dimensions. That is done by gradually moving the probe along its sides.
Should it be small, it will be sufficient that a hole be made through its
most depending portion with a sharp seton needle. If it be large, the
needle should be armed with a piece of tape knotted at one end. The sac
being punctured, the needle is to be drawn through the opening, the tape
being left in the cavity, and a seton is thus formed. The seton should
be knotted at the other end, and moved its entire length every night and
morning. It will prevent all premature attempts to heal, will stimulate
the soft parts to suppuration, and will remove the dirt, as the tape
affords a guide to the secretion. When inserting a seton into the knee,
always use a large curved needle. The size of the instruments should never
be regulated by any foreign standard, but should always be proportioned to
the magnitude of the patient and the intention of the operator.
Three days subsequent to the full establishment of suppuration, cut off
one of the knots, and, laying hold of the other knot, withdraw the seton.
Its advantages by this time are gained, and its longer stay, by hardening
the opening through which it passed, would occasion lasting blemish.
The reason of its insertion is thus explained. Where foreign matter is
confined, no wound will heal; the orifice may close, but soon after
abscess forms. This process is repeated until the suffering is long
protracted. Danger is generally proportioned to the duration of the evil,
where wounds not of a mortal character are concerned. By the agency of
the seton, the foreign matter is removed and the healing process thereby
considerably expedited. After the above plan, all blemish may be lost by
the expiration of the third month, and the once injured knee restored to
its uses, being as fine as any other part of the body.
Everything being accomplished as it is here directed, no attempt must in
the first instance be made to poke out any particle of dirt which the
probe may touch. The bagging skin being divided by the seton having been
established in the sac, no further thought need, for the present, be given
to a common but most vexatious attendant upon the customary treatment for
broken knees.
The animal should be returned to its usual stall and have the head "racked
up." Some cold water should then be procured, with every quart of which
two ounces of tincture of arnica should be blended. A portion of this
fluid ought, with a clean sponge of moderate size, to be poured into a
saucer; the groom must have strict orders to take the sponge, and, having
saturated it with the fluid, to squeeze it quite dry, allowing the liquor
to run over the injured knee--after the manner previously illustrated,
as washing the wound. Two men are required for this office, which should
be performed every half hour throughout the day and night for half a
week. The injury being thus made continuously wet, the cold produced by
evaporation keeps down inflammation, while the arnica is a potent remedy
for bruises and all kinds of contusions or lacerations.
If at the expiration of the period named no swelling appears, and
suppuration seems to be thoroughly established by means of the seton, the
halter may be released to a great extent, a cradle being merely fixed upon
the horse's neck; the animal will thereby be permitted to lie down and to
enjoy its natural rest.
But should the joint be much enlarged, should the part have become acutely
sensitive, while the horse resolutely refuses to bear any weight upon the
injured limb, then withdraw the seton, give the animal two pots of stout
per day, and all the oats mingled with old beans which it will consume.
Untie the head and place the horse in slings; employ the arnica lotion
night and day, until the slough is thrown off, which, having taken place,
change the liquid application for the solution of chloride of zinc--one
scruple to the pint of water--and continue to employ this last lotion
after precisely the same manner as has been previously directed.
Probabilities, however remote they may seem to be, are here endeavored to
be anticipated; although the author's experience cannot recall a single
case where the arnica lotion has been used with proper assiduity, and
any but the most happy results have followed. When an animal has fallen
violently to the earth, and has been, in the first instance, shown to
the writer with much tumefaction and excessive tenderness, a slough has
in exceptional cases followed; but never has the enlargement or the
sensitiveness increased under the proper use of the arnica lotion. The
slough, moreover, in such instances, has been superficial, only entailing
loss of hair, and never occasioning open joint.
All horses are exposed to these accidents for the reasons already stated.
Whenever such misfortunes occur, employ the arnica lotion. Should the
skin be divided, still use the arnica lotion until copious suppuration
is established. The secretion once seen, resort to the lotion formed of
chloride of zinc and water--one grain to the ounce--which operates most
marvelously upon all suppurating wounds.
No absolute period can be stated which a case of broken knees, when
severe, ought to occupy. The danger, however, is generally passed by the
expiration of a week, and the cure commonly entails loss of services for a
couple of months.
[Illustration:
AN ORGANIZED KNEE, ENSUING AFTER A LONG COURSE OF THE ORDINARY
TREATMENT.
]
[Illustration:
THE APPEARANCE OF THE KNEE SUBSEQUENT TO THE HEALING OF THE WORST
CASE THE AUTHOR EVER HAD UNDER HIS CARE.
]
When adopting the foregoing mode of treatment, no bandages are to be
employed. Such wrappers only augment the heat inherent in every species of
inflammation. They dam up the pus and speedily become foul and offensive
rags; cleanliness is one of the primary requisites toward good surgery.
No caustics of any kind are imperative or even necessary. The two lotions,
if used with proper zeal, will accomplish all that can be desired. The
arnica lotion should, however, be in all cases applied night and day
during the early stage; the chloride of zinc lotion ought to be employed
only during the time man is usually out of bed.
The wound, in ordinary cases, should not be washed or touched. Should
proud flesh start up, such is positive proof of the negligence of the
groom, whose duty it was to apply the chloride of zinc lotion. If the
mode of treatment here laid down be strictly pursued, the author can
with confidence promise a satisfactory and a speedy cure. To enforce the
value of the measures recommended, the portraits of two knees, which were
subjected to the opposite processes, have been presented. Both were copied
from living subjects in the sixth week after the misfortune had occurred.
OPEN SYNOVIAL CAVITIES.
The primary cause of these fearful accidents is the pride of mankind;
gentility is always striving to impose upon credulity. It loves to be
mistaken for something better than it really is. After all, this vice
of society is nothing more than the child's game of "Lords and Ladies,"
played by grown-up persons. A horse having a naturally defective neck is
obtained; no barbarity is too abhorrent to repress the hope of making
people believe the steed thus deformed is a creature of extremest
value. The animal, if ridden, has the chin pulled in close to the neck;
if driven, the free carriage of the body is prevented by the cruel
bearing-rein. The horse progresses in agony, while gentility sits smiling
at the result of its artifice. The horse cannot see the ground before it,
because of the constraint imposed upon the head; it cannot fix attention
upon its duty, because of the agony which the cunning of gentility
inflicts upon the lips. The pace is always rapid; the action is high as in
the case of blindness; and the animal generally comes to the earth with
violence. The skin upon the knees is divided, and the structures beneath
are penetrated. One or more =synovial sheaths= are opened, while the
cavities formed by the junction of the separate bones may be lacerated.
Sheath or joint may not be immediately opened by the fall, but either
may have their integrity destroyed through the slough induced by the
contusion consequent upon a broken knee. Moreover, various accidents will
occasionally happen--misfortune is of infinite variety. The synovial
bursæ, sheaths, or cavities of the hind legs are occasionally punctured by
the quadruped kicking violently while in harness. The capsule, embracing
the tendon of the flexor brachii upon the point of the shoulder, has
been opened by the animal drawing a vehicle being run into; or by the
horse running away and coming in contact with some obstacle. Any synovial
cavity within the body may be penetrated by an unfortunate combination of
circumstances; or by the unbridled passion of the groom, who may have a
pitchfork near at hand. So also they have been cut into by the arrogance
of unskillful operators. However, it matters not how the misfortune may
arise, the mode of treatment and the manner of cure is in all such cases
exactly the same.
Neither, as regards the primary effect, is it of subsequent importance
whether air be admitted into an opened bursa or sac, a synovial sheath, or
the interior of a joint. All of these structures are formed into bladders
or closed cavities. They all contain a similar secretion, which is a
transparent, albuminous fluid, resembling white of egg. They all are of
one use, or all serve to facilitate motion. The bursa is the smallest;
the synovial sheath is the next in magnitude; and joints may be much the
largest. The secondary effects are proportioned to their size, but in the
first instance much constitutional disturbance will attend the opening of
each.
These structures are not formed to endure the presence of atmosphere;
air is admitted a short time after each displays inflammation. This
creates symptoms of irritability, and air will enter before we see the
wound. The secondary effect is, however, most to be dreaded. Bursæ are
small bladders, or closed sacs, distributed over the body, and located
wherever the natural motions possibly might originate friction. Sheaths
always embrace tendons, being essentially closed sacs. The secondary
effects of tendinous sheaths are so much the more to be dreaded than those
attending punctured bursæ, because the last generally lie loosely between
highly-organized parts; whereas a sheath is partly fixed upon a tendon,
and tendon, being lowly organized, is more difficult to cure when it is
diseased. However, joints are much worse than the preceding two; because
in these the synovial membrane is partly spread over the cartilage, which
lies upon the articular surfaces of bones. Now, cartilage is the most
lowly organized substance in the entire body. When disease fixes upon
it the morbid condition is so slow, so irritating, and so difficult to
eradicate, that science almost despairs of the issue.
The results indicated show that every effort should be made to ward off
the secondary effect. Therefore, when an accident of this nature occurs,
proceed with the utmost gentleness. Having procured a large sponge and a
pail of milk-warm water, saturate the sponge and squeeze it dry, above the
injury. Do not touch the sore, but allow the fluid, as it gravitates, to
wash off all or any foreign matter. With regard to the wound, dirt seldom
enters that. When it does, the suppuration which must ensue upon the
accident will more effectually remove it than could hogsheads of water,
however unfeelingly it might be employed.
The part having been rendered clean, the wound is to be attentively
observed. When nothing but blood or serum, or thin, discolored fluid can
be seen, this argues the more important structures are entire. Should
there be among, and yet distinct from, those discharges, a transparent,
glairy liquid flowing forth, such is absolute proof some synovial
membrane has been severed. The size of the current and the abundance of
the secretion are also evidences not to be despised. Probabilities may
be inferred from these circumstances. If the amount of the synovia be
small, there is hope that a bursa only has been interfered with; when the
amount is large, it demonstrates that either a sheath is punctured or the
joint itself may have been opened. Synovial cavities between bones may be
larger, and are much more active than the sheaths of tendons; therefore
the magnitude of the current should be observed; although, when the
integrity of many parts has been destroyed, little absolute dependence
will be placed upon the comparative quantity of the synovial secretion.
[Illustration: No. 1.
THE TENDONS WHICH CROSS THE OUTSIDE OF THE KNEE-JOINT.
Explanation of No 1.
1. The extensor metacarpi tendon.
2. The extensor metacarpi obliquus tendon.
3. The extensor pedis tendon.
4, 5, 7. Connecting and restraining bands between the tendons.
6. The extensor suffraginis tendon.
8. The flexor metacarpi externus tendon.
9. The back sinews.
]
[Illustration: No. 2.
THE TENDONS WHICH CROSS THE INSIDE OF THE KNEE-JOINT.
Explanation of No. 2.
1. The extensor metacarpi tendon.
2. The extensor metacarpi obliquus tendon.
3. The flexor metacarpi internus tendon.
4. The back sinews.
The letter _a_ denotes the only spot where the knee-joint could
probably be opened by a fall without lacerating a synovial sheath or
injuring a tendon.
]
Anatomy is, under the circumstances, a fair guide. Where numerous
structures are involved, a well-grounded learning is requisite for
accurate judgment; but as regards the knee of the horse, the spot whence
the synovial discharge issues is of all importance. The incision must
either be very deep and gaping, (all subjacent structures being divided
before the knee-joint can be exposed,) or else the wound must affect a
very circumscribed place. The reader, by consulting the above anatomical
engravings of the horse's knee, will remark how closely it is laced about
with tendon. Each of the tendons, when crossing the joint, is embraced
in a synovial sheath. From such information, it will instantly be seen
how far more likely a sheath is to be lacerated than the joint is to be
punctured.
The single point where the joint could be entered without severing tendon,
lies rather on one side than directly in the center. The vulnerable spot
is therefore not exposed to the full force of the blow. To lay bare the
joint by an ordinary fall several parts must be divided. Rarely is an
accident witnessed of so fearful an extent. Generally that which is spoken
of as open joint proves to be no more than punctured sheath, the presence
of synovia being commonly accepted as the proof. But when the joint is
really laid open, the immense flow of synovia--so many sheaths being
severed--should at once prove the fact.
[Illustration: PROBING BROKEN KNEE.]
The probe must next be used. In the first instance it should be employed
to ascertain whether the fall has left any purse or sac at the inferior
part of the joint. All which was enforced respecting the use of metallic
wire to a raw wound must here be observed. The probe had better be
altogether discarded than employed with the smallest approach to rudeness.
[Illustration:
THE MANNER OF OPENING THE DIRT SAC, IN CASE ONE SHOULD BE PRESENT
WITH OPEN JOINT.
]
The suspected sac having been discovered, a large spatula is placed below
the knee. A knife with a keen point, but with the edge only sharpened for
one-third of its length, is to be used. Upon the cutting point of the
knife a piece of beeswax is firmly moulded. The wax answers the purpose of
a temporary probe; the blade, thus guarded, is cautiously inserted beneath
the loose flap of skin. When the bottom of the pouch is reached, a certain
amount of resistance will be encountered; through this the knife is
driven. The force cuts in twain the wax, and pushes through the integument
the blade, which the spatula guides from the leg. This operation should be
performed quickly; the hand should simply be carried downward, and then
brought upward when all is concluded; care, however, being taken that
the withdrawal of the knife does not injure any part save those it was
designed to cut.
Should the horse be nervous, it is desirable to blindfold the animal and
order the groom to hold up the sound leg; the creature can then only
rear. When thus disabled, that movement is rendered difficult, and it
is proportionably slow. The operation, if properly performed, should be
over before action can be prepared for; and by the knife a considerable
incision is made in the bottom of the sac, through which all grit or dirt
can, with the pus, readily pass.
The examination concludes with a second resort to the probe. The
instrument is in surgery of great use; but as it is commonly employed,
reason may doubt whether injured life has been much benefited by its
invention. It generally is raked and poked about as though the person
holding it was determined, at all hazards, to ascertain the length,
breadth, and every irregularity of the wound he is asked to cure; much
harm is thereby done. Delicate attachments which, if not interfered
with, might induce speedy reunion, are thus broken down, and the injury
aggravated; while the operator thinks he ought to know all about the
lesion he is to treat, and supposes that he can possibly do no harm with
an instrument which the best schools order to be employed.
A good surgeon has no curiosity to gratify; all he desires to know is so
much as will enable him to benefit the patient placed under his care.
Therefore never abuse the probe in cases of open synovial cavities.
Imagine the distance the bones are from the surface; and, if the probe can
enter a very little beyond that distance, such a fact demonstrates the
cavity to be exposed. When a horse is before you with synovia running from
a wound upon the knee, have the leg slightly flexed; look for the most
free space, and into that insert the probe. The bones of the knee-joint
are directly under the skin; and, when no opposition is encountered for
three-quarters of an inch, be sure the joint is exposed.
[Illustration: PROBING AN OPEN JOINT.]
Most of the cases narrated as opened joints were simply punctures into
synovial sheaths; as such, they were sufficiently serious, but not of so
important a character as is assumed for them. Synovia is placed between
the ends of bones, its use being to prevent the friction which otherwise
would be occasioned by the movement of one hard body upon another. Being
confined in a circumscribed sac and incapable of much compression,
the liquid performs all the uses which could appertain to the most
solid substance. When the fluid--which, from its thick appearance and
unctuous feel, was formerly termed "joint oil"--has escaped, the bones
grate against each other, inflammation ensues, all neighboring parts
sympathize, and the constitution suffers from intense irritation.
[Illustration:
THE INJURED LEG, HARD, HOT, TENSE, AND SWOLLEN--ALL RESULTING FROM
THE INJUDICIOUS EMPLOYMENT OF BANDAGES.
]
Something of this kind happens when a synovial sheath is punctured.
The tendon comes in contact with its investing synovial membrane; but
there are reasons why that circumstance is not so serious as when the
lubricating fluid is released from the cavity of a joint. Tendons support
no weight, and their motion is, with the sick, almost optional. The
bones are the pillars on which the body rests; even while the frame is
prostrated, a certain degree of pressure is upon them; for that reason,
and also because tendon is more highly organized than cartilage, the
first-mentioned substance is endowed with the greater renovating energy.
An open joint is consequently far more serious than a punctured sheath.
Notwithstanding the serious nature of these accidents when wrongly
treated, few injuries yield more kindly to proper measures than open
joint. However, should the ordinary treatment of caustics and bandages be
adopted, the entire limb, before the expiration of a week, will be hot,
hard, and tense. The health of the animal will be seriously affected by
the continued irritation, and the body will rapidly become emaciated. The
foot of the limb will with evident difficulty be held from the ground.
Should not death interpose--the animal being unable to lie down, and
the entire weight being cast upon the sound limb--the foot attached to
the healthy member frequently becomes affected with the worst form of
incurable laminitis.
[Illustration:
OSSEOUS STRUCTURE HAS BEEN THROWN OUT, CAUSING ENLARGED KNEE AND
PERMANENT BLEMISH--THE RESULTS OF USING BANDAGES.
]
[Illustration:
EXTENSIVE LOSS OF HAIR, GENERAL ENLARGEMENT OF THE KNEE, AND
ORGANIZED THICKENING OF THE SCAR--RESULTING FROM THE USE OF
BANDAGES.
]
Even should such a misfortune as laminitis not occur, the after-deformity
and blemish renders the horse almost worthless. The bones sympathize in
the general disease, and a large osseous deposit is engendered to mark
the surgical inaptitude. When bony growth does not follow, the parts
lying immediately over the knee thicken; the skin sloughs, and, the
integument never being restored, a full knee with a lasting blemish is the
consequence.
OPEN SYNOVIAL JOINTS.
The more favorable terminations are never to be anticipated when the
barbarity of bandages and the cruelty of caustics are sanctioned. The
horse which recovers from such treatment is, by an enlarged and blemished
limb, rendered an object painful to contemplate, and is entirely unsuited
to any gentleman's uses, while the life of the creature is rendered
burdensome. There is nothing in the proper treatment which a child might
not safely apply. The measures create no pain and require no force; they
rather soothe than irritate, and therefore are always submitted to with
complacency.
[Illustration:
OPEN JOINT ENSUING UPON BROKEN KNEE, AND SOLELY CAUSED BY THE ABUSE
OF BANDAGES.
]
[Illustration:
THE GENERAL APPEARANCE OF AN OPEN JOINT WHEN FIRST SUBMITTED TO THE
NOTICE OF THE SURGEON.
]
The animal, when first brought in, never displays symptoms indicating
the full extent of its injury. The part which has been wounded generally
presents something like the aspect represented in the engraving on the
right. Commonly there is an evident flow of synovia, but the most careful
examination can seldom detect positive evidence of an open joint.
The full extent of the evil cannot be known before the slough takes place.
This is certain to follow upon the customary bleeding, physicking, low
diet, bandages, and caustics being employed. As recovery is wished for,
all such aggravations must be rejected. Proceed, in the first instance, as
has been directed for broken knee; and these things being done, give the
following drink:--
Sulphuric ether One ounce.
Laudanum One ounce.
Water Half a pint.
Give this without noise or violence.
Treat the frightened animal with even more gentleness and patience than
would be bestowed upon a sick child. A harsh word may now, when the
system is shaken and every nerve unstrung, do that harm which no medicine
can repair.
Having given the drink, look at the animal and take the pulse. Should the
appearance denote inward comfort, should the pulse be natural, give no
more drinks; but if the eye is in constant motion, if the horse breathe
hard and start at sounds, if the head is held high and the ears are
active, repeat the ethereal draught, and continue repeating it every hour
until the foregoing symptoms abate.
The object of the medicine being gained, have the horse quietly led into
a stall; the stall it has been used to is the best, and the favorite
neighbor need not be removed. But all other quadrupeds which might disturb
the sick animal should be taken out of the building. A good, clean bed
should be shaken down, and the diet must be suited to the symptoms. If the
pulse is at all low, no hay should be allowed till it amends; should the
arterial beat denote oppression, a rather large proportion of beans may be
blended with the oats. If the breathing is short, the countenance unhappy,
and the eye sleepy, while a very quick and feeble pulse only is to be
detected, give four of the ethereal drinks in the twenty-four hours. Also
allow two quarts of stout daily.
All horses should be accustomed to drink beer; with very little teaching
they abandon their teetotal habits, and will by very expressive action
signify delight at the sight of a pewter pot. The best means of
introducing the beverage to their notice is, in the first instance, to
break a penny loaf into pieces, to soak the pieces in the beverage,
and then to offer them, one by one, from the hand of the master or the
favorite attendant. Animals quickly learn to recognize their owners. The
dog will bestow such a welcome upon its proprietor as is never lavished
upon any stranger. The horse also learns to recognize the individual whose
property it has become. See the animal which has carried the groom without
excitement to the door, and which has walked before the house with pendant
head and listless ears: the moment the door opens and the master appears,
all dejection is cast off; the creature cannot stand still when the foot
is in the stirrup; and, immediately the weight is felt upon the back, the
happy quadruped prances gayly off, often at the risk of unseating him who
has provoked this demonstration of excessive pleasure.
The master who is unknown has earned his fate by his neglect, and probably
may live to repent his inattention to the duties which Providence has
intrusted to his charge. The affections of the meanest creature that
breathes are blessings which the highest and the proudest may well stoop
to gain. The love of a horse is not to be despised; the noble quadruped is
easier controlled by its uncultivated impulses than by all the restraints
which brutes have invented or fools have adopted. It should enter into the
considerations of every life assurance company, whether the man who takes
out a policy is of a nature likely to be loved by the animals which he
possesses.
Beer is everywhere procurable, and it is not to be altogether contemned
as a medicinal stimulant. Many a horse which is now lost upon every hard
field-day would have been saved if the animal had been pulled up at the
nearest public house to be presented with a slice of bread and a pint of
beer. Such nourishment would not load the stomach; but it would serve to
keep off that utter exhaustion from which too many steeds fail.
[Illustration: THE MANNER IN WHICH LOTION SHOULD BE APPLIED TO AN OPEN
JOINT.]
The animal being in its stall, then apply the lotion, composed of tincture
of arnica, two ounces; water, one quart. Use this by means of a sponge and
saucer. Pour some of the liquor into the receptacle. Saturate the sponge
and squeeze the fluid upon the leg, but above the injured knee. Do this
after the manner which is illustrated as the proper mode of washing the
wounded part.
Continue with the arnica lotion, night and day, for half a week. No
periods can be named for applying the sponge, as inflammations, and
therefore the drying powers, vary in different individuals; but the knee
should be always wet. This should be attended to for the first three days
and a half, during which the halter should be tied to the rack. At the end
of that time turn the horse very gently round. Remember the condition of
the limb, and allow time for the performance of an action which is always
an effort to the most agile of the equine species, as few stalls are a
single inch too wide.
The animal being with its face to the gangway, and fastened by the
pillar-reins, place the slings before it. Leave the creature to
contemplate the apparatus for half an hour. Then take the cloth and hold
it up to the inspection of the quadruped. Afterward place it between the
fore and hind legs--pausing and speaking kindly should alarm be displayed.
Thus by degrees fix it to the pulleys and bring it near to the abdomen,
which, however, should by no means be touched. Then caress the creature's
head, and present some of its favorite food: eating generally tranquilizes
the mind of an animal. So much being done, proceed to fix the straps upon
the chest and withers. Then fondle the sufferer again, and it will permit
the hind tackle to be arranged.
When all is fixed, leave a pail of water suspended from one pillar,
and put an elevated trough, charged with favorite provender, in front
of the horse. Let it be watched till a week from the date of the injury
has expired, and never left during that period even for an instant. If
any restlessness is exhibited, the attendant should approach and caress
the creature. Quadrupeds--though none comprehend the precise meaning of
the language--love to be praised. The hand, fondly applied to the skin,
and the human voice, modulated by kindness, seem to convey a purport to
animals which they will suffer pain to deserve. The writer lately had a
favorite dog, whose aversion was dry bread. It would hold the detested
morsel in its mouth for hours, looking most uncomfortable, but making no
attempt at mastication. Yet, upon praise being lavished, the eye would
brighten, and, rather than prove unworthy of so much commendation, the
hardest and stalest crust would be chewed and swallowed.
[Illustration: A HORSE IN SLINGS FOR OPEN JOINT.]
Watching is necessary, because many horses when thus imprisoned, being
left alone, grow terrified and injure themselves by struggling their
bodies out of the slings. The presence of any human being assures the
timidity and checks the active imagination of a solitary animal. The
author well knows that the learning of the present time denies imagination
to animals. Shying, is only the creature imagining something which is not
actually before it. What are dreams but positive evidences of imagination?
All people have heard the suppressed bark and seen the excited limbs
of the dog as it slept upon the hearth rug. How many grooms have been
surprised, upon their earliest visit, to see the stable knocked to pieces
and the horse prostrated amid the ruin it has created! How is this to
be explained if imagination be not present in the animal? This is the
author's interpretation of the mystery. Dreams are active, in proportion
to the immaturity of the reason. Children often wake up in tears, and
continue screaming in terror for long periods if unattended to. The horse
starts out of a fearful vision; darkness is about it; the fear augments;
the animal begins kicking; the sound made by its own feet increases the
creature's alarm; it lashes out frequently until it has pounded part of
its dwelling into atoms and disabled itself to that degree which makes the
highest punishment the greatest mercy.
A high trough is required to guard against the effects of that itching
which attends the healing process, and provokes the animal to strike its
knees. This it would do against the manger were its head in the customary
position. Were a wall before it, the knees might still be laid open; but
with a high trough nothing is within the reach of its injured joint. Even
supposing one of the slender supports, by the cunning of excitement,
to be struck, the substance should be too light to offer any dangerous
resistance, the blow being far more likely to overturn the machine than to
lacerate the limb.
When the quadruped has remained sufficient time in the slings to have
become familiar with them, pull up the cloth so that it may slightly
touch but not press against the belly. Then well secure it, and leave the
animal to rest its wearied limbs, or not, as it pleases. Its suffering
joints will soon teach the horse to bear the entire weight upon such a
support, and to sleep comfortably in the contrivance. With a few, and only
a few examples, living in slings has induced such confirmed constipation
as necessitated a daily resort to bran mashes. Most horses, however,
speedily accept and grow fat, enjoying the relief thus afforded. Only one
caution need be given--look well to the tackle. The horse is very heavy,
and should a single fastening prove insecure, the result might convert a
healing wound into a hopeless injury.
[Illustration:
THE ALBUMINOUS BALL, WHICH FORMS IN SHAPE OF AN OPEN JOINT WHEN
TREATED WITH A SOLUTION OF CHLORIDE OF ZINC.
]
With the employment of slings, change the lotion for one composed of
chloride of zinc, one scruple; water, one pint; this need be applied only
during the day. It is too weak to occasion pain, and should be used with
the saucer and sponge, after the manner of washing a broken knee or open
joint, which has been previously illustrated. The strength, nevertheless,
is sufficient to coagulate the albumen of the synovia. Thus it forms a
species of natural bandage which excludes the air, while at the same time
it stimulates the flesh and causes that to heal under the protection of
its own albuminous secretion.
The coagulated albumen frequently accumulates in front of the knee. The
author has seen it attached to the part quite of the size and very near
to the form of the largest apple. It must on no account be touched,
however large it may grow or however insecure it may appear. Respect
it, and it will fall off when its service is accomplished. The cure is
nearly completed when the white ball falls. Shortly after the wounds being
closed, and pressure made with the fingers--not with the thumb--can be
endured, the slings may be removed; though the healing should be further
confirmed before the horse is allowed to stand opposite to any substance
against which it may strike what recently has been a fearful open joint.
WOUNDS.
To this species of injury the horse is much exposed from the recklessness
or incompetence of those who assume to hold the reins of authority.
Occurrences which are politely termed "accidents," generally entail
suffering upon the blameless animal. The common provocatives of such
_accidents_ are either the drunkenness of man or his utter ignorance
of the mental attributes of the quadruped he has possession of. The
first cause shall be passed over in disgust; the second merits some
consideration, being rather a universal than an individual fault.
When a horse pauses, always endeavor to ascertain the motive; the reason
may be groundless. By gentleness, convince the creature that its fears are
without foundation, and you earn a supremacy as well as win a gratitude
which will always be cheerfully acknowledged. Never employ the whip
to correct "the obstinacy of the brute." The horse is naturally very
fearful; were it not so, man would never have obtained that mastery which
is imperative for domestication. Elderly gentlemen should never thrust
their heads out of carriage windows and shout to the driver to "go on."
Such implied chiding may urge the coachman to display severity, and the
horse is dangerous when alarmed. So long as the animal continues calm,
the superiority of man is submitted to; but once excite the terror of the
quadruped, and all earthly restraint is powerless. Dread assumes the form
of the wildest fury, and the horse tears onward, insensible to mortal
punishment and blind to every danger.
It is in this manner the most terrible wounds are produced. Such injuries,
in surgical language, are defined to be "solutions of continuity," or
"separations of the skin and soft parts underneath." Neither of these
definitions, however, includes a bruise or a contused wound. Therefore,
for the present purpose, a =wound= will be interpreted an injury inflicted
by external violence.
A =lacerated wound= may be too trivial to attract the surgeon's notice,
as a scratch. It may also be a very serious affair, as when a cart-wheel
runs against a horse's thigh, tearing the flesh asunder. Laceration is
generally accompanied by contusion, though contusion forms no necessary
part of a lacerated wound. When such injuries are inflicted, they are
mostly followed by little hemorrhage; yet it is far from unusual for an
animal thus hurt to perish. Shock to the system is the most serious of
the primary effects. Beyond that the immediate consequence appears to be
insignificant. Little blood is lost, for the vessels are stimulated by
the violence which rends these tubes and the soft structures asunder.
Stimulation causes the torn mouths of the arteries and veins to close
or to retract. The ragged coats of the vessels, the loose fibers of the
flesh, and the jagged cellular tissue likewise fall over the orifices, and
help to stay the flow of the vital current.
[Illustration: DIAGRAM OF A SEVERE LACERATED WOUND.]
The dangers attending lacerated wounds spring, in the first instance, from
collapse. This possibility being overcome, the immediate peril has been
surmounted; all injuries of this nature are commonly attended, however,
with more or less contusion. The force necessary to tear open a portion of
the body will, of necessity, bruise or kill some part of the flesh. Any
animal substance, when deprived of vitality, must be cast off by a living
body; a slough must follow. Now that process is attended with hazard in
proportion as it is tardily accomplished. The period of its occurrence is
always one of anxiety; for when this process takes place, the stimulation
that originally caused the vessels to retract no longer exists. All
mechanical opposition to hemorrhage is, with the loss of the dead matter,
generally removed. Everything, therefore, depends upon the fibrinous
deposit--a sort of glutinous material secreted by the body, which is
commonly largely poured forth when any slough by natural and speedy action
is effected. Should the frame be so far debilitated as to prevent all
secretion of fibrin, the most frightful bleeding must ensue.
The horse which has not recovered from the original injury will then sink
under the terrible depletion. Therefore, it is impossible to form any
opinion of the injurious effects or of the consequences likely to follow a
lacerated wound before some time has elapsed.
An =incised wound= implies a division, more or less deep, of the soft
parts. This form of injury produces less shock to the system, and
generally heals more quickly than any other. The principal danger is
encountered at the moment when the wound is inflicted; vessels may be
sundered, and they are cut in twain with the least possible irritation
to the parts within which they are situated. The veins and arteries,
therefore, do not generally retract any more than do the soft structures.
A gash into a fleshy substance always produces a gaping wound, which is
wide in proportion to the depth and length of the injury. From that hurt
the dark-colored venous blood drains in a stream, while the bright scarlet
or arterial blood is propelled forth in jets, sometimes to a considerable
distance. These jets correspond with the pulsations of the heart; but as
syncope or fainting takes place, the emission ceases with the beating of
the circulatory center.
[Illustration: DIAGRAM OF AN INCISED WOUND.]
The danger consequent upon an incised wound is ever measured by the extent
of the hemorrhage. When large arteries are divided, that fact is easily
told by the size and the force of the jets sent forth. A strong horse
may, from that cause, be dead in ten minutes. To enforce the difference
between a lacerated and an incised wound, the reader is reminded of those
painful cases, frequently recorded in the newspapers, where a limb is by
machinery torn from a poor man's body, and scarcely a drop of blood marks
the deprivation; also of death by severing a throat, when sensation ceases
ere the stream has flowed forth. The last is an incised, the first is a
lacerated wound.
[Illustration: DIAGRAM OF AN ABRADED WOUND.]
An =abraded wound=, in its mildest form, is simply a graze. The reader
will, however, remember how acutely painful such accidents always are. The
horse's sufferings are not highly estimated by the generality of people;
nevertheless, an injury of this description is not to be despised, even
when witnessed on the animal. A broken knee, as it generally is exhibited,
is nothing more than an abrasion. An abraded wound may simply mean that
the insensible outer covering of the skin has been injured; it may also
imply that the soft structures beneath have been sundered. Wounds of
this kind are not free from danger when of magnitude. Little blood may
flow, but the cutis is the most sensitive structure of the entire body. A
needle's point cannot enter any part of the skin without sensation warning
the person of a puncture. In human operations, division of the skin, or
separation of the cutis, is known to constitute the major portion of the
patient's agony.
The suffering attendant on the latter class of injuries is increased by
almost every abrasion forcing grit or dirt into the substance of the
cutis. This, of course, is generally washed out. The torture accompanying
a large abraded surface is, therefore, very great; and horses when
suffering from accidents of such a nature sometimes sink from the
irritation consequent upon the injury. When the animals survive, the roots
of the hair too often have been destroyed, and a perpetual blemish is the
result.
[Illustration: DIAGRAM OF A PUNCTURED WOUND.
The engraving supposes the soft parts to have been divided, in order
to show the ragged nature and large extent of the injury, with
the comparatively small opening by which this amount of harm is
characterized.
]
A =punctured wound= is always dangerous; the hazard in this, as in every
species of injury, is greatly increased when inflicted on parts liable to
any vast amount of motion. Thus, punctures occurring over the stifle-joint
too often set our best surgery at defiance. The muscles of the hind leg
contract with every movement of the body. Added to that, the part abounds
with fascia.
The majority of these wounds heal by suppuration. Fascia is a substance
no pus can penetrate, and which is more easily rent than punctured. The
exit of the secretion, therefore, is opposed in many directions, while the
ceaseless motion occasions the matter to burrow. The sinuses thus produced
are by the fascia guided to the stifle-joint; and, when once the synovial
cavity is polluted by the intrusion of the unhealthy pus, all the best
efforts of science are useless.
When a punctured wound occurs, the skin, being elastic, stretches before
the instrument by which the wound is inflicted. The soft parts beneath the
skin, not being elastic to the same degree as the integument, break down
before the penetrating force. They are torn or lacerated; for generally
the muscles receive a larger injury than would be calculated from the size
of the instrument by which the blow was inflicted. The rent flesh must be
cast off by a slough--corruption generally attends that process. Much of
the pus secreted cannot find an exit through the opening in the skin; a
large portion of it is confined within the puncture. There it decays, and,
being impelled by the motion of the limb, readily finds its way in all
directions save the upward one.
No judgment approaching to accuracy can be formed at the first sight of
a punctured wound. The probe may ascertain the depth of the injury, but
it cannot tell the extent of damage done to the interior of the body.
Therefore, whether the hoof is pierced by a nail, or the muscles are
lacerated by the shaft of a cart--be the instrument large or small--the
consequences likely to follow upon the injury cannot be foretold.
[Illustration: DIAGRAM OF A CONTUSED WOUND.]
A =contusion=, in its mildest form, is simply a bruise. Injuries of this
class, when of magnitude, are very deceptive; the surface is unstained
by blood, and there is no flesh exposed. For these reasons the ignorant
are apt to disregard such accidents, and to express surprise when they
terminate otherwise than kindly. When a bruise happens, blood is effused
in smaller or larger quantities according to the extent of the injury. A
small quantity of effused blood, sufficient to discolor the human skin,
may be absorbed; but when the amount is large, the powers of nature are
defied. The blood thrown out, not being taken up again, congeals, and
ultimately corrupts. Then an abscess or a slough is necessitated; both are
attended with danger: the first may be deep seated or superficial; either
form is attended by much weakness. That generates considerable irritation,
and may even be the cause of fatal hemorrhage; or it may lead to sinuses,
the direction, the number, or extent of which, when they do occur, is not
to be predicated. A bruise is, consequently, not to be judged of hastily.
The amount of pain which it provokes is even unworthy dependence, as the
injury may have hurt the bone or the tendon; and then, though the accident
is rendered very serious, in the first instance no sign of agony announces
the extent of the evil.
With regard to treatment, when a =lacerated wound= occurs, the first
attention should be paid to the system, which has always been much shaken.
Give, therefore, the drink composed of one ounce each of laudanum and
sulphuric ether, with half a pint of water; repeat it every quarter of
an hour till the shivering natural to the horse on these occasions has
disappeared, and the pulse has recovered its healthy tone.
Avoid all poultices of the ordinary kind; one composed of one-fourth yeast
and three-fourths of any coarse grain, excepting bran, may be applied. So
also may a lotion thus composed:--
_Lotion for Lacerated Wounds._
Tincture of cantharides One ounce.
Chloride of zinc Two drachms.
Water Three pints.
Mix. Keep a rag constantly wet over the part.
Either will stimulate the parts, and probably prevent any tendency to
unhealthy action. The yeast poultice produces this effect by giving off
carbonic acid; the lotion accomplishes this intention by both its active
ingredients. Each is stimulating, also disinfectant, and will counteract
any filthy odor which may attend the sloughing process; but the lotion is
perhaps to be preferred, as it is more easily applied. When the slough
has taken place, should hemorrhage ensue, dash upon the part jug after
jug of the coldest water; or, should no very cold water be at hand, drive
upon the mouths of the vessels a current of wind from the nozzle of the
bellows. Continue to do this till the bleeding ceases, or until a surgeon
can be obtained to take up the arteries.
The after-treatment is simple: apply frequently the solution of chloride
of zinc, one grain to an ounce of water; that lotion will cleanse the
wound and prevent unpleasant smells.
As respects feeding, this must be regulated by the character of the pulse.
Should the beat of the artery be quick and feeble, no hay should be given;
good, thick gruel should constitute the only drink excepting in extreme
cases, when two pots of porter may be allowed each day. Good oats and old
beans, both crushed and scalded, should then constitute the food, and the
utmost gentleness should be exercised toward the animal.
Should the pulse be natural, allow three feeds of oats each day, as, in
every kind of injury to the horse, more danger is to be apprehended from
debility than from any excess of energy.
=Incised wounds.=--When these happen, always dash the part with plenty
of cold water or blow upon them with the bellows. Place the horse in the
nearest shed; motion promotes hemorrhage, therefore a walk is not to be
hazarded. The bleeding being arrested--for, in severe accidents of this
kind, there is no time to send for assistance--let the animal remain
perfectly quiet until the exposed surface has become almost dry, but on
being touched by the finger feels sticky. Then draw the edges together,
and keep them in that position by means of sutures.
[Illustration:
FIXED SUTURE NEEDLE: VERY USEFUL FOR INCISED WOUNDS OF NO GREAT
DEPTH.
]
The best means of inserting these sutures is with a curved needle fixed
into a handle. The handle is wanted to obtain the necessary power, and the
needle's point should be sharp to penetrate the hide of the horse, which
in places is of considerable thickness. The needle is thrust through the
integument about one inch and a half from one margin of the incision; it
is brought out about the same distance within the divided soft parts. It
enters the opposite side of the sundered flesh even with the place whence
it came forth, and afterward it appears through the skin about equally
distant from the opposite edge of the wound. There is a hole near the
point of the needle; through this opening a piece of strong twine or
narrow tape is threaded; when, the instrument being withdrawn, the twine
or tape is pulled into the puncture which has been made. The needle is
then released, the suture being left in.
[Illustration: THE MANNER OF USING THE FIXED SETON NEEDLE.
A second person pushes the wound together, and, when the point of
the needle appears, threads it with a piece of zinc wire or soft
string. The needle is then retracted, and released from the wire or
string, whereby a suture is left in the wound.
]
So many sutures as may be necessary are thus inserted--in small wounds,
these being about two inches asunder, but in larger injuries, three inches
apart. All are duly placed before any are tied; the whole being ready,
the wound is forced together by an assistant, while the strings are
fastened--care being exercised not to bring any of them actually tight,
lest the motion of the body or the swelling of the part should drag the
sutures through the flesh and thereby tear them out.
[Illustration: DIAGRAM OF SUTURES WHEN TIED AND LEFT IN A WOUND.]
A wound thus united may possibly heal by first intention, or the divided
parts, when brought together, may join, and give no further trouble to the
surgical attendant.
Union by first intention is, however, somewhat rare in the horse; and
should not that take place, suppuration will be established. So soon as
the pus flows freely forth, and the sutures appear to tighten or drag, cut
them out by snipping the twine; but allow the strings to loosen before you
attempt their withdrawal.
If this is not done, the sutures will speedily find an exit for themselves
by causing the flesh against which the tension acts to be absorbed; thus
the original injury will be rendered more complicated, and the ultimate
blemish must be altogether greater.
All that is required after the establishment of suppuration is to bathe
the part with the solution of chloride of zinc, one grain to the ounce
of water. This lotion will suppress any fetor, and gently stimulate the
healing process, as well as prevent the sprouting of fungoid granulations;
it is necessary also to attend strictly to the directions laid down for
feeding during the curing of wounds.
[Illustration: TWO KINDS OF SUTURES RARELY EMPLOYED UPON THE HORSE.
No. 1. The continuous suture, which is employed for sewing up
portions of bowel when the intestines are injured and exposed.
No. 2. The deep suture or the quill suture. In the horse pieces
of wood are substituted for quills. The wood is notched in the
center; and upon the indentations the sutures are fixed, to prevent
the movements of the animal from displacing them. It is sometimes
employed to bring the sides of deep and gaping wounds closer
together.
]
The treatment of an =abraded wound= chiefly consists in cleansing the
surface with plenty of cold water, which should be allowed by its own
weight to wash off any loose particles of dirt. No cloth or other aid
should be employed to scrub the living flesh as though it were an
insensitive board. The matter which cannot be removed by simply sluicing,
had better remain to be expelled by the secretion of pus. The horse,
especially when terrified, endures pain very badly; indeed, the animal is
so timid and so delicately framed that it is always good surgery to spare
all unnecessary suffering.
Support the body with laudanum and ether drinks, one ounce of each to the
pint of water, as often as they may be needed. Let the food be generous,
unless fever should arise, when the directions already given must be
attended to.
=Punctured wounds= require only one kind of treatment, whether a nail be
driven into the flesh of the foot, or the shaft of a cart be forced into
the substance of the thigh. Here the knife must be employed; and, unless
the animal shows evident symptoms of excessive weakness, it is better,
perhaps, to operate while the parts are partially numbed by the shock,
than to wait until a morbid sensibility is provoked. Always enlarge the
opening; do this in the foot by cutting away the horn of the sole around
the small puncture left by the nail. When the soft parts are penetrated,
probe the wound first; then, if possible, insert a knife to the bottom of
the puncture, and, with the edge downward, draw it forth. By this means a
wound resembling a subverted =<= will be instituted. It will be narrowest
toward the extremity, and widest at the mouth. A free opening affords
a ready egress for all sloughs and pus. It materially aids the healing
process, and effectually prevents the establishment of sinuses; while
the clean incision left by the knife is of small import, when taken into
consideration with the other consequences of a punctured wound.
Support the animal if necessary, or regulate the food by the symptoms.
A =contused wound=, when slight, may be rubbed with the iodide of lead
ointment, one drachm of the active agent to the ounce of lard; when all
enlargement will sometimes subside, and the effused blood may be absorbed.
However, the horse commonly receives injuries of magnitude. In the last
case, take a sharp knife and draw it along the entire length of the
swelling. Make a long gash, only through the integument, at every eighth
inch, and be careful to carry the knife through the integument, or to the
lowest portion of the detached skin. Any sac that may be left is certain
to retain corruption, and may produce fearful after-consequences. The
attendant measures consist in bathing the contusion with a lotion composed
of chloride of zinc, one grain, water, one ounce, and diminishing the food
or supporting the body as nature demands such treatment.
The after-treatment of all injuries consists in keeping any external
orifices open till all sloughs and pus have disappeared. In surgery, a
large and depending opening, by means of which the interior may drain, is
always to be preserved, and the knife, to this end, may be employed so
often as the healing process threatens to prematurely close the wound.
Formerly it was the practice to bleed after every injury; this was done
to prevent fever. However, observation has shown that the vital powers
are more often weakened than increased by the shock attendant on severe
accidents. Whenever the contrary happens, it is far better to lower the
pulse by repeated doses of aconite, than to abstract that which will
subsequently be necessary to repair injury.
It was also once the custom to fill wounds with tents or lumps of tow, and
to bandage every injured part. These habits only served to confine that
which nature was striving to cast out. They consequently did much harm,
and are now happily discarded.
A piece of loose rag, saturated in the oil or the solution of tar, should,
during summer, be suspended over the mouth of every wound, to keep off the
flies. The only tent which the author approves of is when an incised wound
happens where assistance is far away, and difficult to procure. Then, to
arrest the hemorrhage, let the horse rug, a man's coat, or anything else
be violently thrust into the gash, and forcibly held there until proper
assistance can be obtained.
Such is the present method of treating wounds; this to the reader may
appear very cruel; but could he have walked through and have inhaled the
atmosphere of the wards in hospitals appropriated to such injuries as they
existed in former times, he would thoroughly understand that apparent want
of feeling is, in reality, the height of charity.
[Illustration: A BANDAGE DESIGNED FOR WOUNDS ON THE TRUNK OF THE HORSE.]
To conclude this part, the author lays before his readers the following
bandage, intended to meet an inconvenience hitherto experienced when a
horse has the walls of the abdomen punctured. The constant motion of the
part renders ordinary sutures of no avail, and for that reason bandages,
unless so tight as to check circulation, are of little use. The annexed
is made like a broad belt, and is buckled round the body. The bars are
composed of vulcanized India-rubber; they will yield to the movements
of the abdomen, and yet serve as sutures supporting any pendant flap,
while at the same time they will allow the wound to be dressed without
disturbing the bandage. They also offer the advantage of permitting the
attendant to pull one support aside without removing the whole.
Every part in the horse subjected to much motion when wounded, should
have an adhesive plaster placed over it, and retained there until the
suppurative action is confirmed. By this means is excluded the atmosphere,
which, when this precaution was neglected, has entered the wound,
penetrated between the muscles, and by distending the body increased the
suffering, as well as led to the worst of consequences.
Wounds in veterinary surgery rank among the most formidable cases with
which the practitioner has to contend. They are not so because the flesh
of the horse is slower to heal than that of the human being. Indeed, the
scale in this respect inclines toward the animal; but they are rendered
slow to heal and difficult to cure by two causes. The horse is always
impatient of restraint; any effort to confine the creature is more likely
to provoke dangerous resistance than to induce the slightest symptom of
amendment. The quadruped naturally delights in motion. It was formed for
activity. Even when in its stall the body is never absolutely still; the
position is being changed; the legs are frequently stamped; the head,
eyes, ears, and tail are never quiet. This innate quality retards the
union of sundered flesh. It favors the gravitation of pus between the
muscles, and thus generates sinuses. These are the torments of veterinary
surgery. Could the sinus be anticipated, or in all cases eradicated, the
principal difficulty would be removed; but intelligent as the horse is,
it proves impossible to make the animal comprehend the necessity for
quietude. Hence any trivial accident may lead to injuries of so extensive
a character and so malignant a nature as will set the best endeavors or
the most consummate skill at defiance.