removed. During the first three days cold in the form of immersion or
continuous irrigation is indicated. Then warm moisture and continuous
pressure are advised. The latter is best applied by placing two padded
splints about the thickness of the thumb along the two sides of the
tendon and binding them in place with even pressure by bandage. Frequent
bathing with warm soap suds is also beneficial. The absorption of the
exudate may be promoted and the work of restoration effected by
frictions with alcohol, tincture of soap, spirits of camphor, mild
liniments, strong, sweating liniments, and blisters. An excellent
ointment to apply with massage consists of equal parts of blue ointment
and green soap, with double the quantity of vaseline. The action of
blisters in these cases depends chiefly upon the massage used in
applying them and upon the continuous pressure of the swollen skin on
the inflamed tendons. In old cases more beneficial results will follow
line firing. In these cases shoeing is very important. Leave the
quarters long, shorten the toe, give the shoe rolling motion, and either
put short heel calks on the branches or thicken the branches. Although
this line of treatment is efficacious in many cases, there are others in
which the thickening of the tendons refuses to yield and the changed
tissues remain firmly organized, leaving them in the form of a thick
mass resting upon the back part of the cannon bone.
KNUCKLING OF FETLOCK.
As a consequence of the last-mentioned lesion of the tendons, a new
condition presents itself in the articular disposition, constituting the
deformity known as the knuckling fetlock. (See also p. 400.)
By this is meant a deformity of the fetlock joint by which the natural
angle is changed from that which pertains to the healthy articulation.
The first pastern, or suffraginis, loses its oblique direction and
assumes another, which varies from the upright to the oblique, from
before backward, and from above downward; in other words, forming an
angle with its apex in front.
_Causes._--This condition, as we have seen, may be the result of chronic
disease producing structural changes in the tendons, and it may also
occur as the result of other affections or some peculiarity independent
of this and situated below the fetlock, such as ringbones, sidebones, or
traumatic disease of the foot proper. Animals are sometimes predisposed
to knuckling, such, for example, as are naturally straight in their
pasterns, or animals which are compelled to labor when too young. The
hind legs are more predisposed than the fore to this deformity, in
consequence of the greater amount of labor they are required to perform
as the propelling levers of the body.
_Symptoms._--The symptoms of knuckling are easily recognized. The
changes in the direction of the bones vary more or less with the degree
of the lesion, sometimes assuming such a direction that it almost
becomes a true dislocation of the pastern.
The effect of knuckling upon the gait also varies according to the
degree of the deformity. As the different degrees of the shortening of
the leg affect the motion of the fetlock, the lameness may be very
slight or quite extreme. Another consequence of this shortening is such
a change in the position of the foot that the heels cease to come in
contact with the ground and assume a greater elevation, and the final
result of this is soon witnessed in the development of a clubfoot.
_Treatment._--To whatever cause the knuckling may be ascribed, it is
always a severe infirmity, and there is but little room for hoping to
overcome it unless it be during the very first stages of the trouble,
and the hope dwindles to still smaller dimensions when it is secondary
to other diseases below the fetlock. If it is caused by overworking the
animal, the first indication, of course, will be rest. Line firing has
proved very efficacious in these cases. The animal must be turned loose
and left unemployed. Careful attention should be given to the condition
of his feet and to the manner of shoeing, while time is allowed for the
tendons to become restored to their normal state and the irritation
caused by excessive stretching has subsided. A shoe with a thick heel
will contribute to this. If no improvement can be obtained, however, and
the tendons though retracted have yet been relieved of much of their
thickening, the case is not a desperate one, and may yet be benefited by
the operation of tenotomy, single or double--an operative expedient
which must be committed to the experienced surgeon for its performance.
SPRUNG KNEES.
Though not positively the result of diseases of the tendons acting upon
the knees, we venture to consider this deformity in connection with that
which we have just described. It consists in such an alteration in the
direction and articulation of the bones which form the various carpal
joints that instead of forming a vertical line from the lower end of the
forearm to the cannon bone they are so united that the knee is more or
less bent forward, presenting a condition caused by the retraction of
two of the principal muscles by which the cannon bone is flexed.
_Cause._--This flexion of the knee may be a congenital deformity and
have continued from the foaling of the animal; or, like clubfoot, it may
be the result of heavy labor which the animal has been compelled to
perform when too young. It may also be due to other diseases existing in
parts below the knee joint.
_Symptoms._--This change of direction largely influences the movement of
the animal by detracting from its firmness and practically weakening the
entire frame, even to the extent of rendering him insecure on his feet
and liable to fall. This condition of weakness is sometimes so
pronounced that he is exposed to fall even when standing at rest and
unmolested, the knees being unable even to bear their portion of the
mere weight of the frame. This results in another trouble--that of being
unable to keep permanently upright. He is liable to fall on his knees,
and by this act becomes presently a sufferer from the lesion known by
the term of "broken knees."
_Treatment._--Whatever may be the originating cause of this
imperfection, it detracts very largely from the usefulness and value of
a horse, disqualifying him for ordinary labor and wholly unfitting him
for service under the saddle without jeopardizing the safety of his
rider. If, however, the trouble is known from the start, and is not the
result of congenital deformity or weakness of the knee joint, or
secondary to other diseases, rest, with fortifying frictions, may
sometimes aid in strengthening the joints; and the application of
blisters on the posterior part of the knee, from a short distance above
to a point a little below the joint, may be followed by some
satisfactory results; but with this trouble, as with knuckling fetlocks,
the danger of relapse must be kept in mind as a contingency always
liable to occur.
CURB.
This lesion is the bulging backward of the posterior part of the hock,
where in the normal state there should be a straight line, extending
from the upper end of the point of the hock down to the fetlock.
_Cause._--The cause may be a sprain of the tendon which passes on the
posterior part of the hock, or of one of its sheaths, or of the strong
ligament situated on the posterior border of the os calcis.
Hocks of a certain conformation seems to possess a greater liability to
curb than others. They are overbent, coarse, and thick in appearance, or
may be too narrow from front to back across the lower portion. This
condition may therefore result as a sequence to congenital malformation,
as in the case of horses that are "saber-legged." It often occurs, also,
as the result of violent efforts, of heavy pulling, of high jumping, or
of slipping; in a word, it may result from any of the causes heretofore
considered as instrumental in producing lacerations of muscular,
tendinous, or ligamentous structure.
_Symptoms._--A hock affected with curb will present at the outset a
swelling more or less diffuse on its posterior portion, with varying
degrees of heat and soreness, and these will be accompanied with
lameness of a permanent character. At a later period, however, the
swelling will become better defined, the deformity more characteristic,
the prominent, curved line readily detected, and the thickness of the
infiltrated tissue easily determined by the fingers. At this time, also,
there may be a condition of lameness, varying in degree, while at
others, again, the irregularity of action at the hock will be so slight
as to escape detection, the animal betraying no appearance of its
existence.
A curb constitutes, by a strict construction of the term, an
"unsoundness," since the hock thus affected is less able to endure
severe labor, and is more liable to give way with the slightest effort.
Yet the prognosis of a curb can not be considered to be serious, as it
generally yields to treatment, or at least the lameness it may occasion
is generally easily relieved, though the loss of contour caused by the
bulging will always constitute a blemish.
_Treatment._--On the first appearance of a curb, when it exhibits the
signs of an acute inflammation, the first indication is to subdue it by
the use of cold applications, as intermittent or constant irrigation or
an ice poultice; when these have exhausted their effect and the swelling
has assumed better defined boundaries, and the infiltration of the
tendons or of the ligaments is all that remains of a morbid state, then
every effort must be directed to the object of effecting its absorption
and reducing its dimensions by pressure and other methods. The
medicaments most to be trusted are blisters of cantharides and frictions
with ointments of iodin, or, preferably, biniodid of mercury. Mercurial
agents alone, by their therapeutic properties or by means of the
artificial bandages which they furnish by their incrustations when their
vesicatory effects are exhausted, will give good results in some
instances by a single application, and often by repeated applications.
The use of the firing iron must, however, be frequently resorted to,
either to remove the lameness or to stimulate the absorption. We believe
that its early application ought to be resorted to in preference to
waiting until the exudation is firmly organized. Firing in dull points
or in lines will prove as beneficial in curb as in any other disease of
a similar nature.
LACERATED TENDONS.
This form of injury, whether of a simple or of a compound character, may
become a lesion of a very serious nature, and will usually require long
and careful treatment, which may yet prove unavailing in consequence
either of the intrinsically fatal character of the wound itself or the
complications which have rendered it incurable.
_Cause._--Like all similar injuries, they are the result of traumatic
violence, such as contact with objects either blunt or sharp; a
curb-stone in the city; in the country, a tree stump or a fence,
especially one of wire. It may easily occur to a runaway horse when he
is "whipped" with fragments of harness or "flogged" by fragments of
splintered shafts "thrashing" his legs, or by the contact of his legs
with the wagon he has overturned and shattered with his heels while
disengaging himself from the wreck.
_Symptoms._--It is not always necessary that the skin be involved in
this form of injury. On the contrary, the tegument is frequently left
entirely intact, especially when the injury follows infectious diseases
or occurs during light exercise after long periods of rest in the
stable. Again, the skin may be cut through and the tendons nearly
severed. A point a little above the fetlock is usually the seat of the
injury. But irrespective of this, and whether the skin is or is not
implicated, the symptoms resemble very much those of a fracture. There
is excessive mobility, at least more than in a normal state, with more
or less inability to carry weight. There may be swelling of the parts,
and on passing the hands carefully along the tendon to the point of
division the stumps of the divided structure will be felt more or less
separated, perhaps wholly divided. The position of the animal while at
rest and standing is peculiar and characteristic. While the heels are
well placed on the ground, the toe is correspondingly elevated, with a
tendency to turn up--a form of breaking down which was described when
speaking of the fracture of the sesamoids. Carrying weight is done only
with considerable difficulty, but with comparatively little pain, and
the animal will unconsciously continue to move the leg as if in great
suffering, notwithstanding the fact that his general condition may be
very good and his appetite unimpaired.
The effect upon the general organism of compound lacerated wounds of
tendinous structures, or those which are associated with injuries of the
skin, are different. The wound becomes in a short time the seat of a
high degree of inflammation, with abundant suppuration filling it from
the bottom; the tendon, whether as the result of the bruise or of the
laceration, or of maceration in the accumulated pus, undergoes a process
of softening, and necrosis and sloughing ensue. This complicates the
case and probably some form of tendinous synovitis follows, running into
suppurative arthritis, to end, if close to a joint, with a fatal result.
_Prognosis._--The prognosis of lacerated tendons should be very
conservative. Under the most favorable circumstances a period of from
six weeks to two months will be necessary for the treatment, before the
formation of the cicatricial callus and the establishment of a firm
union between the tendinous stumps.
_Treatment._--As with fractures, and even in a greater degree, the
necessity is imperative, in the treatment of lacerated tendons, to
obtain as perfect a state of immobility as can be obtained compatibly
with the disposition of the patient; the natural opposition of the
animal, sometimes ill-tempered and fractious at best, under the
necessary restraint causing at times much embarrassment to the
practitioner in applying the necessary treatment. Without the necessary
immobility there can be no close connection of the ends of the tendons.
To fulfill this necessary condition the posterior part of the foot and
the fetlock must be supported and the traction performed by them
relieved, an object which can be obtained by the use of the high-heeled
and bar shoe, or possibly better accomplished with a shoe of the same
kind extending about 2 or 2-1/2 inches back of the heels. The perfect
immobility of the legs is obtained in the same way as in the treatment
of fracture, with splints, bandages, iron apparatus, plaster of adhesive
mixtures, and similar means. So long as the dressings remain in place
undisturbed and no chafing or other evidence of pain is present, the
dressings may be continued without changing, the patient being kept in
the slings for a period sufficient to insure the perfect union of the
tendons. For a compound lesion when there is laceration of the skin some
special care is necessary. The wound must be carefully watched and the
dressings removed at intervals of a few days or as often as may be
needful, all of which additional manipulation and extra nursing, however
indispensable, still adds to the gravity of the case and renders the
prognosis more and more serious. When the tendons have sloughed in
threads of various dimensions, or if in the absence of this process of
mortification healthy granulations should form and fill up the wound,
still very careful attention will be required, the granulating ends of
the tendons having a tendency to bulge between the edges of the skin and
to assume large dimensions, forming bulky excrescences or growths of a
warty or cauliflower appearance, the removal of which becomes a
troublesome matter.
The union of the tendons will at times leave a thickening of varying
degree near the point of cicatrization, the absorption of which becomes
an object of difficult and doubtful accomplishment, but which may be
promoted by moderate blistering and the use of alterative and absorbent
mixtures or perhaps the fire iron. A shoe with heels somewhat higher
than usual will prove a comfort to the animal and aid in moderating and
relieving the tension of the tendons.
RUPTURE OF THE FLEXOR METATARSI.
This is a muscle of the anterior part of the shank. It is situated in
front of the tibia, and is of peculiar formation, being composed of a
muscular portion with a very powerful tendon, which are at first
distinct and separate, to be intimately united lower down, and
terminating at the lower end by a division into four tendinous bands. It
is a powerful muscle of the hinder shank bone, and also acts as a
strong means of support for the stifle joint; that is, of the
articulation of the thigh and shank bone, in front and outside of which
it passes. Its situation and its use cause it to be liable to severe
stretching and straining, and a rupture of some of its fibers is
sometimes the consequence.
_Cause._--This injury may be the result of a violent effort of the
animal in leaping over a high obstacle; in missing his foothold and
suddenly slipping backward while powerfully grasping the ground with the
feet in striving to start a heavily loaded vehicle; in making a violent
effort to prevent a probable fall; or in attempting to lift the feet
from miry ground.
_Symptoms._--The accident is immediately followed by disability which
will vary according to the true seat of the injury and the period of its
duration. This rupture will not prevent the horse from standing
perfectly and firmly on his feet when kept at rest, and while no
muscular efforts are required from him there is no appearance of any
lesion or unsoundness. An attempt to move him backward, however, will
cause him to throw all his weight upon his hind-quarters, and he will
refuse to raise his foot from the ground. If compelled to do so, or
required to move forward, the hock being no longer capable of flexion,
the muscle which effects that movement being the injured one, the
opposite muscles, the extensors, acting freely, the entire lower part of
the leg, from the hock down, will be suddenly, with a jerk, extended on
the tibia or shank bone, and simultaneously with this the tendo
Achillis, the cord of the hock, the tendons of the extensors of the hock
will be put in a wrinkled and relaxed condition. The leg is behind the
animal and the toe rests on the ground. Examination of the fore part of
the shank from the stifle down to the hock may reveal soreness, and
possibly some swelling and heat at the seat of the lesion.
_Treatment._--Our experience with injuries of this form convinces us
that, generally speaking, they are amenable to treatment. Provided a
sufficient time has been allowed for union to take place, very few
instances in which radical recovery has not been effected have come to
our knowledge. The more flexed the leg can be kept, the quicker will it
heal.
In these cases, as in those of simple laceration of tendons, already
considered, the indications resemble those which apply in the treatment
of fractures, as near as coaptation of the lacerated ends is possible,
with immobility, being the necessary conditions to secure. The first is
a matter of very difficult accomplishment, by bandaging alone, and some
have recommended instead the application of charges or blisters in order
to compel the animal to keep more quiet.
To secure the necessary immobility the animal should be placed in slings
snugly applied, and kept in a narrow stall. He should also be tied
short, and restrained from any backward movement by ropes or boards, and
should, moreover, be kept in as quiet a temper as possible by the
exclusion of all causes of irritation or excitement. Weeks must then
elapse, not less, but frequently more than six, often eight, before he
can be considered out of danger and able to return to his labor, which
should for a time be light and easy, and gradually, if ever, increased
to the measure of a thoroughly sound and strong animal. If he is used
too soon the newly formed tissue between the ends of the muscle will be
liable to stretch and leave the flexor muscle too long and permanently
displaced.
SUNDRY ADDITIONAL AFFECTIONS OF THE EXTREMITIES.
Among these there are three which will principally occupy our attention,
and, which may be considered as forming a single group. In some parts of
the legs may be found certain peculiar little structures of a saclike
formation, containing an oily substance designed for the lubrication of
the parts upon which they are placed for the purpose of facilitating the
movements of the tendons which pass over them. These little sacs or
muco-synovial capsules, under peculiar conditions of traumatism, are
liable to become subject to a diseased process, which consists
principally in a hypersecretion of their contents and an increase in
dimensions, and they may undergo peculiar pathological changes of such
character as to disable an animal, and in many instances to cause
serious blemishes which can but depreciate its value. These growths,
which are known as hygromata, may result from external violence, as
blows or bruises, and may appear in the form of small, soft tumors,
painless and not inflammatory in character, but, by a repetition of the
cause or renewal of violence, liable to acquire increased severity.
Severe inflammation, with suppuration, may follow, which, filling up the
cavity, the walls will become thickened and hard, resulting in the
formation of a tumor.
The elbow, the knee, and the hock are the parts of the body where these
lesions are ordinarily found, and on account of their peculiar shape and
the position they occupy they have received the denomination "capped."
They will be considered in their peculiar aspect.
CAPPED ELBOW.
Capped elbow, or "shoe boil," is a term applied to an enlargement often
found at the point of the elbow.
_Cause._--This lesion is due to injury or pressure of the part while it
is resting on the ground. The horse, unlike the cow, does not rest
directly on the under surface of the sternum, or breastbone, on account
of its sharp, ridge-like formation. He rests more on the side of the
breastbone and chest, and consequently the leg which is flexed under
the body is subject to considerable pressure. If the leg is flexed under
the body so that the hoof or shoe is directly in contact with the elbow,
which may occur in horses having an extremely long cannon bone or
excessive length in the shoes, the greater part of the weight of the
chest is concentrated at this point and the pressure may cause a bruise
or an inflammation.
_Symptoms._--Under these conditions the point of the elbow may become
swollen and tender and exhibit heat and pain. This swelling may not only
cover the point of the elbow, but sometimes reaches the axilla and
assumes such proportions that there is great difficulty in using the
leg, the animal showing signs of lameness even to the extent of the
circumflex step, as in shoulder lameness. This edematous condition,
however, does not remain stationary. It may by degrees subside or
perhaps disappear. In the first instance it will become more distinctly
defined, with better marked boundaries, until it is reduced to a soft,
round, fluctuating tumor, with or without heat or pain. There is then
either a bloody or serous tumor or a purulent collection, and following
the puncture of its walls with the knife there will be an escape of
blood, serum, or pus, as the case may be, in variable quantities. In
either case, but principally in that of the cystic form, the tumor will
be found to be subdivided by septa, or bands running in various
directions.
Various changes will follow the opening of the tumor and the escape of
its contents. In a majority of cases the process of cicatrization will
take place, and the cavity fill up by granulation, the discharge, at
first abundant, gradually diminishing and the wound closing, usually
without leaving any mark. At times, however, and especially if the
disease has several times repeated its course, there may remain a
pendulous sac, partly obliterated, which a sufficient amount of
excitement or irritation may soon restore to its previous dimensions and
condition.
In other cases an entirely different process takes place. The walls of
the cavity, cyst, or abscess become ulcerated and thickened, the
granulations of the sac become fibrous in their structure and fill up
the cavity, and it assumes the character of a hard tumor on the back of
the elbow, sometimes partly and sometimes entirely covered by the skin.
It is fibrous in its nature, painless to the touch, well defined in its
contour, and may vary in size from that of a small apple to that of a
child's head.