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diff --git a/16370-8.txt b/16370-8.txt new file mode 100644 index 0000000..077ded3 --- /dev/null +++ b/16370-8.txt @@ -0,0 +1,10605 @@ +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*** + + +******* This file should be named 16370-8.txt or 16370-8.zip ******* + + +This and all associated files of various formats will be found in: +https://www.gutenberg.org/dirs/1/6/3/7/16370 + + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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