peculiar oil bags in the joints, and in some regions of the legs where
the passage of the tendons takes place, and have noticed the similarity
of structure and function of both the articular and the tendinous bursae,
as well as the etiology of their injuries and their pathological
history, and we will now treat of the affections of both.
WINDGALLS.
This name is given to the dilated bursae found at the posterior part of
the fetlock joint. They have their origin in a dropsical condition of
the bursae of the joint itself, also of the tendon which slides behind
it, and are therefore further known by the designations of articular and
tendinous windgalls, or puffs. (See also p. 401.)
They appear in the form of soft and somewhat symmetrical tumors, of
varying dimensions, and generally well defined in their circumference.
They are more or less tense, according to the quantity of secretion they
contain, apparently becoming softer as the foot is raised and the
fetlock flexed. Usually they are painless and only cause lameness under
certain conditions, as when they begin to develop themselves under the
stimulus of inflammatory action, or when large enough to interfere with
the functions of the tendons, or again when they have undergone certain
pathological changes, such as calcification, which is among their
tendencies.
_Cause._--Windgalls may be attributed to external causes, such as severe
labor or strains resulting from heavy pulling, fast driving, or jumping,
or they may be among the sequelae of internal disorders, such as
strangles or the resultants of a pleuritic or pneumonic attack.
Unnecessary anxiety is sometimes experienced respecting these growths,
with much questioning touching the expediency of their removal, all of
which might be spared, for, while they constitute a blemish, their
unsightliness will not hinder the usefulness of the animal, and in any
case they rarely fail to show themselves easily amenable to treatment.
_Treatment._--When in their acute stage, and when the dropsical
condition is not excessive, the inflammation may be checked during the
day by continuous, cold-water irrigation by means of a hose or soaking
tub and at night by applying a moderately tight-roller bandage. Later
absorption may be promoted by a Priessnitz bandage,[2] pressure by
roller bandages, sweating, the use of liniments, or if necessary by a
sharp blister of biniodid of mercury. This treatment should subdue the
inflammation, abate the soreness, absorb the excess of secretion,
strengthen the walls of the sac, and finally cause the windgalls to
disappear, provided the animal is not too quickly returned to labor and
exposed to the same factors that occasioned them at first.
If the inflammation has become chronic, however, and the enlargement has
been of considerable duration, the negative course will be the wiser
one. If any benefit results from treatment it will be of only a
transient kind, the dilatation returning when the patient is again
subjected to labor, and it will be a fortunate circumstance if
inflammation has not supervened.
Notwithstanding the generally benignant nature of the swelling there are
exceptional cases, usually when it is probably undergoing certain
pathological changes, which may result in lameness and disable the
animal, in which case surgical treatment will be indicated, especially
if repeated blisters have failed to improve the symptoms. Line firing is
then a preeminent suggestion, and many a useful life has received a new
lease as the result of this operation timely performed. Another method
of firing, which consists in emptying the sac by means of punctures
through and through, made with a red-hot needle or wire, and the
subsequent injection of certain irritating and alterative compounds into
the cavity, designed to effect its closure by exciting adhesive
inflammation, such as tincture of iodin, may be commended. But they are
all too active and energetic in their effects and require too much
special attention and intelligent management to be trusted to any hands
other than those of an expert veterinarian.
BLOOD SPAVIN, BOG SPAVIN, AND THOROUGHPIN.
The blood spavin is situated in front and to the inside of the hock and
is merely a varicose or dilated condition of the saphena vein. It occurs
directly over the point where the bog spavin is found, and has thus been
frequently confused with the latter.
The complicated arrangement of the hock joint, and the powerful tendons
which pass on the posterior part, are lubricated with the product of
secretion from one tendinous synovial and several articular synovial
sacs. A large articular sac contributes to the lubrication of the shank
bone (the tibia) and one of the bones of the hock (the astragalus). The
tendinous sac lies back of the articulation itself and extends upward
and downward in the groove of that joint through which the flexor
tendons slide. The dilatation of this articular synovial sac is what is
denominated bog spavin, the term thoroughpin being applied to the
dilatation of the tendinous capsule.
The bog spavin is a round, smooth, well-defined, fluctuating tumor
situated in front and a little inward of the hock. On pressure it
disappears at this point to reappear on the outside and just behind the
hock. If pressed to the front from the outside it will then appear on
the inside of the hock. On its outer surface it presents a vein which is
quite prominent, running from below upward, and it is to the
preternatural dilatation of this blood vessel that the term blood spavin
is applied.
The thoroughpin is found at the back and on the top of the hock in that
part known as the "hollows," immediately behind the shank bone. It is
round and smooth, but not so regularly formed as the bog spavin, and is
most apparent when viewed from behind. The swelling is usually on both
sides and a little in front of the so-called hamstring, but may be more
noticeable on the inside or on the outside.
In their general characteristics bog spavins and thoroughpins are
similar to windgalls, and one description of the origin, symptoms,
pathological changes, and treatment will serve for all equally, except
that it is possible for a bog spavin to cause lameness, and thus to
involve a verdict of unsoundness in the patient, a circumstance which
will, of course, justify its classification by itself as a severer form
of a single type of disease.
We have already referred to the subject of treatment and the means
employed--rest, of course--with liniments, blisters, etc., and what we
esteem as the most active and beneficial of any, early, deep, and
well-performed cauterization. There are, besides, commendatory reports
of a form of treatment by the application of pressure pads and peculiar
bandages upon the hocks, and it is asserted that the removal of the
tumors has been effected by their use. Our experience with this
apparatus, however, has not been accompanied with such favorable results
as would justify our indorsement of the flattering representations which
have sometimes appeared in its behalf.
OPEN JOINTS, BROKEN KNEES, SYNOVITIS, AND ARTHRITIS.
The close relationship which exists among these several affections,
their apparently possible connection as successive developments of a
similar, if not an essentially identical, origin, together with the
advantage gained by avoiding frequent repetitions in the details of
symptoms, treatment, etc., are our reasons for treating under a single
head the ailments we have grouped together in the present section.
_Cause._--The great, comprehensive, common cause of, sometimes
permanent, sometimes only transient, disability of the horse is external
traumatism.
Blows, bruises, hurts by nearly every known form of violence, falls,
kicks, lacerations, punctures--we may add compulsory speed in racing and
cruel overloading of draft animals--cover the entire ground of causation
of the diseases and injuries of the joints now receiving our
consideration.
In one case, a working horse making a misstep stumbles, and falling on
his knees receives a hurt, variously severe, from a mere abrasion of the
skin to a laceration, a division of the tegument, a slough,
mortification, and the escape of the synovial fluid, with or without
exposure of the bones and their articular cartilages.
In another case, an animal, from one cause or another, perhaps an
impatient temper, has formed the habit of striking or pawing his manger
with his fore feet until inflammation of the knee joint is induced,
first as a little swelling, diffused, painless; then as a periostitis of
the bones of the knee; later as bony deposits, then lameness, and
finally the implication of the joint, with all the various sequelae of
chronic inflammation of the knee joint.
In another case, a horse has received a blow with a fork from a careless
hostler on or near a joint, or has been kicked by a stable companion,
with the result of a punctured wound, at first mild-looking, painless,
apparently without inflammation, and not yet causing lameness, but
which, in a few hours, or it may be only after a few days, becomes
excessively painful, grows worse, the entire joint swells, presently
discharges, and at last a case of suppurative synovitis is presented,
with perhaps disease of the joint proper, and arthritis as a climax. The
symptoms of articular injuries vary not only in the degrees of the hurt
but in the nature of the lesion.
Or the condition of broken knees, resulting as we have said, may have
for its starting point a mere abrasion of the skin--a scratch,
apparently, which disappears without a scar. The injury may, however,
have been more severe, the blow heavier, the fall aggravated by
occurring upon an irregular surface, or sharp or rough object, with
tearing or cutting of the skin, and this laceration may remain. A more
serious case than the first is now brought to our notice.
Another time, immediately following the accident, or possibly as a
sequel of the traumatism, the tendinous sacs may be opened, with the
escape of the synovia, or, worse, the tendons which pass in front of the
knee are torn, the inflammation spreads, the joint and leg are swollen,
the animal is becoming very lame; synovitis has set in. With this the
danger becomes very great, for soon suppuration will be established,
then the external coat of the articulation proper becomes ulcerated, if
it is not already in that state, and we find ourselves in the presence
of an open joint with suppurative synovitis--that is, with the worst
among the conditions of diseased processes, because of the liability of
the suppuration to become infiltrated into every part of the joint,
macerating the ligaments and irritating the cartilages, soon to be
succeeded by their ulceration, with the destruction of the articular
surface--or the lesion of ulcerative arthritis, one of the gravest among
all the disorders known to the animal economy.
Ulcerative arthritis and suppurative synovitis may be developed
otherwise than in connection with open joints; the simplest and
apparently most harmless punctures may prove to be sufficient cause. For
example, a horse may be kicked, perhaps, on the inside of the hock;
there is a mark and a few drops of blood to indicate the spot; he is put
to work apparently free from pain or lameness and performs his task with
his usual ease and facility. On the following morning, however, the hock
is found to be a little swollen and there is some stiffness. A little
later on he betrays a degree of uneasiness in the leg, and shrinks from
resting his weight upon it, moving it up and down for relief. The
swelling has increased and is increasing; the pain is severe; and
finally, at the spot where the kick inpinged, there is an oozing of an
oily liquid mixed with whitish drops of suppuration. The mischief is
done; a simple, harmless, punctured wound has expanded into a case of
ulcerative arthritis and suppurative synovitis.
_Prognosis._--From ever so brief and succinct description of this
traumatism of the articulations, the serious and important character of
these lesions, irrespective of which particular joint is affected, will
be readily understood. Yet there will be modifications in the prognosis
in different cases, in accordance with the peculiarities of structure in
the joint specially involved, as, for example, it is obvious that a
better result may be expected from treatment when but a single joint,
with only its plain articular surfaces, is the place of injury, than in
one which is composed of several bones, united in a complex formation,
as in the knee or hock. As severe a lesion as suppurative synovitis
always is, and as frequently fatal as it proves to be, still cases arise
in which, the inflammation assuming a modified character and at length
subsiding, the lesion terminates favorably and leaves the animal with a
comparatively sound and useful joint. There are cases, however, which
terminate in no more favorable a result than the union of the bones and
occlusion of the joint, to form an anchylosis, which is scarcely a
condition to justify a high degree of satisfaction, as it insures a
permanent lameness with very little capacity for usefulness.
Appreciating now the dangers associated with all wounds of
articulations, however simple and apparently slight, and how serious and
troublesome are the complications which are liable to arise during their
progress and treatment, we are prepared to understand and realize the
necessity and the value of early and prompt attention upon their
discovery and diagnosis.
_Treatment._--For simple bruises, like those which appear in the form of
broken knees or of carpitis, simple remedies, such as warm fomentations
or cold-water applications and compresses of astringent mixtures,
suggest themselves at once. Injuries of a more complicated character, as
lacerations of the skin or tearing of soft structures, will also be
benefited by simple dressings with antiseptic mixtures, as those of the
carbolic-acid order. The escape of synovia should suggest the prompt use
of collodion dressings to check the flow and prevent the further escape
of the fluid. But if the discharge is abundant and heavily suppurative,
little can be done more than to put in practice the "expectant" method
with warm fomentations, repeatedly applied, and soothing, mucilaginous
poultices. Improvement, if any is possible, will be but slow to manifest
itself. The most difficult of all things to do, in view of varying
interests and opinions--that is, in a practical sense--is to abstain
from "doing" entirely, and yet in the cases we are considering we are
firmly convinced that noninterference is the best and wisest policy.
In cases which are carried to a successful result the discharge will
diminish by degrees, the extreme pain will gradually subside, the
convalescent will begin timidly to rest his foot upon the ground, and
presently to bear weight upon it, and perhaps, after a long and tedious
process of recuperation, he may be returned to his former and normal
condition of usefulness. When the discharge has wholly ceased and the
wounds are entirely healed, a blister covering the whole of the joint
for the purpose of stimulating the absorption of the exudation will be
of great service. If, on the contrary, there is no amelioration of
symptoms and the progress of the disease resists every attempt to check
it; if the discharge continues to flow not only without abatement but in
an increased volume, and not alone by a single opening but by a number
of fistulous tracts which have successively formed; if it seems evident
that this drainage is rapidly and painfully sapping the suffering
animal's vitality, and a deficient _vis vitae_ fails to cooperate with
the means of cure--all rational hope of recovery may be finally
abandoned. Any further waiting for chances, or time lost in
experimenting, will be mere cruelty and there need be no hesitation
concerning the next step. The poor beast is under sentence of death, and
every consideration of interest and of humanity demands an anticipation
of nature's evident intent in the quick and easy execution of the
sentence.
[Illustration: PLATE XXX.
DISLOCATION OF SHOULDER AND ELBOW
Bourgelat's apparatus]
[Illustration: PLATE XXXI.
THE SLING IN USE]
One of the essentials of treatment, and probably an indispensable
condition when recovery is in any wise attainable, is the suspension of
the patient in slings. He should be continued in them so long as he can
be made to submit quietly to their restraint.
DISLOCATIONS.
Dislocations and luxations are interchangeable terms, meaning the
separation and displacement of the articulating surfaces of the bones
entering into the formation of a joint. This injury is rarely
encountered in our large animals on account of the combination of
strength and solidity in the formation of their joints. It is met with
but seldom in cattle and less so in horses, while dogs and smaller
animals are more often the sufferers.
_Cause._--The accident of a luxation is less often encountered in the
animal races than in man. This is not because the former are less
subject to occasional violence involving powerful muscular contractions,
or are less often exposed to casualties similar to those which result
in luxations in the human skeleton, but because it requires the
cooperation of conditions--anatomical, physiological, and perhaps
mechanical--present in the human race and lacking in the others, which,
however, can not in every case be clearly defined. Perhaps the greater
relative length of the bony levers in the human formation may constitute
a cause of the difference.
Among the predisposing causes in animals may be enumerated caries of
articular surfaces, articular abscesses, excessive dropsical conditions,
degenerative softening of the ligaments, and any excessive laxity of the
soft structures.
_Symptoms and diagnosis._--Three signs of dislocation must usually be
taken into consideration. They are: (1) An alteration in the shape of
the joint and in the normal relationship of the articulating surfaces;
(2) an alteration in the length of the limb, either shortening or
lengthening; (3) an alteration in the movableness of the joint, usually
an unnatural immobility. Only the first, however, can be relied upon as
essential. Luxations are not always complete; they may be partial; that
is, the articulating surfaces may be displaced but not separated. In
such cases several symptoms may not be present. And not only may the
third sign be absent, but the mobility of the first be greatly increased
when the character of the injury has been such as to produce extensive
lacerations of the articular ligaments.
In addition to the above signs, a luxation is usually characterized by
pain, swelling, hemorrhage beneath the skin from damaged or ruptured
blood vessels, and even paralysis, when important nerves are pressed on
by the displaced bones.
Sometimes a bone is fractured in the immediate vicinity of a joint. The
knowledge of this fact requires us to be able to diagnose between a
dislocation and such a fracture. In this we generally have three points
to assist us: (1) The immobility of a dislocated joint as against the
apparently remarkable freedom of movement in fracture; (2) in a
dislocation there is no true crepitus--that peculiar grating sensation
heard as well as felt on rubbing together the rough ends of fractured
bones; however, it must be remembered that in a dislocation two or three
days old the inflammatory changes around the joint may give rise to a
crackling sensation similar to that in fracture; (3) as a rule, in
luxations, if the ligamentous and muscular tissues about the joint are
not badly torn, the displacement, when reduced, does not recur.
_Prognosis._--The prognosis of a luxation is comparatively less serious
than that of a fracture, though at time the indications of treatment may
prove to be so difficult to apply that complications of a very severe
character may arise.
_Treatment._--The treatment of luxations must, of course, be similar to
that of fractures. Reduction, naturally, will be the first indication in
both cases, and the retention of the replaced parts must follow. The
reduction involves the same steps of extension and counter extension,
performed in the same manner, with the patient subdued by anesthetics.
The difference between the reduction of a dislocation and that of a
fracture consists in the fact that in the former the object is simply to
restore the bones to their true, normal position, with each articular
surface in exact contact with its companion surface, the apparatus
necessary afterwards to keep them in situ being similar to that which is
employed in fracture cases, and which will usually require to be
retained for a period of from 40 to 50 days, if not longer, before the
ruptured retaining ligaments are sufficiently firm to be trusted to
perform their office unassisted. A variety of manipulations are to be
used by the surgeon, consisting in pushing, pulling, pressing, rotating,
and, indeed, whatever movement may be necessary, until the bones are
forced into such relative positions that the muscular contraction,
operating in just the right directions, pulls the opposite matched ends
together in true coaptation--a head into a cavity, an articular eminence
into a trochlea, as the case may be. The "setting" is accompanied with a
peculiar, snapping sound, audible and significant, as well as a visible
return of the surface to its normal symmetry.
_Special dislocations._--While all the articulations of the body are
liable to this form of injury, there are three in the large animals
which may claim a special consideration, viz:
THE SHOULDER JOINT.
We mention this displacement without intending to imply the
practicability of any ordinary attempt at treatment, which is usually
unsuccessful, the animal whose mishap it has been to become a victim to
it being disabled for life. The superior head of the arm bone as it is
received into the lower cavity of the shoulder blade is so situated as
to be liable to be forced out of place in four directions. It may escape
from its socket, according to the manner in which the violence affects
it--outward, inward, backward, or forward--and the deformity which
results and the effects which follow will correspondingly differ. We
have said that treatment is generally unsuccessful. It may be added that
the difficulties which interpose in the way of reduction are nearly
insurmountable, and that the application of means for the retention of
the parts after reduction would be next to impossible. The prognosis,
from any point of view, is sufficiently grave for the luckless animal
with a dislocated shoulder.
THE HIP JOINT.
This joint partakes very much of the characteristics of the
humero-scapular articulation, but is more strongly built. The head of
the thigh bone is more separated, or prominent and rounder in form, and
the cup-like cavity, or socket, into which it fits is much deeper,
forming together a deep, true ball-and-socket joint, which is, moreover,
reenforced by two strong cords of funicular ligaments, which unite them.
It will be easily comprehended, from this hint of the anatomy of the
region, that a luxation of the hip joint must be an accident of
comparatively rare occurrence; yet cases are recorded in which the head
of the bone has been affirmed to slip out of its cavity and assume
various positions--inward, outward, forward, or backward.
The indications of treatment are those of all cases of dislocation. When
the reduction is accomplished the surgeon will be apprised of the fact
by the peculiar, snapping sound usually heard on such occasions.
PSEUDO-LUXATIONS OF THE PATELLA.