Often pricking is a result of carelessness engendered by a rush of work.

Often it is almost unavoidable on account of the character of the foot that

is brought to be shod. Feet with thin horn, especially a thin sole, feet

with horn shelly and brittle, each in their way are difficult to shoe.

Sometimes pricking is purely accidental, as in the case of a 'split' nail.

The nail as it is driven splits at its point, and continues to split down

its centre, one half emerging at the correct spot on the wall, the other

half bending inwards, and penetrating the sensitive structures.

_Common Situations of the Wound_.--In a case of picked-up nail the common

seat of puncture is about the point of the frog, either in one of the

lateral lacunæ, in the median lacuna, or the apex of the frog itself. In

comparison with this puncture of the sole is rare.

Prick sustained at the hands of the smith may, of course, run in either of

the following directions: (1) Directly into the position where the horny

and sensitive laminæ interleave; (2) between the sensitive laminæ and the

os pedis; (3) into the os pedis itself; (4) the nail may bend excessively

immediately after entering the horn, and so pass either between the horny

and sensitive sole; or (5) between the sensitive sole and the bone.

_Classification_.--Punctured wounds of the foot may be classified as

follows:

_Simple or superficial_ when penetrating no structure of great importance.

For instance, a prick that penetrates to the sensitive sole and is not

driven with sufficient force to seriously injure the os pedis we may regard

as simple. In the same manner a prick to the frog that, although deep, is

mainly concerned with penetrating the plantar cushion may also be classed

as simple.

_Deep or penetrating_ when driven with sufficient force or in such a

direction as to injure structures whose penetration is calculated to give

rise either to serious constitutional disturbance or to permanent lameness.

In this category we may place injuries to the terminal portion of the

perforans, puncture of the navicular bursa, fracture of the navicular bone

and penetration of the pedal articulation, and splintering of the os pedis.

_Symptoms and Diagnosis_.--While discussing the symptoms and diagnosis, we

will still continue to consider our subject under the two headings of (1)

accidental 'gathering' of some foreign body, and (2) pricks inflicted in

the forge.

In a few cases belonging to the former class the veterinary surgeon is

fortunate in obtaining a direct history of the injury. The driver has seen

the animal go suddenly lame, and has examined the foot for the cause.

Either the nail has been found embedded in the horn, or the puncture it has

made detected, and the matter has been reported. The foot is then explored

and the full extent of the injury ascertained.

In many cases, however, it so happens that no evidence of the infliction of

the injury is forthcoming. The momentary lameness occurring at the time of

the prick is unreported at the time by the attendant, and the horse for

a time goes sound. It is not until the changes set up by the subsequent

inflammatory phenomena make their appearance, and lameness results, that

attention is called to the foot. When this happens there has, as a rule,

been time for pus to form around the seat of puncture--a matter of about

forty-eight hours.

The horse is now brought out for the veterinary surgeon's examination,

going distinctly lame. If the case is well marked there may then be noted

by the man of experience many little signs pointing to the foot as the seat

of the lameness. These, though well enough known to the practitioner, are

nevertheless difficult to describe. It is, in fact, hard to say exactly in

what they really consist, appearing to be as much a matter of intuition as

of actual observation.

There is a peculiar 'feeling' characteristic in the gait. The affected foot

is put forward fearlessly enough, but is not nearly so rapidly put to the

ground. When at rest the foot is almost immediately pointed, and the pain

at intervals manifested by pawing movements. It is this extreme liberty of

the rest of the limb, as evinced during the pawing movements, that really

strikes one. Shoulder, elbow, knee, and fetlock are all easily and

painlessly flexed and extended. There is nothing wrong with them; it must

be the foot. The short manipulation necessary to test the lameness--viz.,

the walk and slow trot--is sufficient to raise the animal's pulse and

quicken the breathing.

All this is enough, and more than enough, to lead the veterinary surgeon

to examine the foot. It is hot to the touch, and at the coronet tender to

pressure, possibly in a neglected case fluctuating at the heel. Pain is

evinced by the animal withdrawing his foot when percussion takes place over

the affected spot. In a bad case one gentle tap is all that is needed. The

animal at once snatches away his foot, holds it high from the ground, and

makes pawing movements in the air. At that moment, too, his countenance is

highly expressive of the pain he is suffering. Again the foot is explored,

the injury found, and the pus liberated.

Regarding the manner of exploration of the foot we will take first that

case in which the veterinary surgeon is called in early, and in which pus

has not yet had time to form. Sometimes the merest cleaning up of the

inferior surface of the foot then reveals a distinct stab either in the

sole or the frog.

If the accident be recent only a little blood will be found, either liquid,

or coagulated about the wound. Later there exudes from the stab a flow of

yellow, serous fluid. The opening thus found should be carefully probed,

and its depth and situation noted.

At other times the prick is not so readily apparent. The nail or other

object has penetrated and afterwards withdrawn itself. The natural

elasticity of the horn, especially that of the frog, causes it to contract

upon the puncture, and to largely obliterate the hole made. What,

therefore, may look to be but a simple injury to the horn alone may

in reality be the only evidence of a stab complicating the sensitive

structures. It thus behoves the veterinary surgeon to follow up and

carefully cut out any unnatural-looking mark in the horn, more especially

if the horn is discoloured, or if blood is extravasated into its fibres, or

there is moisture exuding from the part.

In some cases of this description the knife in the act of paring comes into

contact with the cause of the trouble. Sometimes this is a nail, sometimes

a sharp and small piece of flint, so deeply penetrated as to have become

quite buried. When met with in this manner, however, the foreign body is

more often than not a splinter of wood deeply embedded in the cleft of the

frog or in the frog itself.

The fact that multiple punctures may occur should here be remembered, and

the remainder of the inferior surface of the foot thinly pared.

On withdrawal of the foreign object blood may immediately follow. Should

the former have been fixed in position for some time, however, pus is

nearly always found at the bottom of the wound. As a rule, its removal is

comparatively easy, but one case recalls itself to the author's mind in

which the extraction was a matter of considerable difficulty. The offending

object was a large, flat-headed nail, some 2 inches long. This was driven

fast into the os pedis, and necessitated the employment of a pair of

pincers and the exertion of some amount of force to move it from its

position.

In this connection it must be remembered that the penetrating object

sometimes breaks off after entering the foot. The fact that this

occasionally happens only serves to give point to the advice we have

previously rendered--that every stab should be carefully probed, and its

exact condition and depth ascertained.

In those cases where percussion has led to the positive opinion that pus

really exists, then the exploration must be most searching. There may, or

may not, be a suspicious-looking mark to work on. In the latter case, the

veterinary surgeon must not be content with confining his paring operations

to one spot. The sole should be carefully thinned all round, and the

thinning cautiously proceeded with until either small, pin-point

hæmorrhages denote that healthy sensitive structures have been reached, or

a sudden flow of pus indicates that the injury has been definitely located.

While the symptoms remain much about the same, the diagnosis of pricks

received in the forge, as compared with those occurring in the natural

manner, is easy. The animal starts to the forge quite sound, and returns,

perhaps, with a slight limp. The slight limp in two days' time becomes a

decided lameness, and no doubt remains as to what has occurred. The mere

fact of the lameness arising immediately after a visit to the forge should

be sufficient in the majority of cases to lead one to a correct diagnosis.

Where the opinion has been formed that a prick has been received, then the

shoe should be removed.

This operation should always be superintended by the veterinary surgeon

himself. After the removal of the clinches, the nails should be drawn one

at a time with the pincers, and carefully examined. Often the offending

nail may thus be picked out by observing upon it blood-stains, or the

moisture from inflammatory exudate or from pus. Further inflammation will

also be gathered by occasionally meeting with a nail that has split.

At this stage, too, the veterinary surgeon should have noticed whether or

not the smith has previously sent the animal home with what is known as a

'draw back.' He has discovered, immediately after he has done it, that he

has pricked the animal. He has then withdrawn the nail, and either sent the

animal back with that nail altogether missing from the set in the shoe, or

with the hole filled up with a stump.

The shoe once off, the holes made by the nails in the horn should be

minutely examined for the presence of hæmorrhage, inflammatory fluid, or

pus exuding from them, and also for evidence of their correct placing in

the foot. Should fluid matter issue from any one of them, or should it be

deemed that one has approached too near the inner margin of the white

line, more especially if tenderness exists around it, that hole should be

followed up with a 'searcher' or small drawing-knife until diagnosis is

certain.

_Complications_.--Before proceeding to discuss the complications that may

arise in the case of pricked foot, we may call to mind that the anatomy of

the parts teaches us that the most serious position in which a punctured

wound can occur is at the centre of the foot. Here the plantar aponeurosis,

the navicular bursa, the navicular bone itself, or the pedal articulation

may be injured.

Anterior to this position the most serious mischief that can ordinarily

result is stabbing of the os pedis.

Posterior to the position we have named, the only structure to be injured

is the plantar cushion.

Anatomically, then, the inferior surface of the foot may be divided into

three zones, as follows:

_A. Anterior_, extending from the toe to the point of the frog.

_B. Middle_, extending from the point of the frog to the commencement of

its median lacuna.

_C. Posterior_, including everything posterior to the middle zone.

This division of the inferior surface of the foot into zones will be

somewhat of a guide also when describing the complications next to follow:

_(a) Suppuration_.--This is the common complication of most wounds of the

foot. When detected, it calls for immediate surgical interference in the

shape of removal of the horn of the sole or the frog, as the case may be.

This we shall consider further under the treatment.

_(b) Separation of the Horny Frog_.--This is a sequel to pus formation in

the sensitive structures immediately beneath it, and the condition makes

itself apparent by a line of separation between the horn and the skin of

the heel of the injured side.

_(c) Wounding of the Plantar Aponeurosis_.--This occurs when a

moderately-deep penetration of the horn of the middle zone has taken place.

It is always most painful, especially when complicated by necrosis. The

heel is then persistently elevated, and lameness is extreme, in some cases

so severe as to cause the leg to be carried altogether.

In favourable cases the necrosed piece of tendon is sloughed off by the

process of suppuration, and escapes with the discharges from the wound.

There is then an abatement in the symptoms, and recovery is rapid.

Commonly, however, on account of the non-vascularity of the structure of

the tendon, the necrotic spot in it tends to spread. The wound is thus led

to become fistulous in character, and the pus forming within it prevented

from escaping from the original opening. As a result, lameness and fever

persist. There is a gradual increase in the severity of the symptoms, and

later fistulous openings appear in the hollow of the heel.

_(d) Puncture of the Navicular Bursa_.--This results from a prick in

exactly the same position as that last described, and means that the

penetrating object has gone deeper, It may be distinguished from puncture

of the plantar aponeurosis alone by the fact that there is an excessive

discharge of synovia from the wound. This, as it escapes, is at first clear

and straw-coloured. Later it becomes cloudy and flaked with pus, and shows

a tendency to coagulate in yellowish clots.

Pain and accompanying fever is most marked, much more so than when the

plantar aponeurosis alone is injured.

Should the original wound be insufficiently enlarged, or should its opening

become occluded by the solid matters of the discharge, then this condition,

like the last, ends in the formation of fistulous openings in the heel.

These make their appearance as hot, painful, and fluctuating swellings in

that position. Later they break, discharge their contents, and leave a

fistulous track behind.

_(e) Fracture of the Navicular Bone_.--Penetration of the substance of

the navicular bone, _without_ its fracture, adds nothing to the symptoms we

have described under puncture of the bursa. That the bone has been reached

by the penetrating object may be detected by probing. This, however,

must be performed with care, especially if a flow of synovia is absent.

Otherwise, the wound, as yet, perhaps, superficial enough to avoid

penetrating even the bursa, is made a penetrating one by the probe itself.

Fracture of the navicular bone is fortunately rare.

_(f) Penetration of the Pedal Articulation and Arthritis_.--This we shall

consider in greater detail in Chapter XII. It is sufficient here to state

that the condition may be suspected when a hot and painful swelling of the

whole coronet makes its appearance. There is at the same time a diffused

oedema of the fetlock and the region of the cannon, sometimes extending

upwards to the whole of the limb.

Of all the complications to be met with in punctured foot this is the one

most to be dreaded. The intense pain and the high fever render the animal

weak and thin in the extreme. The appetite becomes impaired, sometimes

altogether lost, and the patient in many cases appears to die from sheer

exhaustion. Added to this is always the extreme probability of the wound

becoming purulent, and later the dread of general septic infection of the

blood-stream ensuing, and death resulting from that. Even with the happier

ending of resolution, anchylosis of the joint and incurable lameness is

more often than not left behind. (See Suppurative or Purulent Arthritis,

Chapter XII.)

_(g) Ostitis and Caries of the Os Pedis_.--Injuries to the os pedis are

met with in the anterior zone of the foot. Evidence that the bone has been

injured is not usually forthcoming until after the lapse of some days.

One is led to suspect it by the fact that there is no indication of the

suppurative process extending further upwards, coupled with the facts that

great pain, high fever, and extreme lameness persist, and that there is a

continuous discharge from the wound of a copious blood-stained and foetid

pus. Used now, the probe reveals the fact that the bone is bared, and

conveys to the hand that is holding it a sensation of crumbling fragility.

_(h) Wounding of the Lateral Cartilage and Quittor_.--This occurs as the

result of a deep stab in the posterior zone. Ordinarily, wounds in this

position are unattended with serious consequences, and the prick has to be

a deep and a severe one before the cartilage is reached. What then happens

is that a spot of necrosis is formed round the seat of puncture in the

cartilage. This, unless met with surgical interference, is sufficient

to maintain the wound in a septic condition; it takes on a fistulous

character, and a quittor is formed. (See Chapter X.)

_(i) Septic Infection of the Limb_.--This we have already once or twice

referred to. It simply means that the septic matters from the wound have

gained the lymphatics, and finally the blood-vessels of the limb, and set

up local lesions elsewhere than in the foot. Although dismissed here with

these few words, the condition is a most serious one. Usually, it has

resulted from penetration of the pedal articulation and septic infection of

the joint. In the vast majority of these cases slaughter is both humane and

economical.

_Prognosis_.--The first consideration in giving a prognosis in punctured

foot should be the position of the wound. When occurring in the middle

zone, the surgeon's statements should be most guarded, and the dangers

attending a wound in that particular position fully explained to the owner.

A wound in the anterior position is, as we have said, far less serious, and

one in the posterior region of the foot even less serious still.

Whenever possible, the nail or other object causing the prick should be

examined. Much of the prognosis may be based upon the estimated depth of

the wound, and this, in many cases, it is far safer to calculate from the

length of the offending body than from the use of the probe. We need hardly

say that in the middle zone the deeper the prick, the more serious the

case, and the less favourable the prognosis. As in succession the sensitive

sole, the plantar aponeurosis, the navicular bursa, the navicular bone, or

the pedal articulation is injured, so with each step deeper of the prick is

the severity of the case increased.

The shape of the penetrating object may also be considered. One excessively

blunt, and calculated to bruise and crush the tissues, will inflict a more

serious wound than one of equal length that is pointed and sharp.

The conformation of the foot should also be regarded. Wounds in well-shaped

feet are less serious than in feet with soles that are flat or convex, or

in which the horn is pumiced or otherwise deteriorated in quality.

Although unaffecting the prognosis so far as the actual termination of the

case is concerned, it may be mentioned that punctured foot is far more

serious in a nag than in a heavy draught animal. With an equal degree of

lameness resulting in each case, the former will be well-nigh useless, but

the latter still capable of performing much of his usual labour.

The temperament and condition of the patient will also in many cases

largely influence the prognosis. An animal of excitable and nervous

disposition is far more likely to succumb to the effects of pain and

exhaustion than the horse of a more lymphatic type. In the case of a

patient suffering from a prick to a hind-foot while heavily pregnant, the

attempted forecast of the termination should be cautious. More especially

does this apply to the case of a heavy cart-mare. Ordinarily, the

heavier the breed, the greater the tendency to lymphatic swelling of the

hind-limbs. With pregnancy this tendency is enormously increased, and it is

no uncommon thing to find a cart-mare in this condition, with legs, as the

owner terms it, 'as thick as gate-posts.' A prick to the foot, with the

lymphatics of the limb in this state, is extremely likely to end in septic

infection of the leg, for there appears to be no doubt but that invasion of

the lymphatics with septic matter is favoured by a sluggish stream. Also,

in the case of a patient in the advanced stages of pregnancy, it must be

remembered that, no matter how great may be the need, one is debarred, for

obvious reasons, from using the slings.

_Treatment_.--_In a simple_ case--and by 'simple' here we mean the case

in which the injury is discovered early, and pus has not yet commenced to

form--our first duties are to give the wound free drainage, and to maintain

it in an aseptic condition. The first of these objects is to be arrived at

by paring down the horn in a funnel-shaped fashion over the seat of the

prick. It is, perhaps, even better to thin the horn down to the sensitive

structures for some little distance round the injury. By this latter method

pressure from inflammatory exudate is lessened, and the after-formation of

pus, if unfortunate enough to occur, the more readily detected, and the

less likely to spread upwards. The matter of asepsis may then be attended

to.

When the puncture is sufficiently large to admit of it, the antiseptic

dressing is best applied by means of the probe. This instrument is thinly

wrapped with tow, or other absorbent material, so as to form a small swab.

Dipped in a suitable solution (as, for example, Zinc Chloride, Spts.

Hydrarg. Perchlor., Carbolic Acid, or any other that suggests itself), the

swab is inserted into the prick, and the wound conveniently mopped clean.

A further portion of the medicated tow is then pushed partially into the

wound, and allowed to remain in position. The foot is subsequently wrapped

in a clean bag, and kept free from dirt. This dressing should be repeated

twice daily.

If the prick is in a dangerous position, and deep enough to occasion alarm,

our precautions to prevent the formation of septic matters within it may be

more elaborate. The thinning of the horn and the swabbing of the wound

may, as before, be proceeded with. In addition, the whole foot may then be

immersed for some hours daily in a cold bath, which bath should be strongly

impregnated with one or other of the following salts: Iron Sulphate, Zinc

Sulphate, Copper Sulphate, Aluminium Sulphate, Lead Acetate, or Sodium

Chloride--better still, a mixture of the various sulphates here mentioned.

If preferred, one of the more commonly accepted antiseptics--such as

Carbolic Acid, Lysol, Boracic Acid, or Perchloride of Mercury--may be

substituted.

By the cold of the bath inflammatory phenomena are held in check, while its

added antiseptic prevents the formation of septic discharges. The lameness

gradually diminishes, and resolution is rapid. In this way deep and

serious, wounds are sometimes easily and successfully treated.

_When suppuration has occurred_--and this, by-the-by, is by far the most

frequent condition in which we find punctured foot--treatment must be

prompt and decided. Careful search must at once be made by thinning down

the sole, and carefully trimming the frog. On no account should the

veterinary attendant rest content with 'digging' in one place, and upon

that basing a negative opinion as to the existence of pus. The paring

should be carried on, until either pus or hæmorrhage shows itself, in at

least three positions--namely, at the most anterior portion of the sole,

and in the sole at each side of the frog. In addition to this, the frog

itself should be minutely examined for evidence of puncture, or for leaking

of pus at the spot where the horn of the heels joins the skin.

In many of our cases, however, this careful search is not so necessary.

The accompanying symptoms are so decided as to leave no doubt as to the

condition of the case. In such instances paring may often be commenced over

the exact position of suppuration as previously ascertained by percussion.

When met with, the track formed by the suppurative process should be

followed up in whichever direction it has spread. This will often

necessitate the removal of the greater part, if not the whole, of the horny

sole.

Having given vent to the pus, and opened up the cavity made by its

formation, the foot should be placed in a hot poultice or, preferably, in a

hot antiseptic bath.[A]

[Footnote A: At the time of writing this, a certain amount of discussion is

going on in our veterinary journals as to whether a hot or a cold bath is

the one indicated. It is urged against the application of heat that it

favours organismal growth and reproduction, and tends rather to induce the

spread of the suppurative process than to overcome it. Those who hold this

opinion urge in support of it that cold applications are inimical to the

life of the pus organism. At the same time, it must be remembered that in

just so far as cold inhibits the growth of the invading germ, so in just

the same degree does it adversely influence the functions of the tissues

that are to fight against it. To our minds the question thus set up must

always remain more or less a moot-point, and while we fully agree that cold

undoubtedly checks the growth of septic material, we just as fully believe

that warmth serves to place the healthy surrounding structures in a far

better condition to maintain a vigorous phagocytosis against it. We

thus continue to advise a hot antiseptic poultice, or, better still, a

bath.--THE AUTHOR.]

At the end of the third or fourth day the poultice or the bath may be

discontinued, and the opening in the sole dressed with any suitable

astringent and antiseptic.

The most serious complication arising from this method of treatment is

one of excessive granulation of the sensitive sole. This we find to be

successfully held in check by a daily application of undiluted Spts.

Hydrarg. Perchlor. (Tuson). Should the granulations become very exuberant,

then the knife must be called to our aid, and the wound so made afterwards

dressed with an astringent.

When the suppuration has under-run the horny frog there should be no

hesitation in at once removing all the horn that is visibly separated from

the sensitive structures beneath.

_When the os pedis is splintered and carious_, a portion of the sole round

the wound is removed, and the bone exposed. The diseased portion is scraped

away either with a curette or with the point of the drawing-knife. In this

case the only after-treatment called for is the application of suitable

antiseptic dressings.

_When necrosis of the plantar aponeurosis has occurred_. We have already

pointed out the tendency there is in this case for the wound to maintain a

fistulous character, and lead to the formation of abscesses in the hollow

of the heel. With a wound in this position, as with a wound in any other,

the only method of avoiding this termination consists in removing all that

is visibly diseased, whether it be soft structures, bone, ligament, or

tendon, and giving the wound free drainage.

This can only be done by removing the horny sole and frog, and cutting

boldly down upon the structures beneath. The operation is known as

resection of the plantar aponeurosis, or the complete operation for

gathered nail.

Practised for some years on the Continent, this operation, on account of

its gravity, has been avoided by English veterinarians. From reported

cases, however, it appears often to be followed by success.

That there is a large element of risk in the operation is quite evident, if

only from the two facts mentioned beneath:

1. That the close attachment of the plantar aponeurosis to the navicular

bursa, and the nearness of both to the pedal articulation, render

penetration of a synovial sac or a joint cavity extremely likely.

2. That there is always great difficulty in maintaining strict asepsis of

the foot, more especially if it is a hind one.

On the other hand, it may be argued that equal risk to the patient is run

in allowing him to remain with a disease (and that disease a progressive

one) of the structures so closely antiguous to the navicular bursa and the

pedal articulation.

If only for that reason we give the operation brief mention here.

The animal is prepared in the usual way for the operating bed; the foot

soaked for a day or two previously in a strong antiseptic solution, the

patient cast and chloroformed, and the operation proceeded with.

[Illustration: FIG. 106.--'CURETTE,' OR VOLKMANN'S SPOON.]

An Esmarch's bandage should be first applied, and a tourniquet afterwards

placed higher up on the limb. The foot is then secured as described in an

earlier chapter, and the whole of the horny structures of the lower surface

of the foot (the sole, the frog, and the bars) pared until quite near the

sensitive structures, or, if under-run with pus, stripped off entirely. An

incision is then made in each lateral lacuna of the frog, the two meeting

at the frog's point. Each incision thus made should be carried deep enough

to cut through the substance of the plantar cushion. A tape is then passed

through the point of the frog, tied in a loop, and given to an assistant to

draw backwards. The plantar cushion itself is then incised in a direction

from before backwards, and pulled on by the assistant, so as to expose the

plantar aponeurosis.

Should this be found at all necrotic, it may be taken that purulent

inflammation of the navicular bursa and of the navicular bone itself

exists. The operator must then proceed to resection of the tendon in order

to treat the deeper structures thus affected. At its point of insertion

into the semilunar crest the tendon is severed and afterwards reflected.

This exposes the inferior face of the navicular bone. Instead of the

glistening and clear appearance it ordinarily presents, its glenoid

cartilage is found to be showing hæmorrhagic or even purulent spots of

necrosis. The terminal portion of the tendon must then be excised.

To effect this a clean transverse incision is made at the extreme upper

border of the navicular bone. Here we are in close contact with the pedal

articulation, and great care is necessary in making this last incision, in

order that the synovial sac may not be penetrated.

All structures showing spots of necrosis should now be carefully removed,

either with the knife or with the curette. The knives most suitable for the

last stages of this operation are those depicted in Fig. 45 (_c_, _d_, and

_e_). The curette, or Volkmann's spoon, we show in Fig. 106.

[Illustration: FIG. 107.--RESECTION OF TERMINAL PORTION OF THE PERFORANS.

The horny sole and the horny frog stripped from off the sensitive

structures. _a_, The plantar cushion; _b, b_, the plantar aponeurosis, or

terminal portion of perforans; _c_, the navicular bone; _d_, interosseous

ligaments of the pedal articulation; _e, e_, semilunar crest of the os

pedis; _f_, inferior surface of os pedis; _g, g_, the sensitive laminæ of

the bars; _h, h_, bearing surface of the wall; _i, i_, the sensitive sole;

_k_, the sensitive frog.]

When at all diseased the glenoidal surface of the navicular bone should be

curetted, even to the extent of the removal of the whole of the cartilage.

A healthy, granulating surface is thus insured.

The above figure from Gutenacker's 'Hufkrankheiten' explains shortly the

position of the operation wound and the structures involved, rendering

further description unnecessary here.

The operation ended, the dressing follows. Upon this depends very largely

the ultimate recovery of the patient, for it is only by careful attention

and suitable dressings that effectual repair of the injured structures may

be brought about.

A light shoe is first tacked on to the foot, and those portions of the

horny sole that have been allowed to remain dressed with Venice turpentine,

tar, or other thickly-adherent antiseptic.

The exposed soft tissues are then dressed with pledgets of tow[A] soaked

in alcohol and carbolic acid. This dressing must be allowed to remain in

position, and is kept there by means of a bandage, or the shoe with plates

(Fig. 55) and a bandage over it. No pressure is needed; consequently, the

pledgets of tow must not be too thick.

[Footnote A: When using tow in the form of a pad, it is well to remember

that many small balls of the material rolled lightly in the palm of the

hand and afterwards massed together are far better than one large pad of

the tow taken without this preparation. The irregularities of the wound are

better fitted, and the whole dressing easier remains _in situ_ (H.C.R.).]

In the after-dressing of the wound careful attention must be paid to the

granulating surface. Where tending to become too vigorous in growth it

should be held in check by suitable caustic dressings. At the same time it

must be remembered that the granulating process of repair is always more

rapid upon the plantar cushion and fleshy sole than upon the bone, or upon

tendinous or cartilaginous structures. As a result of this we have a wound

showing various aspects of cicatrization. Healthy granulation may be

profuse in one spot, while in another it may be checked either by a flow

of synovia from the still open bursa, or by fragments of bone or of tendon

still acting as foreign bodies in the wound. These latter may be readily

detected by their standing out as dark and uncovered spots in the healthy

granulation around, and should be at once removed.

The time that an operation wound of this description takes to heal--and

that without complication--is from one to two or three months. Continuation

of pain and intensity of lameness are not to be taken as indications of

failure. The reparative inflammation in the synovial membrane is quite

sufficient to induce pain severe enough to prevent the animal from placing

his foot to the ground for some weeks, even though the progress of the

case, all unknown, may be all that is desired. So long as a great amount of

pain is absent, and so long as appetite remains and swellings in the hollow

of the heel fail to make their appearance, so long may the progress of the

case be deemed satisfactory.

_Recorded Case of the Treatment_.--A cart-horse, aged six years, was sent

to the Alfort School by a veterinary surgeon for having picked up a nail

in the hind-foot. Professor Cadiot, judging the necessity for the complete

operation, performed it on January 14, and spared the plantar cushion

as much as possible. In consequence of the plantar aponeurosis being

extensively necrosed, it was advisable to scrape the navicular bone and

a part of the semilunar crest. The wound having been washed with a 1 per

cent. solution of perchloride of mercury, it was dusted with iodoform

and packed with gauze, and covered with a cotton-wool dressing, kept in

position by means of a suitable shoe.

On January 16 there was no snatching up of the limb when the horse was made

to put weight upon it; he ate his food well, and his condition improved

every day. On January 21 the dressing was removed; the wound appeared pinky

and granular, and there was no suppuration. The clot remaining from the

hæmorrhage after the operation was removed, the wound was irrigated with a

hot solution of sublimate, and then dusted with iodoform and covered with a

dressing of iodoform gauze and absorbent wool. At this date the horse could

stand on the injured limb. On January 31 a second dressing was made, and

the animal almost walked sound. On February 7 the wound had almost closed

up, save in its central part, where there was a small cavity, and the

lameness had disappeared. On February 15 the wound had completely healed,

and its borders were covered by a layer of thin horn. As the animal was

sound it was sent to work.

The author directs attention to the rapidity with which a large and

complete wound cicatrizes after the operation for gathered nail.[A]

[Footnote A: _Veterinary Record_, vol. XV., p. 226 (Jourdan).]

_In the case of Penetrated Navicular Bursa_, unaccompanied by the formation

of any large quantity of pus, and uncomplicated by necrosis of the

aponeurosis, our aim must be to maintain the wound in that happy condition.

This is doubtless best done by keeping the foot continually in a cold bath,

rendered strongly antiseptic by the addition of sulphate of copper and

perchloride of mercury. Should there be intervals when the bath must be

neglected, the foot in the meantime must be kept clean by antiseptic

packing and bandaging, and a clean bag over all. This treatment should be

continued so long as the character of the discharge denotes that synovia is

running. If, in spite of our precautions, the discharge becomes purulent,

then the track made by the penetrating object should be syringed twice

daily with a 1 in 1,000 solution of perchloride of mercury.

During the treatment it will be wise to shoe the animal with a high-heeled

shoe. We do not know as yet the full extent of the injury. The navicular

bone may be tending to caries; or necrosis of the plantar aponeurosis, all

unknown, gradually becoming pronounced. This calls for a relief of tension

on the perforans, and is only to be brought about by the high-heeled shoe.

The result of the inflammatory changes in the tendon, aided possibly by

the use of the high-heeled shoe, is to afterwards bring about contraction.

Where this has occurred, and the animal walks continuously on his toe, the

shoe with the projecting toe-piece (Fig. 84) must be applied. When the

continual use of the toe-piece appears inadvisable, the shoe devised by

Colonel Nunn may be used in its stead (see Fig. 108).

The toe-piece is screwed into the toe of the shoe when the horse is about

to be exercised, and forms a powerful point of leverage with which to

stretch the contracted tendon, and the shoe, being thin at the heels,

admits of this. The advantage of this form of toe-piece over the ordinary

form of fixed toe-lever is that it can be removed when the horse is in the

stable; while the curved point diminishes the danger of the horse hurting

itself--a danger always present if it is on a hind-foot. (See also

Treatment of Purulent Arthritis in Chapter XII.)

[Illustration: FIG. 108.--COLONEL NUNN'S SHOE WITH DETACHABLE TOE

EXTENSION.]

_Should a Sinuous Wound remain in the region of the Lateral Cartilage_,

it should be explored, and its depth and likely number of branches

ascertained. Should this exploration denote that the cartilage itself is

diseased, or that the wound is not able to be sufficiently drained from

the sole, then we know that we have on our hands a case of quittor. The

treatment necessary in such a case will be found described in Chapter X.

_When the Complication of Purulent Arthritis has arisen_, the surgeon has

to admit to himself, reluctantly no doubt, that the case is often beyond

hope of aid from him. Nothing can be done save to order continuous

antiseptic baths and antiseptic irrigation of the wounds with a quittor

syringe, and to attend to the general health and condition of the patient.

At the best it is but a sorry look-out both for the veterinary attendant

and the owner of the animal. Even with resolution incurable lameness

results, and the animal is afterwards more or less a walking exhibition of

the limitations of surgery, while the owner, unless the animal is valuable

for the purpose of breeding, finds himself encumbered with a life that is

practically useless. (See Treatment of Purulent Arthritis, Chapter XII.)

_In the case of Lameness Persisting after the healing of all appreciable

lesions_, then neurectomy is followed by good results. The animal,

apparently recovered, is for a long time useless. Lameness persists for

several months, as if the nail had at the moment of its penetration caused

lesions, which doubtless it sometimes does, similar to those of navicular

disease. Examination of the foot in this case reveals no lesion, and the

pain has evidently a deep origin. The lameness caused by it is subject to

variation. Frequently it becomes lessened during rest, and increased by

hard work, while sometimes it is very much more pronounced at starting than

after exercise.

It is here that neurectomy is called for. The operation does nothing to

impede the work of healing going on, and allows free movement of the foot

and pastern to take place. At the same time suffering and emaciation cease,

and the animal is rendered workable.[A]

[Footnote A: _Veterinary Record_, vol. ii., p. 371.]

C. CORONITIS (SIMPLE).

TREAD, OVERREACH, ETC.

1. _Acute_.

_Definition_.--Under the heading of simple coronitis in its acute form we

intend to describe those inflammatory conditions of the skin and underlying

structures of the coronet occurring without specific cause. Specific

coronitis will be found described in Chapter IX.

_Causes_.--This condition is almost invariably set up by an injury--either

a bruise or an actual wound--to the coronet. By far the most common among

such injuries are those inflicted by the animal himself by means of the

shoes.

That known as 'tread' is caused by the shoe on the opposite foot, and may

happen in a variety of ways. More often than not it is met with in the feet

of heavy draught animals, and is there caused by the calkin, either when

being violently backed or suddenly turned round. It may also occur in

horses with itchy legs, as a result of the animal rubbing the leg with the

shoe of the opposite limb. The irritation in this case is nearly always

due to parasitic infection (_Symbiotes equi_), and becomes sometimes so

unbearable as to render the animal unmindful of the injury he may be

inflicting so long as he experiences the relief obtained by the rubbing.

Self-inflicted tread is also sometimes met with when horses are worked

abreast at plough. The animal in the furrow, with one foot sometimes in and

sometimes out of the hollow, is caused to make a false step, and so brings

the injury about.

Animals worked in pairs are further liable to receive a tread from the foot

of their companion. This is commonly seen in heavy animals at agricultural

labour in fields, where the walking is uneven, and abrupt turning constant.

It is not uncommon either in animals at work in vans in town, and is

occasionally met with in the feet of carriage-horses.

'Overreach' is the term used to indicate the injury inflicted on the

coronary portion of the heel of the fore-foot by the shoe of the hind.

Ordinarily, overreach occurs when the animal is at a gallop, and is thus

met with in its severest form in hunters and steeplechasers. It can only

occur when the fore-foot is raised from the ground and the hind-foot of the

same side reached right forward. When the feet separate the injury takes

place. In its movement backwards the inner border of the shoe of the

hind-foot catches the coronet of the fore, and tears it backwards with it.

Quite frequently a portion of the skin is removed entirely, but often it

hangs as a triangular flap. The flap in such a case is always attached by

its hindermost edge, and indicates plainly enough that the direction of the

blow that cut it must have been from before backwards.

Although ordinarily inflicted at the gallop, the same injury may,

nevertheless, be caused by allowing a fast trotter, and one with extreme

freedom of action behind, to push forward at the utmost limit of his pace.

The outside heel is the one most subject to the injury.

While the common form of injury to the coronet is, as we have described,

that occasioned by the animal's own shoe, or that of a companion, it is

evident that the foot is also open to similar injuries from quite outside

sources. Falls of the shafts when unyoking animals from a heavy cart, blows

or wounds from the stable fork, wounds resulting from the foot becoming

fixed in a gate or a fence, either may equally well set up the mischief.

Apart from severe injury, a particularly troublesome form of coronitis may

arise from the condition of the roads. We refer to the conditions attendant

on a thaw after snow. The animal is called upon to labour in, or perhaps

stand for long periods in, a mixture of snow and water, or snow and mud.

That this must have a prejudicial effect upon the structure of the coronet

is plain. The circulation of the part, already predisposed to sluggishness

by reason of its distance from the heart, is farther impeded by the

action of the cold. Small abrasions of the skin, so small as to scarce

be noticeable, are in this case freely open to infection with the septic

matter the mud contains. Necrosis and consequent sloughing of the skin

is bound to follow, and an extensive ulcerous wound, or a spreading

suppuration of the coronary cushion is the result.

_Symptoms_.--We will take first the case in which no actual wound is

observable. Here the first indication of the trouble is the appearance

of an inflammatory swelling, confined usually to one side, but extending

sometimes to the whole of the coronet. Always the part is hot and tender,

and with it the patient is lame--so much so, in many cases, as to be unable

to put the foot to the ground, the toe alone being used.

In a mild case, uncomplicated by septic infection, these symptoms rapidly

subside, and resolution occurs.

Always, however, the presence of septic infection must be suspected and

looked for. When this has occurred, the inflammatory swelling becomes

larger and more diffuse, and the animal fevered. This is then followed by

a slough of the injured part. A portion of the skin first becomes gray, or

even black, in appearance, and around it oozes an inflammatory exudate, or

even pus. The skin immediately adjoining the spot of necrosis is swollen

and hyperaæmic, and extremely painful and sensitive. Later, the necrosed

portion becomes cast off, and an open wound remains. This as a rule marks

the turning-point in the case. The pain and other symptoms rapidly abate,

and the wound, with proper attention, is not more than ordinarily difficult

to treat.

In the case of an actual wound the symptoms are probably less severe. The

injury is, in this instance, the sooner detected, and remedial measures put

into operation. In this manner the formation of septic material is often

checked, and nothing but the treatment of a simple wound demands attention.

There are, however, complications.

_Complications--(a) Diffuse Purulent Inflammation of the Sub-coronary

Tissue_.--This condition is brought about by the spread into the loose

tissue of the coronary cushion of the septic material introduced by the

tread. The whole coronet in this instance becomes excessively swollen, hot,

and painful, and the dangerous nature of the complication is evident enough

when the structure and situation of the parts involved is considered. The

amount of tendinous and ligamentous material in the neighbourhood offers

a strong predisposition to necrosis, and the necrosis, with its attendant

formation of pus, offers a further danger when the close proximity of

the pedal articulation and the unyielding character of the horny box is

considered with it.

The pus formed in this condition may remain confined to the coronet and

break through the skin as an ordinary abscess, or it may, before so doing,

burrow beneath the wall, and invade the sensitive laminæ. In this case,

whenever portions of the secreting layer of the keratogenous membrane are

destroyed, or perhaps only temporarily prevented from fulfilling their

horn-producing functions, then corresponding cavities in the horn are the

result (see Fig. 109).

_(b) Purulent Arthritis_.--Only too readily the pus so formed tends to

penetration of the articulation and the causation of an incurable arthritis

(see Chapter XII.).

[Illustration: FIG. 109.--MESIAL SECTION OF A HOOF ILLUSTRATING THE

CONDITIONS FOLLOWING UPON CORONITIS. _a_, Cavity in the horn of the

wall; _b_, enlargement of the coronet and the horn of the wall following

subcoronary suppuration; _c_, cavity in the wall following purulent

inflammation of the sensitive laminæ; _d_, hollow in the horn of the sole

consequent upon suppuration of the sensitive sole.]

_(c) Necrosis of the Extensor Pedis_.--This may arise either as a result

of spreading purulent infection of the coronary cushion, or as a result

of direct injury immediately over it. The close relation of the terminal

portion of this tendon with the pedal articulation, and the incomplete

protection from outside injuries here afforded to the joint by the horny

box, sufficiently points out the gravity of the condition.

_(d) Penetration of the Articulation_.--This also may be a result either

of the inroads made by pus, or of an actual wound. When occurring from the

latter, it is seen more often than not in the hind-foot, being there caused

by the calkin of the opposite foot. Where a wound in this position is

characterized by an excessive flow of synovia, the condition should be

suspected, and, if the wound be large enough, the little finger should be

introduced in order to ascertain. Needless to say, the injury is a grave

one.

_(e) Sand-crack_.--Sand-crack is likely to result from tread when an injury

is inflicted in the region of the quarter by a severe overreach. Treads,

too, especially with the calkin of the hind-shoe, are especially apt to end

in this way. In this latter instance the sand-crack usually has its origin

in a nasty jagged tear at the top of the wall of the toe.

_(f) Quittor_.--In one respect any suppurating wound at the coronet may be

deemed a quittor. By indicating quittor as a complication of coronitis,

however, we denote the more serious form of this disease, in which the

wound has taken on a sinuous character, and conducted pus to invasion of

the lateral cartilage. It is one of the worst complications we are likely

to meet with in this condition, and will be found fully described in

Chapter X.

_(g) False Quarter_.--This complication of coronitis occurs when the injury

or after-effect of the formation of pus has been severe enough to destroy

outright a comparatively large portion of the papillary layer of the

coronary cushion. To this condition we devote Section D of this chapter.

_Prognosis_.--In giving a prognosis in a case of coronitis, attention

should be paid to the manner in which the condition originated, and the

extent, when present, of the wound.

When the inflammatory swelling has arisen from bruising alone, without

actual division of the skin, when the weather is that of winter, and the

swelling showing a marked tendency to spread, then the prognosis must be

guarded. As we have seen, this state of affairs is probably ushering in

a condition of spreading suppuration of the coronary cushion, and

considerable gangrene and sloughing of the skin. We have here no intimation

as yet of how far the suppurative process may run, nor what important

structures it may involve. Consequently, the guarded prognosis we have

mentioned is imperative.

Where an actual wound is to be seen, and where advice is sought early,

then a more favourable opinion may be advanced. In this case antiseptic

measures, commenced early and persisted in, may prevent the rise of further

mischief.

It goes without saying that, should there arise any other of the

complications we have mentioned (viz., Arthritis, Necrosis of the Extensor

Pedis, Sand-crack, Quittor, and False Quarter), the fact should be pointed

out to the owner, and the prognosis regulated thereby.

_Treatment--Preventive_.--Seeing that at any rate the majority of cases of

coronitis result from injuries inflicted by the shoes, we may look at once

to that particular for a means of prevention.

Take first the case of 'treads'. There is no doubt that they are most

common in animals shod with heavy shoes and with high and sharp calkins.

This suggests at once that a preventive is to be found in substituting a

calkin that is low and square.

Where the injury is an overreach, and where, on account of the animal's

pace and manner of gait it is in risk of being constantly inflicted, the

shoeing should be seen to at once.

We have already pointed out that it is the inner border of the lower

surface of the toe of the hind-shoe which, in the act of being drawn

backwards, inflicts the injury. (See Fig. 110).

In this case prevention may be brought about either by shoeing with a shoe

whose ground surface is wholly concave, or by bevelling off the sharp

border (see Fig. 110, _a_, p. 236). When the tendency to overreach is not

excessive, prevention may in many cases be effected by simply placing the

shoe of the hind-foot a trifle further backwards than would ordinarily be

correct, thus allowing the horn of the toe to project beyond the shoe. This

at the same time does away with the annoyance of 'forging' or 'clacking,'

which, as a rule, accompanies this condition.

While recognising the value of shoeing in these cases, we must not forget

that a great deal may be brought about by careful horsemanship. The animal

should be held together and kept well up to the bit, but should _not_ be

allowed to push forward at the top of his pace. With many animals of fast

pace and free action overreach is more an indiscretion of youth than any

defect in action or conformation, and his powers should therefore be

husbanded by the driver until the animal has settled down into a convenient

and steady manner of going.

[Illustration: FIG. 110.--UNDER SURFACE OF THE TOE OF A HIND-SHOE. _a_,

Marks the portion of the inner margin that inflicts overreach.]

[Illustration: FIG. 111.--THE INNER MARGIN OF THE INFERIOR SURFACE OF THE

HIND-SHOE BEVELLED TO PREVENT OVERREACH.]

_Curative_.--Although in some cases it is so small as to go undetected,

we may take it that in all cases of coronitis there is a wound, with

consequent danger of septic infection of the surrounding parts. Therefore,

after attention to the shoeing and removal of the cause, the first

indication in the treatment will be to render the parts aseptic. This is

best done by removing the hair from the coronet and soaking the whole foot

in a cold antiseptic solution. After removal from the bath, the coronet

may be dressed with a moderately strong solution of carbolic acid or

perchloride of mercury. When the injury is slight and recent, such is

sufficient to effect resolution.

When marked swelling persists, however, and the increase in heat and

tenderness denotes the formation of pus, recovery is not so easily

obtained. In this case the application of hot poultices or hot baths is

called for. By these means suppuration is promoted and induced to early

break through in the most favourable position--namely, the softened skin of

the coronet. The pus so escaping is always more or less blood-stained, and

contains both large and small pieces of broken down and decomposed tissue.

After discharge of the pus, the cavity remaining should be mopped out with

an antiseptic solution, and a pledget of antiseptic tow or other material

left in position. All that is then needed is constant dressing in a

suitable manner. We prefer in this instance washing some three or four

times a day with hot water until a perfectly clean wound is obtained, and,

after the washing, painting the raw surface with a strong solution (1 in

200, or 1 in 100) of perchloride of mercury.

When the abscess we have described as forming is extremely large, or where

it is more than ordinarily slow in 'pointing,' the likelihood of its having

burrowed for some distance below the upper margin of the wall must be

suspected. Here it is sometimes wise to thin the wall with the rasp

immediately below the point of greatest swelling of the coronet. This will

serve to lessen pressure on the sensitive structures beneath.

Immediately the abscess contents have found exit at the coronet, the cavity

formerly occupied by the pus should be explored. If to any extent it is

found then to have 'pocketed' beneath the upper border of the wall, a

counter-opening should be made where the horn of the wall has been thinned

with the rasp.

When it so happens, either from extensive bruising or from the action of

excessive cold, that we have or suspect the condition of sloughing, then

the first indication is to aid the live tissues to throw off the necrosed

portion. In spite of what is sometimes urged to the contrary, a hot

poultice is, perhaps, the best means of bringing this about. Directly the

necrosed piece is shed, a wound remains which, so far as treatment is

concerned, may be regarded exactly as that left by the formation of pus.

Hot water applications, some three or four times daily, will serve both to

cleanse the wound and also to maintain vitality in the tissues immediately

surrounding it. After each washing, the use of a strong antiseptic solution

to the wound is again beneficial.

In the case of an actual wound, whether, as in overreach, affecting the

coronet alone or involving destruction of part of the wall, or, as in the

case of toe-tread, penetrating the pedal articulation, the treatment to be

followed is simple enough, in theory, if not always easy to carry out. It

consists solely in maintaining a rigid asepsis of the parts until healing

is well advanced or complete. The whole foot, including the coronet, should

first be thoroughly washed in warm water. At the same time there should be

used some agent that will tend to remove the natural grease of the parts.

In this manner cleansing will be rendered more thorough, and penetration of

the antiseptic solution to be afterwards applied made the more certain.

The most ready way of effecting this is to use the ordinary stable

'water'-brush, and plenty of a freely-lathering soap.

This done, the foot should be rinsed in cold water, and afterwards

constantly soaked in a cold antiseptic bath. Where it is inconvenient or

impossible to have the constant bathing carried out, a dry antiseptic

dressing may be tried in its stead. In this case the foot should first be

thoroughly washed and dressed as before. Afterwards an antiseptic powder in

the shape of a mixture of iodoform 1 part, boracic acid 10 parts, should

be freely dusted on the wound, a pledget of carbolized tow or cotton-wool

placed over it, and the whole maintained in position with a bandage

previously soaked in a 1 in 500 solution of perchloride of mercury. Once

on, this dressing should be allowed to remain until healing is complete.

Should the animal manifest pain, however, by constantly pawing, or should

swelling and heat of the parts be suspected, the bandage should be removed,

and the condition of the wound ascertained.

An excellent example of the value of this method of treatment is that given

below:

'I call to mind a valuable hunter in my practice a few seasons since, who,

whilst hunting, we suppose, struck himself in the way we suggest. He not

only removed the superior portion of the inner heel, but tore about 3

inches of the hoof from the top nearly to the bottom. This was clapped back

by the owner, tied with a handkerchief, and the horse removed home. When

the handkerchief was removed, I confess I did not think the horse looked at

all like hunting again. The heel was fairly pulled down, the portion of the

hoof that was hanging to it I could easily have wrenched off. The parts

were fomented, however, with warm water which was slightly carbolized. I

then removed a great portion of the heel and the lateral cartilage, which

was split; placed the portion of hoof again on the laminæ, smothered the

wound with iodoform pulv., covered it with cotton-wool packing, and all

the boracic acid I could get it to hold. A piece of linen bandage was

then tightly wrapped a few times round, and the lot enclosed in a

plaster-of-Paris bandage. I did not undo it for a fortnight, when, to

my great pleasure, the heel and hoof presented a highly satisfactory

appearance. I did it up in much the same way for another ten days, then put

the sand-crack clamps into the hoof and fixed it to the sound part. The

hoof remained in position while the new horn grew from the top, and the

horse hunted again the same season.'[A]

[Footnote A: _Veterinary Record_, vol. ix., p. 501 (Bower).]

_Sequels_.--Either of the complications we have mentioned--as, for

instance, Arthritis, Sand-crack, or Quittor--may persist and remain as

sequels to the case. In addition to these, there may be left behind

a cavity in the horn of the wall (see Fig. 109), or a loss of the

horn-substance of the wall proper, as that depicted in Fig. 112, or

described under the heading of False Quarter.

[Illustration: Fig. 112.--HOOF WITH A CAVITY IN THE SUBSTANCE OF THE WALL

FOLLOWING UPON 'TREAD' TO THE CORONET.]

The treatment of Arthritis, Sand-crack, Quittor, False Quarter, and

Seedy-toe, will be found in the chapters devoted to their consideration.

2. _Chronic_.

_Definition_.--Coronitis in which, owing to the persistence of the cause,

inflammatory phenomena continue, resulting in the growth of large fibrous

tumours about the coronet.

_Causes_.--In many cases it is possible, of course, that abnormal large

growths in this position may have an origin similar to that of neoplasms

elsewhere--that is to say, an origin as yet undiscovered. There is no

doubt, however, that the majority of the huge enlargements about the

coronet have their starting-point in one or other of the diseases to

which the foot is liable, in which the cause remains, and a low type of

inflammation persists.

In chronic and neglected suppurating corn, in untreated quittor, and in

long-standing complicated sand-crack, for instance, we have conditions in

which pus and other septic matters find ready entrance into the subcoronary

tissues. Should either of these be neglected, or should the pus formation

from the onset take on a slow but gradually spreading form (in other words,

should either of these cases run a chronic rather than an acute course)

then, with the persistence of the inflammatory phenomena so caused, is

bound to result a steady and increasing growth of inflammatory fibrous

connective tissue. This, as it grows, becomes in its turn penetrated by the

ever-invading pus, and, under the stimulus thus caused, itself throws out

new tissue. And so, constantly excited, the tumour-like mass tends to

steady increase in size, until enlargements are formed which one may

sometimes truly term enormous.

_Symptoms_.--The appearance of the growth is, of course, immediately

evident. Usually these swellings are slow in forming, so that the size

of the enlargement depends entirely upon its age. We may thus meet with

growths of this description, varying in weight from 4 or 5 pounds to

the almost incredible size of 33-1/2 pounds. In the majority of cases a

discharging sore is to be found upon it--in some cases several. Explored,

these sores reveal their true nature. Their lip-like openings, and the

ready manner in which they may be searched by the probe, show them to be

sinuses.

In a few cases, however, the outer surface of these tumours is intact. When

this is the case, it is possible that the growth is a true fibroma--that is

to say, a non-inflammatory new growth of fibrous connective tissue. On the

other hand, it may have resulted from one or other of the causes we have

enumerated, and its exact diagnosis have been impossible until operative

measures had been proceeded with. In this case, small and encysted foci of

inspissated pus scattered more or less throughout the growth indicate its

true nature.

Pain as a rule is absent, and, unless the growth, on account of its size,

interferes with progress, the animal walks perfectly sound. Here the

patient may, without offending the dictates of humanity, be put to slow

work.

_Treatment_.--In very many cases, possibly on account of the decreased

circulation and vitality of the parts, these growths occur in aged animals.

Here treatment is not economic, and may for that reason be put out of the

question. Further, the growths are more common in heavy cart animals of a

lymphatic type than in those of a lighter breed. Couple this with the fact

that the tumour is often unattended with pain, and we see that the animal

is still able to perform his accustomed labour. Here, again, treatment is

contra-indicated.

For still another reason surgical treatment, which is the only treatment

likely to be of benefit, must not be undertaken rashly. A large and open

wound is bound to be left behind. So large is it in many cases that the

complete covering of the exposed surface with epidermal growths from the

circumference cannot possibly be looked for. There is then left a large and

horny-looking scar, which is an even worse eyesore than was the original

enlargement.

When the patient is a young and otherwise valuable animal, however, and

when the case, judged either by the size of the swelling or its outside

appearance, promises a fair measure of success, operative measures may be

determined on.

In this case the author's practice has been, after casting the animal, to

apply a tourniquet to the limb and proceed to excision. A lozenge-shaped

incision, extending to near but not quite the circumference of the

swelling, should be made with a large knife right through the skin and

deeply into the growth. The whole is then removed, proceeding in an

excavating manner under the thickened skin at the margin. Hæmorrhage,

though proceeding from several apparently large vessels in the structure of

the tumour, and oozing generally over the whole of the outer surface,

is rarely profuse enough to interfere with the operation, and is easily

controlled by cold water douches and the application of the artery forceps

to one or more of the larger vessels. The operation completed, the larger

bleeding-points should be secured by exerting torsion with the artery

forceps, and the surface oozing stayed by frequent dashing with cold water.

When the hæmorrhage has sufficiently ceased, an ordinary flat firing-iron

should be passed over the whole of the cut surface, and an effectual eschar

formed.

Following this, and _before removing the tourniquet_, the wound should be

filled with pledgets of carbolized tow, and the whole tightly secured by a

stout and broad linen bandage of not less than 6 yards in length.

_Reported Case_.--'The patient, a middle-aged cart mare, had a pair of

fore-feet the like of which I never saw. As the result of long-standing and

imperfectly-treated quittor all over the seat of side-bone on the outer

side of each fore-foot, beginning pretty far forward, and extending to the

heel on the inner side, filling up the hollow and reaching nearly to the

fetlock, was a big, bulging, hard, calloused enlargement or tumour standing

out 3 or 4 inches all round, covered with thick horny skin and stubby hair,

and having on its surface the small openings of several sinuses leading

deeply down to the ossified and diseased cartilage underneath. And yet

with all this diseased undergrowth the mare, strangely enough, walked and

trotted sound. I was told that this mare had been troubled with suppurating

corns and quittor, that many unsuccessful attempts had been made at cure,

but that, getting worse instead of better, these tumours had formed.

'After casting and anæsthetizing, a strong rubber tourniquet was placed

above the knee and the operation commenced. With a surgeon's amputating

knife all the big fibrous mass which I could safely remove was cut and

sliced off, and the coronet and pastern reduced as nearly as possible to

its natural dimensions. The diseased cartilage, or side-bone, gave some

trouble, a considerable portion having to be cut and scraped, and the sinus

in it gouged out; but its complete removal did not appear to be called for.

'There was little if any hæmorrhage until release of the tourniquet, when

the whole broad surface became deluged with blood, three or four small

arteries spurting and veins flowing in all directions, so much so that I

was glad to reafix the clasp, and with the firing-iron seal up the vessels,

searing gently all over the surface.

[Illustration: FIG. 113.--CHRONIC CORONITIS FOLLOWING 'TREAD.']

'A good dusting with antiseptic powder, a thick pad of carbolized wool, and

two long calico bandages wound tightly round, completed the work.

'The other, the near-leg, was then dealt with in the same way.

'The mass removed weighed a little over 9-1/2 pounds--5 pounds from the

off-foot and 4-1/2 pounds from the near. Its structure was fibrous tissue,

almost as firm and hard as cartilage, and with no appearance of malignancy.

'The after-treatment consisted simply of fresh dry dressings--copper,

sulphate, zinc sulphate, and calamine, equal parts--applied every third

or fourth day, after first bathing the feet in a shallow tub of warm

antiseptic water.

'At the end of eight or ten weeks a fairly presentable appearance existed.

The greater part of what had been raw surface was covered with healthy

skin, and the remainder had become dry and horny.'[A]

[Footnote A: _Veterinary Record_, vol. xiv., p. 201 (C. Cunningham,

M.R.C.V.S.).]

A further form of chronic coronitis is that shown in Fig. 113.

This condition is commonly the result of a severe and jagged tread with

the calkin, and takes the form of an ulcerous and excessively granulating

wound. As time goes on the granulations become hard and horny-looking, and

their fibrous tissue as hard and unyielding as tendon or cartilage.

These if treated in the early stages with repeated dressings of caustic,

or, if very exuberant, the use of the knife, usually yield to treatment. If

neglected until the condition depicted in the figure is arrived at, then

treatment, as a rule, is of no avail. Neither is treatment of any use if

any great loss of the coronary cushion has occurred.

D. FALSE QUARTER.

_Definition_.--False quarter is the term applied to that condition of the

horn of the quarter in which, owing to disease or injury of the coronet,

the wall is grown in a manner that is incomplete.

_Symptoms_.--This condition of the foot appears as a gap or shallow

indentation, narrow or wide, in the thickness of the wall, with its length

in the direction of the horn fibres. By this we do not mean that the

sensitive laminæ are bared and exposed. Horn of a sort there is, and with

this the sensitive structures are covered. Running down the centre of the

incomplete horn is usually a narrow fissure marking the line of separation

in the papillary layer of the coronary cushion, which, as we shall later

see, is responsible for the malformation.

On either side of the indentation, as if wishing to aid further than

ordinarily it should in bearing the body-weight, the horn takes on an

increased growth, and stands above the level of the horn surrounding it. It

may, as perhaps it really is, be regarded as a form of hypertrophy, brought

about by the increased work that the loss of substance in the region of the

false quarter puts upon it.

So long as the sensitive structures are protected the animal remains sound.

Sometimes, however, from the effects of concussion or of the body-weight, a

fissure appears in the narrow veneer of horn that covers them. Into this,

which, of course, is but a form of sand-crack, gravel and dirt penetrate,

and so set up inflammatory changes in the keratogenous membrane. As a

result suppuration ensues, and the animal is lame.

_Causes_.--False quarter may result from any disease of the foot that

involves destruction of a portion of the coronary cushion. As we may see

from a reference to Chapter III., it is from the papillæ of this body that

the horn tubules of the wall are secreted. Destruction of any portion of it

necessarily results in a corresponding loss of horn in that position. The

disease occasioning this more often than any other is perhaps quittor. It

may also result from suppurating corn, from a severe tread or overreach, or

from the effects of a slowly progressing suppurating coronitis.

_Treatment_.--A radical treatment of false quarter is not to be found. Once

destruction of the secreting layer of the coronary cushion has occurred,

the appearance of the fissure in the wall will always have to be reckoned

with. A false quarter, therefore, not only renders the horse liable to

occasional lameness, but also renders weaker that side of the hoof in which

it occurs.

The only method of treatment that can be practised, therefore, is that of

palliation. Seeing that the trouble the veterinary attendant will have to

deal with is loss of a portion of the weight-bearing surface, his attention

is immediately directed to the shoeing. As with sand-crack, so with false

quarter, the frog and the bars must be called upon to take more of the

body-weight than commonly they do with the ordinary shoe. The indication,

then, is a bar shoe. At the same time, the bearing of the wall on the shoe

on either side of the fissure should be eased by slightly paring it, and

the hypertrophied horn on the outer surface of the wall removed with the

rasp.

In cases where penetration of the sensitive structures has occurred,

complicated with the formation of pus, the same treatment as for

complicated crack is to be followed. The foot should be poulticed for

several days with hot antiseptic dressings, and thorough cleansing of the

infected parted brought about. Afterwards strong solutions of suitable

antiseptics should be applied daily until such time as the horny covering

has renewed itself. This done and the bar shoe applied, the fissure may be

plugged with any effectual stopping. Either a mixture, such as Percival's,

of pitch 2 parts, tar 1 part, and resin 1 part, melted and mixed together,

or one of the artificial hoof-horns may either be used with advantage.

E. ACCIDENTAL TEARING OFF OF THE ENTIRE HOOF.

_Causes_.--Seeing that this accident to, and consequent severe wounding of,

the keratogenous membrane nearly always occurs in but one way, it is worthy

of special mention. So far as we are able to ascertain, it is an accident

peculiar to horses continually engaged in shunting operations either in

pits or station-yards. At the moment the animal is released from the waggon

he has been pulling, and should turn to the right or the left in order

to allow it to pass him, the shoe either becomes wedged in between two

converging rails, or is trapped by the wheel of the waggon. Either the

approaching waggon with the added weight its impetus gives it then pushes

the animal suddenly away, leaving a part of his foot still fixed to the

rails, or the animal himself, feeling securely held, makes a sudden effort

to release himself, and draws his foot cleanly out of the imprisoned horny

box.

The author calls to mind a case in which entire removal of the horn of

the foot of an ox occurred through the passing over it of the wheel of

a heavily-laden cart. It is therefore quite conceivable that the same

accident might occur to the horse. As a matter of fact, we find one case on

record where one-half of the horny box was thus removed.[A]

[Footnote A: _Veterinary Record_, vol. xiii., p. 129.]

So far as we are able to gather, it is more a result of imprisonment of the

shoe than of the foot. It appears, further, to be always a result of the

animal being newly shod, and the clinches firmly secured; so much so that

it would be probable, with imperfectly secured clinches, that the animal

would draw the hoof from the clinches and the shoe rather than the foot

from its horny covering.

Therefore, as the author of one of the cases we shall afterwards relate

suggests, it should be proposed as a preventive that the shoe-nails of

animals regularly engaged in work on the metals should not be clinched in

the regulation manner, but should have their points merely screwed off, and

the nails afterwards rasped level with the wall.

These cases are particularly interesting as illustrating the rapid manner

in which a new hoof is afterwards formed, and the way in which the exposed

sensitive laminæ take their share in adding to, though not forming the bulk

of, the horn of the wall.

From the cases we are able to record it will be seen that this accident

need not be looked upon as fatal, nor the injury itself beyond hope of

repair. Dependent largely upon the temperament of the animal, the amount of

pain that is caused, and the way in which the animal bears it, recovery may

be looked for. Even from the very commencement of the accident, however,

the pain may be so acute and the animal so violent with it that slaughter

becomes necessary.

_Treatment_.--This consists in applying an antiseptic and sedative dressing

to the injured parts (for example, Carbolized Oil and Tincture of Opium,

equal parts) and afterwards bandaging.

From the only data we are able to work on, it appears that this dressing

should be repeated daily, the bandage being removed, each time, the

foot well bathed in warm water, and the dressing and bandage afterwards

replaced. On first sight, it would appear that once cleansed and bandaged

the dressings might be left _in situ_ for several days. Seeing, however,

that suppuration, if once set up, would add further to the intense pain the

animal is already suffering, and considering the always constant exposure

of the foot to infection, it is perhaps wise to persist in daily changing

of the dressings.

At the same time, the general health of the animal should be attended to.

Suitable febrifuges should be administered, either in the shape of a

dose of physic, or salines and liq. ammonia. acetatis; and the pain, if

appearing unbearable, allayed by doses of choral and hypodermic injections

of morphia.

_Recorded Cases_.--1. 'A short time ago I was called to see a horse which

had had his hoof torn off in a railway "point." When I arrived at the

stable the injury had been done two hours, and the horse had been led from

the railway to a loose-box nearly half-a-mile off. On going to this box I

was surprised and horrified to find the poor animal mad with pain, rolling

and dashing himself about. When on his back he would struggle and kick the

walls with the injured foot, as though unconscious of pain. Not one moment

was he still, and as I could see that the sensitive structures were much

damaged by his violence, I obtained a gun and put him out of his pain.

'The accident happened in this way. The horse was employed in shunting

coal-waggons, and had just drawn four loaded trucks up to a point at which

they diverged to the left, and the horse, being unhooked, ought to have

turned to the right. Here, unfortunately, the near fore-foot became wedged

in between two converging railway plates, one of which formed a part of the

waggon-way, on which the trucks were running. The horse was a big animal,

and freshly shod with heavy shoes, on which a toe-piece and calkins were

used. The shoe was roughly but strongly nailed on with eight nails, the

clinches of which were all firm. This shoe was fitted wide at the heels,

and when the foot was fixed in the points (toe downwards) it protruded over

the face of the rail. When the trucks reached it they pressed it down, and,

the horse leaning forward, the hoof was drawn off like a glove. The hoof

was almost as clean inside as if taken off by maceration--only towards the

toe was a small portion of the coffin-bone and some torn laminæ left inside

the hoof.

'As soon as possible after the accident, so I was told, the foot was bound

up with tow and a bandage; then a sack was cut up and placed over all, and

the horse slowly led to his loose-box. He "carried" the leg all the way,

limping along on the three sound ones. Almost immediately after reaching

the box he lay down, but only for a short time. The standing position was

not long maintained--profuse perspiration set in, and the alternations of

position became more rapid and violent, till plunging and rolling were

added to the other signs of excruciating pain. I was also told that the

groaning of the poor animal was almost constant, and at times so loud and

prolonged as to amount to a shriek.

'I have no experience of a similar case, and I should not have supposed

that this accident would have caused such acute suffering and violent

symptoms. I think I have heard of such cases making a complete recovery;

but I feel sure that, in this case, I only anticipated death by, at most, a

few hours.'[A]

[Footnote A: _Veterinary Record_, vol. iv., p. 127.]

2. 'The case I am about to give you an account of, being one of rare

occurrence, I thought would not prove uninteresting to the members of the

Veterinary Medical Association. It is an instance of complete removal of

the hoof by mechanical force.

'Our patient was a brown mare, five years old, the property of Messrs.

Crawshaw and Co., railway contractors on the Sheffield and Manchester line.

'On June 20 the mare was, as usual, working on the line, drawing one of the

waggons for the removal of soil from one place to another, and, as was the

custom, the pace is generally increased at about the distance of from sixty

to eighty yards from where the unloading takes place, in order to add to

the velocity, so that the contents of the waggons might roll down so great

a precipice. It was at this increased action, when the mare was being

removed from the waggon, that she stepped between the ends of two iron

rails, sufficiently apart to admit the foot only, when one end of the rail

inserted itself between the sole and toe of the shoe, the other at the top

and in front of the crust.

'The mare, finding herself fixed, endeavoured to disengage herself, and, in

doing so, got in front of the waggon, which, coming at a great pace, forced

her down into the pit, leaving behind the off fore-hoof, which was only

removed from its situation between the two rails by a large hammer, it

being so firmly wedged in. The shoe and hoof were bent in a very peculiar

manner, as the accompanying cuts will show, the inside heel being

completely raised from above the level of the frog, not one of the nails

being unclenched, or in the slightest degree having given way to so large

an amount of force imposed upon them, although the toe of the shoe was

raised from the sole by the rail being immediately under it (see Fig. 114).

The mare had been shod the day before, and, having a good sound foot, the

shoe was firmly put on.

'Being a mile from home, she was with some difficulty made to travel that

distance. On her arrival, my preceptor, Mr. Taylor, was immediately sent

for, who found her, as I have before stated, with the off fore-foot

hoofless.

'Proceeding to examine the foot, he ascertained that it had bled

considerably, which, however, was stopped by bandages to the foot and a

ligature round the coronet. The laminæ on one side and a small portion of

the sensitive sole, though not to any great extent, were lacerated. The

coffin-bone was not at all injured. The bleeding having nearly ceased,

she was put into slings, the foot carefully washed with warm water, and

immediately bound up with pledgets of tow saturated with the simple

tincture of myrrh and tincture of opium, of each equal parts.

[Illustration: FIG. 114.--HOOF TORN FROM THE FOOT BY ACCIDENT.]

'The dressing was ordered to be allowed to remain on all night, and on the

following morning to be removed. The foot was then bathed, as before,

in warm water, and the application of the tinctures repeated night and

morning. The medicine internally given was castor oil, with tinct. opium,

and this, in a diminished dose, was ordered the next morning. Blood was

also abstracted from the jugular vein, to the amount of 6 quarts, so as

to allay the inflammatory fever set up. The food consisted of bran and

linseed, with small portions of hay and water. The mare being in a highly

excited state, and suffering such severe pain, the opinion Mr. Taylor gave

was that, should she get over the first four days (which appeared quite

uncertain), he had no doubt of her ultimately getting well, and also that

she would have a perfect hoof formed. It was now left for the owners'

consideration, whether they thought the mare worth her keep till such took

place, the time mentioned by Mr. Taylor being four or five months. She was

seen again the fourth day after the accident, and was then found to be

perfectly tranquil and feeding well; her pulse, which at the first visit

could not be counted, was now not more than 65 beats in the minute. On

removing the dressings, the foot presented a very favourable appearance,

the treatment therefore varied only in the application of a linseed-meal

poultice over the former dressings of tinctures of opium and myrrh,

confining the whole in a soft leather boot. Diet as before, in addition to

which give a few oats. Should the bowels become constipated, repeat the

castor oil without the opium.

'_June_ 28.--The animal was again seen, and appeared to be going on very

favourably. The poultices were directed to be discontinued, and the parts

dressed every other day with sol. sulph. cupri, as the granulations were

getting rather luxuriant.

'_July_ 6.--To-day she was found to have gone on so well, having two days

before been removed from the slings, that it was thought justifiable to

turn her out, protecting the foot with a boot, and ordering the dressings

to be repeated.

'_July_ 23.--She was seen by me in the field, where I had the boot removed,

and so much had she improved, that not less than 2 inches of crust,

proceeding from the coronary ring, had been formed, and the foot looked

remarkably healthy.

'It will be seen that the accident occurred on June 20, a fortnight after

which time I observed the horny crust to be forming from the coronet,

and the insensitive laminæ at the same time, in which on every visit an

increase of growth was perceptible, and it soon attained a thickness

exceeding that of the other hoof, but which at the same time presented a

more upright appearance. It was not until three weeks after our first visit

that any formation of new sole or frog was to be seen. Of the two the sole

was the first, being secreted by the sensitive sole, the growth proceeding

from the heels. In like manner the insensitive frog was being produced by

the sensitive.

[Illustration: FIG. 115.--HOOF TORN FROM THE FOOT BY ACCIDENT.]

'During the last week in October the mare, having her foot protected with a

bar shoe plated at the bottom, and so formed as to open without necessity

of removing the shoe, in order to facilitate the applications of the

tinctures, was put to light work, which has since been gradually increased,

and she now performs her usual labour equal to any other horse.

'The growth of the wall or crust and insensitive laminæ is not yet quite

complete, nor is the sole, there being wanting about an inch of the horny

substance of it, the entire completion of which I should rather doubt, as I

mentioned in my former communication that the sensitive laminæ and a small

portion of the sole were lacerated, and it is in these parts that the

imperfections exist.

'The yet imperfectly-formed wall not admitting of the insertion of nails

all around it, the shoe is held on partly by nails and partly by a strap

attached to it bound round the coronet.'[A]

[Footnote A: _Veterinary Record_, vol. iv., p. 182 (B. Cartledge).]

3. 'This case is related by Mr. A. Rogerson, F.R.C.V.S. It occurred to an

animal regularly engaged in shunting, and happened through the corner of

the shoe becoming "trapped" between a line of metal and the wheel of

a truck. It is particularly interesting on account of the photograph

accompanying it, and which we here reproduce in Fig. 115.

'The photograph shows plainly the manner in which the holding of the

"clinches" on the left side of the hoof has resulted in drawing it off

from the foot. Had these clinches, as Mr. Rogerson suggests, been left

unfastened, then the accident in all probability would not have occurred.

The animal was destroyed.'[A]

[Footnote A: _Ibid_., vol. xiii., p. 2.]

CHAPTER IX

INFLAMMATORY AFFECTIONS OF THE KERATOGENOUS APPARATUS

A. ACUTE.

ACUTE LAMINITIS.

_Definition_.--The term 'laminitis' is used to indicate a spontaneous and

diffuse inflammation of the whole of the sensitive structures of the foot,

more particularly the sensitive laminæ. Usually it occurs in the two front

feet, often in all four, and occasionally in the hind alone.

_Causes_.--In dealing with the causes of laminitis, we will first dispose

of those coming under the heading of _traumatic_. Correctly speaking,

however, lesions of the laminæ thus occurring do not present the same

symptoms, nor run an identical course with the disease we now purpose

describing, and for which we would prefer to entirely reserve the term

'laminitis.' The fact, however, that traumatic causes are detailed in other

works on the same subject compels us to give them mention here.

Strictly traumatic causes giving rise to a limited inflammation of the

sensitive laminæ are violent blows upon the foot, either purely accidental,

or self-inflicted by violent kicking.

A similar limited laminitis is to be found in the conditions we have

described under 'Nail-bound and Punctured Foot.' It is met with also in

the injuries resulting from tread and overreach, and in the tissue-changes

accompanying corn.

The tenderness following upon excessive hammering in the forge, or of too

long an application of the shoe in hot-fitting has also been described as

laminitis.

With either of the conditions we have mentioned, it goes without saying

that there is either a simple congestion or an actual inflammation,

localized or general, of the laminæ of the injured foot. In neither case,

however, can the resulting mischief be closely compared with the lesions

attending an attack of laminitis proper, a disease which appears to have an

almost specific cause, and to run a course peculiarly its own.

The specific cause we have indicated as existing can, in the present state

of our knowledge, be only vaguely described as a poisoned state of the

blood-stream. This, as clinical evidence teaches us, may result from a

variety of causes.

Among these, by far the most common is that state of the circulation

induced by excessive feeding with too stimulating or too irritating a diet.

In any case, where the use of old oats as a staple diet is departed from,

and where the quantity and manner of using the substitute is left to the

discretion of careless or unskilled attendants, trouble is likely to ensue.

The food more prone, perhaps, than any other to bring about an attack is

wheat improperly prepared--that is, uncooked or unground. So much so is

this the case that one full meal of this provender to an animal unused to

it is sufficient to lead to a train of symptoms often ending fatally.

Beans, peas, barley, rye, new maize, or even new oats, are all liable, if

carelessly used, to have the same effect.

It is the laminitis following feeding on new oats that has caused us to

apply to the food the adjective 'irritating.' Here, more often than not,

the peristaltic action of the bowels is found to be abnormally in evidence,

and the excessive use of the diet is always accompanied by a more or less

fluid discharge of the intestinal contents.

In addition to the foods we have mentioned, many others might be

enumerated, more especially the numerous 'made-up' feeding materials now

on the market. Many are composed of substances that may be regarded as

absolutely opposed to the correct feeding of a horse, and their use can

only be followed by this and other evil results.

Another most fruitful cause of laminitis is a severe and continued

inflammatory condition of the system elsewhere. It is the laminitis known

to veterinary surgeons as 'metastatic,' and perhaps the two most notable

examples of it are the laminitis following a prolonged attack of pneumonia,

and the 'Parturient Laminitis' occurring as a concomitant of septic

metritis.

Parturient laminitis it is that offers us the most striking illustration of

the truth that a poisoned state of the blood-stream is a sure factor in the

causation of an attack. From the direct evidence of our senses (namely,

manual exploration of the infected womb, and the stench of the exuding

discharge) we know that we have in the interior of the womb matter in a

state of putrescence. From the experience of previous post-mortems we

know, further, that the putrescent matter thus originating often gains the

blood-stream, and forms foci of septic lesions elsewhere--liver or lung.

When, therefore, during an attack of septic metritis a condition of

laminitis supervenes, we are justified in attributing it to the escape of

septic matter from the already infected uterus.

In the same category of laminitis from metastasis may also be placed the

laminitis occurring as a result of an overdose of aloes. The enteritis thus

set up is often followed by laminitis, and that of a serious type.

Prolonged and excessive work upon a hard road is also apt to induce an

attack. When this occurs it in many cases resolves itself into a case of

cruelty. (See reported case, No. 1, p. 279.)

Laminitis from this cause was frequent among coach and carriage horses in

the pre-railroad period, and resulted from attempting to obtain from the

animal a faster pace and a greater number of miles than he was physically

capable of giving.

In our day, however, it is more often a result of gross feeding, combined

with only that amount of work which the horse, if ordinarily fed, would

be easily able to perform. An excellent example of this is the laminitis

occurring in the Shire stallion when commencing his rounds of service in

the spring and early summer. At this season these animals are constantly

supplied with a more than sufficient supply of a highly stimulating and

nutritious diet. In this case the blood is already in that state in which

it is predisposed to the disease. Add to this the unwonted exercise--for

during all the winter the animals are idle--and congestion of the venous

apparatus of the extremities is not to be wondered at.

Passing from these, the more common, we may consider other and less

frequent causes of the disease. Congestion of the laminal blood-vessels and

consequent laminitis occurs when animals are made to maintain a standing

position for prolonged periods, as, for instance, when making sea voyages.

A long and painful disease of one foot, necessitating the whole of the

weight being borne by the other, ends often in laminitis of the second

member. It may thus occur as a sequel to quittor, complicated sand-crack,

suppurating corn, and punctured wounds of the feet.

Laminitis has also been known to occur as a result of septic infection of

the blood-stream consequent on the operation of castration. (See recorded

case, No. 2, p. 281.)

A sudden lowering of the surface circulation at a time when the animal is

excessively perspiring is also said to favour an attack, as also is the

giving to drink of cold water to an animal just in from a long and tiring

journey. Also, according to Zundel, 'the influence of the season cannot be

denied, and it is during the summer months that laminitis is more frequent,

while it is rare in winter, as well as in the spring and autumn.'

Further, laminitis has been described as occurring when the animal is at

grass, and when all causes--at any rate, active ones--have appeared to be

absent. (See reported case, No. 3, p. 282.)

Regarding heredity, we may safely say that, as a cause of laminitis, it may

be almost totally disregarded. That a bad form of foot, either a flat-foot

or a foot with heels contracted, and already thus affected with a mild type

of inflammation, did not offer a certain predisposition, we should not like

to assert. There must, however, be an exciting cause--namely, a poisoned

condition of the blood-stream. This latter cannot, of course, be in any way

regarded as hereditary.

In short, the dietetic cause is by far the most common, and, in prosecuting

inquiries as to the starting-point of an attack, the veterinarian's

attention should be directed in the main to that particular.

_Symptoms_.--Laminitis is always ushered in by a set of symptoms indicative

of a high state of fever. The pulse is raised from the normal to as many as

80 or 90 a minute, muscular tremors are in evidence, the respirations are

short and hurried, and the temperature rises to 105°, 106°, or 107° F. The

visible mucous membranes are injected, that of the eye, in addition to the

hyperæmia, often tinged a dirty yellow. The mouth is dry and hot, the urine

scanty, and the bowels frequently torpid. As yet, however, the walk is

sound.

Called in during this early stage, the veterinarian is often puzzled as

to the exact significance of the symptoms. Enteritis, lymphangitis, or

pneumonia he knows to be often heralded in the same manner. In this

connection, Zundel says: 'Laminitis, in most instances, is preceded by

certain general symptoms, such as are premonitory of the invasions of

ordinary inflammatory diseases, but of an uncertain significance.'

So far we agree with him, but to what we have already said we would add

that, even in this early stage, there is an additional symptom, unmentioned

by Zundel, which often leads one to an exact diagnosis. The feet are in

turn lifted a short distance from the ground, and almost immediately

replaced. This movement ('paddling,' we may term it) is constant, the

animal appearing to obtain ease in no one position for more than a few

moments at a time.

Seen but a few hours later, when the swelling caused by the hyperæmia

and outpouring of the inflammatory exudate has led to compression of the

sensitive structures within the horny box, the symptoms presented admit of

no misreading, save by the most casual and careless observer. The patient

now stands as though fixed to the ground. The pulse is hard and frequent,

the respirations tremendously increased in number, the body wet with a

patchy perspiration, and the countenance indicative of the most acute

suffering. Only with difficulty, and often only at the instigation of the

whip, can the animal be induced to move. This he does by throwing his

weight, so far as he is able, on to the heels of the feet affected, and

putting the feet slowly forward in a shuffling and feeling manner. The feet

themselves give to the hand a sensation of abnormal heat, percussion upon

them with the hammer is followed by painful attempts at withdrawal, while

any effort we may make to remove one foot from the ground is useless, so

great an aversion does the animal show to placing a greater weight upon the

opposite foot.

According as the front-feet alone, the hind-feet alone, or all four feet

are affected, the symptoms will vary.

With all four feet diseased, the animal stands with the two front-feet

extended in front of him, while the hind-limbs are at the same time propped

as far beneath him as is possible. The horse is, in fact, standing upon the

extreme hindermost portions of the feet.

Why the animal should thus distribute his weight is easily explained.

Standing in the normal position, the body-weight is borne by the sensitive

laminæ, the sole, of course, sharing in the burden, but the laminæ taking

by far the greater part of the pressure thus exerted. With the vessels of

the laminæ gorged with blood, and the laminal connective tissue infiltrated

with a profuse inflammatory exudate, the most excruciating pain is bound

to result by reason of the compression of the diseased tissues within the

non-yielding structures. In some little measure the suffering animal may

afford himself relief by partly removing pressure from the fore-parts of

the hoof. When placing the body-weight behind, the pressure, instead of

falling upon the highly sensitive laminæ, is directed to the follicular and

fatty tissues of the plantar cushion: from there, with only a small portion

of the sensitive sole intervening, to the horny frog, and from thence to

the ground.

The same distribution of weight also places the foot in a position of

greatest expansion, thus, by giving greater room to the diseased parts,

again affording relief of pressure on the inflamed lamina, while it at the

same time relieves of weight the foremost portions of the sensitive sole.

With the fore-feet alone attacked, the animal affects exactly the same

position of standing as that just described. The fore-feet are again

extended, and the hind propped far beneath him. The fore extended, in order

to obtain the relief occasioned by standing on the heels; the hind in this

case carried forward in order to take a greater share of the body-weight,

and thus relieve the congested members in front.

With the hind only attacked, then the fore and the hind feet are more

closely approximated than in the normal position. The reason, of course,

is that the hind-feet are carried forward in order to be placed upon the

heels, while the fore are taken backwards to relieve the hind of the

body-weight.

In like manner the movements of the animal will vary with the feet

affected. With only the front-feet diseased the animal is, comparatively

speaking, comfortable. The hind-feet take the weight, and the animal stands

for long periods together, resting alternately first one fore-foot and then

the other, moving often in a circle of which his body is the radius, and

his hind-limbs the centre. If urged to move forward, then immediately his

countenance and movements manifest the pain to which he is put. Only with

reluctance does he cause the fore-feet to take weight. They are shuffled

forward quickly one after the other, so that weight may not be placed

upon them for one instant longer than is necessary, and the hind-limbs

immediately brought again with two short, awkward movements beneath the

body. Progress thus takes place in a succession of movements 'half hobble,'

'half jump.'

Painful though this may appear, progress is still more difficult when the

hind-feet alone are diseased. Afraid that, in placing his fore-members

freely forward, he will add to the pain in his hind, the walk takes place

in a series of extremely short steps, with the feet more or less closely

approximated. The gait is thus rendered extremely awkward, and Zundel, by

saying that 'the animal appears as if treading on sharp needles,' most

fitly describes it.

Movement with all four feet affected, though less awkward in appearance,

is doubtless more painful than in either of the other conditions. Here

the animal can hardly be induced to shift his position at all. Only by

flogging, and that severe, can he be made to go forward. When so induced to

move, the agonizing pain to which the patient is subjected may be gathered

by noting his countenance and manner of progression.

With each movement forward, muscular tremors affect the limbs; each step

is short, jerky, and convulsive; the respirations and pulse are almost

immediately greatly quickened, and the lower lip is hung pendulous, and

moved almost unconsciously up and down with a flapping noise against the

upper. A patchy perspiration breaks out about the body and quarters, and

the tail is outstretched and quivering. At the same time the lines of the

face become drawn, the commissures of the lips pulled upwards, the eyes

staring and haggard, the eyelids puckered, the nostrils extended, and

the whole expression indicative of the intense and agonizing pain of the

disease.

One can perhaps better give one's client some vague idea of the patient's

suffering by likening the pain to the throbbing sensation of a festered

finger-nail. Tell him that each hoof of the horse is similarly, or, if

anything, more delicately, constructed, that in each foot the same process

of 'festering' is going on, and that upon them the animal has perforce to

stand.

As one might expect, the position of greatest ease is the decumbent.

Strange to say, though, in many cases of laminitis the animal persists in

maintaining a standing posture. Once down, however, one has sometimes the

greatest difficulty in persuading him again to rise. The lying position is

so long maintained that bedsores begin to make their appearance, and the

animal rapidly loses flesh, not only by reason of the fever and the pain,

but by giving to rest the time he should normally give to feeding.

Difficulty in rising is greatest when all four feet are affected; is

_nearly_ as great when the hind-limbs only are in trouble, but is least

when the disease exists alone in the two fore-feet.

THE COURSE OF THE DISEASE AND ITS PATHOLOGICAL ANATOMY.--As with

most inflammations of any severity, so with this we may consider the

pathological changes taking place in the foot under three headings: (a)

The period of Congestion; (b) the period of Exudation; (c) the period of

Suppuration.

(a) _Congestion_.--In the early stages of laminitis there is a state of

engorgement of the vessels of the keratogenous apparatus generally, but

more particularly the laminal portion of it. With the hoof removed at this

stage the sensitive laminæ are found to be swollen, dark red in colour, and

affording a distinct feeling of increased thickness when pressed between

the fingers, Incised, there escapes from the cut surface a large flow of

dark venous-looking blood. At this stage hæmorrhages of the laminal vessels

occur. The escaping blood infiltrates the surrounding connective tissue,

and in many cases destroys the union between the horny and sensitive

laminæ. This change is most noticeable in the region of the toe and the

commencement of the quarters, the os pedis appearing as though pushed

backwards by the escaping fluid collected between the wall and the bone. In

severe cases, fortunately but rarely seen, the blood so escaping continues

to infiltrate, and separate the tissues until it is seen to be freely

oozing at the region of the coronet. (See reported case, No. 1, p. 279.)

(b) _Exudation_.--The period of exudation marks the outpouring of the

inflammatory fluid. This, even more than the hæmorrhages attending the

stage of congestion, tends to destroy the intimacy between the sensitive

and the horny laminæ, leading finally to their complete separation at

the region of the toe. Fig. 116 illustrates this state of affairs after

laminitis has existed for a week. The sensitive and horny laminæ are here

shown to be distinctly separated from each other, a well-marked cavity

existing between them, which cavity is greatest in extent at the toe of the

os pedis. With the sensitive structures thus detached from the wall, it is

evident that very much that formerly held the os pedis in normal position

has been destroyed. What then happens is that the whole of the body-weight

is placed upon the sole. Never intended to bear the strain thus imposed,

it naturally sinks. With the sinking is a corresponding 'dropping' of the

pedal bone--in fact, of the whole of the bony column. Seeing that the

structures _above_ the hoof are still normally adherent to the bones, it

follows that they must, as the os pedis sinks, be carried with it. As a

consequence we get a marked depression at the coronet (see Fig. 117, _a_),

which depression may be often noticed after the second or third week of a

severe attack of the disease.

[Illustration: FIG. 116.--LONGITUDINAL SECTION OF A FOOT WITH LAMINITIS OF

EIGHT DAYS' STANDING. The separation between the sensitive structures and

the hoof is indicated by a dark line. The cavity is filled with exudate. It

will be noted that as yet there is little change in the position of the os

pedis.]

Here, again, though to a greater extent than that caused by the hæmorrhage

alone, the os pedis appears to be pushed backwards, the space at the toe

between the bone and the horny box being closely filled with the yellow,

slightly blood-stained exudate. This condition is well depicted in Fig.

117.

[Illustration: FIG. 117.--LONGITUDINAL SECTION OF A FOOT WITH LAMINITIS OF

FOURTEEN DAYS' STANDING. _a_, The depression at the coronet caused by the

dropping of the bony column within the horny-box: _b_, a portion of the

sensitive sole pushed downwards and forwards by the descending os pedis.]

With the descent of the os pedis we get in many cases a penetration of the

horny sole (see Fig. 117), leading always to serious displacement of the

sensitive sole (see Fig. 117, _b_), and often to caries of the exposed

bone.

The backward displacement of the os pedis may be accounted for in two ways.

Firstly, the greater vascularity of the membrane covering its front leads

to a greater outpouring of inflammatory fluid in that particular position.

Here, therefore, loss of adhesion with the wall is greatest, while into the

cavity so formed is poured a large quantity of a fluid that is practically

incompressible. The os pedis _must_ be pushed backwards. Secondly, the

manner in which the animal distributes his weight--namely, upon the

heels--is calculated to aid in the bone's backward movement, for with his

feet in this position tension upon the extensor pedis is relaxed, while

that upon the flexor perforans is greatly increased.

(c) _Suppuration_.--Should the animal survive the pain and exhausting calls

made upon his system by the accompanying fever of the foregoing conditions,

the case ends either in resolution or suppuration. When suppuration occurs

it is found, as a rule, at the sole, leading to almost entire separation of

the sensitive and horny structures. The pain, if possible, is even worse

than in either of the foregoing stages, and relief for the suffering

patient is only obtainable by the natural exit of the pus at the coronet,

or by giving it escape with the knife at the sole. As a rule, suppuration

in laminitis is rare, and then only occurs when the disease has been of

some several days' duration. It has been the author's experience, however,

to meet with it in a case but three days' old. This particular animal had

laminitis restricted to the hind-feet. The condition was diagnosed and pus

liberated at the sole of one foot during the third day of the lameness. The

animal was cast on the fourth day, and pus obtained from the sole of the

opposite foot.

_Complications_.--In a moderate case, carefully treated, laminitis

terminates at the end of three or four days in resolution. The general

symptoms of fever gradually subside, the appetite returns, and the walk

becomes easier. Cases thus terminating fortunately leave behind them no

change of serious importance, either in the sensitive tissues or in the

horny envelope. Should resolution, however, be longer delayed, then the

case, although eventually terminating successfully so far as soundness in

gait is concerned, leaves more or less evidence behind in the shape of

rings about the wall and alterations in the build of the sole.

When the happy ending of rapid resolution is denied us, then, in addition

to the condition we have described as suppuration, we may meet with one or

other of the following complications:

_(a) Metastatic Pneumonia_.--This complication is not uncommon, and,

when occurring, more often than not ends fatally. It may be accounted for

indirectly by the greater work the lungs are called upon to perform in

carrying out the increased number of respirations occasioned by the general

fever and pain, and directly by the poisonous materials circulating in the

blood-stream.

_(b) Metastatic Colic_.--This may be either a subacute obstruction of the

bowel or an enteritis accompanied by an offensive purge.

A striking case of the former is related in the _Veterinary Journal_ (vol.

xvi., p. 180) by H. Thompson, of Aspatria. Here no evacuation of the bowels

occurred for three days, and the pains of laminitis were added to by the

usual pains of intestinal obstruction.

The colic of enteritis is in some cases caused by the nature of the food,

giving rise to laminitis. In our opinion, however, it is more often

occasioned by the drastic action of the aloes nearly always resorted to in

the treatment of the disorder. As does the pneumonia, the enteritis thus

brought about nearly always has a fatal termination.

_(c) Gangrene of the Structures within the Hoof_.--This complication is

the one most to be dreaded. It occurs as a result of the great pressure

exerted by an excessive exudation, and doubtless affects first the laminæ

and softer structures. Once commenced, however, it rapidly extends to death

of the other structures (ligament, tendon, and even bone), and gives a

fatal ending to the case.

That gangrene of the tissues ("mortification" as our older writers called

it) has occurred is soon made evident to the veterinarian by the symptoms

shown by the patient. The agonizingly acute pains suddenly subside, the

feet are placed firmly and squarely to the ground, and the animal walks

with ease. Perhaps but the night before the patient is seen racked with

excruciating pain; the morning sees the astounding change of apparent

absolute recovery. Too well, however, the eye of the experienced veterinary

surgeon sees that such is not the case. Even before proceeding to take a

record of the other symptoms, he knows that it is but the commencement of

the end. Methodically, however, he notes the other conditions. The pulse

he finds small and imperceptible, save at the radial. The thermometer

registers a subnormal temperature, the extremities are cold, and cold

sweats bedew the body. To the same experienced eye the countenance of the

animal is almost suggestive of what has occurred. The drawn and haggard

expression, to which we have previously referred, becomes more marked, and

the angles of the lips are drawn back in what has been described by some

writers as a 'sardonic' grin.

We can best express what the whole look of the animal's countenance

indicates to us by saying that it gives us the impression that the animal

himself knows that some serious change, and a change fatally inimical to

his chances of life, has taken place in his feet.

It may be that in some odd cases, although it has not yet been our lot to

meet with them, gangrene may terminate in the casting off of one or more

hoofs. Needless to say, there can still be but one termination to the case.

_(d) Periostitis and Ostitis_.--This complication is referred to by other

writers under the term of 'Peditis.' It signifies, of course, that the

periosteum and the bone have become invaded by the inflammatory process.

It is our opinion that these two conditions, even including an actual

arthritis, always exist, even in an attack of laminitis that ends

favourably. We do not claim, however, to be able to relate any means, save

that of post-mortem examination, by which it may be singled out from the

other changes occurring in the foot. The high fever and pain occasioned by

the inroads of the inflammation into the other sensitive structures serves

to effectually mask whatever evidence of it we might otherwise obtain.

It may be sometimes only small in degree, but we feel confident that

inflammation, at any rate of the _outer_ layer of the periosteum, is in

laminitis constant even, we repeat, in a mild case.

[Illustration: FIG. 118.--SHOWING CHANGES IN THE OS PEDIS WITH LAMINITIS OF

LONG STANDING, (_a_, Viewed from the front; _b_, viewed from the side.)

The porous condition of the bone, which is here shown, is a result of a

rarefying or rarefactive ostitis. This specimen also illustrated (what the

photograph cannot show) an accompanying condition of condensation of bone,

or osteoplastic ostitis. (For a fuller description of the changes occurring

in these forms of ostitis, see Chapter XI.)]

When the case is a serious one we have ample evidence to show that ostitis

exists, and exists in a severe form. The bones become vastly altered in

shape, a process of absorption leads to the formation of large, irregular

cavities within their substance, and what of the bone is left is rendered

hard and ivory-like (condensed) near what was the original centre, while

the edges and other portions show often a tendency to become brittle and

porous.

Fig. 118 illustrates the effects of a severe ostitis in pedal bones removed

from hoofs with laminitis of several weeks' standing.

_(e) Chronic Laminitis_.--The most common complication--or, perhaps,

rather we should term it 'sequel'--to acute laminitis is the chronic form

of the disease. For this condition we have reserved a separate section of

our work. It will be found described in Section B 1 of this chapter.

_Diagnosis and Prognosis_.--One is almost tempted to state that the

diagnosis of laminitis offers no difficulty. In the very early stages,

however, it may, as we have already indicated, be mistaken for the oncoming

of Enteritis, Lymphangitis, or even Pneumonia. The paddling of the feet

may help us. If this is absent, however, nothing but a most careful

examination, or, if necessary, the withholding of our opinion until the

following visit will prevent a blunder being made.

Even when well established, laminitis has been mistaken for paralysis,

for tetanus, for rheumatic affections of the loins, or even for some

undiscovered affection of the muscles of the arms and chest. This latter is

no doubt suggested to the uninitiated by the reluctance the animal shows to

move the muscles _apparently_ of that region, and led the older writers to

give to the disease its name of 'Chest-founder.' It is only fair to add,

however, that these blunders in diagnosis are nearly always committed by

persons without a veterinary training.

Thus warned, the veterinary surgeon of average ability should have no

difficulty in establishing a distinction between the diseases we have

enumerated as likely to be confounded with it, and the one this chapter is

describing.

The prognosis in laminitis should, in our opinion, always be guarded. No

advice given in a work of this description can be of any real use, for

every case must be judged entirely on its merits. The severity of

the symptoms, the cause of the attack, the complications, and the

idiosyncrasies of the patient, have all to be taken into account. These the

veterinarian must be left to judge for himself.

_Treatment_.--The treatment of acute laminitis in its early stage must be

based upon the fact that we have to deal with a congested state of the

circulatory apparatus of the whole of the keratogenous membrane. This fact

was well enough known to the older veterinarians. It is not surprising,

therefore, to learn that jugular phlebotomy was at once resorted to as the

readiest means of relieving the overcharged vessels of their blood. As a

matter of fact, bleeding from the jugular is still advocated by modern

authorities. We cannot say, however, that we unhesitatingly recommend it.

Mechanically, of course, the removal of a large quantity of blood is

bound to result in a lowering of the pressure in the vessels. The effect,

however, is but transient. Blood removed in this way is again quickly

returned to the vessels so far as its fluid matter is concerned, and the

pressure, removed for a time, is again as great as before. With the

other and more vital constituents of the blood-stream--namely, the

corpuscles--restoration is not so rapid. We have, in fact, a weakened state

of the system, in which it is probable it will not so successfully combat

the adverse conditions the disease may induce.

With these prefatory remarks, we may advise bleeding under certain

conditions. The quantity removed must be moderate (7 to 8 pints), and the

pulse and other conditions must show no signs of weakness or collapse.

Local bleeding, either from the toe or the coronet, is also advised. In

the former situation the sole is thinned down until a sufficient flow

is obtained, while at the coronet scarification is the method adopted.

Bleeding locally, however, is far less effectual than the jugular

operation. Neither must it be forgotten that wounds in these situations,

more particularly at the toe, are extremely liable, especially with

the existing poisoned state of the blood-current, to take on a septic

character. What might possibly have remained a comparatively simple

inflammation is induced by the operation itself to terminate in the more

complicated and serious condition of suppuration.

Other means of combating the congested state of the membrane are

principally those of local applications. With many veterinary surgeons warm

poulticing is still largely advocated and practised. We do not believe in

it. Warmth, as a means of removing local congestion, can only be successful

when applied _widely_ round the congested area, and so dilating surrounding

bloodvessels and lymphatics. Applied to the congested area itself, and to

that alone, it is almost worse than useless.

With the foot, both around and below it, a surrounding area is denied us.

The only vessels we are able to dilate with the warmth, and so enable them

to carry off the fluid from the congested foot, are those in the

limb above. That poulticing cannot be successfully there applied is

self-evident. Apart from that, it is an open question whether poultices may

not do actual harm in inducing suppuration in cases where, probably, it

would not otherwise occur.

For these reasons we hold to the opinion that when a local application is

determined on it should be a cold one. Various methods of applying cold are

in vogue. Cold swabs are perhaps most in favour. They must, however, be

_kept_ cold. When a suitable water-course, pond, or other expanse of

shallow water is at hand, then the animal may be kept standing therein, or

preferably walked about in it. When suitable apparatus is obtainable, a

constant stream over each foot from a rubber hosepipe is most beneficial.

Astringent baths, containing solutions of alum, of copper sulphate, of iron

sulphate, or of common salt, or composed of a mixture of two or more of the

salts mentioned, may also be used with advantage. In addition to the fact

that such solutions are for a time below the temperature of simple water,

we have the advantage that they have also a more or less antiseptic

property.

While on the subject of the relief of the congestion, we must not forget

to mention a treatment which we ourselves have practised with considerable

success--namely, that of forced exercise. It appears to have been first

brought into prominence by Mr. Broad, of Bath, and the two terms 'Forced

Exercise and Rocker Shoes' and 'Broad's Treatment' have come to be

synonymous.

The Broad shoe is a shoe with a web of quite twice the thickness of the

animal's ordinary shoe, and has this web gradually thinned from the toe

backwards until at the heels the shoe is at its thinnest (see Fig. 119).

The excessive thickness of the shoe serves two purposes. It allows of the

requisite amount of slope being given to the web, and so enables the animal

readily to throw himself back on to his heels, a position in which, as we

have already indicated, he obtains the greatest ease. It also minimizes to

some extent the effects of concussion.

[Illustration: FIG. 119.--SEATED ROCKER BAR SHOE (BROAD'S) FOR TREATMENT OF

LAMINITIS.]

With forced exercise, as practised by Mr. Broad, this shoe is first

applied, and the animal afterwards made to walk upon soft ground, or even

upon the roadway, for a half an hour to an hour and a half three times a

day.

For our own part, we consider the shoe to be almost if not quite

superfluous, so far as its influence upon the progress of the disease is

concerned. We therefore dispense with it, and have the animal exercised in

his ordinary shoes. To do this, the patient has sometimes to be severely

flogged into taking the first few steps. After that progress gradually

becomes easier.