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.]