known forms of mild treatment, and removable by the knife only. The
other forms, even that with the inflammatory aspect and its large
edematous swelling which interferes with the work of the animal, may
justify a much milder prognosis, and, aside from their liability to
recur, may be ranked with the comparatively harmless affections.
_Treatment._--So long as the danger of recurrence is the principal bad
feature of capped elbow the most important consideration is that of
devising a means for its prevention. To prevent the animal from lying
down is evidently the simplest method of keeping the heels and the elbow
apart; but the impracticability of this prescription is apparent, since
most animals are obliged to lie down when they sleep, though it is true
that a few take their sleep on their feet. The question of shoeing here
enters into the discussion. The shortening of the inside branch of the
shoe, which is the one with which the pressure is made, may be of
advantage, and especially if the truncated end of the shoe is smooth and
filed over to remove all possibility of pressure and contusion upon the
skin. The protection of the skin of the elbow by interposing soft
tissues between that and the shoe, or by bandaging the heel with bags or
covering it with boots, is considered by many the best of the preventive
methods, and the advantage to be obtained by resorting to it can not be
overlooked when the number of horses which develop shoe boil whenever
the use of the boot is intermitted is considered. In order to prevent
the animal from assuming the sternal decubitus, many give preference to
the plan of fastening a piece of wood across the stall at some distance
from the front wall or manger. It is a simple expedient, primitive,
perhaps, but nevertheless practical, and followed by good results.
The therapeutic treatment is also important. The edematous swelling,
when recognized by its external appearance and the existing
inflammation, should be treated without delay. Warm fomentations,
repeated several times daily, are then indicated, the degree of warmth
being as high as can be borne comfortably. They are easily applied and
often yield decided relief in a few hours. In some cases, however,
astringents, in the form of poultices or pastes, are used in preference;
these are made to cover the entire swelling and allowed to remain,
drying after a short time, it is true, and perhaps falling off, but are
easily renewed and reapplied. An excellent astringent for these cases is
a putty made of powdered chalk and vinegar (acetate of lime), and the
whole swelling is then covered with a thick coating of soft clay made
into a mass with water.
These simple remedies are often all that is required. Under their use
the swelling passes off by degrees and after a short interval the animal
is fit for work again, but not uncommonly instead a swelling develops,
puffy, not painful, and perhaps giving a sensation of crepitation when
pressure is applied with the finger. It is soft, evidently contains a
liquid, and when freely opened with a good-sized incision discharges a
certain quantity of blood, partly liquid and partly coagulated, and
perhaps a little hemorrhage will follow. The cavity should then be well
washed out and a plug of oakum introduced, leaving a small portion
protruding through the cut to prevent it from closing prematurely. It
may be taken off the next day, and a daily cleansing will then be all
that is necessary. In another case the tumor becomes very soft in its
whole extent, with evident fluctuation and a well-defined form. The
discharge of the fluid is then indicated, and a free incision will be
followed by the escape of a quantity of thin yellowish liquid from a
single sac. The wound should be kept clean and dressed frequently, in
order to insure prompt healing. But if the cavity is found to be
subdivided in its interior by numerous bands and the cyst proves to be
multilocular the partitions should be torn out with the fingers and the
cavity then treated in the same manner as the unilocular sac. In still
another case the swelling may be warm and painful with indistinct
fluctuation, or fluctuation only at a certain point. This indicates an
abscess, and necessitates an incision to drain the pus, followed by the
careful cleansing and dressing of the wound.
But cases occur in which all the treatment that has been described fails
to effect a full recovery, and instead a fibrous tumor begins to
develop. A change of treatment is, of course, then in order. The
inflammation being chronic will necessitate stimulating treatment of the
part in order to increase the process of absorption. We must again draw
upon the resources of experience in the form of blisters, the
fomentations, the iodin, and the mercurial ointments, as heretofore
mentioned. Good results may always be insured from their judicious and
timely administration. In applying the powerful mineral inunctions much
patience and wisdom are required. It should be done by carefully and
perseveringly rubbing in small quantities daily; it should be done
softly and gently, not with force, nor with the expectation of producing
an astonishing effect by heavy dosing and main strength in a few hours;
it should be after the manner of a siege rather than that of a charge.
The object is to induce the drugs to permeate the affected part until
the entire mass is penetrated. Of course cases will be encountered which
resist all forms of medical treatment. The tumor remains as a fixed
fact; it continues to grow; it is large and pendulous at the elbow; its
weight is estimated in pounds; it is not an eyesore merely, but an
uncomfortable, burdensome mass, excoriating all the surrounding parts
and being itself excoriated in turn; mild treatment has failed and is no
longer to be relied on.
Resort must now be made to surgical methods, and here again we must
choose between the ligature, the cautery, and the knife. Each has its
advocates among practitioners. In a case like the present, one of the
difficulties arises in connection with the application and retention of
bandages and other dressings after the amputation has been performed. It
is a somewhat difficult problem, owing to the conformation and
proportions of the body of the patient, and involves the exercise of
considerable practical ingenuity to adjust and retain the appliances
necessary to insure a good final result.
In the long description of the treatment of the varieties of capped
elbow I have thus far omitted any mention of one method which is
practiced and commended by not a few. I refer to the use of setons,
introduced through the tumor. My own experience and the observation of
many failures from this method led me to abandon it.
CAPPED KNEE.
The passage of the tendons of the extensor muscle of the cannon, as it
glides in front of the knee joint, is assisted by one of the little
bursae before mentioned, and when this becomes the seat of dropsical
collection a hygroma is formed and the knee is "capped." Though in its
history somewhat analogous to the capped elbow, there are points of
difference between them. Their development may prove a source of great
annoyance from the fact of the blemish which they constitute.
_Cause._--The capped knee presents itself under various conditions. It
is sometimes the result of a bruise or contusion, often repeated,
inflicted upon himself by a horse addicted to the habit of pawing while
in the stable and striking the front of the stall with his knees.
Another class of patients is formed of those weak-kneed animals which
are subject to falling and bruising the front of the joint against the
ground, the results not being always of the same character.
_Symptoms._--The lesion may be a simple bruise, or it may be a severe
contusion with swelling, edema, heat, and pain. The joint becomes so
stiff and rigid that it interferes with locomotion and yet under careful
simple treatment the trouble may disappear.
Again, instead of altogether passing off, the edema may diminish in
extent, becoming more defined in form and may remain as a swelling on
the front part of the knee. Resulting from the crushing of small blood
vessels, this is necessarily full of blood. The swelling is somewhat
soft, diffuse, not painful, more or less fluctuating, and after a few
days becomes crepitant under the pressure of the hand.
Instead of being filled with blood the swelling may be full of serum, as
often occurs when violence, though perhaps slight, has been frequently
repeated. In that case the swelling is generally well defined, soft, and
painless, with more or less fluctuation, and it may even become
pendulous. In other cases the swelling may be of an acute, inflammatory
nature, with heat and pain, accompanied with stiffness of the joint.
This leads to the formation of an abscess. Whatever the nature of these
swellings may be, either full of blood, serum, or pus, some blemish
usually remains after treatment.
_Prognosis._--Though simple bruises of the knee without extensive
lesions are usually of trifling account, a different prognosis must be
pronounced when the lesion assumes more important dimensions, and though
a capped knee may be comparatively of little importance we have seen
cases in which not only extensive blemishes were left to disfigure the
patient, but the animals had become worthless in consequence of the
extension of the diseased process to the various elements composing the
joint, and giving rise to the most complicated cases of carpitis.
_Treatment._--Usually the first symptom of trouble is the edematous
swelling on the front of the "knee." The prevention of the inflammation
and consequently of the abscess, is the prime object in view, and it may
be realized by the use of warm-water fomentations or compresses applied
over the swelling, which may be used either in a simple form or combined
with astringents, such as Goulard's extract, alum, or sulphate of zinc.
The application of warm poultices of oil meal or ground flaxseed,
enveloping the whole joint and kept in place by bandages, is often
followed by absorption of the swelling, or, if the abscess is in process
of formation, by the active excretion of pus. If an abscess forms in
spite of these precautions it may be treated surgically in several ways.
In one it should be done by a careful incision, which will allow the
escape of the blood or the serum, or of the pus which is inclosed in the
sac; in another it may be by means of a seton, in order that the
discharge may be maintained and allowed to escape; for another we may
adopt the more cautious manner of emptying the cavity by means of
punctures with small trocars or aspirators. The danger attending this
last method arises from the possible sloughing of large portions of the
skin, while that attending the first is the hazard of the possibility of
the extension of the inflammation to the capsular ligament of the knee,
with the possibility of an open joint in prospect.
As we have remarked, the cavity after being emptied may rapidly close
and leave in a short time but slight traces of its previous existence.
But in many, if not in most cases, there will remain, after the
cicatrization is complete, a thickening or organized exudation at one
time round and well defined, at another spreading by a diffused
infiltration, to which it will be necessary to give immediate attention,
from the fact of its tendency to form into an organized and permanent
body. To stimulate inflammation in this diseased structure, blisters are
recommended, but chiefly for the purpose of promoting the process of
absorption.
If this treatment fails, the use of iodin and mercurial preparations is
recommended.
Plain mercurial or plain iodin ointment, or both in combination as iodid
of mercury, are commonly used, and may be applied either moderately and
by gentle degrees, as we have suggested, or more freely and vigorously
with a view to more immediate effects, which, however, will also be
more superficial. The use of the firing iron applied deeply with fine
points is then to be strongly recommended, to be followed by blisters
and various liniments. This course may generally be relied on as quite
sure to be followed by satisfactory results.
While the treatment is in progress it will, of course, be necessary to
secure the animal in such manner that a recurrence of the injury will be
impossible from similar causes to those which were previously
responsible.
CAPPED HOCK.
A bad habit of rubbing or striking the partitions of their stalls with
their hocks prevails among some horses, with the result of an injury
which shows itself on the upper points of those bones, the summit of the
os calcis. From its analogy to the condition of capped elbow the
designation of capped hock has been applied to this condition.
_Symptoms._--A capped hock is therefore but the development of a bruise
at the point of the hock, which if many times repeated may excite an
inflammatory process, with all its usual external symptoms of swelling,
heat, soreness, and the rest of the now-familiar phenomena. The swelling
is at first diffused, extending more or less on the exterior part of the
hock, and in a few instances running up along the tendons and muscles of
the back of the shank. Soon, however, unless the irritating causes are
continued and repeated, the edema diminishes, and, becoming more defined
in its external outlines, leaves the hock capped with a hygroma. The
hygroma, at the very beginning of the trouble, contains a bloody
serosity which soon becomes strictly serum, and this, through the
influence of an acute inflammatory action, is liable to undergo a change
which converts it into the usual purulent product of suppuration.
The external appearance ought to be sufficient to determine the
diagnosis, but there are a few signs which may contribute toward a nicer
identification of the lesion. The capped hock, whether under the
appearance of an acute, edematous swelling, or as a bloody serous
collection, or as a simple serous cyst, does not give rise to any
remarkable local manifestation other than such as have already passed
under our survey in considering similar cases, nor will it be liable to
interfere with the functions which belong to the member in question,
unless it assumes very large dimensions and on each side of the tendons,
as well as on the summit of the bone. But if the inflammation is quite
high, if suppuration is developing, if there is a true abscess, or--and
this is a common complication--especially when the kicking or rubbing of
the animal is frequently recurring, then, besides the local trouble of
the cyst or of the abscess, the bones become diseased and the periosteum
inflamed; perhaps the superior ends of the bone and its fibro-cartilage
become affected, and a simple lesion or bruise, whatever it may have
been, becomes complicated with periostitis and ostitis, and is naturally
accompanied with lameness, developed in a greater or less degree, which
in some cases may be permanent and in others increased by work. These
complications, however, are not common or frequent.
_Treatment._--Capped hocks are in many cases amenable to treatment, and
yet they often become the opprobrium of the practioner by remaining, as
they frequently do, an eyesore on the top of the hock; they do not
interfere, it is true, with the work of the horse, but fixing upon him
the stigma of what, in human estimation, is a most unreliable and
objectionable reputation, to wit, that of being an habitual "kicker,"
and, worse than all, one that kicks when fed.
The maxim that "an ounce of prevention is worth a pound of cure" fits
the present case very neatly. A horse whose hocks have a somewhat puffy
look and whose skin on the front of the hock is loose and flabby, justly
subjects himself to a suspicion of addictedness to this bad habit, but a
little watching will soon establish the truth. If, then, the verdict is
one of conviction, precautions should be immediately adopted against a
continuance of the evil. The padding of the sides of the stall with
straw mats or mattresses and covering the posts with similar material,
in such manner as to expose no hard surface with which to come in
contact, will reduce the evil to its minimum. The animal may jar his
frame when he kicks, but even then there will be less force in the
concussion than if it impinged upon the solid plank, and cuts and
abrasions can not be inflicted by a properly made cushion. Hobbles are
also rightly recommended with a view to the required restraint of
motion, so applied as to secure the leg with which the kicking is
performed, or even both hind legs, in such manner as not to interfere
with the movement of lying down and rising again and yet preventing that
of kicking backward. Boots similar in pattern to those which are used
for the prevention of shoe boil are also prescribed. These are placed
above the hock and retained by straps tightly fastened. We apprehend,
however, that the difficulty of retaining them in the proper place
without the danger of chafing from the tightness of the straps may form
an objection to their use. Notwithstanding all precautions, hocks will
be capped in the future as in the past, and the study of their treatment
will always be in order.
The mode of dealing with them will, of course, be greatly influenced by
the condition of the parts. When the inflammation is excessive and the
swelling large, hot, and painful to the touch, the application of warm
water will be very painful. The leg should be well fomented several
times a day, for from 15 to 20 minutes each time, a strong decoction of
marsh-mallow leaves being added to the water, and after each application
swathed with flannel bandages soaked in the same warm mixture. A few
days of this treatment will usually effect a resolution of the
inflammation; if not complete, at least sufficiently so to disclose the
correct outlines of the hygroma and exhibit its peculiar and specific
symptoms. The expediency of its removal and the method of accomplishing
it are then to be considered, with the question of opening it to give
exit to its contents. If the fluid is of a purulent character, the
indication is in favor of its immediate discharge. No time should be
lost, and it should be by means of a small opening made with a narrow
bistoury. If, however, the fluid is a serosity, we prefer to remove it
by punctures with a very small trocar. Our reason for special caution in
these cases is our fear of the possibility of the existence of diseased
conditions of a severe character in the pseudo joint. For the same
reason we prefer the treatment of those growths by external
applications. In the first stages of the disease a severe and stiff
blister, such as the cantharidate of collodium, entirely covering the
cyst, perhaps not yet completely formed, when the inflammation has
subsided, will be of great benefit by its stimulating effect, the
absorption it may excite, and the pressure which, when dry, it will
maintain upon the tumor. If, however, the thickening of the growth fails
to diminish, it should be treated with some of the iodin preparations in
the form of ointments, pure or in combination with potassium, mercury,
etc., of various strengths and in various proportions. My opinion of
setons is not favorable, but the actual cautery, by deep and fine
firing, in points--needle cauterization--I believe to be the best mode
of treatment, and especially when applied early.
A very satisfactory way to treat these cases is to burst the swelling by
pressure from without. A strap or strong linen bandage is placed about
the hock, pressing on the bursa, while the affected leg is on the
ground, the other hind foot being lifted up. When the bandage is in
place the leg should be released, and the horse will violently flex the
bandaged limb and produce pressure on the bursa, with consequent
bursting and discharging of its contents.
Whatever treatment may be adopted for capped hock, patience must be one
of the ingredients. In these parts absorption is slow, the skin is very
thick, and its return to a soft, pliable, natural condition, if effected
at all, will take place only after weeks added to other weeks of medical
treatment and patient waiting.
INTERFERING, AND SPEEDY CUTS.
These designations belong to certain special injuries of the
extremities, produced by similar causes, giving rise to kindred
pathological lesions with allied phenomena, requiring about the same
treatment and often followed by the same results, to wit, a blemish
which may not only subject the animal to a suspicion of unsoundness, but
in some special circumstances may interfere with his ability to labor.
It is known as "interfering" when the location of the trouble is the
inside of the fetlock of either the fore or hind leg. It is called
"speedy cut" when it occurs on the inside of the fore leg, a little
below the knee, at the point of contact of that joint with the cannon.
It is always the result of a blow, self-inflicted, of varying severity,
and giving rise to various lesions. (See also p. 399.)
_Symptoms._--At times the injury is too slight to be seriously noticed,
the hair being scarcely cut and the skin unmarked. At other times the
skin will be cut through, partly or wholly, and it may for the time
cause sufficient pain to check the motion of the animal and induce him
to suspend his labor through his inability to use the wounded limb,
traveling meanwhile for a short space on three legs only. Sometimes a
single blow will suffice, or again there will be a repetition of lighter
strokes. In the latter case the parts will become much swollen, hot, and
so painful to the touch that the motion of the knee or the fetlock will
be sufficiently disturbed to cause lameness of a degree of severity
corresponding to that of the lesion. Following the subsidence of this
diffused and edematous swelling is sometimes the formation of a tumor,
either at the knee or the fetlock. This may be soft at first or become
so by degrees, with fluctuation, its contents being at first
extravasated blood, and later a serosity; or, if there has been a
sufficient degree of inflammation, it may become suppurative. The result
of the fault of interfering may thus be exhibited, whether at the knee
or at the fetlock, as characterized by all the pathological conditions
which have appeared as accompaniments of capped knee or capped hock. If,
in consequence of the force of the blow or blows, the inflammation has
been usually severe, a mortification of the skin may become one of the
consequences, a slough taking-place, succeeded by a cutaneous ulcer on
the inside of the fetlock or when the greater number of the original
wounds are inflicted. If the interfering has been often repeated it may
be followed by another condition, which has been considered in our
remarks upon other affections. It is a plastic exudation or thickening
of the parts, which are commonly said to have become "callous," and the
effect of it is to destroy the regularity of the outlines of the joint
to an extent which constitutes a serious blemish, which will be
permanent, and according to the degree of the aberration from the
natural and symmetrical lines will inevitably depreciate the commercial
value of the animal.
An animal in interfering may thus exhibit a range of symptoms which from
the simplest form of a mere "touching," may successively assume the
serious characters of an ugly cicatrix, a hard, plastic swelling, or
perhaps, as witnessed at the knee, of periostitis with its sequelae.