tissues involved; for in all dense structures the swelling which
accompanies inflammation always produces intense pressure. This pressure
not only adds to the patient's suffering but may at the same time
endanger the life of the affected parts by strangulating the blood
vessels. It is held by some writers that simple quittor is most often
met with in the hind feet, but in my experience more than two-thirds of
the cases have developed in the fore feet. While any part of the coronet
may become the seat of attack, the heels and quarters are undoubtedly
most liable.
_Causes._--Bruises and other wounds of the coronet are often the cause
of cutaneous quittor, yet there can be no question that in the great
majority of cases the disease develops without any known cause. For some
reason not yet satisfactorily explained most cases happen in the fall of
the year. One explanation of this fact has been attempted in the
statement that the disease is due to the injurious action of cold and
mud. This claim, however, seems to lose force when it is remembered that
in many parts of this country the most mud, accompanied with freezing
and thawing weather, is seen in the early springtime without a
corresponding increase of quittor. Furthermore, the serious outbreaks of
this disease in the mountainous regions of Colorado, Wyoming, and
Montana are seen in the fall and winter seasons, when the weather is the
driest. It may be claimed, and perhaps with justice, that during these
seasons, when the water is low, animals are compelled to wade through
more mud to drink from lakes and pools than is necessary at other
seasons of the year, when these lakes and pools are full. Add to these
conditions the further fact that much of this mud is impregnated with
alkaline salts which, like the mineral substances always found in the
mud of cities, are more or less irritating, and it seems fair to
conclude that under certain circumstances mud may become an important
factor in the production of quittor.[3]
While this disease attacks any and all classes of horses, it is the
large, common breeds, with thick skins, heavy coats, and coarse legs
that are most often affected. Horses well groomed and cared for in
stables seem to be less liable to the disease than those running at
large or than those which are kept and worked under adverse
circumstances.
_Symptoms._--Lameness, lasting from one to three or four days, nearly
always precedes the development of the strictly local evidences of
quittor. The next sign is the appearance of a small, tense, hot, and
painful tumor in the skin of the coronary region. If the skin of the
affected foot is white, the inflamed portion will present a dark-red or
even a purplish appearance near the center. Within a few hours the
ankle, or even the whole leg as high as the knee or hock, becomes much
swollen. The lameness is now so great that the patient refuses to use
the foot at all, but carries it if compelled to move. As a consequence,
the opposite leg is required to do the work of both, and if the animal
persists in standing a greater part of the time it, too, becomes
swollen. In many of these cases the suffering is so intense during the
first few days as to cause general fever, dullness, loss of appetite,
and increased thirst. Generally the tumor shows signs of suppuration
within 48 to 72 hours after its first appearance; the summit softens, a
fluctuating fluid is felt beneath the skin, which soon ulcerates
completely through, causing the discharge of a thick, yellow, bloody
pus, containing shreds of dead tissue which have sloughed away. The sore
is now converted into an open ulcer, generally deep, nearly or quite
circular in outline, and with hardened base and edges. In exceptional
cases large patches of skin, varying from 1 to 2-1/2 inches in diameter,
slough away at once, leaving an ugly superficial ulcer. These sores,
especially when deep, suppurate freely, and if there are no
complications they tend to heal rapidly as soon as the degenerated
tissue has softened and is entirely removed. When suppuration is fully
established, the lameness and general symptoms subside. When but a
single tumor and abscess form, the disease progresses rapidly, and
recovery, under proper treatment, may be effected in from two to three
weeks; but when two or more tumors are developed at once, or if the
formation of one tumor is rapidly succeeded by another for an indefinite
time, the sufferings of the patient are greatly increased, the case is
more difficult to treat, and recovery is more slow and less certain.
This form of quittor is often complicated with the tendinous and
subhorny quittors by an extension of the sloughing process.
_Treatment._--The first step in the treatment of an outbreak of quittor
should be the removal of all exciting causes. Crowding animals into
small corrals and stables, where injuries to the coronet are likely to
happen from trampling, especially among unbroken range horses, must be
avoided as much as possible.
Watering places accessible without having to wade through mud should be
provided. In towns, where the mud or dust is largely impregnated with
mineral products, it is not possible to adopt complete preventive
measures. Much can be done, however, by careful cleansing of the feet
and legs as soon as the animal returns from work. Warm water should be
used to remove the mud and dirt, after which the parts are to be
thoroughly dried with soft cloths.
The means which are to be adopted for the cure of cutaneous quittor vary
with the stage of the disease at the time the case is presented for
treatment. If the case is seen early--that is, before any of the signs
of suppuration have developed--the affected foot is to be placed under a
constant stream of cold water, with the object of arresting a further
extension of the inflammatory process. To accomplish this, put the
patient in slings in a narrow stall having a slat or open floor. Bandage
the foot and leg to the knee or hock, as the case may be, with flannel
bandages loosely applied. Set a tub or barrel filled with cold water
above the patient, and by the use of a small rubber hose of sufficient
length make a siphon which will carry the water from the bottom of the
tub to the leg at the top of the bandage. The stream of water should be
quite small, and is to be continued until the inflammation has entirety
subsided or until the presence of pus can be detected in the tumor. When
suppuration has commenced, the process should be aided by the use of
warm baths and poultices of lineseed meal or boiled turnips. If the
tumor is of rapid growth, accompanied with intense pain, relief is
obtained and sloughing largely limited by a free incision of the parts.
The incision should be vertical and deep into the tumor, care being
taken not to divide the coronary band entirely. If the tumor is large,
more than one incision may be necessary.
The foot should now be placed in a warm bath for half an hour or longer
and then poulticed. The hemorrhage produced by the cutting and
encouraged by the warm bath is generally very copious and soon gives
relief to the overtension of the parts.
In other cases it will be found that suppuration is well under way, so
that the center of the tumor is soft when the patient is first presented
for treatment. It is always good surgery to relieve the tumor of pus
whenever its presence can be detected; hence, in these cases a free
incision must be made into the softened parts, the pus evacuated, and
the foot poulticed.
By surgical interference the tumor is now converted into an open sore or
ulcer, which, after it has been well cleaned by warm baths and poultices
applied for two or three days, needs to be protected by proper
dressings. The best of all protective dressings is made of small balls,
or pledgets, of oakum, carefully packed into the wound and held in place
by a roller bandage 4 yards long, from 3 to 4 inches wide, made of
common bedticking and skillfully applied.
The remedies which may be used to stimulate the healing process are
many, and, as a rule, they are applied in the form of solutions or
tinctures.
In my own practice I prefer a solution of bichlorid of mercury 1 part,
water 500 parts, with a few drops of muriatic acid or a few grains of
muriate of ammonia added to dissolve the mercury. The balls of oakum are
wet with this solution before they are applied to the wound.
Among the other remedies which may be used, and perhaps with equally as
good results, will be noted the sulphate of copper, iron, and zinc, 5
grains of either to the ounce of water; chlorid of zinc, 5 grains to the
ounce; carbolic acid, 20 drops dissolved in an equal quantity of
glycerin and added to 1 ounce of water; and nitrate of silver, 10 grains
to the ounce of water.
If the wound is slow to heal, it will be found of advantage to change
the remedies every few days.
If the wound is pale in color, the granulations transparent and
glistening, the tincture of aloes, tincture of gentian, or the spirits
of camphor may do best.
When the sore is red in color and healing rapidly, an ointment made of 1
part of carbolic acid to 40 parts of cosmoline or vaseline is all that
is needed.
If the granulations continue to grow until a tumor is formed which
projects beyond the surrounding skin, it should be cut off with a sharp,
clean knife, and the foot poulticed for twenty-four hours, after which
the wound is to be well cauterized daily with lunar caustic and the
bandages applied with great firmness.
The question as to how often the dressings should be renewed must be
determined by the condition of the wound, etc. If the sore is
suppurating freely, it will be necessary to renew the dressing every 24
or 48 hours; if the discharge is small in quantity and the patient
comfortable, the dressing may be left on for several days; in fact, the
less often the wound is disturbed, the better, so long as the healing
process is healthy. When the sore commences to "skin over," the edges
should be lightly touched with lunar caustic at each dressing. The
patient may now be given a little exercise daily, but the bandages must
be kept on until the wound is entirely healed.
TENDINOUS QUITTOR.
This form of quittor differs from the cutaneous in that it not only
affects the skin and subcutaneous tissues, but involves also the tendons
of the leg, the ligaments of the joints, and, in many cases, the bones
of the foot as well.
Fortunately, this form of quittor is less common than the preceding, yet
any case beginning as simple cutaneous quittor may at any time during
its course become complicated by the death of some part of the tendons,
by gangrene of the ligaments, sloughing of the coronary band, caries of
the bones, or inflammation and suppuration of the synovial sacs and
joints, thereby converting a simple quittor into one which will, in all
probability, either destroy the patient's life or maim him for all time.
_Causes._--Tendinous quittor is caused by the same injuries and
influences that produce the simple form. Zundel believes it to be a not
infrequent accompaniment of distemper. In my own experience I have seen
nothing to verify this belief, but I am convinced that young animals are
more liable to have tendinous quittor than older ones, and that they are
much more likely to make a good recovery.
_Symptoms._--When a case of simple quittor is transformed into the
tendinous variety the change is announced by a sudden increase in the
severity of all the symptoms. On the other hand, if the attack primarily
is one of tendinous quittor, the earliest symptom seen is a well-marked
lameness. In those cases due to causes other than injuries this lameness
is at first very slight, and the animal limps no more in trotting than
in walking; later on, generally during the next 48 hours, the lameness
increases to such extent that the patient often refuses to use the leg
at all. An examination made during the first two days rarely discloses
any cause for this lameness; it may not be possible even to say with
certainty that the foot is the seat of the trouble. On the third or
fourth day, sometimes as late as the fifth, a doughy-feeling tumor will
be found forming on the heel or quarter. This tumor grows rapidly, feels
hot to the touch, and is extremely painful. As the tumor develops, all
the other symptoms increase in intensity; the pulse is rapid and hard;
the breathing quick; the temperature elevated 3 deg. or 4 deg.; the appetite is
gone; thirst increased; and the lameness so great that the foot is
carried if locomotion is attempted. At this stage of the disease the
patient generally seeks relief by lying upon the broad side, with
outstretched legs; the coat is bedewed with a clammy sweat, and every
respiration is accompanied with a moan. The leg soon swells to the
fetlock; later this swelling gradually extends to the knee or hock, and
in some cases reaches the body. As a rule, several days elapse before
the disease develops a well-defined abscess, for, owing to the dense
structure of the bones, ligaments, and tendons, the suppurative process
is a slow one, and the pus is prevented from readily collecting in a
mass.
I made a post-mortem examination on a typical case of this disease, in
which the animal had died on the fourth day after being found on the
range slightly lame. The suffering had been intense, yet the only
external evidences of the disease consisted in the shedding of the hoof
from the right fore foot and a limited swelling of the leg to the knee.
The sloughing of the hoof took place two or three hours before death,
and was accompanied with but little suppuration and no hemorrhage. The
skin from the knee to the foot was thickened from watery infiltration
(edema), and on the inside quarter three holes, each about one-half inch
in diameter, were found. All had ragged edges, while but one had gone
deep enough to perforate the coronary band. The loose connective tissue
beneath the skin was distended, with a gelatinous infiltration over the
whole course of the flexor tendons and to the fetlock joint over the
tendon in front. The soft tissues covering the coffin bone were loosened
in patches by collections of pus which had formed beneath the sensitive
laminae. The coffin and pastern joints were inflamed, as were also the
coffin, navicular, and coronet bones, while the outside toe of the
coffin bone had become softened from suppuration until it readily
crumbled between the fingers. The coronary band was largely destroyed
and completely separated from the other tissues of the foot. The inner
lateral cartilage was gangrenous, as was also a small spot on the
extensor tendon near its point of attachment on the coffin bone. Several
small collections of pus were found deep in the connective tissue of the
coronary region; along the course of the sesamoid ligaments; in the
sheath of the flexor tendons; under the tendon just below the fetlock
joint in front; and in the coffin joint.
But all cases of tendinous quittor are by no means so complicated as
this one was. In rare instances the swelling is slight, and after a few
days the lameness and other symptoms subside, without any discharge of
pus from an external opening. In most cases, however, from one to half a
dozen or more soft points arise on the skin of the coronet, open, and
discharge slowly a thick, yellow, fetid, and bloody matter. In other
cases the suppurative process is largely confined to the sensitive
laminae and plantar cushion, when the suffering is intense until the pus
finds an avenue of escape by separating the hoof from the coronary
band, at or near the heels, without causing a loss of the whole horny
box. When the flexor tendon is involved deep in the foot, the discharge
of pus usually takes place from an opening in the follow of the heel; if
the sesamoid ligament or the sheath of the flexors are affected, the
opening is nearer the fetlock joint, although in most of these cases the
suppuration spreads along the course of the tendons until the navicular
joint is involved, and extensive sloughing of the deeper parts follows.
_Treatment._--The treatment of tendinous quittor is to be directed
toward the saving of the foot. First of all an effort must be made to
prevent suppuration; if the patient is seen at the beginning, cold
irrigation, recommended in the treatment for cutaneous quittor, is to be
resorted to. Later, when the tumor is forming on the coronet, the knife
must be used, and a free and deep incision made into the swelling.
Whenever openings appear, from which pus escapes, they should be
carefully probed; in all instances these fistulous tracts lead down to
dead tissue which nature is trying to remove by the process of
sloughing. If a counter opening can be made, which will enable a more
ready escape of the pus, it should be done at once; for instance, if the
probe shows that the discharge originates from the bottom of the foot,
the sole must be pared through over the seat of trouble. Whenever
suppuration has commenced the process is to be stimulated by the use of
warm baths and poultices. The pus which accumulates in the deeper parts,
especially along the tendons, around the joints, and in the hoof, is to
be removed by pressure and injections made with a small syringe,
repeated two or three times a day. As soon as the discharge assumes a
healthy character and diminishes in quantity, stimulating solutions are
to be injected into the open wounds. When the tendons, ligaments, and
other deeper parts are affected, a strong solution of carbolic acid--1
to 4--should be used at first; or strong solutions of tincture of iodin,
sulphate of iron, sulphate of copper, bichlorid of mercury, etc., may be
used in place of the carbolic; after this the remedies and dressings
directed for use in simple quittor are to be used. In those cases in
which the fistulous tracts refuse to heal it is often necessary to burn
them out with a saturated solution of caustic soda, equal parts of
muriatic acid and water, or, better still, with a long, thin iron,
heated white hot.
But no matter what treatment is adopted, a large percentage of the cases
of tendinous quittor fail to make good recoveries. If the entire hoof
sloughs away, the growth of a new, but soft and imperfect hoof may be
obtained by carefully protecting the exposed tissues with proper
bandages. When the joints are opened by deep sloughing, recovery may
eventually take place, but the joint remains immovable ever after. If
caries of a small part of the coffin bone takes place, it may be
removed by an operation; but if much of the bone is affected, or if the
navicular and coronet bones are involved in the carious process, the
only hope for a cure is in the amputation of the foot. This operation is
advisable only when the animal is valuable for breeding purposes. In all
other cases in which there is no hope for recovery the patient's
suffering should be relieved by death. In tendinous quittor much
thickening of the coronary region, and sometimes of the ankle and
fetlock, remains after suppuration has ceased and the fistulous tracts
have healed. To stimulate the reabsorption of this new and unnecessary
tissue, the parts should be fired with the hot iron, or, in its absence,
repeated blistering with the biniodid of mercury ointment may largely
accomplish the same results.
SUBHORNY QUITTOR.
This is the most common form of the disease. It is generally seen in but
one foot at a time, and more often in the fore than in the hind feet. It
nearly always attacks the inside quarter, but may affect the outside,
the band in front, or the heel, where it is of but little consequence.
It consists in the inflammation of a small part of the coronary band and
adjacent skin, followed by sloughing and suppuration, which in most
cases extends to the neighboring sensitive laminae.
_Causes._--Injuries to the coronet, such as bruises, overreaching, and
calk wounds, are considered as the common causes of this disease. Still,
cases occur in which there appears to be no existing cause, just as in
the other forms of quittor, and it seems fair to conclude that subhorny
quittor may also be produced by internal causes.
_Symptoms._--At the outset the lameness is always severe, and the
patient often refuses to use the affected foot. Swelling of the coronet
close to the top of the hoof causes the quarter to protrude beyond the
wall. This tumor is extremely sensitive, and the whole foot is hot and
painful. After a few days a small spot in the skin, over the most
elevated part of the tumor, softens and opens or the hoof separates from
the coronary band at the quarter or well back toward the heel. From this
opening, wherever it may be, a thin, watery, often dark, offensive
discharge escapes, at times mixed with blood and always containing a
considerable percentage of pus.
Probing will now disclose a fistulous tract leading to the bottom of the
diseased tissues. If the opening is small, there is a tendency upon the
part of the suppurative process to spread downward; the pus gradually
separates the hoof from the sensitive laminae until the sole is reached,
and even a portion of this may be undermined.
As a rule, the slough in this form of quittor is not deep, and if the
case receives early and proper treatment complications are generally
avoided; but if the case is neglected, and, occasionally, even in spite
of the best treatment, the disease spreads until the tendon in front,
the lateral cartilage, or the coffin bone and joint as well are
involved.
In all cases of subhorny quittor much relief is experienced when the
slough comes away, and rapid recovery is made. If, however, after the
lapse of a few days, the lameness remains and the wound continues to
discharge a thin, unhealthy matter, the probabilities are that the
disease is spreading, and pus collecting in the deeper parts of the
foot. In Zundel's opinion, if the use of the probe now detects a pus
cavity below the opening, a cartilaginous quittor is in the course of
development.
_Treatment._--Hot baths and poultices are to be used until the presence
of pus can be determined, when the tumor is to be opened with a knife or
sharp-pointed iron heated white hot. The hot baths and poultices are now
continued for a few days or until the entire slough has come away and
the discharge is diminished, when dressings recommended in the treatment
for cutaneous quittor are to be used until recovery is completed. In
cases in which the discharge comes from a cleft between the upper border
of the hoof and the coronary band, always pare away the loosened horn,
so that the soft tissues beneath are fully exposed, care being taken not
to injure the healthy parts. This operation permits of a thorough
inspection of the diseased parts, the easy removal of all gangrenous
tissue, and a better application of the necessary remedies and
dressings. The only objection to the operation is that the patient is
prevented from being early returned to work.
When the probe shows that pus has collected under the coffin bone the
sole must be pared through, and, if caries of the bone is present, the
dead parts cut away. After either of these operations the wound is to be
dressed with the oakum balls, saturated in the bichlorid of mercury
solution, as previously directed, and the bandages tightly applied.
Generally the discharge for the first two or three days is so great that
the dressings need to be changed every 24 hours; but when the discharge
diminishes, the dressing may be left on from one to two weeks. Before
the patient is returned to work, a bar shoe should be applied, since the
removed quarter or heel can only be made perfect again by a new growth
from the coronary band.
Tendinous or cartilaginous complications are to be treated as directed
under those headings.
CARTILAGINOUS QUITTOR.