+tendons and the leg covered with a heavy layer of cotton, and this is
+snugly held in position with bandages. The application may be used once
+or twice daily, or if it is thought necessary, an attendant may pour a
+quantity of the iodized-glycerin around the leg and under the bandage
+once daily without removing the cotton and bandage. Needless to say,
+absolute rest is imperative.
+
+When all evidence of acute inflammation has subsided vesication is
+indicated. At this stage walking exercise is beneficial and the subject
+may be allowed the freedom of a paddock.
+
+Some practitioners are partial to the use of the actual cautery in these
+cases, but it is doubtful if it is necessary to produce such a great
+degree of counter-irritation in cases where the subject is suffering the
+first attack of tendinitis.
+
+As has been indicated, ample time should be allowed for recovery and
+depending upon conditions, it takes from three weeks to six months for
+complete recovery to become established.
+
+
+Chronic Tendinitis and Contraction of the Flexor Tendons.
+
+Etiology and Occurrence.--Acute inflammation of the flexor tendons may
+result in chronic tendinitis. Recurrent attacks in cases where
+insufficient time is allowed for complete recovery to result, is
+followed by chronic inflammation and hypertrophy of the tendons. Again,
+in subjects where conformation is faulty, no amount of care will be
+sufficient to prevent a recurrence of the inflammation and the condition
+must become chronic.
+
+Symptomatology.--On visual examination of the subject at rest, one may
+note the hypertrophied condition of the affected tendons. Their
+transverse diameter is usually perceptibly increased and in many cases,
+there is an increase in the antero-posterior diameter. The latter
+condition causes a bulging of the tendon that is so noticeable, because
+of the convexity thus formed, it is commonly known as "bowed tendon."
+
+[Illustration: Fig. 20--Contraction of the superficial digital flexor
+tendon (perforatus) of the right hind leg, due to tendinitis.]
+
+In chronic tendinitis there occurs repeated attacks of inflammation
+wherein lameness is pronounced and there exists in reality, at such
+times, acute inflammation of a hypertrophic structure, where at no time
+does inflammation completely subside. Therefore, in chronic tendinitis
+there is to be found at times the same conditions which characterize
+acute inflammation, except that there is usually a variance of symptoms
+because of the difference in the degree of inflammation and pain.
+
+The diagnosis of contraction of tendons is an easy matter because of the
+fact that relations between the phalanges are constantly changed with
+tendinous contraction. If one bears in mind the attachments and function
+of the digital flexors, no difficulty is encountered in recognizing
+contraction of either tendon.
+
+Contraction of the superficial digital flexor (perforatus), when
+uncomplicated, is characterized by volar flexion of the pastern joint.
+The foot is flat on the ground and the heel is not raised because the
+superficial flexor tendon does not have its insertion to the distal
+phalanx (os pedis) and therefore can not affect the position of the
+foot.
+
+By causing the subject to stand on the affected member, one may outline
+the course of the flexor tendons by palpation, and in this way recognize
+any lack of tenseness or contraction of tendons or of the suspensory
+ligament.
+
+[Illustration: Fig. 21--Contraction of the deep flexor tendon
+(perforans) of the right hind leg, due to tendinitis.]
+
+Contraction of the suspensory ligament would cause the pastern joint to
+assume the same position as is occasioned by contraction of the
+superficial digital flexor (perforatus) tendon, but when the subject is
+bearing weight on the affected member, it is easy to determine that no
+contraction of the suspensory ligament exists, by noting an absence of
+abnormal tenseness of this structure. And finally, contraction of the
+suspensory ligament is of rare occurrence.
+
+Contraction of the deep flexor tendon (perforans) causes an elevation of
+the heel. The foot can not set flat because the insertion of the deep
+flexor tendon to the solar surface of the distal phalanx (os pedis)
+causes when the tendon is contracted--a rotation of the distal phalanx
+on its transverse axis--hence the raised heel. No other tendon has this
+same effect on the distal phalanx and the condition is correctly
+diagnosed without difficulty.
+
+[Illustration: Fig. 22--A chronic case of contraction of both flexor
+tendons of the phalanges. In this case (presented at a clinic of the
+Kansas City Veterinary College) because of long continued contraction of
+the flexors, which prevented weight being supported with any degree of
+comfort, there resulted a partial paralysis of the extensors, and
+consequently the extremity was dragged on the ground.]
+
+Course and Complications.--This condition may exist for years without
+causing the subject any serious inconvenience, if the affected animal is
+kept at suitable work. In other instances recurrent attacks of lameness
+are of such frequent occurrence that the subject is not fit for service.
+Many affected animals that are kept in service in spite of lameness (and
+in some instances where no lameness is present), soon become
+unserviceable because of contraction of the inflamed tendon. This, in
+fact, is the condition which eventually becomes established in most
+instances.
+
+Treatment.--Where conformation is not too faulty so that recovery may
+be expected, good results are obtained by line-firing the tendons and
+allowing the subject a few months' rest. In some cases median neurectomy
+is advisable. This is recommended by Breton[25] as being productive of
+good results even where contraction of tendons exists and tenotomy is
+done.
+
+[Illustration: Fig. 23--Contraction of the superficial and deep flexor
+tendons (perforatus and perforans) of the left fore leg.]
+
+By shoeing with high heel-calks considerable strain is taken from the
+inflamed tendons because of the changed position of the foot which
+alters the distribution of weight on different parts of the leg. Rubber
+pads materially diminish concussion and should be made use of when the
+subject is returned to work, if the character of the work is such as to
+occasion much concussion.
+
+It is to be remembered, however, that in sprains there occurs fibrillary
+fracture of soft structures and time is required for regeneration of
+tissue which has been injured or destroyed. Absolute rest is necessary
+where inflammation is acute and in sub-acute or chronic tendinitis
+avoidance of all work which causes irritation to the affected tendons is
+imperative.
+
+[Illustration: Fig. 24--Contraction of superficial digital flexor and
+slight contraction of deep flexor tendon.]
+
+Where contraction of tendons exists surgical treatment is necessary. No
+good comes from appliances which are calculated to stretch the affected
+tendons; in fact, they aggravate the inflamed condition and hasten
+complete loss of function of the affected member. Where there exists no
+articular or ligamentous diseases which would defeat the purpose,
+tenotomy is the only remedy for contracted tendons.
+
+
+Contracted Tendons of Foals.
+
+Etiology and Occurrence.--This condition is occasionally observed and
+no positive explanation of the reason for its existence can be given.
+That mal-position _en utero_ causes the metacarpal bones to develop in
+length so rapidly that the tendons are too short, is an explanation that
+is offered. Be that as it may, in breeding sections of the country the
+general practitioner is obliged to handle these cases and successful
+methods of treatment are essential even though cause is not removable.
+
+Symptomatology.--The superficial flexor tendon (perforatus) alone, is
+the one usually contracted, and while both flexors are at times
+involved, this rarely occurs. The condition is usually bilateral.
+
+The degree of contraction varies greatly in different cases. In some,
+contraction exists to such extent that it is impossible for the colt to
+stand, and because of continual decubitus where no relief is given, the
+subject is lost because of gangrenous infection occasioned by bed sores.
+Otherwise the same symptoms are to be observed in this condition, that
+exist in contraction of tendons of the mature animal.
+
+Treatment.--Wherever contraction is not too marked and weight is borne
+with the affected members, and where the feet can be kept on the ground
+in a nearly normal position, it is possible to correct the condition
+without doing tenotomy. That is, in cases where the subject is simply
+"cock-ankled", where volar flexion of the pastern joint exists but the
+foot is kept flat on the ground, correction is possible without
+tenotomy.
+
+In such instances the foal must be treated early--before the skin on the
+anterior pastern region has been badly damaged by knuckling over. It is
+possible in many cases to stretch the flexor tendons by grasping the
+colt's foot with one hand, and with the other hand one may push the
+pastern in the direction of dorsal flexion. This may be tried and when a
+reasonable amount of force is employed, no harm is done, even though no
+material benefit results. Some veterinarians claim good results from
+this treatment alone and direct their clients to repeat the stretching
+process several times daily.
+
+Whether the tendons are manually stretched or not, splints should be
+adjusted to the affected members. The legs are padded with cotton and
+bandages and a suitable splint is applied on either side of the members
+and securely fixed in position by bandaging.
+
+The splints are kept in position for four or five days and then removed
+for inspection of the affected parts. If necessary, they are reapplied
+and left in position for a week; however, this is unnecessary in the
+average case that is treated in this manner.
+
+Where contraction exists to the extent that the subject can not stand
+and where no weight is borne by the feet, it is necessary to divide the
+affected tendons surgically. The same technic is put into practice that
+is employed in the mature subject but there is much greater chance for a
+favorable outcome in the foal. Further, if necessary, one may divide
+with impunity, both tendons on each leg, at the same time. In all cases
+this operation is done by observing strict aseptic precautions and the
+legs are, of course, bandaged. If both tendons are divided, splints
+should be employed and kept in position for ten days or two weeks.
+Primary union of the small surgical wound of the skin and fascia occurs
+in forty-eight hours.
+
+The reader is referred to William's "Veterinary Surgical and Obstetrical
+Operations," for a complete description of this operation.
+
+     In veterinary literature there is occasionally described a
+     condition which affects young foals wherein symptoms similar to
+     those of contraction of the flexors are manifested, but upon
+     examination it is found that rupture of the extensor of the digit
+     (extensor pedis) exists. This affection is briefly described by
+     Cadiot but no complete treatise on this condition has been
+     published.
+
+     In parts of Canada foals of from one to three days of age are found
+     affected in such manner that more or less interference with the
+     gait is to be seen in those moderately affected. There is, in some
+     subjects, only a slight impediment in locomotion which is
+     occasioned by inability to properly extend the digit. In other
+     subjects, while able to stand and walk, great difficulty is
+     experienced because of volar flexion of the phalanges. The more
+     seriously affected animals are unable to stand and, in most
+     instances, perish because of the effects of prolonged decubitus.
+
+     A local enlargement occurs at the anterior carpal region and the
+     mass is somewhat fluctuating, extravasated fluids becoming infected
+     in many instances, and necrosis of the skin and fascia provide
+     means for spontaneous discharge of the contents of the enlargement
+     if it is not opened. The infection when it becomes generalized
+     causes a fatal termination in most cases that are not treated.
+
+[Illustration: Fig. 25--"Fish knees."--Photo by Thos. Millar,
+M.R.C.V.S.]
+
+     Native stock owners of some parts of Canada know this condition as
+     "fish knees" because of the presence of the ruptured end of the
+     extensor tendon which is found coiled in the cavity of the
+     enlargements caused by the ruptured tendon.
+
+     Local practitioners have treated the condition by incising the
+     swollen mass and removing the part of tendon contained within such
+     cavities. Treatment has not proved entirely satisfactory in the
+     majority of instances, perhaps because of tardy interference.
+
+     In a colt's leg sent the author by Mr. Thomas Millar, M.R.C.V.S.,
+     of Asquith, Saskatchewan, a careful dissection of the carpal region
+     revealed the fact that in this case the ruptured extensor tendon
+     was due to injury. The colt may have been trampled upon by its dam
+     in such manner that the tendon was divided. No noticeable evidence
+     of injury to the skin was to be seen on its outer surface, but on
+     the fascial side a cyanotic congested area, which was situated
+     immediately over the site of the ruptured tendon, was very
+     evident.
+
+     With the execution of a good surgical technic, the ruptured tendon
+     might be sutured; the wound of the tendon sheath as well as that of
+     the skin carefully united by means of gut sutures, the leg bandaged
+     and immobilized with leather splints and recovery follow in a
+     reasonable percentage of cases so treated. These cases afford an
+     opportunity for the perfection of practical means of treatment by
+     those who frequently meet with this affection.
+
+
+Rupture of the Flexor Tendons and Suspensory Ligament.
+
+Etiology and Occurrence.--Rupture of the flexor tendons or of the
+suspensory ligament is of rare occurrence. Frequently, these structures
+are divided as the result of wounds; but rupture, due to strain, is not
+frequent.
+
+[Illustration: Fig. 26--Extreme dorsal flexion said to have resulted
+from an attack of distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No.
+4.]
+
+In some cases in running horses, or in animals that are put to strenuous
+performances, such as are jumpers, rupture of tendons or of the
+suspensory ligament takes place. However, more frequently this follows
+certain debilitating diseases such as influenza or local infectious
+inflammation of the parts which results in degenerative changes and
+rupture follows.
+
+The non-elastic suspensory ligament receives some heavy strains during
+certain attitudes which are taken by horses in hurdle jumping as is
+explained in detail by Montane and Bourdelle[26] under the description
+of this ligament. But in spite of the frequent and unusually heavy
+strains, which these structures receive, complete rupture is not
+frequently seen.
+
+Symptomatology.--When the anatomy and function of the flexor tendons
+and suspensory ligament is thoroughly understood, recognition of rupture
+of either of these structures is easily recognized. When one considers
+that in rupture, a position directly opposite to that which is seen in
+contraction in either one of these structures, is assumed, a detailed
+description of each separate condition is needless repetition.
+
+However, it is pertinent to suggest that rupture of the deep flexor
+tendon (perforans) allows a turning up of the toe. Whether it be torn
+loose from its point of attachment or ruptured at some point proximal
+thereto, the position is the same--heel flat on the ground, toe slightly
+raised and this raising of the toe varies in degree as the subject moves
+about.
+
+When the superficial flexor (perforatus) is ruptured there is no change
+in the position of the foot but the fetlock joint is slightly lowered.
+The pathognomonic symptom is the lax tendon during weight bearing, which
+may be felt by palpation of the tendon along its course in the
+metacarpal region.
+
+With complete rupture of the suspensory ligament there occurs a marked
+dropping of the fetlock joint and an abnormal amount of weight is then
+thrown upon the superficial flexor tendon (perforatus), causing it to be
+markedly tensed. This is readily recognized by palpation. By palpating
+the suspensory ligament from its proximal portion down to and beyond its
+bifurcation, while the affected member is supporting weight, it is
+possible to diagnose rupture of one of its branches.
+
+Prognosis and Treatment.--In rupture of the superficial flexor tendon
+(perforatus) because of its comparatively less important function,
+prognosis is favorable and recovery takes place when proper treatment is
+put into practice.
+
+With rupture of the deep flexor tendon (perforans), especially when it
+occurs at or near its point of insertion and sometimes following
+disease, prognosis is unfavorable.
+
+Rupture of the suspensory ligament constitutes a condition which is, as
+a rule, hopeless, because of the impracticability of treating such
+cases.
+
+The salient feature which characterizes any practical attempt at
+treatment of ruptured tendons or other portions of the inhibitory
+apparatus of the fetlock region, is to retain the phalanges in their
+normal position for a sufficient length of time that the approximated
+ends of ruptured tendons or ligaments may unite. The length of time
+required for this to occur, together with the difficulties encountered
+in confining the affected extremities in suitable braces or supportive
+appliances, precludes all possibility of this condition's being
+practically amenable to treatment when the deep flexor tendon
+(perforans) and suspensory ligament are simultaneously ruptured. It does
+not follow, even so, that recovery does not succeed treatment in some of
+these unfavorable cases.
+
+[Illustration: Fig. 27--A good style of shoe for bracing the fetlock
+where tenotomy has been performed, or in case of traumatic division of
+the flexor tendons. An invention of Dr. G.H. Roberts.]
+
+Affected subjects are kept in slings as long as it seems
+necessary--until they learn to get up without deranging the braces worn.
+
+Several styles of braces are in use and each has its objections;
+nevertheless some sort of support to the affected member is necessary
+and steel braces which are connected with shoes are usually employed.
+
+The principal difficulty which attends the use of braces is
+pressure-necrosis of the skin which is caused by the constant and firm
+contact of the metal support. The practitioner's ingenuity is taxed in
+every case to contrive practical means of padding the exposed parts in
+order to prevent or minimize necrosis from pressure. This is
+attempted--with more or less success--by frequent changing of bandages
+and the local application of such agents as alcohol or witch hazel.
+Needless to say, the skin must be kept perfectly clean and the dressings
+free from all irritating substances.
+
+[Illustration: Fig. 28--Showing the Roberts brace in operation.]
+
+The fact that tendons or ligaments which are ruptured, do not regenerate
+as readily as in cases where traumatic or surgical division occurs, must
+not be lost sight of, and prognosis is given in accordance.
+
+
+Thecitis and Bursitis in the Fetlock Region.
+
+Etiology and Occurrence.--Synovial distension of tendon sheaths and
+bursae in the region of the fetlock are caused by the same active
+agencies which produce this condition in other parts. The fetlock region
+is exposed to more frequent injury than is the carpus and as a
+consequence is more often affected. The same proportionate amount of
+irritation affects this part of the leg, owing to strains, as affect the
+carpus from a similar cause; and synovitis from this cause, is as
+frequent in one case as in the other. Therefore, it is a natural
+sequence that the tendon sheaths of the metacarpophalangeal region are
+frequently distended because of chronic synovitis and thecitis. These
+inflammations are usually non-infective in character.
+
+The _cul-de-sac_ of the capsular ligament of the fetlock joint which
+extends upward between the bifurcation of the suspensory ligament is the
+most frequently affected structure in this region. When distended, two
+spheroidal masses bulge laterally and anterior to the flexor tendons in
+a characteristic manner. This condition is known among horsemen as
+"wind-gall" or "fetlock-gall."
+
+The sheath of the flexor tendons, which begins about the middle portion
+of the lower third of the metacarpus, and continues downward below the
+pastern joint is often distended.
+
+Excepting in cases of acute inflammation attending synovitis of these
+parts, no lameness marks its existence and in chronic cases of synovial
+distension the service of affected animals is not interfered with. These
+distensions constitute unsightly blemishes and they are treated chiefly
+for this reason.
+
+No difficulty is encountered in recognizing these conditions even where
+considerable organization of tissue overlying distended thecae occurs.
+In such cases there may be only slight fluctuation of the enlargement,
+but if necessary, an aseptic exploratory puncture may be made with a
+suitable needle or trocar.
+
+Treatment.--Complete rest and the local application of cold packs are
+in order in acute synovitis when there is distension of tendon sheaths.
+In the fetlock region, because of the ease with which pressure may be
+employed, the parts should be kept snugly wrapped with cotton, and derby
+bandages are used to exert the desired amount of pressure over the
+affected region. The pressure-bandages should be employed as soon as all
+acute and painful inflammation has subsided; and then they should be
+continued, day and night, for ten days or two weeks. The bandages should
+be removed morning and night. After the skin of the leg has thoroughly
+dried off, an infriction of alcohol or distilled extract of hamamelis is
+given the parts and the cotton and bandages are readjusted. A good, even
+and firm pressure in such cases is productive of satisfactory results.
+
+[Illustration: Fig. 29--Distension of theca of the extensor of the digit
+(extensor pedis).]
+
+In chronic distensions of tendon sheaths synovia may be aspirated and
+about five cubic centimeters of equal parts of tincture of iodin and
+alcohol is injected into the cavity. This is not done, however, without
+usual aseptic precautions. If no marked swelling results within
+forty-eight hours the entire fetlock region is thoroughly vesicated and,
+as soon as the skin has recovered from the effects of the vesicant,
+pressure bandages may be employed. In these cases, subjects may be put
+into service after all swelling which the injection or the vesicant has
+produced has subsided. The pressure bandages are used at night or during
+the time that the horse is in its stall and they are not worn by the
+subject while at work.
+
+Where no marked swelling occurs within ten days, as the result of the
+injection of iodin, the injection may be repeated and, if thought
+necessary, the quantity may be materially increased. If swelling does
+not occur it is indicative that no particular irritation has been
+caused.
+
+Some swelling is desirable and much swelling sometimes results and
+persists for weeks. This is not in any way likely to cause permanent
+trouble; and if the technic of injection is skilfully executed no
+infection will follow.
+
+By persistent and careful use of suitable elastic bandages, the support
+thus given the parts, together with the absorption of products of
+inflammation which constant pressure occasions, some chronic cases of
+synovial distension of tendon sheaths recover in two or three months and
+this without other treatment. Such good results are not to be expected
+in aged subjects, nor in horses having at the same time, chronic
+lymphangitis.
+
+Where bandages of pure rubber are employed great care is necessary, if
+one is not experienced in their use, lest necrosis result. Where
+bandages are uncomfortably tight the subject will manifest discomfort,
+and an attendant should observe the animal at intervals for a few hours
+(where there may be some doubt as to the degree of pressure which is
+exerted by elastic bandages) and readjustment made before any harm is
+done.
+
+
+Arthritis of the Fetlock Joint.
+
+Anatomy.--The anatomy of the metacarpophalangeal articulation is
+briefly reviewed on page 58 under the heading of "Anatomo-Physiological
+Review of Parts of the Foreleg."
+
+Etiology and Occurrence.--The chief causes of non-infective arthritis
+of the fetlock joint are irritations from concussion and contusions due
+to interfering. The condition occurs in young animals that are
+over-driven in livery service or other similar exhausting work, where
+they become so weary that serious injury is done these parts by striking
+the pasterns with the feet--interfering. In these "leg-weary" animals,
+that are always kept shod with fairly heavy shoes, much direct injury is
+done at times by concussion due to self-inflicted blows. In older
+animals, where there exists similar conditions, with respect to their
+being worn from fatigue and, in addition, periarticular inflammatory
+organizations, arthritis is not of uncommon occurrence.
+
+[Illustration: Fig. 30--Rarefying osteitis wherein articular cartilage
+was destroyed in a case of arthritis of fetlock joint.]
+
+Symptomatology.--In true arthritis there exists a very painful
+affection which is characterized by manifestations of distress. The
+subject may keep the extremity moving about--where pain is
+great--suspended and swinging. There is swelling which is more or less
+hot to the touch and compression of the parts with the fingers increases
+pain. Lameness is always pronounced and no weight is supported with the
+affected member in very acute and generalized arthritic inflammations.
+There occurs the usual facial manifestations of pain--the tense
+condition of the facial muscles and the fixed eye and nostril are in
+evidence.
+
+In cases where there exists a synovitis or where a very limited portion
+of the articulation is involved, a somewhat different clinical picture
+is presented. Then, the disturbance causes less distress; local swelling
+and evidence of supersensitiveness are not so pronounced and lameness is
+not intense, though weight-bearing is painful.
+
+Prognosis.--There is a constant difference in the degree of pain
+manifested, as well as the other symptoms of inflammation, between true
+arthritis, which involves much of the joint, and synovitis; or synovitis
+plus a small circumscribed area of joint involvement. This difference is
+present in all joint affections of the extremities and, in passing, it
+is well to say that infection usually increases every manifestation of
+pain. Infection occasions more pronounced local symptoms of inflammation
+and, because of the rapid progress of necrotic destruction of cartilage,
+the course of the affection is usually rapid; ankylosis is a frequent
+result and loss of the subject is often inevitable. However, in
+non-infective arthritis of the fetlock joint, prognosis is favorable.
+
+Treatment.--The same general principles which are employed in
+arthritis of other joints are used here. Rest and comfort for the
+patient is sought in every available manner. If the subject remains
+standing too long, the sling should be used and a well-bedded box-stall
+will contribute much to the comfort of the patient.
+
+Pain and acute inflammation is diminished or controlled, if possible, by
+using ice-cold packs. In nervous, well-bred animals analgesic agents may
+be employed; or small doses of morphin sulphate--one to two
+grains--given at intervals of three hours during the first stages of the
+affection is very beneficial. This is especially indicated in infectious
+arthritis.
+
+As inflammation subsides, hot applications are used and finally counter
+irritants are employed. Their selection is a matter of choice with the
+practitioner. The object sought is the same with every practitioner and
+while methods employed vary, results are not markedly different except
+in so far as the degree of counter irritation which is produced varies
+in given cases. Where a great degree of counter irritation is thought
+necessary, line-firing with the actual cautery is the remedy _par
+excellence_.
+
+After-care.--In the course of three or four weeks subjects may be
+allowed the run of a paddock and, after a complete rest of six weeks at
+pasture, they may be returned to work with care, if the work is not of a
+nature to occasion concussion or other manner of irritation to the
+articulation.
+
+Neurectomy is not indicated even though there is a recurrence of
+lameness, unless the lameness is not pronounced and inflammation is
+periarticular and no osseous enlargements mechanically interfere with
+function of the joint. There are few cases then, where neurectomy is
+materially helpful.
+
+
+Ossification of the Cartilages of the Third Phalanx.
+(Ossification of the Lateral Cartilages.)
+
+Anatomy and Function of the Cartilages.--Surmounting each wing of the
+distal phalanx (os pedis) is the irregularly-quadrangular cartilage. The
+superior border of this cartilage is thin, generally convex, and
+perforated for vessels to pass to the frog; the inferior border is
+attached to the wing of the third phalanx and posteriorly, it is
+reflected inward and is continuous with the inferior surface of the
+sensitive frog. The anterior border which is directed obliquely downward
+and backward becomes blended with the anterior lateral ligament of the
+coffin joint. The fibrous expansion of the anterior digital extensor
+(extensor pedis) is united to the anterior borders of the lateral
+cartilages.
+
+     According to Smith[27]: These structures form an elastic wall to
+     the sensitive foot, and attachment to the vascular laminae; they
+     also admit of increase in width occurring at the posterior part of
+     the foot without destroying the union of the two set of leaves.
+     Further, by their connection with the vascular system of the foot,
+     their elastic movements materially assist the circulation. The
+     primary use of the lateral cartilages is to render the internal
+     foot elastic, and admit of its change in shape which occurs under
+     the influence of the weight of the body. The alteration in the
+     shape of the foot is brought about by pressure on the pad, which
+     widens and in consequence presses on the bars. The pressure
+     received by the pad is also transmitted to the plantar cushion,
+     which likewise flattens and spreads under pressure. Both of these
+     factors force the cartilages slightly outwards. When the posterior
+     wall recoils the cartilages are carried back to their original
+     position. Should the elastic cartilage under pathological
+     conditions become converted into bone, its functions are destroyed,
+     and lameness may occur.
+
+Etiology and Occurrence.--The causes of ossification of these
+cartilages are several. No doubt there exists a predisposition to this
+condition for it is of such frequent occurrence in heavy draft types of
+horses. Concussion plays an important role and, according to
+Moeller's[28] theory, which is sound, high heel calks prevent the frog
+from contacting the ground, and as weight is placed upon the foot "the
+lateral cartilages are subjected to a continuous inward and downward
+dragging strain."
+
+[Illustration: Fig. 31--Ringbone and sidebone.]
+
+The condition affects the cartilages of the fore feet more frequently
+than those of the hind and the outer cartilage is more often ossified
+than is the inner. This fact may be accounted for by its more exposed
+position; it is also frequently injured by being trampled upon and
+otherwise contused or cut, as in lacerated wounds of the quarter.
+
+Symptomatology.--Ossification of the cartilages is known by grasping
+the free borders with the fingers and attempting their flexion; the
+rigid inflexible ossified cartilage is thus easily recognized.
+
+Lameness during weight-bearing occurs in the majority of cases at some
+time. Much depends on the conformation of the foot and whether the
+involvement affects one or both cartilages as to the degree and duration
+of lameness which marks this affection. In narrow and contracted heels
+it is reasonable to expect more lameness than in well formed feet. Where
+only one cartilage is ossified, the other being flexible, there is less
+inconvenience experienced by the subject during weight-bearing, because
+of the expansion of the heel which the one normal cartilage allows.
+
+Treatment.--There is little if anything to be done in case the
+cartilage has become ossified except to shoe without high calks but
+preferably with rubber pads. The hoof should be kept moist; the wall at
+the quarter may be rasped thin and kept anointed. Firing is of no
+practical benefit in these cases, and it is doubtful if vesication is
+helpful excepting where only a part of the cartilage is ossified.
+
+Subjects which continue somewhat lame, because of complete ossification
+of both cartilages, are best put to slow work on soft ground and not
+driven on pavements.
+
+
+Navicular Disease.
+
+This more or less ambiguous term has been applied to various diseases
+affecting the structures which make up the coffin joint. We consider
+this name to be applicable to inflammatory involvement of the third
+sesamoid (navicular bone), the deep flexor tendon (perforans) and the
+bursa podotrochlearis or navicular bursa.
+
+Etiology and Occurrence.--In 1864 Thomas Greaves[29] wrote on the
+subject of navicular disease as follows: "The opinion I entertain upon
+the subject of navicular disease is, that in by far the greater majority
+(if not all) of these cases there exists in the animal affected a
+congenital tendency or predisposition, that, generally speaking, it is
+the high stepper, the good goer, that becomes the victim to this
+disease; and it is a fact well attested, that it as frequently develops
+itself in the feet with wide frogs, bulbous heels, shallow heels, spread
+flattish feet, as in the narrow upright feet.... I have known foals,
+born from defective parents, in which this condition was so strongly
+developed, that all men would at once pronounce them affected with
+navicular disease, and such lameness was permanent."
+
+Often both fore feet are affected and this would point toward its being
+a disease wherein either conformation or congenital tendencies exists.
+It is rare that hind feet are involved.
+
+There are many theories regarding the possible exciting causes of
+navicular disease and, when one has carefully considered the
+explanations as offered by Peters, Moeller, Branell, Schrader and others,
+he may conclude that navicular disease is a non-infectuous inflammatory
+affection of the third sesamoid (navicular) bone, deep flexor tendon
+(perforans) and adjoining structures. Whether it originates in the
+flexor tendon or whether the bone is the original part affected, the
+disease is frequently met, and of all possible causes, jars and
+irritation incident to concussion of travel, are probably the principal
+causative agents.
+
+Symptomatology.--Lameness is the primary indicator and a constant
+symptom which attends navicular disease wherever much structural change
+affects the infirm parts. As the degree of intensity or extent varies,
+so is there a dissimilarity in the character of the impediment.
+Incipient cases of bilateral involvement are more difficult to diagnose
+than are unilateral affections, particularly when lameness is not
+marked. There is manifested a supporting-leg-lameness which varies as to
+degree in the same subject at different times. This may be noticed
+during the same trip in an animal that is being driven. There is a
+tendency for the subject to stumble and, of course, where the affection
+is bilateral, there is a stilted gait owing to shortened strides.
+
+At rest the lame animal usually points with the affected member. Because
+of the fact that the distance is lessened between the origin and
+insertion of the deep flexor tendon (perforans) by this attitude, one
+may readily understand the reason for the position assumed by the
+subject. Pressure on the navicular bone is diminished and tension on the
+flexor tendon is relieved by even slight volar flexion.
+
+In acute inflammatory affections abnormal heat may be detected in the
+region of the heel. By exerting tension on the flexor tendon, by means
+of passive dorsal flexion of the member, evidence of hyperesthesia may
+be detected. With the hoof testers one may determine supersensitivenss
+in most instances. There occurs more or less contraction of the hoof in
+navicular disease, but this is not to be taken as a cause of the
+affection, but rather a sequence.
+
+[Illustration: Fig. 32--"Pointing"--the position assumed by horse having
+unilateral navicular disease.]
+
+In some cases of unilateral navicular disease there is a marked contrast
+in size between the sound and unsound foot. However, one must not be
+misguided in this particular, for in some pairs of sound feet there
+exists considerable difference in size. Finally, by a change from the
+normal position of the foot to one in which the heel is somewhat
+elevated (as may be obtained by shoeing with high heel calks), relief is
+evident, and in the opposite position, the condition is aggravated.
+This experiment may be used for diagnostic purposes.
+
+Treatment.--When the anatomy of the diseased parts is taken into
+consideration, and an analysis of the lesions which occur in cases where
+considerable structural change is occasioned by this affection, it is
+obvious that recovery is impossible. Only in cases where the
+inflammation is promptly checked before damage has been done the
+navicular bone or the flexor tendon, is permanent recovery possible. The
+disease is not frequently treated during this stage, however, and in the
+majority of instances the condition becomes chronic.
+
+As soon as a diagnosis is made the shoes must be removed, the toe
+shortened with the hoof pincers and rasp and the subject is put in a
+well bedded box-stall. If the animal is very lame and the inflammation
+is acute, ice-cold packs should be applied to the feet. As soon as acute
+inflammation has subsided the foot may be so pared that all excess of
+sole and frog is removed without lowering the heels, and the animal may
+be blistered about the coronet region. The subject may be shod later,
+with heel calks that raise the heel moderately and a protracted period
+of rest should be enforced.
+
+In cases where no acute inflammatory condition exists, neurectomy is
+beneficial. One must discriminate, however, between favorable and
+unfavorable subjects. This is not a last resort expedient to be employed
+in cases where extensive lesions of the navicular structures exists.
+With proper shoeing, and by putting the subject at suitable work, where
+concussion of fast travel on hard roads is not necessary, the best
+results are obtainable.
+
+
+Laminitis.
+
+This disease is primarily a non-infective inflammation of the sensitive
+laminae which very frequently affects the front feet. Often all four
+feet are affected, less frequently one foot (when its fellow is unable
+to sustain weight) and rarely the hind feet alone.
+
+Occurrence.--Probably a greater number of cases of laminitis occur in
+localities where horses that are worked on heavy transfer wagons are,
+when in a state of perspiration, allowed to stand exposed to sudden
+lowering of temperature and to stand in a cool or cold shower of rain
+such as occurs near the coast of the Great Lakes or the ocean in some
+parts of this country.
+
+This disease occurs in connection with digestive disorders of various
+kinds and, because of the frequent association of the two conditions,
+the common term "founder" has long been employed to designate laminitis.
+In cases of "over-loading," particularly when a large quantity of wheat
+has been eaten by animals that are unaccustomed to this diet, laminitis
+almost constantly results.
+
+Large draughts of cold water, when drunk by animals that are overheated
+is often followed by laminitis. Concussion, such as attends hard
+driving, especially in unshod horses or on rough and hard roads, is
+often succeeded by this affection. Likewise, as has been stated, injury
+such as is occasioned by long continued standing on the same foot is
+followed by laminitis. Some horses that are frequently shod, suffer from
+this affection a few hours after shoes have been reset. Dr. Chas. R.
+Treadway of Kansas City reports the rather frequent occurrence of such
+conditions in horses that are in the fire department service in his
+city.
+
+Age in no way influences the occurrence of laminitis and the general
+condition of an animal with regard to its vigor or state of flesh has no
+apparent influence toward predisposing horses to this ailment.
+
+Etiology and Classification.--As it is with some other diseases, one
+may unprofitably theorize on cause and readily enumerate many conditions
+which are apparently contributory toward producing the affection. Causes
+may well be grouped, however, and a more definite understanding of
+laminitis is possible as a result. Such collocation would include
+conditions which directly or indirectly affect the digestion, such as
+puerperal laminitis, drinking of large quantities of cold water and
+exposure to cold and rain when the body is warm. All of these various
+conditions might be said to affect the vaso-constrictor nerves in such
+manner that the natural tendency (because of the peculiar structure of
+the sensitive laminae and their mode of attachment to the non-sensitive
+wall) which solipeds have for this affection is indirectly due to this
+one cause--vaso-constriction. According to Dr. D.M. Campbell, the effect
+of toxic materials, which may be absorbed from the digestive tract or
+the uterus in parturient females, upon the vaso-constrictor nerves, is
+such that a passive congestion of the sensitive laminae occurs and
+laminitis is the result. He believes that even the chilling of the
+surface of the body when very warm, by a cold rain, constitutes a
+condition wherein the effect upon the vaso-constrictors is the same.
+
+This grouping does not include the effect of direct injuries of any and
+all kinds to which the feet are subjected such as: Concussion in fast
+road work, injuries occasioned by tight or ill fitting shoes, contusions
+of any kind resulting in non-infectious inflammation of the sensitive
+laminae, as well as the causes which produce laminitis where weight is
+borne by one foot when its fellow is out of function.
+
+A classification which is practical is that of _acute_ and _chronic_
+laminitis. To the practicing veterinarian it is this manner of
+consideration that is essential in the handling of these cases.
+
+Symptomatology.--In the acute attack the condition is so well
+described by Dr. R.C. Moore[30] that we quote him in part as follows:
+
+     The acute form is generally ushered in very suddenly. Often a horse
+     that is perfectly free from symptoms of the disease is found a few
+     hours later so stiff and sore that he will scarcely move. They
+     stand like they were riveted to the ground. If forced to move the
+     evidence of pain subsides to some extent after they have gone a
+     short distance, to return more severe than ever after they have
+     been allowed to stand for a short time. If the disease is confined
+     to the two front feet, the hind feet are placed well under the
+     center of the body to support the weight and the front ones are
+     advanced in front of a perpendicular line so as to lessen the
+     weight they must bear. If they are made to move, the same position
+     of the feet is maintained. If made to turn in a small circle, they
+     do so by using the hind feet as a pivot, bringing the front parts
+     around by placing as little weight on them as possible.
+
+     Placing the hind feet so far under the body, arches the back and
+     often leads to errors in diagnosis, the condition sometimes being
+     taken for diseases of the loins or kidneys.
+
+     If all four feet are involved, the animal stands in the usual
+     position assumed in health, but if urged to move, the least effort
+     to do so usually brings on chronic spasms of the entire body. In
+     very severe cases, a slight touch of the hand will develop the
+     spasms. At times they are so severe, and have such short
+     intermissions, that the disease has been mistaken for tetanus.
+     However, the clonic nature of the spasm should prevent such an
+     error. If they are lying down, it is difficult to get them to
+     arise, and if they do so, they show marked symptoms of pain for
+     some time after rising.
+
+     If the disease is confined to the hind feet, they are placed well
+     forward to relieve the strain on the toe caused by the downward
+     pull of the perforans (deep flexor) tendon, but in place of the
+     front feet being kept in front of a perpendicular line, as they are
+     when the disease is confined to the front ones, they are placed far
+     back under the body, so they will carry the maximum share of the
+     body weight of which they are capable. The position of the feet is
+     of great importance and offers symptoms that should not be
+     overlooked.
+
+When the subject is caused to walk, symptoms of excruciating pain are
+manifested in all acute cases of laminitis. In some cases where all four
+feet are affected, no reasonable amount of persuasion will cause the
+suffering animal to move from its tracks.
+
+There is acceleration of the rate of heart action; the pulse is full and
+in some cases, bounding. As the affection progresses the pulse becomes
+rather weak and irregular. The character of the pulse in the region of
+the extremity is a reliable indicator; but one has to learn to make
+necessary discrimination because of the condition of the parts, as in
+some cases of lymphangitis or where the skin is abnormally thick. The
+characteristic throbbing pulse is, however, easily recognized in most
+cases. Temperature is variable, though usually elevated from one to four
+degrees above normal. This symptom varies with the type and stage of the
+affection. In a subject that has been down, unable to rise for several
+days, where there is a suppurative and sloughing condition of the
+laminae, the temperature is high. Whereas, in some other and less
+destructive cases there may be little thermic disturbance after the
+first few hours have lapsed.
+
+A constant symptom in bilateral affections of acute laminitis is the
+difficulty with which the subject supports weight with one foot. It is
+this which causes the victim to stand as if "rooted to the ground" when
+all four feet are involved. If one attempts to take up one foot, thus
+causing the subject to stand on the other, there is much resistance and
+in many cases the animal refuses to give the foot.
+
+When we consider that the sensitive parts of the foot are encased by a
+horny, unyielding box and that, when the laminae are congested, a great
+pressure is brought to bear upon the sensitive structures, it is easy to
+understand why the condition is so painful.
+
+_Chronic laminitis_ is a sequel of acute inflammation of the sensitive
+laminae. It varies as to intensity and the exact manner of its
+manifestation depends upon preexisting disturbances.
+
+In some mild cases of laminitis there are recurrent attacks wherein no
+particular structural change exists, and diagnosis is established
+chiefly by noting the character of the pulse at the bifurcation of the
+large metacarpal (or metatarsal) artery just above the fetlock. The same
+manifestation of pain is present when weight is supported by one foot,
+though in a lesser degree. There is less local heat to be detected by
+palpation than in the acute cases.
+
+Chronic laminitis as it occurs following acute attacks which have
+resulted in structural changes of the foot, present the same symptoms
+just described and, in addition, the peculiar alterations in structure
+exist. When, owing to acute inflammation of the sensitive laminae, there
+has resulted necrosis of this sensitive tissue together with
+infiltration between the anterior surface of the distal phalanx (os
+pedis) and the contacting hoof, the lower portion of the distal phalanx
+is turned downward and backward (rotated upon its transverse axis).
+Because of the traction which is exerted by the deep flexor tendon
+(perforans), as it attaches to the solar surface of the distal phalanx,
+this rotation is facilitated. With hyperplasia of lamina, at the
+anterior portion of the distal phalanx, there results a thick "white
+line." Rotation of the distal phalanx necessitates a descent of its
+apical portion and there occurs a "dropped sole."
+
+In time, partly because of excessive wear of hoof at the heel, owing to
+an altered condition in the normal antagonistic relation between the
+flexor and extensor tendons, the toe makes an excessive growth, and the
+concavity of the anterior line is accentuated owing to this abnormal
+length of hoof. The hoof, because of recurrent inflammatory attacks, is
+corrugated--elevations of horn in parallel rings are usually present.
+
+[Illustration: Fig. 33--The hoof in chronic laminitis. Note the
+concavity. This animal was serviceable for any work that could be
+performed at a walk.]
+
+Animals that are so affected in traveling strike the heel first and the
+toe is later contacted with the ground surface. Rotation of the distal
+phalanx upon its transverse axis produces a condition, with respect to
+this peculiar impediment, that is equivalent to added and excessive
+length of the deep flexor tendon.
+
+Where there occurs suppuration, by careful inspection of the coronary
+region, one may early recognize detachment of hoof. In such cases
+animals remain recumbent and, while the condition is not so painful at
+this stage, the practitioner must not overlook the real state of
+affairs. History, if obtainable, will be a helpful guide in such cases.
+Separation of hoof occurs as a rule in from four to ten days after the
+initial attack of acute laminitis. Needless to say these cases are
+hopeless, when the economic phase of handling subjects is considered.
+
+[Illustration: Fig. 34--Showing the effects of laminitis. By permission,
+from Merillat's "Veterinary Surgical Operations."]
+
+Treatment.--Much depends upon the concomitant disturbances (or causes
+if one is justified in referring to them as such) as to the manner in
+which laminitis is to be treated. In all cases where digestive
+disturbances exist, the prompt unloading of the contents of the
+alimentary canal is certainly indicated. D.M. Campbell[31] in a
+discussion of laminitis has the following to say regarding the treatment
+of such cases:
+
+     Because superpurgation may be followed by laminitis, the
+     advisability of using the active hypodermic cathartics is
+     questioned. Neither arecolin nor eserin can cause superpurgation.
+     The action of the former does not continue longer than an hour
+     after administration and of the latter not more than eight hours.
+     The action of either is mild after the first few minutes.
+
+     I do not think that anyone has recommended either arecolin or
+     eserin where there is severe purgation. Where the intestinal canal
+     is fairly well emptied and its contents fluid, I should be inclined
+     to rely upon intestinal antiseptics to hold in check harmful
+     bacterial growth.
+
+     The use of alum in the treatment of laminitis is held to be without
+     reason other than the empirical one that it is beneficial. If
+     laminitis is due chiefly to an autointoxication, good and
+     sufficient reason for the administration of alum can be shown based
+     upon its known physiological action. It is the most powerful
+     intestinal astringent that I know of and has the fewest
+     disadvantages. I have not noted constipation following its use nor
+     diarrhea, nor a stopping of peristalsis, nor indigestion, and in
+     any case its action lasts at most only a few hours, and if it did
+     all these, it could not much matter. Quitman says, that it
+     constricts the capillaries. If this is true, a thing of which I am
+     not certain, is it not reasonable to suppose that as with other
+     vaso-constrictors, e.g., digitalis, there is a selective action on
+     the part of the capillaries (not of the drug) and those that need
+     it most, i.e., those of the affected feet in laminitis, are
+     constricted most? All body cells exert this selective action in the
+     assimilation of food, the tissue needing most any particular kind
+     of food circulating in the blood, gets it.
+
+     Our first consideration in laminitis should be to remove the
+     cause--to stop the absorption of the toxin in the intestinal tract
+     that is producing the condition. This we accomplish by partially
+     unloading it by the use of the active hypodermic cathartics and
+     stopping absorption by the surest and most harmless of intestinal
+     astringents. Whether the astonishingly prompt and certain action of
+     alum in this case is due wholly to its astringent action or whether
+     alum combines with the harmful bacterial products chemically and
+     forms an innocuous combination, I can only surmise, and it is
+     unimportant. At any rate, when alum is administered, the onslaught
+     of the disease is promptly stopped. Irreparable damage may already
+     have been done if the case is a neglected one, but whether
+     administered early or late in acute attacks, the progress of the
+     disease is stopped immediately.
+
+The same authority may be profitably quoted in the matter of handling
+all cases wherein the revulsive effect of agents which diminish vascular
+tension are chiefly indicated or necessary as adjuvants. In this
+connection, Campbell says:
+
+     The early and vigorous administration of aconitin in laminitis to
+     its full physiological effect, is more logical. Assuming that
+     laminitis is due to absorption of harmful products from the
+     intestinal tract permitted through the deranged functioning of the
+     organs of digestion, or assuming that it is due to an extension of
+     the inflammation from the mucosa to the sensitive lamina, or that
+     it is a reflex from a sudden chilling of the skin, we have in any
+     of these conditions a disturbed circulation, and aconitin is the
+     first and foremost of circulation "equalizers." Furthermore, in
+     laminitis there is an elevation of the temperature, an almost
+     invariable indication for aconitin. A speedy return of the
+     temperature to normal, a very marked diminution of the pain and
+     improved conditions generally, appear coincident with the symptoms
+     of full physiological effect of aconitin when given in cases of
+     laminitis, which constitutes assuredly an important part of its
+     treatment.
+
+[Illustration: Fig. 35--Inferior (convex) surface of Cochran shoe.]
+
+Where lameness is not great as in cases wherein no marked structural
+change of the foot has occurred, proper shoeing is very beneficial. By
+keeping the heels as low as possible and shoeing without heel calks a
+more comfortable position is made possible. Thin rubber pads which do
+not elevate the heel are of service in diminishing concussion.
+
+Dr. David W. Cochran of New York City has attained unusual success in
+cases of chronic laminitis with dropped sole by the use of a specially
+designed shoe.
+
+[Illustration: Fig. 36--Superior surface, showing concavity or bowl, as
+formed by the toe and branches of the shoe, as designed by Dr. David W.
+Cochran.]
+
+Cochran claims that, not only are horses with dropped soles that would
+otherwise have to be put off the streets enabled to do a fair amount of
+work by means of this shoe, but that continually wearing it, meanwhile
+keeping the convexity of the front of the hoof rasped thin, in time
+brings about a marked improvement, and that after some months or years
+of use the animals are able to work with ordinary rubber-pad shoes,
+provided they are arranged to facilitate breaking over.
+
+From having been successfully used on some race horses of high value,
+the Cochran shoe has attained considerable notoriety and is being used
+by a number of practitioners. A disadvantage, however, arises from the
+fact that few horseshoers other than Doctor Cochran seem able to make
+the shoe, the peculiar shape of which offers considerable difficulty in
+forging. Concerning the application of the shoe Cochran[32] says:
+
+     "The most important primary procedure is the preparation of the
+     foot to receive the shoe. All excess of growth must be removed from
+     the anterior face of the hoof. The outer face must be reduced at
+     the toe (not shortened), but rasped down thin for the lighter the
+     top of the foot is, the more chance the sole and coffin bone will
+     have of resuming their former normal position. The pressure of the
+     wall at the toe upon the exudate between wall and coffin bone,
+     tends to force the coffin bone and sole out of their normal
+     position. Leave the sole alone. You can lower the excess of growth
+     at the heels.
+
+     "There are many designs of shoes to relieve this condition. A great
+     deal depends on the judgment of the shoer to meet the conditions
+     presented, depending on the degree of the convexity and strength of
+     the sole. In some cases we use a shoe that admits of a large amount
+     of sole room. Again, we shoe with a shoe of wide cover. In other
+     cases a shoe with even pressure over the whole sole. In some cases
+     a high, narrow shoe, resting only on the wall, or the ordinary
+     plain shoe with side calks welded close to the outside edge and the
+     shoe dished well from these as a foundation. Then we have the air
+     cushion pad designed after the model of the bowl shoe."
+
+In cases when slight and persistent lameness interferes sufficiently to
+prevent using an animal at any sort of work on hard roads, median
+neurectomy will relieve all lameness in most instances. This is a safe
+operation, moreover, in that no bad after effects are to be feared, even
+though lameness were to continue.
+
+
+Calk Wounds. (Paronychia.)
+
+Etiology and Occurrence.--Injuries of various kinds are inflicted upon
+the coronary region but usually they are due to the foot being trampled
+upon. When the foot that inflicts the injury happens to be unshod, a
+contusion of the injured member is occasioned, but in the majority of
+instances, wounds that demand attention are the result of shoe calks
+which have penetrated the tissues in the region of the coronary band.
+Often calk wounds are self-inflicted. When animals are excited and in
+turning crowd one another, they often perform dancing movements which
+frequently result in deep calk wounds of the coronet. Some horses have a
+habit of resting the heel of one hind foot upon the anterior coronary
+region of the other. While sleeping in this position, if they are
+suddenly awakened, the weight is abruptly shifted to the uppermost foot
+and the one underneath is (because of the pain attending its being
+wounded) quickly drawn out from under its fellow. In this way deep cuts
+may divide the coronary band and inflict extensive injury to the
+sensitive lamina as well.
+
+An infectious type of coronary inflammation occurs in some localities
+during the winter months, wherein the condition is enzootic.
+
+Symptomatology.--Depending upon the manner in which the injury has
+been produced, the appearance of the wound varies and likewise lameness
+is more or less pronounced. If the tissues are not divided and the wound
+is chiefly of the subsurface structures, there will not immediately
+occur pronounced local evidence of the existence of injury; but as soon
+as the lame animal is made to move, the peculiar character of the
+impediment (supporting-leg lameness with the affected foot kept well in
+advance of its normal position) directs attention to the extremity and
+all of the symptoms of acute inflammation are discovered.
+
+Where a wound is inflicted which divides, in some manner, the surface
+structures (skin, coronary band, or the hoof wall) one's attention is at
+once called to the existence of the wound.
+
+Because of the fact that there is every facility for the production of a
+sub-coronary and podophylous infection, these wounds should receive
+prompt attention. In some instances, the pastern joint is opened by calk
+wounds and then, of course, an infectious arthritis succeeds the injury.
+
+Treatment.--In all contused wounds of the coronary region the parts
+need thorough cleansing; the hair, if long is clipped and a cataplasm is
+applied. Or preferably, an iodin-glycerin combination of one part of
+iodin to four parts of glycerin is poured on a layer of cotton, and
+this is confined in contact with the inflamed parts by means of a
+bandage.
+
+Where normal resistance to infection obtains, the subject usually
+suffers no suppurative disturbance when the surface structures are not
+broken; and daily applications of the antiseptic lotion above referred
+to stimulates complete resolution. This may be expected in from four to
+ten days depending upon the extent of the injury.
+
+If a calk wound has been inflicted, the adjoining surface structures are
+freed of hair and the parts cleansed in the usual manner, (which in
+wounds recently inflicted, should be done without employing quantities
+of water) and after painting the wound surface with tincture of iodin
+and saturating its depths with the same agent, the wound is cleansed, if
+it contains filth, by means of a small curette. By using a small and
+sharp curette, one is enabled to cleanse the average wound quickly and
+almost painlessly.
+
+In such cases, equal parts of tincture of iodin and glycerin are
+employed. The wound is filled with this preparation and a quantity of it
+is poured upon a suitable piece of aseptic gauze or cotton and this is
+contacted with the wound. The extremity is carefully bandaged and this
+dressing is left in position for forty-eight hours unless there occurs,
+in the meanwhile, evidence of profuse suppuration--which is unusual.
+
+One is to be guided as to the progress made by the degree of lameness
+present. If little or no lameness develops, it is reasonable to expect
+that infection has been checked; that the wound is dry and redressing
+every second day is sufficiently frequent.
+
+Where cases progress favorably, recovery (unless infectious arthritis
+results) should occur in from ten days to three weeks. Where extensive
+sub-coronary fistulae result, either from lack of prompt or proper
+attention, the condition is then one requiring a radical operation to
+establish drainage and to disinfect if possible, the suppurating
+tissues.
+
+
+Corns.
+
+Etiology and Occurrence.--In horses, because of a tendency toward
+contraction of the heel in some subjects, together with work on hard
+roads and pavements, where the feet become dry and brittle, and because
+of neglect of the matter of shoeing, this affection is of frequent
+occurrence. Unshod horses are rarely affected. If conformation is faulty
+and too much weight is borne on the inner or the outer quarter, and the
+hoof wall at the quarter tends to turn inward, corns are usually
+present. They occur more frequently on the inner quarters of the front
+feet, though the outer quarters are occasionally also affected and in
+rare instances corns are found at the toes. They do not often affect the
+hind feet.
+
+As soon as injury by pressure, such as is supposed to cause the
+formation of corns, is brought to bear on the sensitive sole, an
+extravasation of blood occurs. In time when the cause remains active,
+this discoloration is evident in the substance of the insensitive sole
+and consists in a red or yellowish spot which varies in size--this is
+ordinarily termed dry corn.
+
+In some cases where infection of this extravasation of blood and serum
+occurs, instead of desiccation and discoloration of the insensitive
+parts, there is, in time, manifested a circumscribed area of destruction
+of the insensitive sole and the abscess may, where no provision for
+drainage exists, burrow between sensitive and insensitive laminae and
+perforate the tissues at the coronet. If the suppurative material
+discharges readily by way of the sole, no disturbance of the heel or
+quarters occurs above the hoof.
+
+Symptomatology.--A supporting-leg-lameness characterizes this
+condition; and this lameness in most instances varies in degree with the
+amount of distress which is occasioned by pressure upon the inflamed
+parts. By an examination of the sole after having removed all dirt, and
+exposed the horny sole to view, no difficulty is encountered in locating
+the cause of the trouble.
+
+Treatment.--Before suppuration has taken place and in the cases where
+suppuration does not occur, the horse-shoer's method of paring out the
+diseased tissue affords a means of temporary relief; but unless
+frequently done, in many cases, lameness results within about three
+weeks after such treatment has been given. In other instances temporary
+relief is not to be gotten in this manner for any great length of time
+or until a more rational mode of treatment becomes necessary so that the
+subject may experience a cessation of the inconvenience or distress.
+
+The general plan which meets with the approval of most practitioners
+consists in careful leveling of the foot and removing enough of the wall
+and sole at the quarters to make possible frog pressure by means of a
+bar shoe. With frog pressure, expansion of the heel follows in time, and
+permanent relief is obtainable in this manner. Thinning the wall of the
+quarter is advocated by many practitioners and is undoubtedly beneficial
+in chronic cases where marked contraction has taken place. The wall must
+be thinned with a rasp until it is readily flexible by compressing with
+the thumbs.
+
+There are instances, however, where corns and contraction of the heel
+have existed so long that they do not yield to treatment. Such cases are
+found in old light-harness or saddle-horses that have been more or less
+lame for years and where there exists marked contraction of the heels,
+rough hoof walls, and hard and atrophied frogs.
+
+Suppurating corns require surgical attention in the way of removal of
+the purulent necrotic mass and making provision for drainage. Dry
+dressings, such as equal parts of zinc sulphate and boric acid, may be
+employed to pack the cavity. After the infectious condition has been
+controlled, and the wound is dry, the same plan of treatment is
+indicated that is employed in the non-suppurating corn. Ample time is
+allowed, however, for the surgically invaded tissues to granulate and,
+if the subject is to be put in service, a leather pad, under which there
+has been packed oakum and tar, affords good protection.
+
+
+Quittor.
+
+This name is employed to designate an infectious inflammation of the
+lateral cartilage and adjoining structures. The disease is characterized
+by a slowly progressive necrosis and by a destruction of more or less of
+the cartilage and by the presence of fistulous tracts.
+
+Etiology and Occurrence.--The disease is due to the introduction of
+pus producing organisms into the subcoronary region of the foot under
+conditions which favor the retention of such contagium and extension of
+infection into contiguous tissues.
+
+Morbific material is introduced into the region of the lateral cartilage
+by means of calk wounds and other penetrant injuries of the foot. A
+sub-coronary abscess which, because of lack of proper care or because of
+virulency of the contagium or low vitality of the subject, is quite apt
+to result in cartilaginous affection and its perforation by necrosis
+follows.
+
+Symptomatology.--Quittor is readily diagnosed on sight in many
+instances. Where there is dependable history or other evidence of the
+chronicity of an infectious inflammation of the kind, quittor is easily
+identified. If no positive evidence of the disease exists, by means of
+careful exploration of sinuses with the probe, one may distinguish
+between true cartilaginous quittor and superficial abscess formation
+that is often accompanied by hyperplasia.
+
+Lameness depends upon the extent of the involvement as it affects the
+structures contiguous to the cartilage. A variable degree of lameness is
+manifested in different cases.
+
+Treatment.--Two general plans of handling this disease are in vogue.
+One, the more popular method, consists in the injection of caustic
+solutions of various kinds into the fistulous openings with the object
+of causing sloughing of necrotic tissue and the stimulation of healthy
+granulation of such wounds. The other mode consists in either complete
+surgical removal of the cartilage or its remaining portions, or removal
+of the diseased parts of curettage.
+
+When quittor has not extensively damaged the foot and the lateral
+cartilage is not partly ossified as it is in some old chronic cases, the
+complete removal of the lateral cartilage by means of the Bayer
+operation or a modification thereof is indicated. A complete description
+of the Bayer operation as well as Merillat's operation for this disease
+(the latter consisting in part, in the removal of diseased cartilage
+with the curette) are given in Volume three of Merillat's "Veterinary
+Surgical Operations."
+
+Treatment by injection of caustic solutions has many advocates and
+because of the fact that, in many instances the condition is such that
+they are not desirable surgical cases and also because some animals may
+be put in service before treatment is completed, the injection method is
+popular.
+
+The mode of treatment advocated by Joseph Hughes, M.R.C.V.S.,
+constitutes a very successful manner of handling quittor and we can do
+no better than quote Dr. J.T. Seeley[33] on his manner of using this
+particular treatment.
+
+[Illustration: Fig. 37--Hyperplasia of right fore foot, due to chronic
+quittor.]
+
+     Preparation.--First remove the shoe, have the foot pared very
+     thin and balanced as nicely as possible. Moreover, all loose
+     fragments of horn must be detached and all crevices cleaned
+     thoroughly.
+
+     Next, have the leg brushed and hair clipped from the knee or hock
+     to the foot and scrubbed with ethereal soap and warm water, after
+     which the foot must be scrubbed in like manner. The foot is then
+     placed in a bichlorid bath several hours daily, for from two to
+     five days, depending upon whether or not soreness is shown. The
+     bichlorid solution is 1 to 1,000 strength.
+
+     On removing the horse from the bath a liberal layer of gauze is
+     soaked in 1 to 1,000 bichlorid solution and placed so as to cover
+     the entire foot. On discontinuing the bath, cover the foot with
+     gauze saturated with a 1 to 1,000 bichlorid solution. This is to be
+     covered with absorbent cotton and a gauze bandage, and over all is
+     placed an oil cloth or silk covering. This pack is kept moist with
+     bichloride solution for forty-eight hours. The foot is then ready
+     for injection.
+
+[Illustration: Fig. 38--Chronic quittor, left hind foot. Showing
+position assumed because of painfulness of the affection.]
+
+     Preparation of the Injection Fluids.--Have on hand a pint of a
+     one per cent aqueous solution of formaldehyd made under cleanly
+     conditions, even to a clean bottle and cork, and a clean container
+     when ready to use the liquid. Prepare also a bichlorid of mercury
+     solution as follows: Hydrarg. Chlor. Corros. 3IV; Acid Hydrochlor.
+     3Iss.; Aqua Bulliens, Oij. This should be thoroughly triturated,
+     and then filtered into a clean bottle, when it is ready for use.
+
+     Injection.--The patient should be laid on a table, if one is
+     available, or cast, and the foot securely fixed. Then, with an
+     ordinary one-ounce hard rubber syringe, with a good plunger (tried
+     first to note whether or not any fluid works around between the
+     barrel and the plunger), introduce one syringe full of the
+     formaldehyd solution, then thoroughly probe the quittor to
+     determine the number of sinuses. This done, inject each sinus. If
+     two sinuses open on the surface, close one with cotton while
+     filling the other so that if there is a connection the solution
+     will come in contact with all tissues involved. Irrigate with the
+     full pint of formaldehyd solution first, then follow with six or
+     eight ounces of the bichlorid solution. Never probe the foot nor
+     allow it to be tampered with except in the manner prescribed.
+
+     After-Treatment.--Put on a pack saturated with a solution of
+     bichlorid of mercury 1 to 1,000 and let it remain two days. Remove
+     pack, and once daily afterwards wipe off with cotton the secretion
+     which accumulates on the outside, and apply a dry dressing or
+     healing oil composed of phenol, camphor gum and olive oil.
+
+     When Dangerous to Inject.--Never inject a quittor in the acute
+     stage. Never inject a quittor if considerable lameness is present.
+     On injecting a solution of formalin, hold cotton tightly around the
+     nozzle of the syringe, when the plunger is down, then withdraw the
+     syringe gently and note particularly if the fluid returns through
+     the opening; if none returns cease operations at once, as it is
+     dangerous to proceed farther, it indicates that the sinus is not
+     well defined and the fluid retained will cause much trouble and
+     often the death of the patient.
+
+Experience has taught that, if extensive destructive changes of the foot
+exist, the Bayer operation is not indicated. In the country, where
+quittors are not so frequently met as in urban practice, the Merillat
+operation is preferable in all cases. However, the cost of the
+protracted period of idleness, which convalescent surgical patients
+require, renders the Hughes method more satisfactory in the hands of the
+general practitioner, especially in the city.
+
+
+Nail Punctures.
+
+Nail punctures, as herein considered, embrace all penetrant wounds of
+the solar surface of the horse's foot due to trampling upon street
+nails. This does not include accidental nail pricks occasioned in
+shoeing. In city practice, in some stables, these cases are of frequent
+occurrence; and, generally speaking, nail punctures are observed more
+frequently in urban horses than in animals that are kept in the country.
+
+Occurrence and Method of Examination.--This condition, then, is a
+rather common cause of lameness and in no case, where cause of the
+claudication is not obvious, is the practitioner warranted in concluding
+his examination without careful search for the possible existence of
+nail puncture of the solar surface of the foot.
+
+[Illustration: Fig. 39--Skiagraph of foot. The X-ray offers very limited
+possibilities in the diagnosis of lameness. The location of a "gravel"
+or a nail that had worked its way some distance from the surface, or of
+an abscess of some proportion, deep in the tissues, might be facilitated
+under some circumstances by the aid of the X-ray. Its use in the
+detention of fractures is very limited, owing to the difficulty
+encountered in getting a view from the right position--many trials being
+necessary in most cases. The case shown above was diagnosed clinically
+as incipient ringbone. The X-ray revealed no lesions. (Photo by L.
+Griessmann.)]
+
+In occasional instances there co-exists an obvious cause for
+supporting-leg-lameness and an occult cause--a nail puncture. Where such
+complications are met, the practitioner is not necessarily guilty of
+neglect or carelessness when the nail puncture is not discovered at
+once, nevertheless, an examination is not complete until practically
+every possible cause of lameness has been located or excluded in any
+given case.
+
+In a search for nail puncture it is necessary to expose to view every
+portion of the sole and frog in such manner that the existence of the
+smallest possible wound will be revealed. This necessitates removal of
+the shoe, if, after a preliminary examination, a puncture is not found,
+when there is good reason to suspect its presence. However, where it is
+readily possible to locate and care for a wound without removal of the
+shoe, allowing the shoe to remain materially facilitates retaining
+dressings in position and relieves the solar surface of contact with the
+ground. If extensive injury or infection exists, it is of course
+necessary to remove the shoe and leave it off. By removing a superficial
+portion of all of the sole and frog, thus carefully and completely
+exposing to view all parts of the solar surface of the foot, and with
+the aid of hoof-testers one is enabled to positively determine the
+existence of nail punctures. Because of the tendency of puncture wounds
+of the foot to close, and since the superficial portion of the solar
+structures are usually soiled, it is absolutely necessary to conduct
+examinations of this kind in a thorough manner.
+
+Symtomatology.--Not all cases of nail puncture cause lameness during
+the course of the disturbance and in many instances no lameness is
+manifested for some time after the injury has been inflicted--not until
+infection has been the means of causing considerable inflammation of
+sensitive structures. Nevertheless, this lack of manifestation occurs
+only in cases where serious injury has not taken place and the degree of
+lameness is a constant and reliable indicator of the character and
+extent of nail punctures within twenty-four hours after injury has been
+inflicted.
+
+The position assumed by the affected animal inconstantly varies with the
+location and nature of the injury and is not of particular importance in
+establishing a diagnosis. The subject may support some weight with the
+affected member and stand "base-wide" or "base-narrow," or no weight may
+be borne with the foot or the animal may point or keep the extremity in
+a state of volar flexion. In cases where extensive injury has been
+inflicted, and great pain exists, the foot is kept off the ground much
+of the time and it may be swung back and forth as in all painful
+affections of the extremity.
+
+Nail punctures cause typical supporting-leg-lameness and in some cases
+certain peculiarities of locomotory impediment are worthy of notice.
+Punctures of the region of the heel, which directly affect or involve
+the deep tendon sheath, cause a type of lameness wherein pain is
+augmented, when dorsal flexion of the extremity occurs as well as when
+weight is borne. Wounds in the region of the toe of the hind feet
+sometimes cause the subject to carry the extremity considerably in
+advance of the point where it is planted and, just before placing the
+foot on the ground, it is carried backward a little way--ten or twelve
+inches.
+
+However, diagnosis of nail puncture is based on the finding of the
+characteristic wound or resultant local changes.
+
+Course and Prognosis.--The nature of the progress and the manner of
+termination of these cases are variable. If the coffin joint has been
+invaded, and a septic arthritis exists, the condition is at once grave.
+An open and infected tendon sheath, while not so serious, constitutes a
+condition which is distressing, and recovery is slow even under the most
+favorable conditions. Where a heavy, rigid and sharp nail enters the
+foot, in such manner that fracture of the third phalanx (os pedis)
+occurs, this complication makes for a protraction of the condition.
+Experience teaches that the natural course and termination in these
+cases are modified by the location and depth of the injury, virulency of
+the contagium and resistance of the subject to such infection.
+
+Prevention.--In all horses which are kept at such work that exposure
+to nail punctures is frequent, a practical means of prevention of such
+injuries consists in the employment of heavy sole leather or suitable
+sheet metal to cover the sole of the foot and, at the same time, confine
+oakum and tar in contact with the solar surface to prevent the
+introduction of foreign material between the foot and such protecting
+appliances. Further, if drivers and owners could be impressed with the
+serious complications which so frequently attend wounds of this kind,
+undoubtedly many cases which are now lost, because of ignorance or
+neglect on the part of the teamsters or proprietors of horses, would be
+saved by prompt and rational treatment.
+
+Treatment.--The treatment of this condition falls so largely within
+the dominion of surgery that we can give little more than an outline
+here.
+
+In cases where there exists no evidence of open joint or open tendon
+sheath as judged by the site of the puncture and degree of lameness
+present (after having thoroughly cleansed the solar surface of the foot
+and enlarged the opening in the nonsensitive sole) a little phenol is
+introduced into the wound. In such cases, where it is possible for the
+antiseptic to contact every part of wound surface to the extreme depths
+of the puncture, infection is prevented when such treatment is promptly
+administered. This may be considered as first aid, or emergency care,
+and is indicated in all wounds of the foot whether the injury be serious
+or almost insignificant.
+
+Subsequently one of two general courses may be pursued in the treatment
+of cases of nail puncture. One, by the employment of means to keep the
+wound patent and injection of suitable antiseptics, or agents that are
+more or less caustic in conjunction with strict observance of asepsis
+and wound protection. The other method consists in prompt establishment
+of drainage by surgical means and includes exploration and curettage.
+
+The first method is better adapted to the use of the average general
+practitioner and he would do well to keep the opening in the
+nonsensitive structures patent. By introducing equal parts of tincture
+of iodin and glycerin daily, good results will follow in most instances.
+The wound is protected in unshod horses, either by completely bandaging
+the foot and retaining, in contact with the wound, cotton that is
+saturated with iodin and glycerin, or, if a minor injury exists, the
+moderately enlarged opening in the nonsensitive sole or frog, which has
+been moistened with the antiseptic, is packed with a very small quantity
+of cotton. A little practice in this mode of closing benign puncture
+wounds will enable the practitioner to successfully protect the
+sensitive parts in the treatment of such cases in unshod country
+horses.
+
+When the condition progresses favorably the wound may be dressed every
+second day or twice weekly, and in the course of from two to six weeks
+recovery should be complete.
+
+If the practitioner is somewhat proficient as a surgeon, and has at his
+command facilities for doing surgery, the second method is preferable in
+many cases. By using a local anesthetic on the plantar nerves and
+confining the subject on an operating table, restraint should be
+perfect. The solar surface of the foot is first thoroughly cleansed, the
+puncture wound is enlarged in the nonsensitive structures and the parts
+are then moistened with phenol or other suitable antiseptics. By means
+of a small probe the puncture is explored and, depending on the
+character of the wound and the structures involved, surgical
+intervention is varied to suit the case. If necessary, all of the
+insensitive frog is removed, and in wounds affecting the region of the
+heel the tissues may be incised from the puncture outward dividing all
+of the tissues outward and backward to the surface. A suitable surgical
+dressing is then applied.
+
+If, on the other hand, the puncture extends into the navicular bursa,
+the radical operation is perhaps indicated, though not until one is sure
+that infection of the bursa and serious consequences are to follow if
+this operation is not performed. Detailed description of the technic of
+this operation belongs to the realm of surgery and a good discussion of
+it is to be found in William's work on veterinary surgical and
+obstetrical operations.
+
+One may summarize the discussion of treatment of nail puncture by saying
+that emergency care as herein described is of first consideration. In
+every case an immunizing dose of anti-tetanic serum should be given.
+Subsequently, the method employed must suit the character of the wound,
+existing facilities for handling the subject and the skill and aptitude
+of the practitioner.
+
+FOOTNOTES:
+
+[Footnote 5: Manual of Veterinary Physiology, by Major-General F. Smith,
+page 590.]
+
+[Footnote 6: Manual of Veterinary Physiology by Major-General F. Smith,
+page 589.]
+
+[Footnote 7: Regional Veterinary Surgery and Operative Technique, Jno.
+A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 765.]
+
+[Footnote 8: Dr. Roscoe R. Bell in the Proceedings, N.Y. State
+Veterinary Medical Society, 1899.]
+
+[Footnote 9: American Veterinary Review, Vol. 35, P. 456.]
+
+[Footnote 10: "Radial Paralysis and Its Treatment by Mechanical Fixation
+of Knee and Ankle," Geo. H. Berns, D.V.S. Proceedings of the American
+Veterinary Medical Association, 1912, p. 219.]
+
+[Footnote 11: As quoted by Berns, in Radial Paralysis, etc., Proceedings
+of the A.V.M.A., 1912.]
+
+[Footnote 12: Veterinary Surgical Operations, by L.A. Merillat, V.S., p.
+507.]
+
+[Footnote 13: A paper presented before the Illinois Veterinary Medical
+Assn. by Dr. H. Thompson of Paxton, Ill., American Veterinary Review,
+Vol. 15, p. 134.]
+
+[Footnote 14: "Fractures in Foals," by Dr. Wilfred Walters, M.R.C.V.S.,
+American Journal of Veterinary Medicine, Vol. 8, p. 669.]
+
+[Footnote 15: American Veterinary Review, Vol. 26, p. 1068.]
+
+[Footnote 16: Fractures, by H. Thompson, Paxton, Ill., American
+Veterinary Review, Vol. 15, p. 134.]
+
+[Footnote 17: Veterinary Surgical Operations, by L.A. Merillat, Vol. 3,
+p. 198.]
+
+[Footnote 18: Wilfred Walters, American Journal of Veterinary Medicine,
+Vol. 8, p. 606.]
+
+[Footnote 19: J.N. Frost, assistant professor of Surgery, Veterinary
+Dept., Cornell University, in "Wound Treatment," page 159.]
+
+[Footnote 20: Open Joints and Their Treatment in my practice, by J.V.
+Lacroix, American Journal of Veterinary Medicine, Vol. 5, page 203.]
+
+[Footnote 21: Regional Veterinary Surgery Moeller--Dollar, page 605.]
+
+[Footnote 22: Extract from Receuil de Medecine Veterinaire in Ameircan
+Veterinary Review, Vol. 23, p. 893.]
+
+[Footnote 23: Fracture of All the Sesamoid Bones, by R.F. Frost,
+M.R.C.V.S., A.V.D., Rangoon, Burmah, in American Veterinary Review, Vol.
+5, p. 362.]
+
+[Footnote 24: The Anatomy of the Domestic Animal, by Septimus Sisson,
+S.B., V.S.]
+
+[Footnote 25: Traite De Therapeutique Chirurgicale Des Animaux
+Domestique, par P.J. Cadiot et J. Almy, Tome Second, page 547.]
+
+[Footnote 26: Anatomie Regionale Des Animaux Domestique, page 695.]
+
+[Footnote 27: Manual of Veterinary Physiology, by Major-General F.
+Smith, C.B., C.M.G., page 678.]
+
+[Footnote 28: Moeller's Regional Veterinary Surgery, by Dollar, page
+630.]
+
+[Footnote 29: Edinburgh Veterinary Review, Vol. VI, page 616.]
+
+[Footnote 30: Equine Laminitis or Pododermatitis, by R.C. Moore, D.V.S.,
+American Journal of Veterinary Medicine, Vol. XI, page 284.]
+
+[Footnote 31: American Journal of Veterinary Medicine, Vol. XI, page
+318.]
+
+[Footnote 32: The Shoeing of a Dropped Sole Foot by Dr. David W.
+Cochran, New York City, The Horse Shoers Journal, March, 1915.]
+
+[Footnote 33: Quittor and Its Treatment by the Hughes Method, J.T.
+Seeley, M.D.C., Seattle, Washington, Chicago Veterinary College
+Quarterly Bulletin, Vol. 9, page 27.]
+
+
+
+
+SECTION IV.
+
+LAMENESS IN THE HIND LEG.
+
+
+Anatomo-Physiological Consideration of the Pelvic Limbs.
+
+The pelvic bones as a whole constitute the analogue of the scapulae with
+respect to their function as a part of the mechanism of locomotive and
+supportive apparatus of the horse. The manner of attachment or
+connection between the ilia and the trunk is materially different from
+that of the scapulae, however, and the angles as formed by the long axes
+of the ilia in relation to the spinal column are maintained by two
+functionally antagonistic structures--the sacrosciatic ligaments, and
+the abdominal muscles by means of the prepubian tendon. The sacro-iliac
+articulations are such that a very limited amount of movement is
+possible; free movement, however, is unnecessary because of the
+enarthrodial (ball and socket) femeropelvic joint.
+
+The various muscles which exert their effect upon the pelvis in changing
+their relationship between the long axes of the ilia and spinal column,
+are concerned but little more in propulsion and weight bearing than are
+the pectoral muscles. A general treatise on the subject of lameness does
+not properly include such structures any more than it does the various
+affections of the dorsal, lumbar and sacral vertebrae or inflammation of
+the abdominal parietes. Involvement of such parts cause manifestations
+of lameness but the matter of establishing a diagnosis is difficult in
+many instances and in some cases impossible.
+
+The femeropelvic articulation is formed by the hemispherical head of the
+femur and the acetabulum; the latter constituting a cotyloid cavity
+which is deepened by the cotyloid ligament.
+
+The round ligament (ligamentum teres) is the principal binding structure
+of the hip joint and it arises in a notch in the head of the femur and
+is attached in the subpubic groove close to the acetabular notch.
+Another ligament, peculiar to Equidae--the accessory (pubiofemoral)--is
+attached to the head of the femur near the round ligament and passes
+through the cotyloid notch and along the under side of the pubis. It
+is inserted or blends with the prepubic tendon. This ligament prevents
+extreme abduction of the leg. The joint capsule encompasses the
+articulation and is attached to the brim of the acetabulum and the edge
+of the head of the femur.
+
+[Illustration: Fig. 40--Sagital section of right hock. The section
+passes through the middle of the groove of the trochlea of the tibial
+tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick
+part of joint capsule over which deep flexor tendon plays. 4. Fibular
+tarsal bone (sustentaculum). A large vein crosses the upper part of the
+joint capsule (in front of 1). (From Sisson's "Anatomy of the Domestic
+Animals.")]
+
+[Illustration: Fig. 41--Muscles of right leg; front view. The greater
+part of the long extensor has been removed. 1, 2, 3. Stumps of patellar
+ligaments. 4. Tuberosity of tibia. (From Sisson's "Anatomy of the
+Domestic Animals.")]
+
+The stifle joint is analagous to the knee joint of man and is to be
+considered an atypical ginglymus (hinge) articulation formed by the
+femur, tibia and patella. The ligaments are femerotibial, femeropatellar
+and capsular.
+
+In addition to the usual provision for articulation of bones there are
+situated cartilaginous _menisci_ between the condyles of the femur and
+the head of the tibia. These discs surround the tibial spine and are
+otherwise shaped to fit perfectly between the articular portions of the
+femur and tibia.
+
+Collateral ligaments (internal and external lateral) pass from the
+distal end of the femur to the proximal portion of the tibia. The mesial
+(internal) arises from the internal condyle of the femur and is attached
+to a rough area below the margin of the medial (internal) condyle of the
+tibia. The lateral (external), shorter and thicker, arises from the
+depression on the lateral epicondyle and inserts to the head of the
+fibula.
+
+The crucial or interosseus, anterior and posterior, are situated between
+the femur and tibia, and according to Smith,[34] the crucial ligaments
+are necessary to properly join the two bones, because of the character
+of the structure of the articular ends of the femur and tibia.
+
+The femeropatella ligaments are two thin bands which reinforce the
+capsular ligament. They arise from the lateral aspects of the femur,
+just above the condyles and are inserted to the corresponding surfaces
+of the patella.
+
+The patellar ligaments are three strong bands which arise from the
+antero-inferior surface of the patella, and are inserted to the anterior
+aspect of the tuberosity of the tibia.
+
+Taken as a whole, the tarsal bones, interarticulating and articulating
+with the tibia and metatarsal bones form the hock joint and this
+articulation is analagous to the carpus. As with the carpus, there is
+less movement in the inferior portion of the joint than in the
+superior part of the articulation. The chief articulating parts are the
+tibia with the tibial tarsal bone (astragulus).
+
+[Illustration: Fig. 42--Muscles of lower part of thigh, leg and foot;
+lateral view, o', Fascia lata; q, q', q", biceps femoris; r,
+semitendinosus; 21', lateral condyle of tibia. The extensor brevis is
+visible in the angle between the long and lateral extensor tendons.
+(After Ellenberger-Baum, Anat. fuer Kuenstler.) (From Sisson's "Anatomy of
+the Domestic Animals.")]
+
+The capsular ligament is attached around the margin of the articular
+surfaces of the tibia, to the tarsal bones, the collateral ligaments
+(internal and external lateral) and to the metatarsus.
+
+[Illustration: Fig. 43--Right stifle joint; lateral view. The
+femoro-patellar capsule was filled with plaster-of-Paris and then
+removed after the cast was set. The femoro-tibial capsule and most of
+the lateral patellar ligament are removed. M. Lateral meniscus. (From
+Sisson's "Anatomy of the Domestic Animals.")]
+
+The common ligaments of the tarsal joint are the collateral, the plantar
+(calcaneo-metatarsal and c. cuboid) and dorsal ligaments (oblique).
+
+The medial (internal lateral) ligament serves to join the medial
+(internal) tibial malleolus with tibial tarsal (astragalus) and other
+tarsal bones.
+
+The lateral (external lateral) ligament is inserted to the lateral
+(external) tibial malleolus and its distal portions are attached to the
+tibial tarsal (astragalus), fibular tarsal (calcaneum) bone, fourth
+tarsal (cuboid) and metatarsus bones.
+
+[Illustration: Fig. 44--Left stifle joint; medial view. The capsules are
+removed. (From Sisson's "Anatomy of the Domestic Animals.")]
+
+The plantar ligament (calcaneo-cuboid) is a strong flat band which is
+attached to the plantar surface of the fibular and fourth tarsal bones
+(calcaneum and cuboid) and the head of the lateral metatarsal (external
+small) bone.
+
+The dorsal (oblique) ligament is attached above to the distal tuberosity
+on the inner side of the tibia. It is inserted below to the central
+(cuneiform magnum) and third (c. medium) tarsal bones, to the proximal
+ends of the large and outer small metatarsal bones.
+
+The tarsus is a true hinge joint and because of the great strain which
+it sustains, is subject to frequent injury. About seventy-five percent
+of cases of lameness affecting the hind leg may be said to arise from
+disease of the hock.
+
+As members of locomotion the legs receive strains of two kinds: those of
+concussion and weight-bearing and strains of propulsion; the latter are
+the greater. In the horse as a work animal, the hind legs are probably
+subjected to greater strains than are the front but the manner of
+construction of the various parts of the pelvic limbs with the possible
+exception (according to some authorities) of the tibial tarsal joint,
+offsets this condition.
+
+The femur may be considered analagous to the humerus in that it bears a
+similar relationship to the ilium, that exist between the humerus and
+scapula. Further flexion during repose is prevented chiefly by the
+glutens medius (maximus) muscle and its tendons. The larger tendon
+inserts to the summit of the trochanter major of the femur and
+corresponds to the biceps brachii in the action of the latter on the
+scapulohumeral joint, except that the gluteus medius, in attaching to
+the femoral trochanter, exerts its effect as a lever of the first class.
+Because of the relationship between the long axes of the femur and iliac
+shaft it is evident that the angle formed by these two bones is
+maintained chiefly by the gluteus muscles during weight bearing.
+Contraction of muscular fibers of the gluteus medius causes extension of
+the femur and muscular strain is prevented to a great degree by the
+inelastic portion of this muscle. The chief physiological antagonistics
+of the glutei are the quadriceps femoris and tensor fascia lata.
+
+While the leg is supporting weight the stifle joint is fixed in position
+mainly by the quadriceps femoris group of muscles which are attached to
+the patella. Tendinous fibres intersect this muscular mass and relieve
+muscular strain during weight bearing. Because of the manner in which
+the patella functionates with the trochlea of the femur, comparatively
+little energy is required to prevent further flexion of the stifle
+joint. The patella, according to Strangeways, may be considered a
+sesamoid bone.
+
+[Illustration: Fig. 45--Left stifle joint; front view. The capsules are
+removed. 1. Middle patellar ligament. 2. Stump of fascia lata. 3. Stump
+of common tendon of extensor longus and peroneus tertius. (From Sisson's
+"Anatomy of Domestic Animals.")]
+
+The quadriceps group of muscles is assisted by the anterior digital
+extensor (extensor pedis) peroneus tertius and tibialis anticus (flexor
+metatarsi) muscles. The latter pair (flexor metatarsi, muscular and
+tendinous portions, because of their attachment to the external condyle
+of the femur and to the metatarsal bone) are enabled to automatically
+flex the tarsal joint when the stifle is flexed.
+
+The hock is kept fixed in position by the gastrocnemius and the
+superficial digital flexor (perforatus). The latter structure, which is
+chiefly tendinous, originates in the supracondyloid fossa of the femur
+and has an insertion to the summit of the fibular tarsal (calcis) bone.
+It relieves the gastrocnemius of muscular strain during weight bearing.
+
+Smith[35] styles the function of the stifle and hock joints a
+reciprocating action, and we quote from this authority the following:
+
+     From what has been said, it is evident that flexion and extension
+     of stifle and hock are identical in their action. When the stifle
+     is extended, the hock is automatically extended, nor can it under
+     any circumstances flex without the previous flexion of the stifle.
+     There is no parallel to this in the body. The two joints, though
+     far apart, act as one, and they are locked by the drawing up of the
+     patella, and in no other way. The so-called dislocation of the
+     stifle in the horse is a misnomer. That the patella is capable of
+     being dislocated is beyond doubt, but the ordinary condition
+     described under that term, when the stifle and hock are rigid while
+     the foot is turned back with its wall on the ground, is nothing
+     more than spasm of the muscles which keeps the patella drawn up.
+     The moment they relax the previously immovable limb and useless
+     foot have their function restored as if by magic, but are
+     immediately thrown out of gear in the course of a few minutes as a
+     recurrence of the tetanus of the petallar muscle takes place. The
+     fascia of the thigh, like that of the arm, is a most potent factor
+     in giving assistance to the constant strain imposed on the muscles
+     of the limbs during standing.
+
+     Below the hock the hind limb is arranged like that of the fore, the
+     deep flexor (perforans) receiving its additional support from the
+     "check ligament," as in the fore leg.
+
+     The natural attitude of standing adopted by the horse is to rest on
+     three legs--one hind and two fore. If he is alert, he stands on all
+     four limbs; but if standing in the ordinary manner, he always rests
+     on one hind leg. He does not remain long in this position without
+     changing to the other. Hour by hour he stands, shifting his weight
+     at intervals from one to the other hind leg, and resting its fellow
+     by flexing the hock and standing on the toe. He never spares his
+     fore-limbs in this manner in a state of health, but always stands
+     squarely on them.
+
+
+Hip Lameness.
+
+Fortunately, because of the heavy musculature which goes to form a part
+of the locomotive apparatus of the rear extremity, hip lameness is
+comparatively rare. While the term is in itself ambiguous and signifies
+nothing more definite than does "shoulder lameness," yet diagnosis of
+almost any condition that may be classed under the head of "hip
+lameness" is not easy except in cases where the cause is obvious, as in
+wounds of the musculature and certain fractures. To the complexity which
+the gait of the quadruped contributes, because of its being four-legged,
+there is added the complicated manner of articulation of the bones of
+the hind leg. This involves the hip in the manner of diagnostic problems
+and because of the inaccessibility of certain parts, owing to the bulk
+of the musculature of these parts, diagnosis of some hip ailments
+becomes an intricate problem. Consequently, in some instances, before
+one may arrive at definite and enlightening conclusions, repeated
+examinations are necessary as well as a knowledge of reliable history
+and recorded observations of the subject over a considerable period.
+
+Rheumatic affections, when present, usually cause recurrent attacks of
+lameness; myalgia, due to subsurface injury occasioned by contusion,
+generally produces an ephemeral disturbance; and while these are
+examples of cases where occult causes are active, they are by no means
+unprecedented. In cases where the cause of lameness is not definitely
+located, and when by the process of exclusion one is enabled to decide
+that the seat of trouble is in the hip, a tentative diagnosis of hip
+lameness is always appropriate.
+
+In one instance a Shetland pony evinced a peculiar form of intermittent
+lameness which affected the left hip, and repeated examinations did not
+disclose the cause of the trouble. After about a year there was
+established spontaneously an opening through the integument overlying
+the region of the attachment of the psoas major (magnus), through which
+pus discharged. With the occurrence of this fistula, lameness almost
+entirely disappeared, but the emission of a small amount of pus
+persisted for more than a year. The subject was not observed thereafter
+and the outcome in this case is not a matter of record. Whether there
+existed a psoic phlegmon due to metastatic infection or necrosis of a
+part of a lumber or dorsal vertebra is a matter for speculation. Thus
+the presence of some anomalous conditions which affect the pelvic region
+and cause lameness may be discovered, yet both in hip and shoulder
+regions causes may not be definitely located by means of practical
+methods of examination.
+
+Injuries of all kinds are the more frequent causes of hip lameness. In
+such cases, lameness may result directly and resolution be prompt, or
+the claudication become aggravated in time, due to muscular atrophy or
+degenerative changes affecting the hip joint or nerves. Rheumatism or
+metastatic infection may be the cause of hip lameness as well as
+affections of the pelvic bones, lumbar and sacral vertebrae. Hip
+lameness may also be provoked by melanotic or other tumors.
+
+In the diagnosis of hip lameness, one is guided in a general way by the
+character of the impediment manifested. Swinging-leg lameness is often
+present and the impediment is more accentuated when the animal is caused
+to step backward. In many cases lameness is mixed, being about equally
+noticeable during weight bearing and while the member is being swung. By
+exclusion of causes which might affect other parts; one may definitely
+locate the cause of the trouble or determine that a certain region is
+affected.
+
+The sudden manifestation of lameness is indicative of injury; thermic
+disturbances may signalize metastatic infection; history, if dependable,
+is always helpful. Repeated observations, taking into account the course
+which the affection assumes during a period of a few days, often serve
+to afford a means of establishing a diagnosis in baffling cases.
+
+
+Fractures of the Pelvic Bones.
+
+The os innominatum may be so fractured that the pelvic girdle is broken,
+as in fracture of the iliac shaft, or in a manner that the girdling
+continuity of the innominate bones is not interrupted. It naturally
+follows that greater injury is done when the pelvic girdle is broken
+than when it is not, except in cases where the acetabulum is involved
+and its brim not completely divided.
+
+Etiology and Occurrence.--Pelvic fractures are usually caused by falls
+or other manner of contusion. Cases are reported where it would seem
+that fracture of the iliac angle resulted from muscular contraction, but
+it is certain that most fractures of this kind are due to collisions
+with door jambs or similar injuries. In old horses especially, fracture
+of pelvic bones occurs frequently. This form of injury is of more
+frequent occurrence in animals of all ages that work on paved streets.
+The country horse is not subjected to the uncertain footing of the
+slippery pavement, nor to injuries which compare with those caused by
+contusions sustained in falling upon asphalt or cobble-stones.
+
+Symptomatology.--While in many cases of pelvic fracture lameness or
+abnormal decumbency are the salient manifestations, yet the pathognomic
+symptoms are crepitation or palpable evidence which may be obtained by
+rectal or vaginal examination. In fractures of the angle of the ilium
+and the ischial tuberosity, perceptible evidence always exists.
+
+In cases where fracture of some portion of the pelvic girdle is
+suspected and the subject is able to walk, crepitation is sought by
+placing one hand on an external angle of the ilium and the other on the
+ischial tuberosity and the animal is then made to walk. Or, by placing
+the hands as just directed, an assistant may grasp the horse's tail and
+by alternately exerting traction on the tail and pushing against the hip
+in such manner that weight is shifted from one leg to the other,
+crepitation may be detected.
+
+Fracture of the pubis near its symphysis constitutes a grave injury, as
+there is danger of the bladder becoming caught in the fissure and
+perforation of its wall may result. Such a case is reported by
+Bauman[36] wherein a three-year-old gelding bore the history of having
+been lame for ten days. Upon rectal examination the bladder was found to
+be hard and tumor-like and about the size of a baseball. The body of the
+ischium in this case was fractured and a rent in the bladder was caused
+by a sharp projecting piece of bone. Autopsy revealed, in addition to
+the fracture and rent of the bladder wall, a large quantity of urine in
+the peritoneal cavity.
+
+In other instances hemorrhage caused death and not infrequently
+infection was responsible for a fatal issue. Moller,[37] quoting Nocard,
+describes a case where fracture occurred through the region of the
+foramen ovale and paralysis of the obturator nerve followed.
+
+Fractures which include the acetabular bones cause great pain. This is
+manifested by marked lameness, both during weight bearing and when the
+member is swung. Such cases terminate unfavorably--complete recovery is
+impossible.
+
+Where small portions of the angle of the ilium are broken, and the skin
+is left intact, there exists the least troublesome class of pelvic
+fracture. If large portions of the ilium are fractured, considerable
+disturbance results. There eventually occurs more or less displacement
+in such cases, if such displacement does not take place at the time of
+injury. The same may be said of fracture of the tuber ischii, but when
+these bones are fractured a more serious condition results.
+
+Treatment.--When a case is found to be uncomplicated, that is, if the
+fracture is such that recovery seems possible and after having
+determined that treatment may be practicable, the first consideration is
+that of confining the subject in suitable slings. In many cases of
+pelvic fracture, the affected animal will need to be kept in slings from
+six weeks to three months, and it becomes a difficult problem to
+minimize the distress during this long period of confinement in the
+peculiar manner required for favorable outcome.
+
+The pattern of sling employed should be the best that is obtainable and
+the matter of its adjustment is quite important lest unnecessary chafing
+or even necrosis of skin result. Frequent readjustment may be necessary,
+and time is well spent in this manner since this contributes materially
+toward a favorable termination by encouraging the subject to remain
+quiet so that coaptation of the broken bones may be maintained. Aside
+from slings, mechanical appliances that are helpful in the treatment of
+these cases are not yet in use.
+
+A regimen that is nutritive and at the same time laxative is essential
+and in some cases cathartics and enemata are necessary. Also, during the
+first few days, if there is retention of urine, catheterization is
+imperative. In a word, the handling of such cases consists largely in
+keeping the subject inactive, as comfortable as possible, and giving
+attention to suitable diet.
+
+Simple fracture of the external iliac angle needs no particular
+attention, except that the subject is kept quiet until lameness
+subsides. In all cases where much of the bone is broken, the animal is
+blemished, but interference with function does not follow. If infection
+results because of a compound fracture, loose pieces of bone must be
+removed surgically and drainage provided for.
+
+In fracture of the ischial tuberosity, infection is more apt to result
+than in like injury of the ilium, and greater displacement of bone
+occurs. This displacement, due to contraction of the attached muscles,
+is in some instances a contributing cause to the infection which often
+follows in these cases. In females where the body of the ischium is
+fractured, lacerations of the vagina may be present, and this
+constitutes a serious complication which usually terminates fatally.
+
+After-care in fracture of the pelvic girdle consists principally in
+allowing a protracted period of rest before subjects are put to work.
+
+
+Fractures of the Femur.
+
+Etiology and Occurrence.--This is a comparatively rare injury in the
+horse because of the protection afforded the femur by the heavy
+musculature. Fragilitas of the bone probably exists in many cases when
+fracture of its diaphysis occurs. It is generally conceded that the neck
+of the femur is rarely broken because of a lack of constriction in this
+part, but fracture of the trochanters has been recorded rather
+frequently. However, Lienaux and Zwanenpoete[38] state that fracture of
+the neck of the femur is of frequent occurrence in Belgian colts.
+Tapley[39] reports in the Veterinary Journal (English) fracture of the
+head and internal trochanter of the femur and patellar luxation
+occurring simultaneously affecting a mule. In this case the mule was
+found decumbent on a concrete floor. After three weeks, the subject was
+destroyed and autopsy revealed rupture of the left pubiofemoral
+ligament, tearing with it a portion of the articular surface of the
+femur. The internal trochanter was also fractured in four small pieces.
+In this case it is fair to suppose that the mule in trying to regain
+footing on a slippery floor violently abducted the legs and fracture
+resulted. It is possible also that a temporary luxation of the patella
+took place first and caused the animal to struggle in such manner that
+fracture followed.
+
+[Illustration: Fig. 46--Oblique fracture of the femur of a 1,500
+six-year-old draft horse. Showing shortening of bone, owing to a lateral
+approximation of the diaphysis because of muscular contraction. Photo by
+Dr. Edward Merillat.]
+
+Symptomatology.--According to Cadiot and Almy,[40] "regardless of the
+location of femoral fractures, the subject is usually intensely lame,
+the animal frequently walking on three legs--fractures of the diaphysis
+are characterized by an abnormal mobility."
+
+As a rule, crepitation is to be recognized in fractures of the shaft of
+the bone, by passively moving the leg to and from the medial plane
+(adduction and abduction).
+
+Fracture of the trochanter major is signalized by local swelling and
+evidence of pain; the forward stride is shortened because this movement
+tenses the tendon of the gluteus major (maximus) which is attached
+principally to the trochanter.
+
+[Illustration: Fig. 47--Same bone as in Fig. 46 after about six months'
+treatment. In this case Dr. Merillat employed a weight to counteract
+muscular contraction. It is noticeable that very little provisional
+callus has formed in this case, and in spite of unusual ingenuity and
+good facilities for caring for the subject, union of bone did not
+occur.]
+
+Treatment.--Reduction of femoral fracture in the horse is practically
+impossible, and retaining the broken bones in coaptation is not possible
+by means of mechanical appliances. Consequently, prognosis is
+unfavorable in fracture of the body of the femur. When union of bone
+occurs, there results shortening of the leg and animals are rendered
+permanently lame. If the immediate region of the head of the bone is
+involved as well as in case of fracture of the condyles, an incurable
+arthritis ensues.
+
+Where the trochanters are broken, chronic lameness and muscular atrophy
+is the result. Therefore, it is evident that, because of the manner of
+function of the femur, the leverage afforded by its great trochanter and
+its heavy muscular attachments, fractures of this bone in the horse do
+not terminate favorably.
+
+
+Luxation of the Femur.
+
+Etiology and Occurrence.--Uncomplicated femoral luxation is of less
+frequent occurrence in the horse than in the other domestic animals.
+The deep cotyloid cavity renders disarticulation difficult and luxation
+does not often take place. Complications that usually occur are rupture
+of the round (coxofemoral) ligament or fracture of the neck of the
+femur. Falls or violent strains are necessary to produce this luxation.
+Goubaux is quoted by Cadiot and Almy[41] as having observed the head of
+the femur in an instance wherein luxation had long existed. In this case
+autopsy revealed the fact that the inner portion (two-thirds) of the
+head of the femur had completely disappeared.
+
+Luxation of the femur is observed in old emaciated animals that are
+worked on slippery pavements. Occasionally, evidence of chronic luxation
+of the femur is observed in the anatomical laboratory. The chronicity of
+the condition is obvious when one notes the well formed articulation
+which Nature provides for the head of the femur, where fracture or other
+serious complications are not present.
+
+Symptomatology.--In every case there must exist either restriction of
+movement or an evident abnormal position of the leg, or both conditions
+may exist at once. Also, the leg may be markedly shortened.
+Manifestation of this affection varies, depending upon the character of
+the luxation (position of the head of the humerus with relation to the
+acetabulum). Lusk[42] cites a case of a mule which had suffered femoral
+luxation. The animal was destroyed and on autopsy the head of the femur
+found to be contained within a false articular cavity situated about
+four inches above the acetabulum. In Dr. Lusk's case as he states it,
+the following symptoms were presented: "Limb shortened and fixed in a
+position of adduction. While standing the affected limb hung directly
+across and in front of the opposite one; upper trochanter very
+prominent; skin over hip joint very tense. The mobility of the limb was
+very limited, especially in the forward direction."
+
+Being very prominent when there is an upward luxation and less
+perceptible in downward displacement, the location of the trochanter
+major is an indicator of the character of the luxation with respect to
+the position of the head of the femur. This variation of position
+causes abnormal tenseness or looseness of the skin over the region of
+the trochanter major. Rectal examination is of aid in locating the head
+of the humerus.
+
+Treatment.--When it is evident that a subject should be given
+treatment and not destroyed, the animal must be cast and completely
+anesthetized. With complete relaxation thus secured by rotation of the
+limb, using the hip joint region as a pivot, reduction may be effected.
+Traction is exerted in the same direction from the acetabulum that the
+head of the femur is situated and by pressing over the joint, the
+displaced bone may be returned in position. If luxation is downward,
+traction on the extremity will tend to dislodge the head of the femur
+from the inferior acetabular margin making reduction possible.
+
+The same general plan which is ordinarily employed in correcting
+luxation is indicated here, but because of the heavy musculature of the
+hip, complete anesthesia is imperative in all such manipulations.
+
+
+Gluteal Tendo-Synovitis.
+
+The glutens medius (g. maximus) muscle is inserted chiefly by means of
+two tendons; one to the summit of the trochanter major of the femur and
+the other passing over the anterior part of the convexity of the
+trochanter, and being attached to the crest below it. The trochanter is
+covered with cartilage, and a bursa (the trochanteric) is interposed
+between the tendon and the cartilage.
+
+Etiology and Occurrence.--This affection is probably caused in most
+instances by direct injury to the parts, such as may be occasioned by
+being kicked, falling on pavement, or being struck by the body of a
+heavy wagon. Strains in pulling or in slipping are undoubtedly causative
+factors and in draft horses such strains may result in involvement of
+this synovial apparatus.
+
+Symptomatology.--If pain be severe and inflammation acute, weight may
+not be borne with the affected member. There is some local manifestation
+of the condition in acute cases. Swelling of the tissues contiguous to
+the bursa is present and pain is evinced upon manipulation of the
+parts. A characteristic gait marks inflammation of the trochanteric
+bursa, and as Gunther has put it, the subject generally moves or trots
+as does the dog--the sound member being carried in advance of the
+affected one and the forward stride of the diseased leg is shortened. In
+some chronic cases crepitation is discernible by holding the hand on the
+trochanter while the subject walks.
+
+Treatment.--In the first stages of an acute affection absolute quiet
+must be enforced; local antiphlogistic applications are beneficial.
+Later, vesication of a liberal area surrounding the trochanter major is
+indicated. Where the condition has become chronic in horses that are to
+be kept at heavy draft work there is little chance for complete
+recovery. And, naturally, one is not to expect resolution in cases where
+there exist erosion and ossification of cartilage--where crepitation is
+discernible.
+
+
+Paralysis of the Hind Leg.
+
+Aside from paraplegic conditions due to disease of the cord or the
+lumbosacral plexus, and monoplegic affections resultant from
+disturbances of this plexus, paralysis of certain nerves are
+occasionally encountered.
+
+Anatomy.--The lumbosacral plexus results substantially from the union
+of the ventral branches of the last three lumbar and the first two
+sacral nerves, but it derives a small root from the third lumbar nerve
+also. The anterior part of the plexus lies in front of the internal
+iliac artery, between the lumbar transverse processes and the psoas
+minor. It supplies branches to the iliopsoas[43] (designated by Girard,
+the iliacomuscular nerves). The posterior part lies partly upon and
+partly in the texture of the sacrosciatic ligament. From the plexus are
+derived the nerves of the pelvic limb (Sisson).
+
+
+Paralysis of the Femoral (Crural) Nerve.
+
+Anatomy.--The femoral nerve (crural) is derived chiefly from the
+fourth and fifth lumbar nerves. It runs ventrally and backward, at
+first between the psoas major and minor, then crosses the deep face of
+the tendon of the latter and descends under cover of the sartorious over
+the terminal part of the iliopsoas. It innervates the psoas major
+(magnus), psoas minor (parvus), sartorious, rectus femoris, vastus
+lateralis (interims). Branches supply the stifle and the adductor and
+pectineus muscles.
+
+Etiology and Occurrence.--While paralysis of the femoral nerve, also
+known as "dropped stifle" occurs as a result of local injuries and
+melanotic tumors in gray horses, most cases are due to azoturia.
+So-called crural paralysis or "hip swinney" is occasionally observed but
+this is not a condition wherein the nerve is affected in the manner that
+characterizes the marked atrophy of quadriceps femoris (crural) muscles
+in some cases of hemaglobinuria. This form of paralysis according to
+Hutyra and Marek is due primarily to diffuse degeneration of the
+muscles.
+
+Symptomatology.--When muscular atrophy is not extensive no particular
+evidence of this condition may be manifested while the subject is at
+rest, but where muscular waste has occurred, the nature of the ailment
+is at once recognized. Since the femoral nerve supplies the quadriceps
+femoris muscles, it follows that when the psoic portion of this nerve
+becomes diseased, the stifle loses its support, and in a unilateral
+involvement when the subject attempts to walk on the affected member,
+the stifle sinks down for want of support and the leg collapses unless
+weight is caught up with the other leg. Often, following azoturia, a
+bilateral affection is to be observed.
+
+Treatment.--Horses may be restrained in the standing position, and in
+the average instance, a twitch and hood are all the restraining
+appliances necessary.
+
+In cases where the disease is unilateral and atrophy is not of too long
+standing, recovery is possible in vigorous subjects. All affections,
+however, wherein degenerative changes involve the nerve trunk, whether
+due to diffuse myositis or pressure from malignant tumors, will not
+yield to treatment.
+
+The same general plan of treatment is indicated that is described on
+page 74 in the consideration of atrophy of the scapular muscles. It is
+especially important to provide for the subject to be exercised when
+there is atrophy of the quadriceps muscles following azoturia.
+
+In addition to the foregoing, good results have attended the use of
+intramuscular injections of oxygen. The technic of the operation
+consists in preparing the area of skin which covers the atrophied
+muscles as for any operation. The hair is clipped over five or six or
+more circular areas of about an inch in diameter; the skin is cleansed
+and then painted with tincture of iodin.
+
+A long heavy sterile needle, which is connected with an oxygen tank by
+means of six feet of rubber tubing, is thrust into the depths of the
+affected muscles and the gas is gently introduced into the tissues. One
+needs exercise extreme care that the gas enter slowly because great pain
+is produced by the sudden injection of the oxygen. Likewise too much of
+the gas must not be introduced at one place. When the oxygen is slowly
+introduced it may be allowed to enter the tissues until the subject
+gives evidence of experiencing considerable pain, or if the parts are
+not particularly sensitive, a reasonable amount (enough to cause a mild
+degree of diffuse inflammation) is introduced at each one of five or six
+points. In large animals more points of injection may be used.
+
+No infection or other bad results will follow the execution of a good
+technic and the treatment may be repeated every three or four weeks
+until either marked regeneration of tissue is evident or the case is
+obviously proved hopeless.
+
+
+Paralysis of the Obturator Nerve.
+
+Anatomy.--The obturator nerve, situated at first under the peritoneum,
+accompanies the obturator artery through the obturator foramen and
+gaining the muscles on the internal face of the thigh, terminates in the
+obturator externus, adductors, pectineus and gracilis, also giving twigs
+to the obturator internus (Strangeways).
+
+Etiology and Occurrence.--This condition occurs upon rare occasions as
+the result of injury such as falls which cause extreme abduction of the
+legs, or in pelvic fracture where the nerve is directly injured, or
+when melanotic tumors or other new growths compress the nerve in such
+manner that its function is suspended. Paralysis of the obturator nerve
+or nerves is met with rather frequently, notwithstanding, in mares,
+following dystocia. The nerves (one or both) may become bruised at the
+brim of the obturator foramen by being caught between the pelvis and the
+body of the fetus in some cases of protracted labor.
+
+Symptomatology.--In a unilateral affection there may be little
+evidence of the trouble while the subject is standing; or there is to be
+seen some abduction; or the affected member may present abduction of the
+stifle and stand "toe outward." If the animal is walked there will be
+manifested more or less abduction and the character of the impediment
+varies according to the nature of the involvement.
+
+Following protracted cases of labor in some instances where only a
+unilateral paralysis exists, walking is performed with difficulty; the
+subject may be unable to support weight with the affected member and is
+obliged to hop on the one sound hind leg. In bilateral affections, they
+are unable to rise. If the condition is severe the sling is required to
+keep the subject standing, and with this care, recovery will follow.
+
+Treatment.--If new growths or callosities or similar conditions affect
+the nerve, little, if any, hope for recovery exists. In young and
+vigorous subjects where cause is not definitely known, a course of
+strychnin may be given. Good nursing, providing for the subject's
+comfort and allowing moderate exercise, constitute rational treatment.
+Stimulating embrocations on the abductor muscles resorted to in cases
+during the incipient stage may prove helpful.
+
+When paralysis of the obturator nerve occurs as a post-partum
+complication, and other conditions are favorable, the subject should be
+raised to its feet without unnecessary delay. If the mare is unable to
+assist in regaining her feet, a sling is required. Usually little else
+is necessary and after a few days in the sling the subject can get about
+unassisted. In the meanwhile the well-being of the affected animal is to
+be considered just as in any other case where the patient is so
+confined. The foal in such instances constitutes a source of some
+trouble, but the average mare offers no serious resistance to the
+confinement occasioned by the sling.
+
+Good hygienic care, a suitable diet and full physiological doses of
+strychnin are indicated. Cadiot and Almy recommend vaginal douches of
+cold water and counterirritation of the region of the inner thigh in
+these cases.
+
+
+Paralysis of the Sciatic Nerve.
+
+Anatomy.--The great sciatic nerve leaves the pelvis in company with
+the gluteal nerves, through the great sciatic foramen (notch), passing
+downward along the posterior face of the femur. Near the stifle it
+passes between the two heads of the gastrocnemius muscle and continues
+as the tibial. Branches supply the following muscles--obturator,
+semimembranosus (adductor magnus), biceps femoris (triceps abductor
+femoris), semitendinosus (biceps rotator tibialis), lateral extensor
+(peroneus) and the tibial nerve, its continuation, innervates the
+digital flexors.
+
+Etiology and Occurrence.--Paralysis of the great sciatic nerve may be
+caused by central disorders, injury in falling, fractures and new
+growths. Because of its protected position, this nerve does not often
+suffer injury, and paralysis of the sciatic nerve is recorded in a few
+instances owing to its rarity.
+
+Symptomatology.--When consideration is given the number of muscles
+that are supplied by the sciatic nerve and the function of these
+muscular structures, it is obvious that the leg cannot be used in
+sciatic paralysis. However, the limb is capable of sustaining weight
+when it is fixed in position, but this is done without exertion of
+muscular fibers which are supplied by the great sciatic nerve. Trotting
+is impossible and flexion of the affected member is also likewise
+precluded. The foot is dragged when the subject is caused to advance.
+
+Under the heading "sciatica," Scott[44] has described a case of acute
+sciatic affection wherein a pacing horse manifested evidence of great
+pain of a nervous character. There were muscular twitchings and the leg
+was held off the floor and moved about convulsively. Breathing was very
+much accelerated, pulse 85 per minute, the temperature was 103 deg. and
+manipulation of the hips augmented the pain.
+
+This was not a paralytic condition and recovery resulted, yet
+undoubtedly this was a case which, if not properly cared for, might have
+terminated unfavorably.
+
+Treatment.--Prognosis is decidedly unfavorable in paralysis of the
+great sciatic nerve. If treatment is attempted, it is to be conducted
+along the same general lines as in femoral paralysis. Particular
+attention should be given to conditions which will make for the
+patient's comfort, and as soon as it is evident that the affection is
+not progressing favorably, the subject should be humanely destroyed.
+
+
+Iliac Thrombosis.
+
+This condition is undoubtedly of more frequent occurrence than we are
+wont to grant when one considers the comparatively small number of cases
+that are actually recognized in practice. It does not follow, however,
+that iliac thrombosis rarely exists. Probably in the majority of
+instances there is insufficient obstruction of the lumina of vessels to
+provoke noticeable inconvenience. Or, if circulation is hampered to the
+extent that function is impaired and manifestations are observed by the
+driver, the subject may be permitted to rest a few days and partial
+resolution occurs, so that further trouble is not noticeable.
+
+As judged by lesions of the aorta and iliac arteries in dissecting
+subjects, the conclusion that arteritis and resultant disorders are of
+rather frequent occurrence, is logical.
+
+Etiology.--Inflammation of the vessel walls and resultant
+prolifieration of tissue together with the accumulation of clotted blood
+becoming organized, serve to obstruct the lumen of the affected artery.
+The cause of arteritis is unknown in many instances, but parasitic
+invasion and contiguous involvement of vessels in some inflammatory
+injuries are etiological factors.
+
+Symptomatology.--A characteristic type of lameness signalizes iliac
+thrombosis and the following brief abstract from a contribution on this
+subject by Drs. Merillat[45], clearly portrays the chief symptoms:
+
+[Illustration: Fig. 48--Exposure of aorta and its branches, showing
+location of thrombi in numerous places. In this case (same as Fig. 49)
+Dr. L.A. and Dr. Edward Merillat found the cause of the condition to be
+due to sclerastomiasis.]
+
+     The seizures are accompanied with profuse sudation, tremors,
+     dilated nostrils, accelerated respirations and other symptoms of
+     pain and distress, all of which, together with the lameness,
+     disappear as rapidly as they had developed, leaving the animal in
+     an apparently perfect state of health, ready to fall with another
+     attack of precisely the same kind, as soon as enough exercise is
+     forced upon it. The rectal explorations may reveal a pulseless
+     state of one or more of the iliac arteries and a hardness and
+     enlargement of the aortic quadrifurcation, but sometimes this
+     palpation fails to disclose any _perceptible_ diminution of the
+     blood current of these vessels. The obturation being incomplete, it
+     may be impossible by palpation to decide that thrombosis really
+     exists. In this event and, in fact, in all eases, the clinical
+     symptoms are sufficiently characteristic to make a diagnosis
+     without reservation. It cannot be mistaken for any other disease,
+     once properly investigated. Any given seizure may easily be
+     mistaken for azoturia, at first, but a better examination soon
+     excludes that disease.
+
+[Illustration: Fig. 49--Illustrative of thrombosis of the aorta, iliacs
+and branches. Photo by Dr. L.A. Merillat.]
+
+     Prognosis and Treatment.--In the majority of instances, when
+     there is occasioned serious inconvenience, the outcome is not
+     likely to be favorable, according to Moeller. Detachment of a
+     portion of the thrombus, according to Hoare, may result in the
+     lodgment of an embolus in the brain or kidneys. The latter
+     authority also states that muscular atrophy may occur owing to lack
+     of blood supply in some of these cases. Moeller states that
+     moderate exercise or work stimulates the establishment of
+     collateral circulation. Massage per rectum is condemned as
+     dangerous by Cadiot.
+
+
+Fracture of the Patella.
+
+Etiology and Occurrence.--Patellar fractures are rarely met with in
+the horse but may be caused by falls and heavy contusions. Violent
+muscular contraction, it is said, may also bring about the same
+condition.
+
+Symptomatology.--Fracture may be transverse or vertical, and depending
+on the manner in which the bone is broken, prognosis is either at once
+rendered favorable or unfavorable. The patella performs a function which
+is in a way similar to that of the sesamoids and when fractured,
+complete recovery is improbable in the average instance. When complete,
+transverse fractures permit of separation of the parts of bone. Tension
+on the straight ligaments below and contraction of the quadriceps above
+usually cause insuperable difficulty in the handling of this type of
+fracture in the horse.
+
+Compound fractures as well as multiple or comminuted fractures
+occasionally occur and these constitute injuries which are generally
+considered fatal, although Andrien, according to Cadiot and Almy,
+succeeded in obtaining complete recovery in a case of compound fracture
+of the patella and the horse was in service and almost free from
+lameness two months after treatment was begun.
+
+No difficulty is encountered in recognizing the fracture of the patella
+because of the exposed position of the bone. Crepitation, and in some
+cases fissures, may be easily detected.
+
+Treatment.--In simple fracture, when treatment is thought advisable,
+the subject is put in a sling and kept as nearly comfortable as
+possible. If little inflammation exists, the application of a vesicant
+two or three weeks after the injury has been inflicted will be helpful
+and serve to hasten repair.
+
+Bandages or mechanical appliances are of no practical use in the
+handling of these cases.
+
+
+Luxation of the Patella.
+
+Etiology and Occurrence.--This, the most common luxation met with in
+the equine subject, has been described by writers as existing in many
+forms. Patellar disarticulation may be more practically considered as
+_momentary_ and _fixed_, regardless of the position taken by the
+patella. Described under the title of false luxation are recorded cases
+wherein the quadriceps (crural) muscles become contracted in such manner
+that a condition simulating true disarticulation of the patella obtains.
+Also, some practictioners report cases of patellar luxation and refer to
+pseudo-luxations, without clearly defining the conditions which
+constitute pseudo-luxation. This has contributed to the extant cause of
+misconception as to actual differences between luxation and conditions
+simulating dislocation.
+
+Luxation of the patella is a condition wherein the articular portions of
+the femur and patella assume abnormal relations whether such
+displacement of the patella be momentary and capable of spontaneous
+reduction, or fixed and requiring corrective manipulation. Spasmodic
+contraction of the crural muscles which sometimes retains the patella in
+such position that the leg is rigidly extended, does not in itself
+constitute luxation of the patella; and unless this bone becomes lodged
+on the upper portion of a femoral condyle or laterally displaced out of
+its femoral groove, luxation cannot be said to exist in the horse. These
+are sub-luxations.
+
+Occasionally one may observe in suckling colts outward luxation of the
+patella wherein there is history of navel infection and no marked
+evidence of rachitis is present. Some of these cases recover. In a
+unilateral involvement of this kind in a three-month-old mule colt, the
+author observed a case wherein an unfavorable prognosis was given and
+destruction of the subject advised, because of the extreme dislocation
+of the patella. This colt, however, was not destroyed and in three weeks
+had apparently recovered. No treatment was given in this instance; the
+colt was allowed the run of a small pasture with its dam and in time it
+matured, becoming a sound and serviceable animal.
+
+Classification.--Two forms of true patellar luxation in the horse may
+be considered; one which is due to the patella becoming fixed upon the
+internal trochlear rim of the femur and the other when the patella slips
+over the outer rim of the trochlea.
+
+The first form is known as _upward_ luxation and is made possible by
+rupture of the mesial (internal) femeropatellar ligament. According to
+Cadiot and Almy, it is only by the rupture of this ligament--the
+femeropatellar--that upward luxation may occur. This type of luxation is
+rarely observed and is usually due to violent strain and abnormal
+extension of the stifle joint.
+
+The second class, _outward_ luxation, occurs in colts and is, in many
+instances, congenital. This form of luxation is also the one usually
+seen following debilitating diseases such as influenza and pneumonia.
+
+_Upward luxation of the patella_ is characterized by the stiff-extended
+position of the leg. When the patella is situated upon the inner
+trochlear rim, the tibia must be extended because of the traction
+exerted by the straight ligaments. Since the stifle and hock joints
+extend and flex in unison, there is presented also an extension of the
+tarsus. Extension of the stifle joint would increase the distance
+between the femoral origin of the gastrocnemius and its insertion to the
+summit of fibular tarsal bone (calcis) were it not for the gastrocnemius
+and superficial flexor (perforatus). Extension of the hock in upward
+luxation of the patella, permits of flexion of the phalanges. In upward
+luxation, then, the leg is extended as if too long, but the phalanges
+may be in a state of moderate flexion. If the foot rests on the ground
+when the extremity is not flexed, it is almost impossible for the
+subject to step backward. Because of immobilization of the stifle and
+hock joints in upward luxation, the subject can walk only by hopping on
+the sound leg and then the extremity is flexed, allowing the anterior
+portion of the fetlock to drag on the ground.
+
+In some cases practitioners are called to attend young animals that are
+reported to be "stifled" (often in young mules that have made a rapid
+growth) and upon arrival the only noticeable symptom of preexisting
+luxation is the soiled condition of the anterior fetlock
+region--evidence of its having been dragged. Such cases may be styled
+momentary luxation, whether they are due to a weakened condition of the
+patellar ligaments or spasmodic contraction of the crural muscles.
+
+In upward luxation, reduction is effected by attempting further
+extension of the stifle joint and at the same time the patella is pulled
+outward, off the internal rim of the trochlea. This is attempted by
+securing the subject in a standing position; the sound side is kept
+against a wall if possible and a rope is tied to the extremity of the
+affected leg. Traction is exerted upon the rope and at the same time
+force is directed against the stifle joint to produce further extension
+if possible, so that the straight patellar ligaments may relax
+sufficiently to allow the patella to be dislodged from its position upon
+the inner trochlear lip. Failing in this manner of procedure, the
+affected animal is to be cast and anesthetized with chloroform. The
+relaxation which attends surgical anesthesia will permit of reduction of
+the dislocated bone and manipulations such as have just been outlined
+may be employed.
+
+Following reduction in the average case it is essential that the subject
+be given vigorous exercise for a few minutes. Reduction having been
+affected, the application of a vesicant over the whole patellar region
+is customary.
+
+In cases of habitual luxation, unless the ligaments are so lax that the
+patella may be displaced laterally over the inner as well as the outer
+trochler rims, division of the inner straight patellar ligament will
+correct the condition. This desmotomy has been advocated by Bassi, and
+good results in appropriate cases have been reported by Cadiot, Merillat
+and Schumacher. This operation has been found a corrective in cases of
+outward luxation as well as those of upward dislocation of the patella
+when resorted to before the trochleae are worn from frequent luxation.
+
+_Outward luxation of the patella_ is occasioned by a lax condition of
+the internal femeropatellar ligament or a rupture of the same so that
+the patella slips over the outer femoral trochlear rim and permits of an
+abnormal flexion of the stifle joint. The outer trochlear rim being the
+smaller of the two, inward luxation does not occur in the horse. With
+the patella disarticulated in this manner, the action of the quapriceps
+femoral group of muscles has no effect on the stifle joint and,
+therefore, flexion of this articulation occurs as soon as the subject
+attempts to sustain weight and the leg collapses unless weight is at
+once taken up by the other member if sound.
+
+As a rule, the reduction of this form of luxation is not difficult. The
+patella may be pushed inward and into position without manipulation of
+the leg. Retention of the patella in position is a difficult problem.
+Bandaging is considered impractical and is not ordinarily done in this
+country. Benard, according to Cadiot and Almy, recommends bandaging with
+a heavy piece of cloth in which an opening is made through which the
+patella is allowed to protrude, and by turning such a bandage snugly
+about the stifle several times, the patella is held in position. This
+bandage should be kept in place for about ten days.
+
+In young and rachitic animals outdoor exercise and a good nutritive
+ration for the subject are indicated. Hypophosphites in assimilable form
+may be beneficial, and vesication of the patellar region contributes to
+recovery.
+
+Where extreme luxation is present in both stifles, the prognosis is
+unfavorable. In such cases, degenerative changes may exist and in some
+instances the ligaments are so diseased and elongated that regeneration
+is impossible. Williams[46] reports a case where bilateral "floating"
+(outward) luxation was present and extensive degeneration changes
+affected the articulation.
+
+In subjects suffering frequent dislocation of the patella (habitual
+luxation) it is possible in some cases, to prevent its occurrence or at
+least to minimize the distress occasioned by momentary luxation, by
+keeping the animals in wide stalls so that "backing" is unnecessary. In
+some nervous subjects that seem to be suffering from cramp of the crural
+muscles, the difficulty and pain of their being backed out of narrow
+stalls, accentuates the nervousness. Sudation and restlessness are
+manifested and the subject presents a clinical picture of distress and
+fear of a painful ordeal. In some cases of this kind, complete recovery
+takes place by the time animals are five or six years of age. One should
+avoid keeping such subjects in narrow stalls. Preferably patellar
+desmotomy should be performed that relief may be obtained at once.
+
+Luxations attending some cases of influenza recover promptly when
+subjects are kept comfortably confined in roomy box-stalls. The
+administration of stimulative medicaments such as nux vomica and the
+application of an active blistering agent to the patella serve to hasten
+recovery. Dislocations in such cases are often bilateral and they are
+usually momentary. Reduction occurs spontaneously, as a rule, and the
+subjects are not occasioned much distress if they are kept quiet for a
+few days.
+
+
+Chronic Gonitis.
+
+Etiology and Occurrence.--Chronic inflammation of the stifle joint is
+met with following acute synovitis due to strains and concussion. It is
+an ailment which affects heavy horses and particularly animals that are
+kept at work on paved streets, but this does not explain its existence
+in animals that are not subjected to work likely to cause concussion.
+Berns[47] considers rheumatism a probable cause of gonitis and, as he
+states, the dropsical form of affection of this joint is not ordinarily
+attended with manifestations of inconvenience to the subject. Gonitis is
+often bilateral and its onset is insidious in many instances.
+
+Symptomatology.--In unilateral gonitis weight is not borne by the
+affected member. There is noticeable distension of the joint capsule--a
+characteristic pendant pouching protrusion. When both stifles are
+affected the subject frequently shifts the weight from one limb to the
+other. Lameness comes on gradually and during the incipient stages may
+be intermittent but it progressively increases so that in time affected
+animals become useless. In bilateral affections animals drag the toes
+because of the pain incident to flexing the stifles. This is
+particularly evident when the subject is made to trot. As the disease
+progresses, atrophy of the quadriceps femoris muscles becomes pronounced
+and as destructive changes involving the articular cartilages take
+place. The subject becomes more lame and eventually is rendered
+incapable of service.
+
+Upon manipulation of the patellar region, one is impressed with the fact
+that hyperesthesia does not exist in proportion to the pain manifested
+during locomotion. In some cases a gelatinous swelling is present and
+may be detected by palpating between the straight ligaments of the
+patella. Williams, Hughes, Merillat, Hadley and others have directed
+attention to the existence of floating masses (_corpora oryzoidea_) in
+the synovial capsule of this joint in gonitis, and as with all cases of
+arthritis, irreparable damage is often done the articular cartilages
+during the course of the ailment.
+
+[Illustration: Fig. 50--Chronic gonitis. The knuckling which results
+from long continued inactivity of the crural muscles in chronic cases is
+marked in this instance. Photo by Dr. L.A. Merillat.]
+
+Treatment.--No effective method is as yet known which will control
+this condition during its incipiency. The disease progresses, and more
+or less damage is done the affected parts in the course of months or
+even years in some cases before subjects are rendered hopelessly
+crippled. When recognized early (before chronic gonitis exists)
+aspiration of the synovia and the injection of diluted tincture of iodin
+might prove beneficial in cases of synovial distension. Chronic gonitis
+is considered an incurable affection and as soon as subjects manifest
+evidence of distress from this condition they should by all means be
+taken from work. Firing and vesication have not been productive of
+beneficial results.
+
+[Illustration: Fig. 51--Gonitis. Showing position assumed in such cases
+because of pain occasioned. Photo by Dr. C.A. McKillip.]
+
+
+Open Stifle Joint.
+
+Anatomy of the Joint Capsule.--This joint capsule is thin and very
+capacious. On the patella it is attached around the margin of the
+articular surface, but on the femur the line of attachment is at a
+varying distance from the articular surface. On the medial side it is an
+inch or more from the articular cartilage; on the lateral side and
+above, about half an inch. It pouches upward under the quadriceps
+femoris for a distance of two or three inches, a pad of fat separating
+the capsule from the muscle. Below the patella it is separated from the
+patellar ligaments by a thick pad of fat, but inferiorly it is in
+contact with the femerotibial capsules. The joint cavity is the most
+extensive in the body. It usually communicates with the medial sac of
+the femerotibial joint cavity by a slit-like opening situated at the
+lowest part of the medial ridge of the trochlea. A similar, usually
+smaller, communication with the lateral sac of the femerotibial capsule
+is often found at the lowest part of the lateral ridge. (Sisson's
+Anatomy.)
+
+Thus it is seen that because of its frequent communication with the
+other parts of this large synovial membrane, a wound which opens the
+external portion of the femerotibial capsule may be the cause of
+contamination and resultant infectious arthritis of the whole stifle
+joint. Because of the distance between the most dependent part of the
+femerotibial articulation and the summit of the patella, one may
+misjudge the exact location of the lowermost part of this portion of the
+capsular ligament of the stifle joint and thereby fail at once to
+appreciate the seriousness of calk wounds in this region.
+
+Etiology and Occurrence.--Wounds to the patellar region are of rather
+frequent occurrence, and because of the comparatively unprotected
+position of these structures, the capsular ligaments of the stifle joint
+may be perforated as a result of violence in some form. Calk wounds
+which penetrate the tissues in the immediate region of the lower portion
+of the external part of the femerotibial capsule sometimes result in
+open joint because of tissue necrosis resulting from the introduction of
+infection. Contused wounds sometimes destroy the skin and fascia over
+large areas on the lateral patellar region and because of subsequent
+sloughing of tissue due to infection as well as to the manner in which
+such wounds are inflicted, septic arthritis subsequently occurs.
+Penetrant wounds, such as may be caused by a fork tine may not result in
+infection; if infectious material is introduced an infectious arthritis
+does not necessarily follow, though such cases should be considered as
+serious from the outset.
+
+Symptomatology.--The pathognomonic symptom of open stifle joint is the
+profuse escape of synovia, indicating perforation of the synovial
+capsule; by means of a probe the wound may be explored in a way that
+will clearly reveal the nature of the injury.
+
+After a few days have elapsed in cases where considerable infection has
+taken place, there is manifestation of pain as in all cases of infective
+arthritis. Hughes[48] gives an excellent description of the clinical
+aspect of arthritis which applies here:
+
+     Acute arthritis begins like an ordinary attack of synovitis. In
+     joints other than the pedal and pastern, there is sudden and
+     extensive swelling, which at first is intra-articular, succeeded by
+     extra-articular tumefaction, and accompanied by violent lameness.
+     The pain soon becomes intense and agonizing. There is severe
+     constitutional disturbance, the temperature ranging from 104 to 106
+     degrees and the pulse from 60 to 72. Painful convulsions of the
+     limb occur, shown by involuntary spasmodic elevations due to reflex
+     irritation of the muscles. There is loss of appetite, rapid
+     emaciation, the flank is tucked up and the back arched. In from
+     three to six days, the tumefaction around the joint tends to soften
+     at a particular place, and bursts, and a discharge that is
+     sometimes of a sanious character, mixed with synovia, escapes.
+     Great exhaustion at times supervenes, and if the joint is an
+     important one, the horse lies or falls and is unable to rise.
+
+Treatment.--In small puncture wounds the immediate application of a
+vesicating ointment has given good results, but when infection has taken
+place to such extent that the animal manifests evidence of intense pain,
+and lameness is marked and local swelling and hyperesthesia are great,
+vesication is contraindicated. In such instances the exterior of the
+wound and its margins should be prepared as in similar affections of
+other joints. A quantity of synovia is then aspirated by means of a
+small trocar and care should be taken to observe all due aseptic
+precautions. Subsequently the injection of from four to six ounces of a
+mixture of tincture of iodin, one part to ten parts of glycerin, and
+gentle massage of the joint immediately after the injection has been
+made, serves to check the infective process in some cases.
+
+The subject should be cared for as has been previously suggested in
+arthritis proper provisions for comfort being made. Good nursing is
+always essential to a successful issue. However, the author cannot view
+cases of open stifle joint with the same optimism concerning their
+course and outcome that is expressed by a number of writers on this
+subject. It is a grave condition wherein the prognosis should be given
+advisedly.
+
+
+Fracture of the Tibia.
+
+Etiology and Occurrence.--Because of its exposed position to kicks,
+and its lack of protection by heavy musculature (especially on its inner
+surface), there is afforded ample opportunity for frequent injury to the
+tibia. Fractures are complete and varying as to nature, or incomplete.
+The heavy tibial fascia affords sufficient protection so that fissures
+without entire solution of continuity of the bone may occur from
+violence to which this part is often subjected. Moeller classes tibial
+fracture as ranking second in frequency--pelvic fracture being more
+often met with in horses. This does not apply in our country as
+phalangeal and metacarpal and even metatarsal fractures are observed in
+more instances than are such injuries to the tibia. The tibia is
+occasionally broken at its middle and lower thirds, but malleolar
+fractures are not common.
+
+Symptomatology.--When fracture is complete and all support is removed,
+the leg dangles, and the nature of the injury is so obvious that there
+is no mistaking its identity. However, in case of incomplete fracture
+one needs to base all conclusions upon the history of the case, evidence
+of injury, or other knowledge of the character of violence to which
+this bone has been exposed. For without the presence of crepitation
+(even by excluding other possible causes for the pronounced lameness
+which characterizes some of these cases) we can only resort to the
+knowledge which experience has taught that fracture may be deemed
+probable in many injuries to the tibial region. Consequently, we are to
+look upon all injuries that affect the tibia as being fractures of some
+sort when there is either local evidence of the infliction of violence
+or whenever marked lameness attends such injuries, unless there is
+positive indication that no fractures exist.
+
+A careful examination of parts of the tibia, i.e., noting the amount and
+painfulness of swellings, exploration with the probe, and observations
+of the course taken in any given case, will determine the exact nature
+of injuries. Such examination needs to extend over a period of a week or
+in some instances two or three weeks may pass before the true state of
+affairs is apparent. In the meanwhile, cases are to be handled as though
+tibial fracture certainly existed.
+
+Prognosis.--Prediction of the outcome in tibial fracture is somewhat
+presumptuous, but in the majority of cases in mature subjects fatality
+results. Cadiot[49], however, views this condition with more optimism
+than have American practitioners. While he considers the condition
+grave, in citing case reports of successful treatment by d'Arboval,
+Duchemin, Leblanc, and others, his conclusion is that many practitioners
+erroneously consider fractures of the tibia as incurable.
+
+The method of handling these cases by Leblanc is as follows: The subject
+is placed in a sling; a pit is excavated below the affected member so
+that a heavy weight may be attached to the extremity; splints are
+applied to each side of the leg, which is padded with oakum, and this is
+kept in position by means of bandages covered with pitch. The outer
+splint extends from the hoof to the stifle and the inner one from the
+hoof to the upper third of the leg. This method in the hands of Leblanc
+has been successful in several instances, according to Cadiot.
+
+In a foal the author has in one instance succeeded in obtaining complete
+recovery in a simple fracture of the lower third of the tibia where the
+only support given the broken bone was a four-inch plaster-of-paris
+bandage which was adjusted above the hock. Below the tarsus a cotton and
+gauze bandage was applied to prevent swelling of the extremity. In this
+instance (an emergency case in which materials that are not to be
+recommended were necessarily employed) recovery took place within thirty
+days.
+
+As has been mentioned in the consideration of radial fractures, heavy
+leather is better suited for immobilization of these parts than a cast
+or other rigid splint materials. Mature animals may be expected to
+resist the immobilization of the hind legs because of the normal manner
+of flexion of the tarsal and stifle joints in unison. Therefore, the
+application of rigid splints to the leg and including the hock is
+productive of disastrous results in some cases.
+
+The application of cotton and bandages to pad the member and the
+adjusting of heavy leather splints on either side of the leg, and
+retaining them in position with four-inch gauze bandages will prove more
+nearly satisfactory than some other methods employed. Prognosis is
+unfavorable, however, in most cases of compound fracture and recovery is
+improbable when the upper portion of the tibia is broken.
+
+
+Rupture and Wounds of the Tendo Achillis.
+
+Etiology and Occurrence.--Cases are recorded by Uhlrich in which
+rupture has followed degenerative changes affecting the tendo Achillis.
+Not infrequently, the result of a trauma, division of the tendo Achillis
+occurs. Moeller states that rupture of this tendon may be due to jumping,
+in riding horses and in draught horses, in their efforts to avoid
+slipping. In runaways, it sometimes occurs where sharp-edged implements
+are bounced against the legs in such fashion that division of the tendon
+results.
+
+Symptomatology.--With division of the tendo Achillis or of the
+musculature of the gastroenemii and the superficial flexor
+(perforatus), there remains nothing to inhibit tarsal flexion except the
+deep flexor tendon (perforans) and this does not support the leg. When
+attempt is made to sustain weight with the affected member, abnormal
+flexion of the tarsus takes place and the hock sinks almost to the
+ground. The symptoms are so characteristic that recognition is always
+easy even in case no wound of the skin exists.
+
+Prognosis.--Spontaneous recoveries occur and such cases are reported
+by Bouley who is quoted by Cadiot as having observed division of the
+tendo Achillis due to a sword wound wherein at the end of four months
+recovery was complete. Division of this tendon in brood mares has been
+practiced by the early settlers of parts of the United States for the
+purpose of preventing their straying too far from home. In such
+instances one leg only was so mutilated and in most instances, it is
+reported that spontaneous recovery took place.
+
+In unilateral involvement without complications, the prognosis is not
+unfavorable if provisions for giving necessary attention are available.
+
+Treatment.--The subject is to be confined in a sling and the member
+bandaged and supported by means of leather splints. Immobilization as
+for fracture is not necessary but, nevertheless, movement is to be
+restricted as much as possible. In case of open wounds, the exposed
+tissues are cared for along general surgical lines. Where the divided
+parts of the tendon are maintained in fairly close and constant
+relation, granulation of tissue, sufficient to sustain weight takes
+place in from six weeks to three months.
+
+
+Spring-Halt. (String-Halt.)
+
+Occurrence.--This condition is a myoclonic affection of the hind leg
+which is discussed in works on theory and practice under the head of
+neuroses, but the cause or causes have not been established. Theories
+that heredity is responsible have their supporters and advocates of
+hypotheses attributing it to disease of the sciatic nerve, patellar
+subluxation, fascial contraction of various muscles, "dry spavin"
+(tarsal arthritis), iliac exostoses, disease of the foot and contraction
+of the hoof, are on record in veterinary literature. This ailment
+affects old horses more frequently than it does young and is seen in all
+breeds of animals including mules.
+
+[Illustration: Fig. 52--Spring-halt.]
+
+Symptomatology.--This disease develops slowly, and progressively
+increases in severity as a rule, but does not ordinarily constitute
+cause for rendering an animal unserviceable. While the affection is
+sometimes bilateral (occasionally affections of the forelegs are
+reported) and the extreme flexion of the legs in the spasmodic manner
+which characterizes spring-halt, cause great waste of energy during
+locomotion, yet such cases are rare. Usually the ailment is markedly
+evinced when subjects are first taken from the stable, but as they are
+exercised the manifestation diminishes, and in many instances it
+completely subsides. The condition is generally more noticeable when the
+subject is made to step backward. In some animals there is marked
+abduction at the time flexion occurs and in singular instances the
+spasmodic contraction is so violent that the subject falls to the ground
+as a result of the peculiar flexion of the leg.
+
+In severe cases of "scratches" or chemical irritation of the extremity,
+the legs are abnormally flexed in a manner which simulates spring-halt,
+but because of the evident injury of the parts this is not likely to
+confuse. Since all facts concerning etiological agencies are surrounded
+with so much obscurity, classification does not lend any particular
+assistance in the consideration of this ailment.
+
+Prognosis.--One cannot intelligently give a prognosis in these cases
+if forecast is expected to state the exact course following treatment.
+However, in a general way, cases of recent affection are thought more
+favorable than are those of long standing or in old animals where
+myositis and other muscular and fascial affections exist owing to years
+of hard service.
+
+Treatment.--No known line of medicinal treatment is of service, nor is
+any particular surgical operation to be considered dependable for
+obtaining relief. Operations of almost every conceivable nature have
+been tried with the hope of securing recovery in spring-halt but under
+no condition can the practitioner as yet be reasonably certain of
+effecting permanent relief in any case. Treatment is, therefore,
+entirely empirical.
+
+Neurectomies have been performed and recoveries following were
+attributed thereto; fascial divisions in the crural region have been
+done with good results and this manner of treatment has its favorers.
+Advocates of tenotomies, likewise, are to be found. Consequently, one
+may summarize thus: Spring-halt is a disease of unknown origin--the
+exact cause has not been determined; therefore, all treatment is, in a
+way, experimental. The recommendation of any given procedure in handling
+cases must then be a matter of opinion based either upon practical
+experience or knowledge of the experiences of others. Divisions of the
+lateral digital extensor (peroneus) below the tarsus near its point of
+insertion to the extensor of the digit is recommended here because it is
+followed by a percentage of recoveries that is as large as in any other
+method of treatment and the operation is not difficult to perform nor
+is its performance fraught with any dangerous complications. In selected
+subjects about fifty per cent of cases recover in from two to six weeks
+following this operation.
+
+[Illustration: Fig. 53--Lateral (external) view of tarsus showing
+effects of generalized tarsitis.]
+
+
+Open Tarsal Joint.
+
+Like the tibia the hock is exposed to frequent injuries and in some
+cases wounds perforate the joint capsule. When due to calk wounds where
+horses are kicked, the injury is often on the side of the tarsus (medial
+or lateral) and such wounds not infrequently result in infectious
+arthritis. Horses sometimes jump over wire fences and wounds are
+inflicted which constitute extensive laceration of the joint capsule. In
+firing for bone spavin, where a deep puncture is made very near the
+tibial tarsal (tibioastragular) joint if infection gains entrance,
+serious and generalized infection of the open joint cavity supervenes in
+some cases.
+
+Symptomatology.--There is no marked difference in the constitutional
+disturbances which are occasioned in this condition and those
+encountered in other cases of septic arthritis (previously considered
+herein) except that there is a difference in the degree of resultant
+derangement and local tissue changes. Chiefly, because of the difficulty
+encountered in keeping the hock joint in an aseptic condition or
+securely bandaged, open tarsal joint constitutes a more serious
+condition than a similar affection of the fetlock. Otherwise, a very
+similar condition obtains and the same diagnostic principles serve here
+that have been described on page 110 in considering open fetlock joint.
+
+Treatment.--The same plan that is described in detail for treatment of
+similar conditions affecting the fetlock joint is indicated in this
+affection. Exceeding care must be exercised in bandaging the hock,
+however, lest the animal be so irritated that in the extreme flexion of
+the tarsus which is often caused by bandaging, the wound dressings may
+be completely deranged. A wide gauze bandage material is most
+satisfactory; cotton of long fiber is separated in thin layers and wound
+about the hock, extending from the site of injury to a point about six
+inches proximal to the summit of the os calcis. By using an abundance
+of cotton in this way, it will not be found necessary to apply the
+bandages very snugly; with a four-inch gauze bandage material, which is
+supported above the cap of the hock and brought across the anterior face
+of the tarsus in a diagonal manner, a comfortable and very serviceable
+protective dressing is provided for. Animals so treated will not
+ordinarily resist because of pressure from the bandages. Pressure is
+unavoidable in the use of adhesive dressings or where careful attention
+is not given the manner of applying cotton to the parts. Such methods
+are sure to result disastrously. But if subjects are kept quiet after
+the parts have been properly bandaged, no difficulty is encountered in
+maintaining asepsis in an uninfected wound. Recovery takes place in
+favorable cases in from three weeks to three months, depending on the
+nature and extent of injuries inflicted.
+
+
+Fracture of the Fibular Tarsal Bone (Calcaneum.)
+
+Etiology and Occurrence.--This condition though rarely met with in the
+horse, is the result of violent strain upon the os calcis by the
+gastrocnemius and superficial flexor tendons in efforts put forth by
+animals in attempts to regain a footing when the hind feet slip forward
+under the body, or in jumping and in falls or direct contusion by heavy
+bodies. Hoare[50] reports a case of a mare that had produced fracture in
+jumping.
+
+Fracture of the other tarsal bones are very seldom observed but may be
+occasioned by contusions wherein multiple or comminuted fractures are
+produced, such as are to be seen in small animals. Fracture of the
+tibial tarsal bone (astragalus) is to be observed as a complication in
+luxations of the tarsal joint and, according to Cadiot, the other tarsal
+bones may likewise suffer fracture in luxations of the hock.
+
+Symptomatology.--Great pain attends this accident according to the
+observations given in recorded cases. In the case cited by Hoare the
+animal evinced great pain and uneasiness; the hock was unduly flexed;
+the calcaneum was displaced forward; and marked crepitation was present.
+A portion of the body of the calcaneum was protruding through the
+perforated skin. The animal was destroyed and the bone was found broken
+in three pieces.
+
+[Illustration: Fig. 54--Right hock joint. Viewed from the front and
+slightly laterally after removal of joint capsule and long collateral
+ligaments. T.t., Tibial tarsal bone (distal tuberosity). T.c., central
+tarsal bone. T.3. Ridge of third tarsal bone. T.f. Fibular tarsal bone
+(distal end). T.4. Fourth tarsal bone. Mt. III, Mt. IV. Metatarsal
+bones. Arrow points to vascular canal. (From Sisson's "Anatomy of the
+Domestic Animals.")]
+
+Since the support for the tendo Achillis is removed in such fracture and
+no leverage on the metatarsus obtains, it naturally follows that any
+attempt to sustain weight must result in extreme flexion of the hock and
+descent of this part in a manner similar to cases of rupture or division
+of the Achilles' tendon. The two conditions should not be confused,
+however, as the parts may be definitely outlined by palpation and the
+slack condition of the tendon and displaced summit of the calcaneum,
+which characterize fracture of the fibular tarsal bone, are easily
+recognized.
+
+Treatment.--Prognosis is unfavorable in the majority of cases, but
+should attempts at treatment be undertaken in young and quiet mares
+which might prove valuable for breeding purposes in case of imperfect
+recovery, they should be put in slings and the member is to be
+immobilized as in tibial fracture. Authorities are agreed that prognosis
+is entirely unfavorable in mature animals, when the case is viewed from
+an economic standpoint.
+
+
+Tarsal Sprains.
+
+Etiology and Occurrence.--The hock joint is often subjected to great
+strain because of the structural nature of this part and its relation to
+the hip as well as the manner in which the tarsus functionates during
+locomotion. That ligamentous injuries owing to sprain frequently occur
+and attendant periarticular inflammations with subsequent hypertrophic
+changes follow, is a logical inference. Fibrillary fracture of the
+collateral ligaments may take place in falls or when animals make
+violent efforts to maintain their footing on slippery streets. In
+expressing opinions concerning the frequency with which the hock is
+found to be the seat of trouble in lameness of the pelvic members,
+different writers place the percentage of hock lameness at from
+seventy-five to ninety per cent. And when one considers the possibility
+that a goodly proportion of cases of tarsal exostis are the outcome of
+sprains, the occurrence of tarsal sprains may be more generally
+admitted.
+
+Symptomatology.--A mixed type of lameness is present and the nature of
+the impediment varies, depending upon the location of the injury.
+Sprains of the mesial tarsal ligaments cause lameness somewhat similar
+to that of spavin. However, in establishing a diagnosis, local evidence
+in these cases is of greater significance than the manner of locomotion.
+During the acute stage of inflammation there is to be detected local
+hyperthermia, some hyperesthesia and a little swelling. Later, when
+resolution is not prompt, considerable swelling (or perhaps correctly
+speaking, an indurated enlargement) variable in size is developed. In
+some cases the entire tarsal region becomes greatly enlarged and this
+swelling is very slowly absorbed in part or completely. Such sub-acute
+cases are observed during the winter season and particularly where
+subjects are kept in tie stalls without exercise for weeks at a time.
+
+Treatment.--Attention should be directed toward relief for the animal
+in all acute inflammations. Local applications of heat are helpful and,
+of course, rest is essential. Towels that are wrung out of hot water and
+held in position by means of a few turns of a loose bandage and this
+covered with an impervious rubber sheet, will serve as a practical means
+of application of hydrotherapy. Following this when conditions improve,
+as in the handling of all similar cases, counterirritation is indicated.
+
+When proper care is given at the onset and where injury does not involve
+too much ligamentous tissue, recovery takes place in a few weeks but in
+some cases which occur during the winter season in farm horses, complete
+recovery does not result until several months have passed.
+
+
+Curb.
+
+The hock is said to be curbed when the normal appearance, viewed from
+the side, is that of bulging posteriorly at any point between the summit
+of the calcaneum and the upper third of the metatarsus. Among some
+horsemen a hock is said to be "curby" whenever there exists an
+enlargement of any kind on the posterior face of the tarsus whether it
+be due to sprain, exostosis or proliferation of tissue as a result of
+contusion.
+
+French veterinarians consider under the title of "courbe," an exostosis
+situated on the mesial side of the distal end of the tibia. Cadiot and
+Almy state that this condition (courbe) is of rare occurrence. Percivall
+defines curb as "a prominence upon the back of the hind leg, a little
+below the hock, of a curvilinear shape, running in a direct line
+downwards and consisting of infusion into, or thickening of, the sheath
+of the flexor tendons." Moeller's version of true curb is a thickening of
+the plantar ligament (calcaneocuboid or calcaneometatarsal). Hughes and
+Merillat consider curb as a synovitis having for its seat the synovial
+bursa which is situated between the superficial flexor tendon
+(perforatus) and the plantar ligament.
+
+Occurrence.--Certain predisposing factors seem to favor the occurrence
+of curb. A malformation of the inferior part of the tarsus so that its
+antero-posterior diameter is considerably less than normal is a
+contributing cause. Such hocks are known as "tied-in." Another fault in
+conformation is the existence of a weak hock that is set low down on a
+crooked leg, especially when such a member is heavily muscled at the
+hip. Given such conformation in an excitable horse, and curb is usually
+produced before the subject is old enough for service. It is certain
+that in cases where conformation is bad, greater strain is put upon the
+plantar ligament. This structure serves to bind the tibial tarsal
+(calcis) bone to the metatarsus; traction exerted upon its summit by the
+tendo Achillis is great when animals run, jump or rear and also at heavy
+pulling. In animals having curby hocks, sprain is likely to result and
+curb supervenes.
+
+Symptomatology.--The characteristic swelling which marks curb may
+develop quickly and lameness occur suddenly or the enlargement comes on
+gradually and slowly, causing little lameness. Lameness is not
+proportionate to the size of the swelling and in all cases whether
+subacute or chronic, the condition improves with rest, but lameness is
+again manifested upon exertion. A horse which "throws a curb" will go
+lame until the acute inflammatory condition subsides and depending upon
+treatment received and conformation of the hock, this requires from
+three days to two or three weeks.
+
+The character of the swelling varies; in some cases it is not large but
+rather dense and lacking in evidence of heat and hyperesthesia; in other
+cases there is considerable swelling, which is hot and doughy, somewhat
+painful to the touch but not necessarily productive of much lameness. In
+any event, whether the swelling or enlargement is big or little, its
+location makes it conspicuous when viewed in profile.
+
+In most cases after the acute inflammatory period has passed, lameness
+is slight, if at all present, and in time no interference with the
+subject's usefulness is occasioned because of the curb, but the animals
+often remain blemished--complete resorption of inflammatory products
+being unusual when much disturbance has existed.
+
+Treatment.--The handling of curb during the acute inflammatory stage
+is along the same lines as in sprain--local applications of cold and
+heat. Subjects must be kept quiet until all inflammation has subsided,
+for there are no cases wherein a little brisk exercise is more likely to
+cause a recurrence of lameness before recovery is complete than in curb.
+Vesication is in order in a week or ten days after the affection has set
+in; in old stubborn cases that have resisted ordinary treatment for a
+few months, the use of the actual cautery (line firing) is to be
+recommended.
+
+[Illustration: Fig. 55--Spavin.]
+
+
+Spavin. (Bone Spavin.)
+
+This term is applied to an affection of the tarsus which is usually
+characterized by the existence of an exostosis on the mesial and
+inferior portion of the hock. There is also included under this name,
+articular inflammation wherein no external evidence is shown. Spavin
+lameness has long been recognized and much has been written upon this
+subject. Since authorities are agreed that most cases of lameness in the
+hind leg are due to hock affection, and because the majority of cases of
+lameness which have the tarsal region as the seat of trouble are
+instances of spavin lameness, this disease merits all the attention it
+has received.
+
+Etiology and Occurrence.--Causes may well be classified as
+predisposing and exciting, for there are many etiologic factors to be
+reckoned with in spavin, some of which are widely different in nature.
+
+Considered as predisposing causes, hereditary influences play an
+important role and may, owing to faulty conformation, subject an animal
+to affections of this kind because of disproportionate development of
+parts (weak and small joints and heavy muscular hips); or as a
+consequence of inherited traits, a subject may manifest susceptibility
+to degenerative bone changes which are signalized by the formation of
+exostoses of different parts on one or more of the legs. Hereditary
+predispositions make for the presence of spavin in a large percentage of
+the progeny of sires so affected. This fact has been repeatedly
+demonstrated in this country as well as elsewhere according to Quitman,
+Dalrymple and Merillat.[51] A number of states have passed stallion
+inspection laws stipulating that animals having such exostoses as spavin
+and ringbone cannot be registered except as "unsound."
+
+Asymmetrical conformation, particularly where the hock is obviously
+small and weak as compared with other parts of the leg, constitutes a
+noteworthy predisposing cause.
+
+Peters' theory is plausible that the screw-like joint between the tibia
+and the tibial tarsal (astragulus) bones causes these structures to
+functionate in a manner not in harmony with the provisions allowed by
+the collateral ligaments of the tarsus, permitting movement only in a
+direction parallel with the long axis of the body.
+
+Because of the quality of their temperaments, nervous animals possessing
+no particular congenital structural defects of the hock and having no
+history of spavined progenitors, are subject to spavin when kept at work
+likely to produce tarsal sprain. Spavin usually develops early in such
+subjects and examples of this kind may be frequently observed in
+agricultural sections of the country. Where spavin develops in unshod
+colts at three and four years of age, shoeing is not an influencing
+agency when animals are not worked on pavements.
+
+Exciting causes of spavin are sprain and concussion. Various hypotheses
+are recorded as to how sprains are influenced and among others may be
+mentioned that of McDonough[52], which is that the foot is robbed of its
+normal manner of support by the ordinary three-calked shoe. With such a
+shoe, little support is given the sides of the foot; hence, undue strain
+is put upon the collateral ligaments of the tarsus. Moreover, the shoe
+with its calks increases the length of the leg and adds to the leverage
+on the hock, by virtue of such added length. This makes for greater
+strain upon the mesial or lateral tarsal ligaments whenever the foot
+bears upon a sloping ground surface, so that one side (inner or outer)
+is higher or lower than the other. But according to McDonough's theory
+(a good one concerning horses that work on pavements), the chief error
+in shoeing lies in that the foot is deprived of its normal base or
+support on the sides--the three-calked shoe being an unstable
+support--and that this manner of shoeing city horses working on
+pavements is an "inhumane" practice, a "diabolical method."
+
+Whether spavin has its point of origin within the articulation as a
+rarefying ostitis of the cancellated structure of the lower tarsal bones
+as suggested by Eberlein; or, as Diekerhoff asserts, that the cunean
+bursa may be the initial point of affection, is unsettled; but it is
+reasonable to consider occult spavin as having its origin within the
+articulation, and that cases readily yielding to cunean tenotomy are
+primarily due to affection of the cunean bursa.
+
+Symptomatology.--Where a visible exostosis exists, the presence of
+spavin is easily detected, yet exostoses that extend over large areas
+may constitute cause for serious trouble and still be difficult of
+detection. By observing the internal surface of the hock from various
+suitable angles, such as from between the forelegs or directly behind
+the subject, one may note the presence of any ordinary exostosis.
+
+The position assumed by the spavined horse is often characteristic. More
+or less knuckling is usually present (Liautard, McDonald). There is
+abduction of the stifle in some cases, or the toe may be worn in unshod
+horses so that it presents a straight line at the surface. This is
+manifested to a great degree in some animals and in others the foot is
+not dragged and there is no wearing of the hoof at the toe.
+
+Spavin lameness is so distinctive that one trained and experienced in
+the examination of horses that are spavined, should correctly diagnose
+the condition in practically every instance without recourse to other
+means than noting the peculiar character of the gait of the subject.
+Lameness develops gradually in the majority of instances, and an
+important feature in spavin lameness is that it disappears after the
+subject has gone a little way, to return again as soon as the animal has
+rested for a variable length of time--from a half hour to several hours.
+This "warming out" is marked during the incipient stage, but less
+pronounced in most chronic cases. A complete disappearance of lameness
+is observed in some instances, while in others only partial subsidence
+is evident. Because of the fact that pain is occasioned both during
+weight bearing and while the leg is being flexed and advanced, there is
+manifested the characteristic mixed lameness and exaggerated hip action
+which typifies spavin. By throwing the hips upward with the sound member
+it is possible to advance the affected leg with less flexion, hence less
+pain is experienced in this manner of locomotion. When made to step
+aside in the stall, a spavined horse will flex the affected member
+abruptly and when weight is taken on the diseased leg, symptoms are
+evinced of pain, and weight is immediately shifted to the sound limb.
+This is marked during the incipient stages of spavin. Lameness usually
+precedes the formation of exostosis, though cases are observed wherein
+an exostosis is present and no lameness is manifested and no history of
+the previous existence of lameness is available.
+
+The "spavin test" is of value as a diagnostic measure when it is
+employed with other means of examination, though reaction to this test
+is seen in some cases in old "crampy" horses that have experienced hard
+service. The test consists in flexing the affected leg (elevating the
+foot from the ground twelve to twenty-four inches) and holding the
+member in this position for a minute, whereupon the animal is made to
+step away immediately at a trot. During the first few steps taken
+directly thereafter, the subject shows pronounced lameness and this
+constitutes a reaction to the spavin test.
+
+Where no exostosis is present it becomes necessary to exclude other
+causes for lameness but the characteristic spavin lameness is to be
+relied upon to a greater extent in such cases than are other means of
+examination. Such cases are known as occult spavin and may be present
+for months before any external changes in structure are observable. In
+some instances no extoses form even during the course of years. The
+spavin test is of aid in establishing a diagnosis here but the marked
+"warming out" peculiar to spavin is not so pronounced in such cases.
+
+Prognosis.--An animal having hereditary predisposition to spavin is
+not likely to recover completely whether this predisposition be due to
+faulty conformation or susceptibility to bone changes. In predicting the
+outcome, the temperament of the subject is to be taken into account, as
+well as the character of service the animal is expected to perform. And
+finally, a very important feature to be noted, is the location of the
+exostosis. If situated rather high and extending anterior to the hock,
+there is less likelihood of recovery resulting than where an exostosis
+is confined to the lower row of tarsal bones. When situated anterior to
+the tarsus a large exostosis may by mechanical interference to function,
+cause lameness when all other causes are absent. In making examinations
+one must not be deceived by the inconspicuous and seemingly
+insignificant exostosis which has a broad base. In some cases of this
+kind, dealers style the condition as "rough in the hock" when as a
+matter of fact, in some instances, incurable spavin lameness develops.
+
+Treatment.--Many incipient cases of spavin yield to vesication and a
+protracted period of rest. Results depend primarily upon the nature of
+the affection. However, in every instance if there is involvement of the
+tibial tarsal (astragalus) bone, complete recovery is highly improbable.
+When the disease is confined to the lower tarsal bones, lameness
+subsides as soon as the degenerative changes are checked and ankylosis
+occurs.
+
+The use of the actual cautery when properly employed constitutes an
+excellent method of treatment. The "auto-cautery" when equipped with a
+point of about one-eighth of an inch in diameter and about three-fourths
+of an inch in length is well suited for this particular operation.
+Before deciding to cauterize, it is necessary to ascertain the extent of
+area affected. The nearness of the exostosis to the tibiotarsal
+articulation can be definitely determined by palpation. The hair over
+the entire surgical field is clipped and the cautery at white heat is
+pushed through the overlying soft tissues and into the central part of
+the exostosis. Care is taken to keep the cautery-point away from the
+articular margin of the tibial tarsal bone about three-fourths of an
+inch. No danger will result from cauterizing to a depth of three-fourths
+of an inch in the average case. Two or three (and not more) centrally
+located points for penetration with the cautery are sufficient.
+Experience has shown that several (five or six or more) punctures are
+not productive of good results. When considerable cicatricial tissue is
+present, due to the action of depilating vesicants or other chemicals,
+sloughing of tissue is very apt to follow deep cauterization, if one is
+not careful to keep the punctures at least one-half inch apart when
+three are made. It is best, in such cases, to make but two deep
+penetrations with the cautery but additional superficial punctures may
+be made if kept about three-fourths of an inch distant and not nearer
+than this to one another. Sloughing of tissue is not necessarily
+productive of bad results but there is occasioned an open wound which
+usually becomes infected and necrosis of tissue may extend into the
+articulation. No benefit results from sloughing and it should be
+avoided. In small horses, one deep point of cauterization is sufficient
+if the osseous tissues are penetrated to a proper depth so that an
+active inflammation is induced. The cautery may, if necessary, be
+reintroduced several times. When the field of operation has been
+properly prepared and it is thought advisable (as where subjects are
+kept in the hospital for a time), the hock may be covered with cotton
+and bandaged and no chance for infection will occur.
+
+After cauterization the subject should be kept quiet in a comfortable
+stall for three weeks; thereafter, if the animal is not too playful, the
+run of a paddock may be allowed for about ten days and a protracted rest
+of a month or more at pasture is best. It is unwise in the average case
+to put an animal in service earlier than two months after having been
+"fired."
+
+Where cases progress favorably, lameness subsides in about three weeks
+after cauterization and little if any recurrence of the impediment is
+manifested thereafter. However, because of violent exercise taken in
+some instances when subjects are put out after being confined in the
+stall, a return of lameness occurs and it may remain for several days or
+in some cases become permanent. No good comes from the use of blistering
+ointments immediately after cauterization. The actual cautery is a means
+of producing all necessary inflammation and it should be so employed
+that sufficient reactionary inflammation succeeds such firing. The use
+of a vesicating ointment subsequent to cauterization invites infection
+because of the dust that is retained in contact with the wound. The
+employment of irritating chemicals in a liquid form following firing is
+needless and cruel.
+
+In many instances lameness is not relieved and subjects show no
+improvement at the end of six weeks time and it then becomes a question
+of whether or not recovery is to be expected even with continued rest
+and treatment. As a rule, such cases are unfavorable. In one instance
+the author employed the actual cautery three times during the course of
+six months and lameness gradually diminished for a year. In this case
+the spavin was of nearly one year's standing when treatment was
+instituted. The subject was a nervous and restless but well-formed
+seven-year-old gelding. Recovery was not complete; recurrent intervals
+of lameness marked this case, but the horse limped so slightly that the
+average observer could not detect its existence after the animal had
+been driven a little way.
+
+Cunean tenotomy has been advocated and practiced by Abildgaard, Lafosse,
+Peters, Herring, Zuill and others and good results have followed in many
+cases so treated.
+
+Considering results, the employment of chemicals of various kinds for
+the purpose of relieving spavin lameness does not compare favorably with
+firing. Moreover, so many animals have been tortured and needlessly
+blemished in the attempted cure of spavin that agents which are not of
+known value, the use of which are likely to result in extensive injury
+to the tissues, are only to be condemned.
+
+When spavin is bilateral and lameness is likewise affecting both
+members, prognosis is at once unfavorable. Such cases are often
+benefited by cauterization but only one leg at a time should be treated.
+
+Bossi's double tarsal neurectomy (division of the anterior and posterior
+tibial nerves) has undoubtedly been of decided benefit in many cases,
+but is not at present a popular method of treatment in this country.
+This operation has its indications, however, and may be recommended in
+chronic lameness where no extensive exostosis exists which may
+mechanically interfere with function.
+
+
+Distension of the Tarsal Joint Capsule. (Bog Spavin.)
+
+Distension of the capsular ligament of the tibial tarsal
+(tibioastragular) joint with synovia is commonly known as bog spavin.
+This condition is separate and distinct from that of distension of the
+sheath of the deep flexor tendon (perforans) though not infrequently the
+two affections coexist.
+
+Etiology and Occurrence.--Following strains from work in the harness
+or under the saddle, horses develop an acute synovitis of the hock
+joint, which often results in chronic synovial distension. Debilitating
+diseases favor the production of this affection in some animals. It is
+also frequently observed in young horses and in draught colts of twelve
+to eighteen months of age. This condition occurs while the subjects are
+at pasture and often spontaneous recovery results by the time the
+animals are two years of age.
+
+[Illustration: Fig. 56--Bog spavin. Showing point of view which may be
+most advantageously taken by the diagnostician in examining for
+distension of the capsular ligament of the tarsal joint.]
+
+Symptomatology.--Bog spavin is recognized by the distended condition
+of the joint capsule which is prominent just below the internal tibial
+malleolus and this affection is characterized by a fluctuating swelling
+which varies considerably in size in different subjects. Except in cases
+of acute synovitis, lameness is not present and in chronic distension of
+the capsule of the tarsal joint, no interference with the subject's
+usefulness occurs. In the majority of instances, the disfigurement which
+attends bog spavin is the principal objectionable feature. The condition
+is bilateral in many instances, and in such cases the subjects have a
+predisposition to this condition or it follows attacks of strangles or
+other debilitating ailments. Because of a rapid and unusual growth,
+bilateral affections are of frequent occurrence in some animals.
+
+Treatment.--The most practical method of handling bog spavin consists
+in aspiration of synovia and injection of tincture of iodin. Discretion
+should be employed in selecting subjects for treatment, regardless of
+the manner in which such cases are to be handled. Where there exists
+chronic distension of the joint capsule of several years' standing in
+old or weak subjects, needless to say, recovery is not likely to result.
+When animals are vigorous and two or three months' time is available,
+treatment may be begun with reasonable hope for success.
+
+The average subject is handled standing and can be restrained with a
+twitch, sideline and hood. Aspirating needles and all necessary
+equipment must be in readiness (sterile and wrapped in aseptic cotton or
+gauze) so that no delay will occur from this cause when the operation
+has been started. The central or most prominent part of the distended
+portion of the capsule is chosen for perforation and an area of an inch
+and a half in diameter is shaved. The skin is cleansed and then painted
+with tincture of iodin. The sterile aspirating needle is pushed through
+the tissues and into the capsule with a sudden thrust. With a large and
+sharp needle (fourteen gauge), synovia can be drawn from the cavity in
+most instances and the subject usually offers no resistance. By
+compressing the distended capsule and surrounding structures with the
+fingers, considerable synovia may be evacuated. In singular instances,
+no synovia is to be aspirated with the needle, and in such cases the
+amount of iodin injected needs be increased, possibly twenty-five per
+cent., as experience will indicate. From two to five cubic centimeters
+of U.S.P. tincture of iodin is injected through the aspirating needle
+into the synovial cavity of the joint, and the exterior of the parts are
+vigorously massaged immediately after injection to stimulate
+distribution of the iodin throughout the synovial cavity. Where a
+bilateral affection exists, two or three weeks' time should intervene
+between the treatments of each leg. A sterile metal syringe equipped
+with a slip joint for the needle is well adapted to this operation.
+Lubrication of the plunger with heavy sterile vaseline or glycerin will
+prevent the syringe from being ruined by the iodin.
+
+Following the injection, the subject is kept in a stall or in a suitable
+paddock, so that conditions may be observed for four or five days. The
+object sought by the introduction of iodin is not only for a local
+effect upon the synovial membranes in checking secretions, but the
+production of an active inflammation and great swelling, which will
+remain from four weeks to three months subsequent to the injection. This
+periarticular swelling should produce and maintain a constant pressure
+over the entire affected parts for a sufficient length of time until
+normal tone is re-established.
+
+In some cases, swelling does not develop as the result of a single
+injection of iodin. When marked swelling has not taken place within five
+days, none will occur and a repetition of the injection may be made
+within ten days after the first treatment has been given. One may safely
+increase the amount of iodin at the second injection in such cases by
+one-fourth to one-third.
+
+In Europe this method of treating bog spavin has been employed by
+Leblanc, Abadie, Dupont and others according to Cadiot; but Bouley, Rey,
+Lafosse and Varrier used it with bad results. Where a perfect technic is
+executed (and no other is excusable in this operation), no infection
+will occur if a reasonable amount of iodin is injected. The dilution of
+iodin with an equal amount of alcohol has been practised by the author
+in many cases, but later this was found unnecessary.
+
+Other methods of treatment have been used with success. Perhaps the most
+heroic consists in opening the joint capsule with a bistoury or with
+the actual cautery. Such practice is too hazardous for general use and
+is not to be recommended, although good results should follow the
+employment of such methods if infectious arthritis does not occur.
+
+Line firing over the distended capsule is a practical method of
+treatment. This is attended with good results in young animals in many
+cases, but considerable blemish is caused when sufficient irritation is
+produced to stimulate resolution.
+
+Vesication also is successfully employed in some instances. However,
+only cases of recent origin in young animals--colts of two years or
+younger--yield to blistering, and in some affected colts no doubt
+recovery would have been spontaneous had no treatment been instituted.
+
+Ligation of the saphenous vein at two points, one above and the other
+below the distended ligamentous capsule, is an old operation, which has
+undoubtedly given good results in some cases, although it does not seem
+to be a rational procedure.
+
+After-Care.--After swelling has fully developed--which occurs within a
+week--the subject is turned to pasture and no attention is necessary
+thereafter. A gradual subsidence of the swelling occurs and in the
+average instance, this completely resolves within six or eight weeks.
+
+Complete recovery succeeds the aspiration-and-injection-treatment in
+about seventy-five per cent of cases as the result of one operation, and
+subjects may be gradually and carefully returned to work in about sixty
+days after treatment has been given.
+
+
+Distension of the Tarsal Sheath of the Deep Digital Flexor.
+(Thoroughpin.)
+
+The terms "thoroughpin" or "throughpin" are translations from the French
+_vessignon cheville_ and have the same significance. They are so named
+because of the diametrically opposed distensions of the sheath of the
+deep flexor tendon in such manner that the distensions appear to be due
+to a supporting peg.
+
+Anatomy.--The theca through which the deep digital flexor (perforans)
+plays in the tarsal region, begins about three inches above the inner
+tibial malleolus and extends about one-fourth of the way down the
+metatarsus. The posterior part of the capsular ligament of the hock
+joint is very thick in its most dependent portions and is in part
+cartilaginous, forming a suitable groove for the passage of the deep
+flexor tendon.
+
+[Illustration: Fig. 57--Thoroughpin. Showing distension of the sheath of
+the deep flexor tendon as it protrudes antero-externally to the fibular
+tarsal bone (calcaneum).]
+
+Etiology and Occurrence.--Strains and sequellae to debilitating
+diseases constitute the usual causes of this affection. As a result of
+acute synovitis a chronic synovial distension of the tarsal sheath
+occurs. Bog spavin is often present in case of thoroughpin but the two
+conditions are separate and distinct excepting in that both may occur
+simultaneously and as the result of the same cause. Some animals are
+undoubtedly predisposed to disease of synovial structures. The average
+horse that has been subjected to hard service on pavements or hard roads
+at fast work suffers synovial distension of bursae, thecae or of joint
+capsules. Some of the well bred types such as the thoroughbred horses
+may be subjected to years of hard service and still remain "clean
+limbed" and free from all blemishes. Thus it seems that subjects of
+rather faulty conformation, animals having lymphatic temperaments and
+the coarse-bred types, are prone to synovial disturbances such as
+thoroughpin, bog spavin, etc., sometimes having both legs affected.
+
+[Illustration: Fig. 58--Fibrosity of tarsus as a complication in chronic
+thoroughpin.]
+
+Symptomatology.--Thoroughpin is characterized by a distended condition
+of the tarsal sheath which is manifested by protrusions anterior to the
+tendo Achillis. However, where but moderate distension of the sheath
+exists, there is little, if any, bulging on the mesial side of the hock
+and but a small hemispherical enlargement is presented on the outer side
+of the tarsus, anterior to the summit of the os calcis. In some
+instances the protruding parts assume large proportions, but always,
+because of the relationship between the fibular tarsal bone (calcaneum)
+and the tendon sheath, the larger protrusion is situated mesially.
+
+During the acute inflammatory stage there is marked lameness present but
+this soon subsides when local antiphlogistic agents are applied to the
+parts. In fact, spontaneous relief from lameness usually results in the
+course of ten days' time following the appearance of thoroughpin. No
+lameness marks the advent of this affection when it develops as the
+result of continuous strain and concussion occasioned by hard service,
+and local changes tend to remain in _status quo_.
+
+[Illustration: Fig. 59--Another view of same case as illustrated in Fig.
+58.]
+
+Treatment.--Rest and the local application of heat or cold will suffice
+to promote resolution of acute inflammation and lameness when present
+will subside within two weeks. In chronic affections, however, the matter
+and manner of effecting a correction of the condition--distended tarsal
+sheath--merit careful consideration. While drainage of distended thecae
+and bursae by means of openings made with hot irons was practiced by the
+Arabs, centuries ago, and good results have attended such heroic
+corrective measures, nevertheless the occasional serious complications
+which result from infection likely to be introduced in following such
+procedures, cause the prudent and skilful practitioner to employ safer
+methods of treatment.
+
+The application of blistering agents is of no value in stimulating
+resorption of an excessive amount of synovia in chronic cases and the
+actual cautery when employed without perforation of the synovial
+structure, is of little benefit. Trusses or mechanical appliances for
+the purpose of maintaining pressure upon the distended parts are of no
+practical value because of the great difficulty of keeping such
+contrivances in position. They usually cause so much discomfort to the
+subject that they are not tolerated.
+
+A very practical and fairly successful method of treatment consists in
+the aspiration of a quantity of synovia and injecting tincture of iodin.
+Cadiot recommends the drainage of synovia with a suitable trocar and
+cannula and injecting a mixture consisting of tincture of iodin, one
+part, to two parts of sterile water, to which is added a small quantity
+of potassium iodid. The latter agent is added to prevent precipitation
+of the iodin. This authority (Cadiot) further advocates the removal of
+practically all of the synovia that will run out through the cannula and
+the immediate introduction of as much as one hundred cubic centimeters
+of the above mentioned iodin solution. This solution is allowed to
+remain in the synovial cavity a few minutes and by compressing the
+tissues surrounding the tendon sheath, the evacuation of as much of the
+contents of the synovial cavity as is practicable, is effected.
+Subsequently the subject is allowed absolute rest and more or less
+inflammatory reaction follows. In some cases there occur marked lameness
+and some febrile disturbance, but where a good technic is carried out,
+no bad results follow. At the end of four weeks' time, horses so treated
+may be returned to service, but the full beneficial effect of such
+treatment is not experienced until several months' time have elapsed.
+
+Where good facilities for executing a careful technic in every detail
+are at hand, incision of the tarsal sheath, evacuation of its contents
+and uniting its walls again by means of sutures and providing for
+drainage with a suitable drainage tube, may be practiced. This manner of
+treatment has been satisfactory in the hands of a number of surgeons.
+
+
+Capped Hock.
+
+Enlargements which occur upon the summit of the os calcis, whether
+hypertrophy of the skin and subcuticular fascia, the result of injury or
+repeated vesication, distension of the subcutaneous bursa or injury to
+the superficial flexor tendon (perforatus) or its sheath, are generally
+known as capped hock. However, the term should be restricted to use in
+reference to distensions of synovial structures of that region.
+
+Etiology and Occurrence.--Usually there occurs a hygromatous
+involvement of the subcutaneous bursa due to contusion. As in bog
+spavin, following certain infectious diseases (influenza, purpura
+hemorrhagica, etc.) there remains a distended condition of the
+subcutaneous bursa, after swelling of the member has subsided. In
+feeding pens where numbers of young mules are kept in crowded quarters
+many cases may be observed. In some instances where violent contusions
+result from kicking cross-bars of wagon shafts (by nymphomaniacs or in
+habitual kickers where there is opportunity for doing such injury) the
+superficial flexor tendon and its synovial apparatus are injured and a
+more serious condition may result.
+
+Symptomatology.--In acute and extensive inflammation of the parts,
+lameness is present, but in the average case no inconvenience to the
+subject results. The prominent site of the affection is cause for an
+unsightly blemish. This is undesirable, particularly in light-harness or
+saddle horses. These affections are characterized by a fluctuating mass
+which has a thin wall and in all cases of long standing the condition is
+painless.
+
+By careful palpation one may readily distinguish between a hygromatous
+condition of the superficial bursa and involvement of the underlying
+structures. Affection of the expanded portion of the flexor tendon and
+contiguous structures makes for an organized mass of tissue which is
+somewhat dense and in some instances painful to the subject when
+manipulated. This is particularly noticeable in cases where the parts
+are regularly and repeatedly injured as in habitual kickers.
+
+[Illustration: Fig. 60--"Capped hock." Distension of the bursa over the
+summit of the os calcis.]
+
+Treatment.--In acute inflammation, antiphlogistic applications are
+indicated and the subject must be kept quiet. The matter of bandaging
+the hock is a difficult problem in some cases and needs be done with
+care. As has been previously stated in this volume, the tarsus needs to
+be well padded with cotton before the bandages are applied and only a
+moderate degree of tension is employed in applying the bandages lest
+anemic-necrosis result from pressure. In distension of the superficial
+bursa, after clipping the hair over a liberal area and preparing the
+skin by thoroughly cleansing and painting with tincture of iodin, the
+capsule is incised with a bistoury. An incision about an inch in length,
+situated low enough to provide drainage, is made through the tissues and
+the contents are evacuated. Tincture of iodin is injected into the
+cavity and the parts are covered with cotton and bandaged. No after-care
+is necessary except to retain the dressing in position, which is not
+difficult in the average case if the subject is kept tied. If much
+resistance is exhibited, such as extreme flexion of the bandaged hock,
+the animal may be put in a sling and little if any objection to the
+bandage will be offered thereafter. The wound may be dressed at the end
+of forty-eight hours and no redressing will be necessary in the average
+instance if infection is not present. But slight local disturbance and
+little distress to the subject result in cases so treated even when
+infection occurs, but a good technic is possible of execution in most
+instances and no infection should take place.
+
+The surgical wound heals in two or three weeks and inflammation
+gradually subsides. Bandages are retained one or two weeks, as the case
+may require, and subsequently a good wound lotion may be employed
+several times daily. A good lotion for such cases as well as in many
+others has long been employed with success by Dr. A. Trickett of Kansas
+City. It consists of approximately equal parts of glycerin, alcohol and
+distilled extract of witch hazel, to which is added liquor cresolis
+compositus, two percent, and coloring matter q.s.
+
+Complete resolution does not occur in the average case. There remains
+some hyperplastic tissue and even where the enlargement is slight, the
+prominent situation of the affection precludes its being unnoticed.
+
+In disease of the flexor tendon and its bursa where contiguous
+inflammation of tissue is present, the parts are blistered or fired.
+Line firing is beneficial in such instances but in all cases the cause
+is to be removed if possible.
+
+
+Rupture and Division of the Long Digital Extensor
+(Extensor Pedis).
+
+Etiology and Occurrence.--Because of the fact that the long digital
+extensor is the only extensor of the phalanges of the pelvic limb, its
+rupture or division constitutes a troublesome condition, which in some
+cases does not readily respond to treatment.
+
+Rupture of this tendon may occur during work on rough and uneven roads,
+particularly in range horses that are ridden over ground that is
+burrowed by gophers or prairie dogs; in such cases, horses are apt to
+suddenly and violently turn the foot in position of volar flexion,
+thereby causing undue strain to the digital extensor and its rupture
+sometimes follows. In foals of one or two days of age, this tendon is
+sometimes found parted or ruptured and the condition may be bilateral.
+
+As the result of accidents, the digital extensor may be divided and when
+the wound becomes contaminated, as it does because of the marked volar
+flexion (knuckling) which occurs during the course of this affection,
+regeneration of tissue is checked and recovery is tardy.
+
+Symptomatology.--There is no interference with ability to sustain
+weight in such cases, when the foot is placed in normal position; but
+immediately upon attempting to walk, the toe is dragged, and if weight
+is borne with the affected member, it comes upon the anterior face of
+the fetlock. The flexors are not antagonized and if there be an open
+wound the parts soon become contaminated; or, in rupture, if animals
+travel about very much, there soon occurs necrosis of the tissues of the
+anterior fetlock region and the condition is rendered incurable. Cases
+are reported of animals that have suffered rupture of the long digital
+extensor and the subjects learned to throw the member forward during
+extension, substituting for the extensor tendon the pendulum-like
+momentum which the foot affords when so employed; and a walking and even
+a trotting pace was possible without doing injury to the fetlock region.
+
+Where a subcutaneous division exists as in rupture, the divided ends of
+the tendon may be definitely recognized by palpation.
+
+Treatment.--Subjects are best put in slings and kept so confined until
+regeneration of tendinous structures has been completed. This requires
+from six weeks to two months' time. In addition, the extremity is kept
+in a state of extension by means of suitable splints and shoes,--a shoe
+equipped with an extension at the toe and perforated so that a steel
+brace may be hooked into the perforation and the brace fashioned to be
+buckled to the upper metatarsal region. When braces are placed in front
+of the foot, great care is necessary in properly padding the member with
+cotton lest sloughing from pressure occurs at the coronet; but this does
+not apply in rupture of extensors so much as where flexors are ruptured.
+
+Open wounds are treated along general surgical lines, dressed as
+frequently as occasion demands, and recovery will be complete in a few
+months' time unless much of the tendon has been destroyed. In one
+instance, the author had occasion to observe such a condition, which,
+because of the extensive destruction of tendon and lack of facilities
+for giving proper attention to the subject, results were so unfavorable
+that it was deemed necessary to destroy the animal.
+
+
+Wounds From Interfering.
+
+When, during locomotion, injury is inflicted upon the mesial side of an
+extremity by the swinging foot of the other member, the condition is
+termed interfering.
+
+Etiology and Occurrence.--Faulty conformation, bad shoeing and
+over-work are the principal causes of interfering. Horses that are "base
+narrow" or that have crooked legs are quite apt to interfere. Shoes that
+are put on a foot that is not level or applied in a twisted position, or
+shoes wide at the heel will often cause interfering and injury. Animals
+that are driven at fast work until they become nearly exhausted may be
+expected to interfere. Such cases are frequently observed in young
+horses that are driven over rough roads, particularly when so nearly
+exhausted or weakened from disease or inanition that the feet are
+dragged forward rather than picked up and advanced in the normal manner.
+
+Symptomatology.--Wounds inflicted by striking the extremities in this
+manner present various appearances and occasion dissimilar
+manifestations. The hind legs are almost as frequently affected as the
+front and the fetlock region is most often injured, though wounds may be
+inflicted to the coronet. In front, the carpus is sometimes the site of
+injury.
+
+When only an abrasion is caused, little if any lameness occurs, but
+where interfering is continued and nerves are involved or subfascial
+infection and extensive inflammation succeed such abrasions, marked
+lameness and evidence of great pain are manifested. Frequently, in
+chronic cases affecting the hind leg, the fetlock assumes large
+proportions, and at times during the course of every drive the subject
+strikes the inflamed part, immediately flexing and abducting the injured
+member, and the victim hops on the other leg until pain has somewhat
+subsided.
+
+Interfering is much more serious in animals that are used at fast work
+than in draft horses. In light-harness or saddle horses, it may render
+the subject practically valueless or unserviceable if the condition
+cannot be corrected.
+
+Treatment.--Wherever possible, cause is to be removed and if animals
+are properly used, ordinary interfering wounds will yield to treatment.
+If the shoeing is faulty, this should be corrected, the foot properly
+prepared and leveled before being shod and suitable shoes applied. In
+young animals that become "leg-weary" from constant overwork, rest and
+recuperation are necessary to enhance recovery. In such cases it will be
+found that very light shoes, frequently reset, will tend to prevent
+injury to the fetlock region such as characterizes these injuries of
+hind legs.
+
+Palliative measures of various kinds are employed where cause is not to
+be removed and a degree of success attends such effort. In draft horses
+or animals that are used at a slow pace, shields of various kinds are
+strapped to the extremity and protection is thus afforded. Or, large
+encircling pads of leather, variously constructed, serve to cause the
+subject to walk with the extremities apart.
+
+Interfering shoes of different types are of material benefit in many
+instances. Often the principle upon which corrective shoeing is based is
+that the mesial (inner) side of the foot is too low; the foot is
+consequently leveled and the inner branch of the shoe is made thicker
+than the outer, altering the position of the foot in this way. This is
+productive of desirable results. However, much depends upon the manner
+in which the foot in motion strikes the weight-bearing member as to the
+corrective measures that are indicated. This belongs to the domain of
+pathological shoeing and the reader is referred to works on this subject
+for further study of this phase of lameness.
+
+
+Lymphangitis.
+
+Excluding glanders, in the majority of instances, lymphangitis in the
+horse, such as frequently affects the hind legs, is due to the local
+introduction of infectious material into the tissues as a result of
+wounds. However, one may observe in some instances an acute lymphangitis
+which affects the pelvic limbs of horses and no evidence of infection
+exists. Consequently, lymphangitis may be considered as _infectious_ and
+_non-infectious_.
+
+
+INFECTIOUS LYMPHANGITIS.
+
+Etiology and Occurrence.--Traumatisms of the legs frequently result in
+infection and when such injuries are near lymph glands, even though the
+degree of infection be slight, more or less disturbance of function of
+the muscles in the vicinity of such glands occurs and lameness follows.
+
+The prescapular, axillary and cubital lymph glands when in a state of
+inflammation, cause lameness of the front leg, and the superficial
+inguinal and deep inguinal lymph glands not infrequently become involved
+also. Because of the location of these lymph glands, they are subject to
+comparatively frequent injury and inflammation, causing lameness more
+often than other lymph-gland-affections.
+
+Small puncture wounds in the region of the elbow are often met with.
+These may be inflicted when horses lie down upon sharp stumps of
+vegetation or shoe-calk injuries may be the means of introducing
+contagium, and an infectious inflammation results. Abscess formation,
+the result of strangles or other infection in the prescapular glands,
+may be observed at times. Following castration, the inguinal lymph
+glands may become involved in an infectious inflammation and locomotion
+is impeded to a marked degree. Horses running at pasture sometimes
+become injured by trampling upon pieces of wood, causing one end of
+these or of various implements to become embedded in the soft earth and
+the other end to enter at the inguinal region and even penetrate the
+tissues to and through the skin and fascia just below the perineal
+region.
+
+Nail punctures resulting in infection frequently cause an infectious
+lymphangitis and a marked and painful swelling of the legs supervenes.
+
+[Illustration: Fig. 61--Chronic lymphangitis. Showing hypertrophy of the
+left hind leg, due to repeated inflammation.]
+
+Symptomatology.--Lameness, mixed or swinging-leg, signalizes the
+presence of acute lymphangitis. There is always more or less swelling
+present and manipulation of the affected parts gives pain to the
+subject. Depending upon the character of the infection and its extent,
+there is presented a varying degree of constitutional disturbance. There
+may be a rise in temperature of from two to five degrees, and in such
+instances there is an accelerated pulse. Where much intoxication is
+present, anorexia and dipsosis are to be noticed.
+
+Swelling may increase gradually and in time discharge of pus may take
+place spontaneously without drainage being provided for, if the
+character of the infection does not cause early death. In these cases
+lameness is pronounced and the cause of the disturbance is to be sought,
+particularly if the condition be due to a nail puncture.
+
+[Illustration: Fig. 62--Elephantiasis.]
+
+Treatment.--Location of the site of injury is advisable in all cases
+and in some instances provision for drainage, as in puncture wounds, is
+helpful. Locally, curettage and the application of suitable antiseptics
+are indicated. Hot fomentations are beneficial and should be continued
+for several days if necessary, to stimulate resolution. A brisk purge
+should be admintered at the onset and strychnin, because of its indirect
+stimulative effect upon the circulation together with its tonic effect
+upon the musculature, is beneficial.
+
+In all such cases rational treatment, good hygiene and careful nursing
+are the principal factors which stimulate recovery. Individual
+resistance or lowered vitality has a marked influence on the course of
+this affection.
+
+
+NON-INFECTIOUS LYMPHANGITIS.
+
+This type of lymphangitis is associated with, or the result of, a
+derangement of digestion. It affects heavy draft horses, rarely other
+types of animals, and involves one or both hind legs.
+
+Occurrence.--In healthy and well nourished horses irregularly used,
+this affection may suddenly manifest itself. It occurs in singular
+instances in mares that are in advanced pregnancy even when such animals
+are at pasture. Usually, however, this malady is found in heavy draft
+horses that have been kept stabled from one to three days.
+
+Symptomatology.--At the outset in severe cases, there is elevation of
+temperature, labored breathing, accelerated pulse, anorexia and more or
+less swelling of the affected members. Swelling is very painful and when
+the affected legs are palpated, pain is manifested by flinching. The
+inguinal lymph glands are often swollen but in some cases they are not
+affected in any perceptible degree. In the average case suppuration does
+not occur and when conditions are favorable, resolution is complete
+within ten days. The extent of the involvement and the intensity of the
+affection vary materially in different cases and a chronic lymphangitis
+may succeed the acute attacks and finally in some instances,
+elephantiasis results.
+
+Treatment.--An active purgative should be given at once and in the
+ordinary case, stimulants are indicated. If marked distress is present,
+morphin is given and where there is much rise of temperature, cold
+drinking water is offered in abundance and catharsis is enhanced by
+enemata. Locally, hot applications are of benefit. Hot towels or cotton
+held in position by bandages and kept soaked with warm water will
+relieve pain and stimulate resolution. Diuretics may be of benefit and
+anodyne applications are to be employed with profit in some cases.
+Walking exercise, if not indulged in to excess, is helpful as soon as
+acute inflammation has subsided. By giving careful attention to the
+regimen and providing regular exercise for susceptible subjects, this
+type of lymphangitis is often forestalled.
+
+FOOTNOTES:
+
+[Footnote 34: Manual of Veterinary Physiology. Page 610.]
+
+[Footnote 35: Manual of Veterinary Physiology, page 601.]
+
+[Footnote 36: Case report at meeting of the Iowa State Veterinary
+Medical Association, Jan., 1904, by Dr. S.H. Bauman, Birmingham, Ia.]
+
+[Footnote 37: Regional Veterinary Surgery and Operative Technique, by
+John A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 733.]
+
+[Footnote 38: As quoted by A. Liautard, M.D., V.M., American Veterinary
+Review, Vol. 37, page 667.]
+
+[Footnote 39: Quoted by Prof. Liautard, American Veterinary Review, Vol.
+33, page 190.]
+
+[Footnote 40: Traite de Therapeutique Chirurgical des Animaux Domestique
+par P.J. Cadiot et J. Almy, Tome second, page 460.]
+
+[Footnote 41: Traite de Therapeutique Chirurgical, Tome second, page
+465.]
+
+[Footnote 42: Luxation of the Femur, by Wm. V. Lusk, Veterinary Surgeon,
+U.S. Cavalry, American Veterinary Review, Vol. 21, page 254.]
+
+[Footnote 43: Because of the intimacy of the psoas major (p. magnus) and
+the iliacus they are sometimes called iliopsoas.]
+
+[Footnote 44: Dr. John Scott, Peoria, Ill., in The American Veterinary
+Review, Vol. 16, page 16.]
+
+[Footnote 45: Annotation on Surgical Items, by Drs. L.A. and Edward
+Merillat, American Veterinary Review, Vol. 31, page 358.]
+
+[Footnote 46: W.L. Williams in American Veterinary Review, Vol. 21, page
+452.]
+
+[Footnote 47: Geo. H. Berns, D.V.S., report, American Veterinary Medical
+Association, 1912, page 238.]
+
+[Footnote 48: Joseph Hughes, M.R.C.V.S., in the Chicago Veterinary
+College Quarterly Bulletin, Vol. 10, page 15.]
+
+[Footnote 49: Traite de Therap. Chir. Cadiot et Almy, Tome second, page
+480.]
+
+[Footnote 50: E. Wallis Hoare, F.R.C.V.S., American Veterinary Review,
+Vol. 27, page 1189.]
+
+[Footnote 51: Discussions on paper entitled "The Spavin Group of
+Lamenesses," by W.L. Williams, Carl W. Fisher and D.H. Udall,
+Proceedings of American Veterinary Medical Association, 1905.]
+
+[Footnote 52: "Hock-Joint Lameness," by Dr. James McDonough, Proceedings
+of the A.V.M.A., 1913, page 545.]
+
+
+
+
+INDEX
+
+
+A
+
+Acetabulum, 185
+
+Acute arthritis, 65
+
+Acute laminitis, 162
+
+Acute tendinitis, 135
+
+Affections of blood vessels, 31
+
+Affections of bursae and thecae, 27
+
+Affections of the feet, 34
+
+Affections of ligaments, 20
+
+Affections of lymph vessels and glands, 32
+
+Affections of muscles and tendons, 28
+
+Affections of nerves, 30
+
+Anamnesis, 38
+
+Anatomo-physiological review of parts of fore leg, 55
+
+Anatomo-physiological consideration of the pelvic limbs, 185
+
+Anatomy of the joint capsule, 220
+
+Annular ligament, 58
+
+Antea-spinatus muscle, 65
+
+Anterior brachial region, wounds of, 90
+
+Anterior digital extensor muscle, 193
+
+Arteritis, 209
+
+Artery (brachial), thrombosis of the, 81
+
+Arthritis, 22, 84
+
+Arthritis, acute, 65
+
+Arthritis, chronic, 65
+
+Arthritis, infectious, 66
+
+Arthritis, metastatic, 25
+
+Arthritis of the fetlock joint, 152
+
+Arthritis, rheumatic, 26
+
+Arthritis, scapulohumeral, 65
+
+Arthritis, tarsal, 225
+
+Arthritis, traumatic, 22
+
+Articular ringbone, 121
+
+Articulation, femeropelvic, 185
+
+Articulation, metacarpophalangeal, 58
+
+Articulation, scapulohumeral, 55
+
+Aspiration-and-injection treatment of bog spavin, 244
+
+Aspiration-and-injection treatment of capped hock, 252
+
+Aspiration-and-injection treatment of thoroughpin, 250
+
+Astragalus, 190
+
+Astragalus, fracture of the, 230
+
+Attitude of the subject, 41
+
+Atrophy of the quadriceps muscles, 205
+
+Atrophy, shoulder, 73
+
+
+B
+
+Biceps brachii, 58, 65, 68, 69
+
+Bicipital bursa, inflammation of, 68
+
+Blood vessels, affections of, 31
+
+Bog spavin, 242
+
+Bog spavin, aspiration-and-injection treatment of, 244
+
+Bog spavin, line firing for, 246
+
+Bog spavin, vesication for, 246
+
+Bone spavin, 235
+
+Bones, degenerative changes in, 16
+
+Bones, tarsal, 190
+
+Bossi's double tarsal neurectomy, 242
+
+Brachial artery, thrombosis of the, 81
+
+Brachial paralysis, 77
+
+Bursa intertubercularis, 62, 69
+
+Bursa podotrochlearis, inflammation of the, 157
+
+Bursae, affections of, 27
+
+Bursitis, 27, 104
+
+Bursitis, infectious, 28
+
+Bursitis in the fetlock region, 150
+
+Bursitis intertubercularis, 68
+
+Bursitis, noninfectious, 28
+
+
+C
+
+Calcaneo-cuboid ligaments, 190
+
+Calcaneo-metatarsal ligaments, 190
+
+Calcaneum, fracture of the, 230
+
+Calk wounds, 170
+
+Capped hock, 251
+
+Capped hock, aspiration-and-injection treatment of, 252
+
+Capsular ligament, 190
+
+Caput muscles, 71
+
+Carpal bones, fracture of the, 96
+
+Carpal bones, luxation of the, 96
+
+Carpal flexors, contraction of the, 93
+
+Carpal flexors, inflammation of the, 93
+
+Carpal joint, 58
+
+Carpal joint, open, 100
+
+Carpitis, 98
+
+Carpus, inflammation of the, 98
+
+Cartilage, lateral, inflammation of, 174
+
+Cartilages of the third phalanx, ossification of the, 155
+
+Chronic arthritis, 65
+
+Chronic gonitis, 217
+
+Chronic laminitis, 164
+
+Chronic tendinitis, 137
+
+Cochran shoe for dropped soles, 169
+
+Collateral ligaments, 190
+
+Comminuted fractures, 17
+
+Compound fractures, 17
+
+Contracted tendons of foals, 143
+
+Contraction of the carpal flexors, 93
+
+Contraction of the flexor tendons, 137
+
+Contusions of the triceps brachii, 71
+
+Contusive wounds, 85
+
+Coracoradialis, 58
+
+Corns, 172
+
+Coronary region, wounds of the, 170
+
+Corpora oryzoidea, 218
+
+Cotyloid ligament, 185
+
+Courbe, 233
+
+Crepitation, false, 48
+
+Crepitation, true, 47
+
+Crucial ligaments, 188
+
+Crural nerve, paralysis of the, 204
+
+Cunean bursa, 237
+
+Cunean tenotomy, 242
+
+Cuneiform magnum, 191
+
+Cuneiform medium, 191
+
+Curb, 233
+
+
+D
+
+Deep digital flexor, distension of the tarsal sheath of, 246
+
+Deep flexor tendon (perforans), 60
+
+Degenerative changes in bones, 16
+
+Diagnosis by exclusion, 53
+
+Diagnosis by use of the X-ray, 179
+
+Diagnostic principles, 37
+
+Disease, navicular, 157
+
+Dislocations, 21
+
+Distension of the tarsal joint capsule, 242
+
+Distension of the tarsal sheath of the deep digital flexor, 246
+
+Division of long digital extensor, 253
+
+Dorsal ligaments, 190
+
+Dropped elbow, 71, 80
+
+Dropped soles, shoe for, 169
+
+Dropped stifle, 205
+
+Dry spavin, 225
+
+
+E
+
+Elbow, dropped, 71, 80
+
+Elbow, inflammation of the, 84
+
+Elbow joint, 58
+
+Elephantiasis, 34
+
+Etiology, general discussion of, 15
+
+Examination by palpation, 43
+
+Examination, special methods of, 53
+
+Examination, visual, 39
+
+Exclusion, diagnosis by, 53
+
+Exostosis of splint bones, 107
+
+Exostosis, phalangeal, 118
+
+Extensor (long digital) rupture and division of, 253
+
+Extensor of the digit, rupture of, 145
+
+Extensor pedis, 60
+
+Extensor pedis, rupture of, 145
+
+Extensor pedis, rupture and division of, 253
+
+
+F
+
+False crepitation, 48
+
+Feet, affection of the, 34
+
+Femoral nerve, paralysis of the, 204
+
+Femeropatella ligaments, 188
+
+Femeropelvic articulation, 185
+
+Femur, 185, 192
+
+Femur, fracture of the, 199
+
+Femur, luxation of the, 201
+
+Fetlock joint, 58
+
+Fetlock joint, arthritis of the, 152
+
+Fetlock joint, luxation of the, 125
+
+Fetlock joint, open, 110
+
+Fetlock region, thecitis and bursitis in, 148
+
+Fetlock, shoe for bracing the, 181
+
+Fibular tarsal bone, fracture of the, 230
+
+Firing, treatment of ringbone by, 123
+
+First phalanx, 59
+
+"Fish knees", 145
+
+Fixed luxations, 21
+
+Fixed patellar disarticulation, 213
+
+Flexor brachii, 58, 68, 69
+
+Flexor carpiradialis, 93
+
+Flexor carpiulnaris, 93
+
+Flexor metacarpi externus, 94
+
+Flexor metacarpi internus, 93
+
+Flexor metacarpi medius, 93
+
+Flexor metatarsi, 193
+
+Flexor, superficial digital, 194
+
+Flexor tendons, contraction of the, 137
+
+Flexor tendons, inflammation of the, 135
+
+Flexor tendons, rupture of, 146
+
+Flexors of phalanges, open sheath of, 124
+
+Foals, contracted tendons of, 143
+
+Forearm, wounds of, 90
+
+Fore leg, lameness in the, 55
+
+Fracture of the carpal bones, 96
+
+Fracture of the femur, 199
+
+Fracture of the fibular tarsal bone, 230
+
+Fracture of first and second phalanges, 131
+
+Fracture of humerus, 82
+
+Fracture of the ilium, 198
+
+Fracture of the ischial tuberosity, 199
+
+Fracture of the metacarpus, 106
+
+Fracture of the patella, 212
+
+Fractures of the pelvic bones, 196
+
+Fracture of the proximal sesamoids, 128
+
+Fracture of the pubis, 197
+
+Fracture of the radius, 87
+
+Fracture of the scapula, 62
+
+Fracture of the tibia, 222
+
+Fracture of the tibial tarsal bone, 230
+
+Fracture of the ulna, 86
+
+Fractures, 16
+
+Fractures, comminuted, 17
+
+Fractures, compound, 17
+
+Fractures, green stick, 18
+
+Fractures, impacted, 19
+
+Fractures, longitudinal, 18
+
+Fractures, multiple, 18
+
+Fractures, multiple longitudinal, 19
+
+Fractures, oblique, 18
+
+Fractures, simple, 17
+
+Fractures, simple transverse, 18
+
+Fractures, transverse, 18
+
+Fragilitas, 199
+
+Fragilitas osseum, 128
+
+
+G
+
+Gait, observing character of, 48
+
+Gastrocnemius, 194
+
+Gluteal tendo-synovitis, 203
+
+Gluteus medius muscle, 192, 203
+
+Gonitis, chronic, 217
+
+Green stick fractures, 18
+
+
+H
+
+Hind leg, lameness in the, 185
+
+Hind leg, paralysis of the, 204
+
+Hip lameness, 195
+
+Hip swinney, 205
+
+Hock, capped, 251
+
+Hock joint, 188
+
+Hoof testers, 53
+
+Humeroradioulnar joint, 58
+
+Humerus, fracture of, 82
+
+
+I
+
+Iliac thrombosis, 209
+
+Iliopsoas, 204
+
+Ilium, fracture of the, 198
+
+Impacted fractures, 19
+
+Infectious arthritis, 66
+
+Infectious bursitis, 28
+
+Infectious inflammation of the lateral cartilage, 173
+
+Infectious lymphangitis, 257
+
+Infectious synovitis, 124
+
+Inflammation of the bicipital bursa, 68
+
+Inflammation of the bursa podotrochlearis, 157
+
+Inflammation of the carpal flexors, 93
+
+Inflammation of the carpus, 98
+
+Inflammation of the elbow, 84
+
+Inflammation of the flexor tendons, 135
+
+Inflammation of posterior ligaments of pastern, 129
+
+Inflammation of proximal sesamoid bones, 127
+
+Inflammation of third sesamoid and deep flexor tendon, 157
+
+Inflammation of the trochanteric bursa, 204
+
+Infraspinatus muscle, 65
+
+Injection of fluids for quittor, 177
+
+Injuries to scapulohumeral joint, 66
+
+Interfering, shoeing for, 256
+
+Interfering, wounds from, 255
+
+Ischial tuberosity, fracture of the, 199
+
+
+J
+
+Joint capsule, anatomy of the, 220
+
+Joint, carpal, 58
+
+Joint, elbow, 58
+
+Joint, fetlock, 58
+
+Joint capsule, tarsal, distension of the, 242
+
+Joint, fetlock, arthritis of the, 152
+
+Joint, fetlock, luxation of, 125
+
+Joint, hock, 188
+
+Joint, humeroradioulnar, 58
+
+Joint, open, 67
+
+Joint, open carpal, 100
+
+Joint, open fetlock, 110
+
+Joint, pastern proximal interphalangeal, 129
+
+Joint, shoulder, 55
+
+Joint, stifle, open, 220
+
+Joint, tarsal, open, 229
+
+
+L
+
+Lameness, hip, 195
+
+Lameness, mixed, 49
+
+Lameness in the fore leg, 55
+
+Lameness in the hind leg, 185
+
+Lameness, shoulder, 61
+
+Lameness, supporting-leg, 49
+
+Lameness, swinging-leg, 49
+
+Laminitis, 160
+
+Laminitis, acute, 162
+
+Laminitis, chronic, 164
+
+Lateral cartilage, infectious inflammation of the, 174
+
+Lateral cartilages, ossification of, 155
+
+Ligaments, affections of, 20
+
+Ligament, capsular, 190
+
+Ligaments, collateral, 190
+
+Ligament, cotyloid, 185
+
+Ligaments, crucial, 188
+
+Ligaments, dorsal, 190
+
+Ligaments, femeropatella, 188
+
+Ligament, medial, 190
+
+Ligaments, mesial tarsal, sprains of the, 232
+
+Ligaments of pastern proximal interphalangeal joint, inflammation of, 129
+
+Ligaments, patellar, 188
+
+Ligaments, plantar, 190
+
+Ligament, pubiofemoral, 185
+
+Ligament, superior check, 58
+
+Ligament, suspensory, rupture of, 146
+
+Ligaments, volar, 129
+
+Ligament, volar-carpal or annular, 58
+
+Ligation of the saphenous vein, 246
+
+Line firing for bog spavin, 246
+
+Longitudinal fractures, 18
+
+Lumbosacral plexus, 204
+
+Luxation of the carpal bones, 96
+
+Luxation of the femur, 201
+
+Luxation of fetlock joint, 125
+
+Luxation of the patella, 213
+
+Luxation of the patella, outward, 215
+
+Luxation of the patella, upward, 214
+
+Luxation of scapulohumeral joint, 67
+
+Luxations, 21
+
+Luxations, fixed, 21
+
+Luxations, temporary, 21
+
+Lymph vessels and glands, affections of, 32
+
+Lymphangitis, 32
+
+Lymphangitis, infectious, 257
+
+Lymphangitis, non-infectious, 260
+
+
+M
+
+Medial ligament, 190
+
+Median neurectomy, 124
+
+Mesial tarsal ligaments, sprains of the, 232
+
+Metacarpophalangeal articulation, 58
+
+Metacarpus, fracture of the, 106
+
+Metastatic arthritis, 25
+
+Mixed lameness, 49
+
+Momentary patellar disarticulation, 213
+
+Movements, passive, 47
+
+Multiple fractures, 18
+
+Multiple longitudinal fractures, 19
+
+Muscles, affections of, 28
+
+Muscle, antea-spinatus, 65
+
+Muscle, anterior digital extensor, 193
+
+Muscle, biceps brachii, 58
+
+Muscle, caput, 71
+
+Muscle, gluteus medium, 192, 203
+
+Muscle, infraspinatus, 65
+
+Muscle, peroneus tertius, 193
+
+Muscle, postea-spinatus, 65
+
+Muscles, quadriceps, 193
+
+Muscles, quadriceps, atrophy of the, 205
+
+Muscle, subscapularis, 65
+
+Muscle, supraspinatus, 65
+
+Muscle, tibialis anticus, 193
+
+Muscle, triceps brachii, 58
+
+Myalgia, 195
+
+
+N
+
+Nail punctures, 178
+
+Navicular disease, 157
+
+Nerves, affections of, 30
+
+Nerve, femoral, paralysis of the, 204
+
+Nerve, obturator, paralysis of the, 206
+
+Nerve, sciatic, paralysis of the, 208
+
+Nerve, (suprascapular) paralysis of the, 75
+
+Non-infectious lymphangitis, 260
+
+Non-infectious bursitis, 28
+
+Neurectomy, Bossi's double tarsal, 242
+
+Neurectomy, median, 124
+
+Neurectomy, plantar, 124
+
+
+O
+
+Oblique fractures, 18
+
+Observing character of gait, 48
+
+Obturator nerve, paralysis of the, 206
+
+Occurrence, general discussion of, 15
+
+Omphalophlebitis, 25
+
+Open carpal joint, 100
+
+Open fetlock joint, 110
+
+Open joint, 67
+
+Open sheath of flexors of phalanges, 124
+
+Open stifle joint, 220
+
+Open tarsal joint, 229
+
+Os corona, 60
+
+Ossification of cartilages of the third phalanx, 155
+
+Ossification of the lateral cartilages, 155
+
+Os innominatum, 196
+
+Os suffraginis, 59
+
+Osteitis, rarefying, 16
+
+Outward luxation of the patella, 215
+
+
+P
+
+Palpation, examination by, 43
+
+Paralysis, brachial, 77
+
+Paralysis of the femoral nerve, 204
+
+Paralysis of the hind leg, 204
+
+Paralysis of the obturator nerve, 206
+
+Paralysis of the sciatic nerve, 208
+
+Paralysis of the suprascapular nerve, 75
+
+Paralysis, radial, 77
+
+Paronychia, 170
+
+Passive movements, 47
+
+Pastern proximal interphalangeal joint, inflammation of ligaments of, 129
+
+Patella, 188
+
+Patella, fracture of the, 212
+
+Patella, luxation of the, 213
+
+Patella, outward luxation of the, 215
+
+Patella, upward luxation of the, 214
+
+Patellar disarticulation, fixed, 213
+
+Patellar disarticulation, momentary, 213
+
+Patellar ligaments, 188
+
+Pelvic bones, fractures of the, 196
+
+Pelvic limbs, anatomo-physiological consideration of the, 185
+
+Penetrative wounds, 85
+
+Periarticular ringbone, 122
+
+Peroneus tertius muscle, 193
+
+Phalangeal exostosis, 118
+
+Phalanges, fracture of first and second, 131
+
+Phalanges, open sheath of flexors of, 124
+
+Phalanx, first, 59
+
+Phalanx, second, 60
+
+Phalanx, third, ossification of cartilages of, 155
+
+Plantar ligaments, 190
+
+Plantar neurectomy, 124
+
+Polyarthritis, 25
+
+Postea-spinatus muscle, 65
+
+Principles, diagnostic, 37
+
+Proximal sesamoid bones, inflammation of, 127
+
+Proximal sesamoids, fracture of, 128
+
+Pubiofemoral ligament, 185
+
+Pubis, fracture of the, 197
+
+Punctures, nail, 178
+
+
+Q
+
+Quadriceps muscles, 193
+
+Quadriceps muscles, atrophy of the, 205
+
+Quittor, 174
+
+Quittor, injection of fluids for, 177
+
+
+R
+
+Rachitic ringbone, 122
+
+Radial paralysis, 77
+
+Radius, fracture of the, 87
+
+Rarefying osteitis, 16
+
+Rheumatic arthritis, 26
+
+Rheumatism, 196
+
+Ringbone, 118
+
+Ringbone, articular, 121
+
+Ringbone, periarticular, 122
+
+Ringbone, rachitic, 122
+
+Ringbone, traumatic, 122
+
+Ringbone treated by firing, 123
+
+Roberts shoe for bracing the fetlock, 181
+
+Rupture of the extensor pedis, 145
+
+Rupture of flexor tendons and suspensory ligament, 146
+
+Rupture of long digital extensor, 253
+
+Rupture of the tendo archillis, 224
+
+
+S
+
+Saphenous vein, ligation of the, 246
+
+Scapula, fracture of the, 62
+
+Scapulohumeral articulation, 55
+
+Scapulohumeral joint, injuries to, 66
+
+Scapulohumeral joint, luxation of, 67
+
+Scapulohumeral joint, wounds of, 67
+
+Scapulohumeral arthritis, 65
+
+Sciatica, 208
+
+Sciatic nerve, paralysis of the, 208
+
+Second phalanx, 60
+
+Sesamoid bones, 59
+
+Sesamoid, third, inflammation of the, 157
+
+Sesamoids, proximal, fracture of, 128
+
+Sesamoiditis, 127
+
+Setons, 75
+
+Sheath of flexors of phalanges, open, 124
+
+Sheath (tarsal) of the deep digital flexor, distension of the, 246
+
+Shoe for dropped soles, 169
+
+Shoeing for interfering, 256
+
+Shoulder atrophy, 73
+
+Shoulder joint, 55
+
+Shoulder lameness, 61
+
+Simple fractures, 17
+
+Simple transverse fractures, 18
+
+Soles, dropped, shoe for, 169
+
+Spavin, bog, 242
+
+Spavin, bone, 235
+
+Spavin, dry, 225
+
+Spavin test, 239
+
+Special methods of examination, 53
+
+Sprains of the mesial tarsal ligaments, 232
+
+Sprains, tarsal, 232
+
+Splints, 107
+
+Spring-halt, 225
+
+Stifle, dropped, 205
+
+Stifle joint, open, 220
+
+Strangles, 25
+
+Streptococcus equi, 25
+
+String-halt, 225
+
+Subject, attitude of the, 41
+
+Subscapularis muscle, 65
+
+Supporting-leg-lameness, 49
+
+Suprascapular nerve, paralysis of the, 75
+
+Supraspinatus muscle, 65
+
+Superficial digital flexor, 194
+
+Superior check ligament, 58
+
+Suspensory ligament, rupture of, 146
+
+Sweeny, 73
+
+Swinging-leg-lameness, 49
+
+Swinney, 73
+
+Swinney, hip, 205
+
+Synovial distension of tendon sheaths, 104
+
+Synovitis, 25
+
+Synovitis, infectious, 124
+
+
+T
+
+Tarsal arthritis, 225
+
+Tarsal bones, 190
+
+Tarsal joint capsule, distension of the, 242
+
+Tarsal joint, open, 229
+
+Tarsal sheath of the deep digital flexor, distension of the, 246
+
+Tarsal sprains, 232
+
+Tarsus, 192
+
+Temporary luxations, 21
+
+Tendinitis, 135
+
+Tendinitis, acute, 135
+
+Tendinitis, chronic, 137
+
+Tendo achillis, rupture and wounds of the, 224
+
+Tendon, deep flexor, inflammation of the, 157
+
+Tendon, deep flexor (perforans), 60
+
+Tendon, extensor, rupture of, 145
+
+Tendon, flexor, rupture of, 146
+
+Tendons of foals, contracted, 143
+
+Tendon sheaths, synovial distension of, 104
+
+Tendons, affections of, 28
+
+Tendons, flexor, contraction of the, 137
+
+Tendons, flexor, inflammation of the, 135
+
+Tendo-synovitis, gluteal, 203
+
+Tenotomy, cunean, 242
+
+Tensor fascia lata, 192
+
+Test, spavin, 239
+
+Testers, hoof, 53
+
+Thecae, affections of, 27
+
+Thecitis, 27, 104
+
+Thecitis in the fetlock region, 150
+
+Thoroughpin, 246
+
+Thoroughpin, aspiration-and-injection treatment of, 250
+
+Thrombosis, iliac, 209
+
+Thrombosis of the brachial artery, 81
+
+Tibia, 188
+
+Tibia, fracture of the, 222
+
+Tibial tarsal bone, fracture of the, 230
+
+Tibialis anticus muscle, 193
+
+Tibioastragular joint, distension of the, 242
+
+Transverse fractures, 18
+
+Traumatic arthritis, 22
+
+Traumatic ringbone, 122
+
+Treatment of bog spavin by aspiration and injection, 244
+
+Treatment of capped hock by aspiration and injection, 252
+
+Treatment of ringbone by firing, 123
+
+Treatment of thoroughpin by aspiration and injection, 250
+
+Triceps brachii, 58
+
+Triceps brachii, contusions of, 71
+
+Triceps extensor brachii, 71
+
+Trochanteric bursa, inflammation of the, 204
+
+True crepitation, 47
+
+
+U
+
+Ulna, fracture of the, 86
+
+Ulnaris lateralis, 94
+
+Upward luxation of the patella, 214
+
+
+V
+
+Vein, saphenous, ligation of the, 246
+
+Vesication for bog spavin, 246
+
+Vessignon cheville, 246
+
+Visual examination, 39
+
+Volar-carpal ligament, 58
+
+Volar ligaments, 129
+
+
+W
+
+Wounds, calk, 170
+
+Wounds, contusive, 85
+
+Wounds from interfering, 255
+
+Wounds of anterior brachial region, 90
+
+Wounds of coronary region, 170
+
+Wounds of scapulohumeral joint, 67
+
+Wounds of tendo achillis, 224
+
+Wounds, penetrative, 85
+
+
+X
+
+X-ray diagnosis, 179
+
+
+
+
+
+AUTHORITIES CITED
+
+
+Almy, J., 141, 200, 202, 208, 212, 216, 214, 233
+
+Bassi, 215
+Bauman, S.H., 197
+Bell, Roscoe R., 69
+Benard, 216
+Berns, Geo. H., 77, 218
+Bouley, 225
+Bourdelle, 147
+
+Cadiot, P.J., 78, 141, 200, 202, 208, 212, 214, 216, 223, 225, 233, 245,
+    250
+Campbell, D.M., 162, 166, 167
+Castagne, 84
+Cochran, David W., 169, 170
+
+Diekerhoff, 237
+Dollar, Jno. A.W., 68, 198
+
+Eberlein, 237
+
+Fisher, Carl W., 236
+Frost, J.N., 113
+Frost, R.F., 128
+
+Greaves, Thomas, 157
+
+Hoare, E. Wallis, 25, 211, 230
+Hughes, Joseph, 176, 221
+Hutyra and Marek, 205
+
+Law, James, 33
+Leblanc, 223
+Liautard, A., 84, 199, 238
+Lusk, Wm. V., 203
+
+McDonough, James, 237
+Merillat, Edward, 210
+Merillat, L.A., 80, 96, 175, 210
+Millar, Thomas, 145
+Moeller, H., 119, 156, 211, 222
+Montane, 147
+Moore, R.C., 162
+
+Roberts, G.H., 181
+
+Schumacher, 215
+Scott, John, 208
+Seeley, J.T., 176
+Sisson, Septimus, 129, 204, 220
+Smith, F., Major General, 56, 60, 155, 188, 194
+Strangeways, 193
+
+Taylor, Henry, 71
+Thompson, H., 83, 87
+Trickett, A., 253
+
+Udall, D.H., 236
+Uhlrich, 224
+
+Walters, Wilfred, 83, 97
+Williams, W.L., 217, 236
+
+
+Transcriber's notes:
+
+   Accented words: The following spelling differences have been
+   maintained:
+
+      Moller / Moeller
+      Montane / Montane
+      Traite / Traite.
+
+   Hyphenation: The following hyphenation differences have been
+   maintained:
+
+      bilateral / bi-lateral
+      calcaneocuboid / calcaneo-cuboid
+      calcaneometatarsal / calcaneo-metatarsal
+      counterirritation / counter-irritation
+      counterirritating / counter-irritating
+      foreleg / fore-leg
+      interphalangeal / inter-phalangeal
+      noninfectious / non-infectious
+      nonsensitive / non-sensitive
+      overwork / over-work
+      posteaspinatus / postea-spinatus
+      ringbone / ring-bone
+      subacute / sub-acute
+      subcoronary / sub-coronary
+      subfascial / sub-fascial
+      subperiosteal / sub-periosteal
+
+   Typographical errors:
+
+      sub-facial         for  sub-fascial
+      "At two-year-old"  for  "A two-year-old"
+      Ameircan           for  American
+      Symtomatology      for  Symptomatology
+      extoses            for  exostoses
+      admintered         for  administered
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK LAMENESS OF THE HORSE***
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