TlBRARY OF CONGRESS. Shelf .. tion of the same term for application to both joints alike. The tendinous thorouglipin, or hydrarthrosis of the knee is constituted by either a dropsical con- dition of the synovial sheaths which facilitate the sliding of the extensor tendons upon the anterior face of the knee, or by the dilatation of the carpal tendinous synovial sheath on its posterior face. The synovial sacs of the extensor tendons assist their action in gliding in the sheaths formed at the expense of the common anterior ligament of the carpus. They sometimes communicate with the articular capsules, an important peculiarity to consider in view of the danger attending their opening. The flexor tendons, as they pass through the carpal arch are surrounded by a vaginal synovial sac, which by reflecting upon the tendons forms, above and below^ two cul-de-sacs, which are rendered more prominent by the occurrence of a dropsical condition of the synovial capsules. The superior cul-de-sac runs at the side of the flexor muscles, as high as the lower quarter of the radius, while the inferior surrounds the perforatus and the perforans tendons, and ex- tends downard as far as the superior third of the metacarpus. Hydrarthroses of the knees are situated along the tract of the tendons of both the flexors and extens LAMENESS OF HORSES. 133 sors of the phalanges, where they constitute tumors anterior and posterior. The posterior gives rise, behind the carpus, to two tumors of unequal size, the external being much more voluminous than the internal. It is of an oval form and situated on each side, between the radius and flexor muscles of the metacarpus, nearer to the muscles than to the bone. It is more elongated superiorly, and extends downward below the knee, as an elongated mass, irregular on its surface, and somewhat bosselated according to the pressure of the anatomical struc- ture of the region. There is considerable variation in the dimensions of these hydrarthrosis, and they possess a tendency, according to Bouley, to indura- tion of the walls, with even a possibility of of ossi- fication. The dilatation of the tendinous sheaths of the extensor tendons may give rise to tumors of various size, small at first, and elongated, along the course of the tendons but becoming much larger, and sometimes uniting together and communicating with the articular capsular sac. The walls usually become ossified and the cavity frequently contains floating bodies. They are distinguished by the depth at which they are found from the hygroma, which is always superficial. In the treatment of this form of tendinous dropsy, 134: LAMENESS OF HORSES. needle canterization is recommended, and tincture of iodine injections are of service, but this refers to the posterior tumors only, their use in those situated anteriorly being precluded by the danger of estab- lishing communication with the articular synovial capsule. The deep or needle cauterization is with- out doubt, the most efficacious and lest hazardous of all modes of treatment. The dimensions sometimes attained by posterior thorough-pin of the knee are too great to consist with the possibility, or in any case, to justify any thing like a hope of recovery. Yet a case in our own practice, in which the fore arm, the knee and the upper portion of the canon were involved, and in such a condition of deformity from the enormous dilatation of the tendinous carpal sac, as to cause much hesitation in regard to the indication most expedient to adopt, yielded to a treatment which consisted in puncturing the tumor in various places* and vigorously applying the blistering process, until the mass was reduced to dimensions so compara- tively insignificant that it no longer incapacitated the patient from resuming his labors. LAMENESS OF HORSES. 135 SPEEDY CUT. The reader is referecl to another page for the con- sideration of this ailment as we consider it one of the forms of interfering treated among the injuries of the fetlock. SPRUNG KNEES. In this defective condition of the anterior limbs the horse stands with the kneo partly flexed, so that a line from the fore arm to the fetlock, instead of falling perpendiculary, forms a curve with the con- vexity looking forwards. Such a condition may exist in varying degrees, from that of the slightest departure from a symmetrical posture to a variation so extreme as almost to cause a disability to bear the weight of the body, and to subject the animal to constant danger of falling. Though they may be at times a congenital infirmity, they are usually the result of old age, excessive labor or hard work imposed too early on young animals; or they may result from actual disease of the articulation. An attack of arthritis, a large carpal thorough-pin, an exostosis of the carpal bones, or even disease of the lower part of the leg may by degrees, and with time become the cause of this change in the direction of the long bones of the leg, by the retraction of the fibrous cord of the flexor brachii inserted in the 136 LAMENESS OF HORSES. aponeurosis of the radial region, as suggested by some authors, but more usually by the retraction of the flexors of the knee joint proper i. e., the external and oblique flexor metatarsi. With sprung knees, the animal loses a great deal of solidity and strength as to the motive function, is deficient in general activity, and even becomes liable to frequent falls. The horse, more than any other animal, is subject to this infirmity, and though he may not always be entirely disabled from labor, which is compatible with slow movements, he is of course quite unfitted for rapid travelling, and especially unfitted for such a function as that of a light carriage or a saddle horse. In the last named capacity his employment would be quite inconsistent with the safety of his rider. Scarcely another infir- mity, whatever congenital or acquired, so depreciates the value of the horse as this malformation. The question of treatment for sprung knees has long been one of interest among veterinarians, and from the importance of the subject has naturally elicited a large amount of discussion, and the sug- gestion of a wide variety of methods for the relief of the difficulty, but for the most part, hitherto with- out the development of any practicable or satisfac- tory result. When they are the result of congenital weakness, or are brought on by labor imposed at LAMENESS OF HORSES. 137 too early a period of life, a run in the pasture for a few months will sometimes be of service. Blisters have been recommended, especially in cases of weakness of the joints. For very young colts splints have been tried. But usually, if any relief has been secured, it has been of a mere temporary duration, and the deformity has returned with the discontinu- ance of the treatment for help, and the renewal of the labor of the patient. When orthopedic appliances and shoeing prove insufficient for the remedy of the evil, the most promising means of attaining the object is the oper- ation of tenotomy, either by the section of the band of the coraco-radialis, or better still, of the tendons of the flexor metacarpi. The first is an old opera- tion, recommended by Solleysel and Lafosee, but which has proved unsuccessful in the hands of Del- ward and others. The other, usually known as car- pal tenotomy, consists in the division of the tendons of the external and middle flexors of the metacarpus. It is simple in its various steps, and considering the good results which have followed it, it is somewhat remarkable that it has not been oftener performed. Although the origin of this operation is a matter of some obscurity, it is from German writers that our knowledge of it is first derived. Dietrichs and Hering have performed it with success, Brogniez 138 LAMENESS, OF HORSES. was one of the first to put it to the test. By his method the tendons are divided transversely with a narrow bistoury, after being exposed by means of a longitudinal incision made above the trapezium. The disposition of the wound thus made, to assume the granulating process, from which trouble some- times arose, from an indisposition to heal readily, suggested a change in the method of manipulation, and the adoption of the subcutaneous plan. The modus operandi to which we give the prefer- ence over those generally recommended by Gourdon, Peuch, Toussaint and others, is very simple. The animal being thrown, on the side opposite to that of the operation, a rope is placed on the upper end of the fore arm and another at the lower end of the canon, and both are pulled in different directions, in order to hold the leg in extreme extension at the knee. The operator, who is placed in front of the knee, feels for the separation which exists between the two muscles as they are about to unite. This being found, a straight tenotomy knife is introduced from before backward about two inches above the superior border of the trapezium, through the skin and under the thickness of the oblique or middle flexor of the metacarpus. When the point of this knife is felt on the other border of the muscle, the curved tenotomy knife is introduced into the wound, LAMENESS OF HORSES. 139 while the straight one is carefully drawn out and then the tendon is easily divided by bringing the sharp edge of the instrument across the tense tend- inous fibres. This muscle being cut, about one inch nearer to the border of the bone, the pointed tenot- omy knife is introduced from behind forward on the posterior border of the external flexor, under its thickness, until the point of the instrument is felt on the anterior border, when the curved instrument is again introduced, and the division of the tendons performed, as in the case of the first muscle. A light bandage, antiseptics and rest for about three weeks is all that is necessary. No hemorrhage, but little swelling, in fact, no accident of a serious nature has as yet been recorded. CHAPTER IV. THE POSTERIOR LEG. HIP JOINT. Diagnosis. — The formation of an acurate diagnosis in cases of lameness which appear to implicate the hip joint is not the least of the difficulties which are incident to veterinary practice. To comprehend this implied difficulty, the complex anatomy of the joint the strength and compactness of the connecting tis- sues which combine to unite and consolidate the various parts of the structure ; and the volume and power of the thick muscles which cover it and con- trol its action, must all be taken into consideration. It naturally follows from the operation of the same elements that the lesions which usually become the originating causes of lameness are of rare occur- rence in the hip joint proper. This fact is amply confirmed by the statement of Bouley, whose statis- tics, if we accept them as authentic, prove that out of every hundred cases of lameness in the posterior limbs of the horse, at least ninety are referable to LAMENESS OF HORSES. 141 lesions of the hock. The facility with which errors of diagnosis may occnr when the seat of an existing lameness is too confidently located in the hip joint, may be easily inferred from this fact. Still, with careful observation, a true diagnosis, even if but rarely accomplished, is attainable, and especially when inflammation can be certainly indi- cated in the joint proper. The serious changes which accompany and characterize that condition cannot easily evade observation. Disease of the synovial capsule, softening and dis- organization of ligaments, ulceration of the carti- lage, necrosis of the bones — in a word, all the lesions to which the human formation is subject, when suf- fering with an attack of morbus coxarius, may in like manner, affect the lower animals. An interest- ing fact in this connection is here in point. The ex- treme pain attending this disease in the human sub- ject, and its disabling interference with the function of locomotion, are matters of common knowledge, and yet, we have met with a large number of cases in which this acute suffering and the accompanying excessive lameness have quite escaped observation, notwithstanding the fact that both the acetabulum and the head of the femur have been both diseased. It is only in cases where the lesions of the bones are extensive, and the articulation proper largely 142 LAMENESS OF HORSES. involved, that a severe form of lameness exists, or great pain appears to be present. It is not alone the joint proper that may become the seat of disease. The ligaments, the tendons of the gluteal muscles, and these muscles themselves; the bones, and especially the great trochanter, may each become the seat of lesion. Yet too often these are all comprehensively considered, and indiscrimin- ately referred to by the single term of hip joint lameness, or sprain of the hip. The causes which are likely to result in sprains of the hip are sliding or falling on slippery ground, when the hind legs are suddenly thrown into extreme abduction, or indood any violent effort, accompanied by powerful muscular contraction, or laceration of the soft structures at the joint, as when an animal has been cast for an operation, and kept continu- ously in a strained posture ; or the strain of his resistance while being placed in the stocks for a similar purpose ; or his opposition to the pressure of a heavy load while descending a declivity, and the like. Hip lameness is not uncommonly associated with rheumatic disease, and it may also occur as a symp- tomatic affection in distemper, in glanders, or in farcy : and it is affirmed by Percivall that " foals and calves are occasionally subject to scrofulous inflam- mation of the hip joint." LAMENESS OF HOUSES 143 But although the symptoms of hip lameness are not always readily subject to distinct characteriza- tion ; and in this lies the principal difficulty of diag- nosis, it is still true, as before intimated, that by a careful scrutiny of the movements of the patient, under varying circumstances of repose and activity, a true location of the seat of the lesion may, in not a few instances, be positively determined. It will, however, only be as the reward of a thorough and intelligent analysis of existing pathological phe- nomena. Among the signs to be studied are these : There is a restrain in the action of the joint in walking, and the free forward and backward motion of nature is lacking, leaving, on the contrary, a dis- cernible hesitation and stiffness, accompanying the displacement of the thigh, and a consequent shorten- ing of the step on the affected side. There may also, besides this, be a certain gesture of abduction, or rather a suggestion of circumduction, similar to that which may be observed in lameness of the shoulder. But inasmuch as this style of movement may also occur in association with other affections, such as enlargement of the spermatic cord, or disease of the inguinal ganglions^ or of the testicles, it must be remembered that it is not pathognomonic, and that the absence of these affections must be duly 144 LAMENESS OF HOMES. accepted as an important element of the case. This is specially to be noted in respect to the abduction movement referred to. As a fact to be duly weighed, it must be noted that this feature is not always dis- tinctly seen while the animal is walking, and becomes, at times, conspicuous only when the gait is increased to a trot, when its discovery becomes much easier. Percivall and Williams thus allude to this circum- " stance : There is a hop and a catch in the movement " of the lame limb, which to the practiced eye pretty " clearly show the lameness to be in the hip. The " whole of the quarter on the lame side is elevated " with as little motion of the hip as possible ; the " other articulations being flexed with ease." The presence of pain may also be betrayed by a move- ment of the leg up and down, and though it may not be of a lancinating character, it is yet sufficiently expressive of the inability of the animal to carry weight. Manipulations of the joint are not a little serviceable as a means of forming a judgement, in respect to the hip, as well as in the shoulder, though it is more difficult to produce the necessary excessive movement in the former than in the latter, and possibly, the result, even when there is an evi- dent experience of pain, is not equally positive. Percussion over the joint, or pressure of the bones one against the other, will often, we believe, assist ip LAMENESS OF HORSES. 145 the diagnosis . Yariations of temperature over the joint, and a careful comparison of the dimensions of the two sides has sometimes proved more than sufficient to fix the locality of the ailment. An examination per rectum, according to Williams, may cause a manifestation of pain from pressure on the joint. Exercise upon soft ground, involving an increased demand upon the muscular resources as compared with that upon a hard surface, where only a minimum of force is required, will easily determine whether the suspected joint is abnormally sensitive. Atrophy of the muscles has sometimes been con- sidered as a valuable symptom. But if this is not an unfrequent, it still is but a deceptive one. It must be born in mind that it maybe in fact but the result of the non-use of the joint, arising from a state of rest induced by the presence of other lesions, exis- ting in regions remote from the hip, as spavins, ring bones, injuries of the feet, etc. Prognosis. — The prognosis of hip lameness is usu- ally a serious one. The tenacity of the disorder and its resistance to treatment concur in rendering it liable to an increased persistency and confirmed obstinacy, greater or less, according to the special features and the extent of the lesions. Treatment. — The treatment of hip lameness must be varied according to circumstances. But it must 146 LAMENESS OF MOUSES. include the essential condition of rest, which must always be as complete as can be attained, even to complete immobilization, when that is possible. Both the cold douche and the warm fomentations are recommended in the beginning of treatment, but the wiser course is to avoid the loss of time involved in these palliative expedients, and to proceed without delay to the use of more effective and reliable meas- ures. Among the more reliable remedies are the stimulating liniments, applied with friction, such as tincture of camphor, ammoniacal liniment, oil of turpentine and tincture of cantharadis. One class of practitioners give the preference to charges and blisters varying in strength, and applied in succes- sion, until a good effect is produced, and they claim favorable results. Caustic trochisci, rowels, setons crossing and intersecting one another, as in shoulder lameness, have also their advocates. The actual cautery, both in dots and lines, is favored by not a few, and the blemishes which follow this severe treatment, are visible in a sufficient number of re- covered patients to testify to its popularity and pre- valence among practitioners. The use of canteriza- tion by Professor De Nanzio, of Naples, may be mentioned, but not, as we think, with strong recom- mendation. Professor Williams advises the use of a high LAMENESS OF MOUSES. U1 heeled shoe, designed to assist the parts in main- taining a position of repose. But on the contrary, the treatment of Luchow endorsed by Hertwig and Delwart, has also shown excellent results, and though we cannot truly endorse the theory upon which it is founded, we describe it as being applica- ble to the same form of disease in both the shoulder and hip. It will be seen at once that the plan is contrary to all generally received suggestions in respect to the treatment of lameness of the nature of that which we are considering, in favoring forced exercise and excessive motion, in common with the cold affusions of hydrotherapy. The modus operandi f is thus described in the " Repertoire de Medecine Vet: erinaire de Belgique :" " Hydrotherapy has been advantageously used in " the treatment of shoulder lameness by a German " veterinarian, Luchow. This treatment, which is " applicable as well to hip lameness, consists in cov- " ering the animal with a hood and double blankets " and rubbing the deceased joint with a mixture of " liquor ammonia and spirits of turpentine, of each " one part, and camphorated alcohol and tincture of " soap, of each one and a half parts. The friction is " ended when the skin is covered with a light foam. " The animal is then exercised, to the plate longe, turn- " ing on the sound leg, and when in a profuse per- 148 LAMENESS OF HORSES. " spiration is returned to the stable, where notwith- " standing this sweating condition, the lame joint is " covered with thick compress, wet with cold water. " This is changed every, two hours. The last one is " removed the next day. During eight days the '' animal, well blanketed, is walked for half an hour. " As the animal improves, the gait is increased. " Eecovery is ordinarily complete after two or three " weeks." There is however, another form of hydrotherapic treatment, which has proved more successful in both chronic and recent cases of hip lameness ; it is the use of cold water, either in douches or in sprays, it is immaterial which, if only a certain degree of force accompanies the contacts. STIFLE JOINT The stifle joint, which is a very complicated appar- atus, is formed by the articular surfaces of three bones, and constituting almost two distinct joints, the femoro-tibial and the femoro-patellar, all the various elements being mutually united, adapted and strengthened through the medium of inter-artic- ular menisci, fibrous pads added to articular sur- faces, with inter-articular and surrounding funicular ligaments. Although from the fact of this compli- cation of construction it might be inferred that LAMENESS OF HOUSES. 149 injuries would be of easy and frequent occurrence at this point, yet the truth is that the literature of this subject is exceedingly meager and imperfect. That sprains and lacerations of the ligamentous attach- ments must occasionally occur, cannot be doubted, or that the bones and their articular surfaces must undergo the various changes naturally incident to the osseous structure when in a pathological condi- tion, implicating the joints, of course . So much is evident from the developments of post mortem investigations in cases of inflammation and ulcera- tion, and of bony desposites — all of which have been found, essential pathological lesions, which must necessarily have occasioned a greater or less degree of lameness. Notwithstanding all this, however, the writings of veterinary authors are nearly silent upon the subject. The external manifestations of injuries of the stifle-joint are exceedingly obscure, although it is true that swelling of the entire joint, with an un- usual heat, and perhaps soreness on lateral pressure, must naturally suggest this point, as the seat of disease. The position of the animal while at rest is corroborative of this suggestion. Standing with the limb flexed, the thigh upon the pelvis and the tibia upon the femur, it is obviously, an attitude which the animal would instinctively assume in order to 150 LAMENESS OF HOUSES. avoid the painful pressure of the bones against each other. In referring to this, Williams says : " there " is then, when the animal is called to move, a " peculiar condition, by which extension succeeds to " this semi-flexion, which is the consequence of the " rigidly extented state of the stifle, and as a result " the heel of the foot strikes the ground first." This semi-flexion of the entire leg appears to be one of the most essential symptoms of disease of the stifle. But the motion ; the difficulty attending the flexion of the joint, with its tendency rather to the opposite condition of extension ; the occasional dragging of the toe on the ground ; sometimes the associated suggestion of a slight circumductory sweep ; and with these, soreness on pressure, with heat and swelling, readily discovered by the touch — considered together, this group of appearances furnishes quite sufficient evidence of the presence of disease of the femoro-tibial or femoro-patellar articu- lation. Out of numerous post mortem examinations of the stifle joint made by us, we have in but very few instances discovered the series of lesions commonly met with in arthritis. Indeed, comparatively very few cases of lameness in this articulation, from any cause, have fallen under our practical observation, and we feel justified by a large experience, in affirm- LAMENESS OF HORSES 151 ing our conviction that notwithstanding the many conditions of exposure to injuries incident to its sit- uation and its functions, such injuries or lesions are in any case of very rare occurrence. And it is our further conviction that when they are encountered, the wisest and most promising indication of treat- ment will be fulfilled — as we have before mentioned, in respect to the treatment of lameness generally — in long rest, with a good deal of non-interference. HYDRARTHROSIS OF THE STIFLE. The motions of the joint are assisted by three syn- ovial capsules, one pertaining to the femur and the patella, or the femoro-patellar, and two connecting the condyles of the femur and the facettes of the tibia. Although these synovial sacs do not often assume a dropsical condition, still they do at times become thus affected, and quite extensively tume- fied in consequence. This assumes the form of a soft tumor on the anterior face of the stifle, in front of the patella, and is developed somewhat more inwardly than outwardly. The appearance of the tumor itself furnishes the first intimation of the existence of the lesion. If, of considerable size, this may seriously interfere wi'th the movement of the joint, and produce a marked and troublesome lame- ness. 152 LAMENESS OF HORSES. Caution must be observed in order to avoid the error of confounding this tumefied condition with an apparent enlargement sometimes observed in a healthy stifle, when the animal is seen standing in an easy position, but with the limb semi-flexed, as may occasionally take place. The flexion of the joint is very much interfered with, in hydrarthrosis, in consequence of the incompressibility of the con- fined liquid, and when this is the case there will be a marked peculiarity in the style of walking, the animal either dragging the leg or carrying the foot forward by a single movement to the spot where it is to be set down. The liability of this disease to result in an enor- mous enlargement of the joint is among its most serious dangers. To relieve this condition resort must chiefly be had to blistering or to the cantery, the application of the latter by deep penetrating points. The puncture of the tumor with a fine tro- car, followed by fine cauterization through the skin, and the application of a layer of cantharides oint- ment has produced advantageous results. Ointment of bichromate of potash is also advocated, though not in preference to the actual cantery. LAMENESS OF HORSES. 153 HYGEOMA. A large collection of this nature which came under our own observation, enables us to present an au- thentic description of this affection. It appeared in the form of a very large, soft, fluctuating tumor, in front and somewhat on the inside of the stifle, and of a shape somewhat elongated in its supero-infe- rior diameter. Though not painful to the touch, it interfered greatly with the function of locomotion, in consequence of its bulk alone. After treating it outwardly by the application of mild absorbants and the cold water douche, we decided upon more thorough measures, and proceeded to empty the tumor of its entire contents, by means of the aspi- rator. The result of this operation was the removal of fifty-two ounces of a thin, slightly albuminous, yellow fluid, and the sac having nearly refiled, a repetition of the puncture the day following, with the discharge of twenty-six ounces more. The tro- car of the aspirator was then left in the opening, and about six ounces of a very weak aqueous solu- tion of tincture of iodine injected into the cavity. The injected fluid was not suffered to remain in the sac, but after being brought by means of the mas- sage process, into contact with all parts of the inte- rior surface, was withdrawn through the trocar, by 154 LAMENESS OF HORSES, the aspirator, in the same manner in whicii the orig- inal fluid was removed. Further treatment being now intermitted, the parts became the seat of a flat swelling, slightly warm and somewhat painful, until a few days subsequently, when a return of the serous collection became manifest. A third puncture, and the removal of about four ounces more of fluid, fol- lowed by a second injection of diluted tincture of iodine completed the recovery. A slight swelling which had remained disappeared after a few days and the animal was returned to his work. CRAMPS OF THE PATELLAR MUSCLES. A true luxation of the patella consists in a dis- placement of the bone, either inwardly or outwardly, from the femoral trochlea, and this cannot take place upon the femur, unless the ligaments which unite them are either lacerated or extremely elon- gated. Such a lesion would be necessarily accom- panied with either swelling of the stifle, inflamma- tion of the joint, or arthritis, and would necessitate a careful and protracted course of treatment. But these conditions are not those which characterize the case which is commonly described as a " stifle out of place." There is however, a condition which may result in a simulated, or pseudo dislocation of the patella, LAMENESS OF HORSES. 155 and is the effect of cramps of the muscles of the stifle, which produce a physiological displacement of the patella, with a corresponding lameness, and having peculiar characteristics of its own. The experimental observations and researches of Mr. Yiolet have proved that this pseudo dislocation of the patella is simply the arrest and lodgement of the bone upon the upper end of the internal hip of the femoral trochlea. This part being well fitted by its peculiar formation to prevent the patella from sliding back over the rim and being drawn down- wards to its normal place, then becomes fixed in its new position by the irregular and violent contrac- tions of the muscles involved in the abnormal tension. The main symptom to which this condition gives rise is essentially characteristic. It is a sudden rig- idity of one or other of the hinder extremities, so extreme and extensive that the entire limb assumes the appearance of an inflexible bar throughout its entire length. This symptom may become manifest both in and out of the stable, either while the ani- mal is rising up, or possibly even while he is simply in the act of moving backward and forward in his stall. When compelled to move, the act is performed without visible flexion, either at the stifle or the hock, both joints having become wholly immobilized. 1B6 LAMENESS OF HORSES. In that condition, as Bouley and Nocard remark, "femur and tibia, tibia and metatarsus, form but " one single stiff rod, and so the foot cannot be " raised from the ground, the flexion of the phalan- " ges takes place by the anterior face of the foot, •' which drags on the ground, with its plantar sur- " face turned backward, and as a consequence, the " hip is lowered in proportion." In this condition the act of walking is accomp- lished only with great difficulty and by violent exertions, as the suffering animal testifies, intelligibly enough, by his anxious countenance, his dilated nostrils and his hurried respiration. On examining the stifle, a deformity soon appears, on the outside, at its superior part, in the form of a hard, resisting prominence. This is the dislocated patella. The lameness characteristic of this lesion is strictly inter- mittent. It disappears at once when the patellar slides back into its place, but returns immediately whenever the obstruction again interferes with the proper downward motion. It may return to its proper location by a spontaneous action, or it may require the interference of the surgeon for its reduc- tion, In either case, however, immobility of the stifle and hock joints disappears at once, as the patella glides, back over the femur, their flexion being re-established without pain or stiffness. The LAMENESS OF HORSES. 15? essential causes of this peculiar lesion are considered by Yiolet to be either the spasmodic contraction, or cramp of the inferior fibres of the internal vastus, or a paralysis, soreness, or weakness of a portion of the superficial glutens. Whatever may be the explanation of their phenome- na, their occurrence is most common in young colts, and in horses from four to five years old, and espe- cially during convalescence after prostrated and debilitating diseases ; after attacks of distemper, influenza, etc., and after excessive exertion following a long inactivity. "Williams speaks of their occurrence as supervening upon attacks of indigestion, and as yielding to one or two doses of purgative medicine. In view of the nature of some of the originating causes of patella displacement which have been referred to, the suggestion naturally presents itself, of the practicability and value of preventive meas- ures, and one of the most important and obvious of these would seem to be suitable and continuous exercise, by which the animal would escape the danger of a sudden change from protracted rest to sudden and violent labor. The curative treatment consists, of course, in replacing the dislocated bone from its abnormal to its normal position, and preventing, if possible, a recurrence of the luxation. 158 LAMENESS OF HOUSES. In fulfilling the first indication the leg is brought into excessive extension, either by an assistant, or with the aid of a rope, while the surgeon, placed towards the back of the animal forcibly pushes the patella forward and inward. When the luxation is successfully reduced the fact is known by a peculiar sound, accompanied by a sudden jerking of the leg and the simultaneous flexion of the stifle and of the hock. But although, when the bone is once returned it will frequently maintain its position, the trouble may recur after walking a few steps, and the process of reduction may become necessary a second, end even a third time. The question of preventive treatment becomes, therefore, one of interest and importance. Stimulating frictions are recommended, with this view, and are practised with embrocations of various degrees of strength, from the mildest lin- iment to the most energetic blistering. Sometimes when the surgeon finds his manipulations over the joint insufficient, soothing medications, chloroform, and opiates over the muscles of the femur, are said to be beneficial, while again, severe showering douches, or hot fomentations have relieved when all other means had failed. In our own experience we have always observed that good results have followed moderate exercise immediately after the reduction, and very often the LAMENESS OF HORSES, 159 simple fact of turning the patient loose in a large box stall has been sufficent to prevent a return of the difficulty., even when the displacement had pre- viously disappeared and returned intermitingly, while the patient was kept in a single stall. The subcutaneous section of the internal tibio- patellar ligament has been recommended as a last resort, by Italian veterinarians, and seems to have been recognized as good practice by Professor Noc- ard, who states that it has been performed several times, and has been followed by complete success. To whatever originating causes these displace- ments may be due, we must look in that direction for the suggestion of the reasons which offer them- selves for surgical interference, when that seems to be indicated. With this view, and for the further illustration of the subject, the relation of a case which occurred in our experience, and which we reported in 1885, in the American Veterinary Review, may possess a value. The favorable result which followed in that special case would fully justify us in again employing the same remedial means, if the opportunity were again to present themselves. The record of the case was made by Dr. Eyder, House Surgeon of the American Veterinary College Hos- pital, and is as follows : 160 LAMENESS OF HOUSES. LUXATION OF THE PATELLA OF SEVERAL MONTHS STAND- ING. — DIVISION OF THE LONG VASTUS MUSCLE.— RECOVERY. Description and History. — A brown stallion, three years old, had been in training at the Long Branch race ground, when about the middle of May he was found in his stall with his off hind leg extended backwards, unable to carry it forward, and moving with great difficulty. "When the door of his stall was opened, he fell down, and it was with great dif- ficulty that he regained his feet. A veterinarian was called who made the diagnosis of sprain of the an- terior tibial muscles, and treated him for that lesion until the end of July, when the owner had him brought to the hospital in an ambulance. Condition at Admission. — The animal being unable to back from the conveyance in which he was moved, was turned and led out. He was a fine looking colt, and in good condition. In walking he carried his off hind leg in excessive extension, first backward, then by a sudden movement of abduction bringing it forward without any flexion of the leg below the coxo-femoral articulation. The muscles of the ante- rior crural region, and especially the fascia lata, seemed to be atrophied. Those of the gluteal were much smaller on that side. As the animal arrived late in the evening he was placed in a stall and left LAMENESS OF HORSES. 161 until the next morning for more careful examina- tion. On the 29th. he was with difficulty, backed, or rather, pushed back from his stall. He was in the same condition, and had not laid down during the night, the off leg was then seized by an assistant, brought well forward, and held in that position, while by manipulations and pressure upon the exter- nal face of the patellar from behind forward, the bone was felt slipping from under the hand, and with a sharp cracking sound, returned to its place. — The leg flexed suddenly, and the animal, being led forward, more freely, with perfect flexion of the stifle joint : but as soon as the pressure of the hand ceased, and the animal had made two or three steps, the same condition returned, of extentions of the limb inability to walk. —This was repeated several times with like results. — The ordinary simple treatment of hot fomentations being considered of little advantage in a case of such standing, a severe blister was applied over the joint, extending a great distance all around. The effects of the application seemed to be, at first, satisfactory. An enormous swelling took place ; the scabs of the blister formed a firm bandage, but the result was nevertheless negative. No improvement was obtained ; the leg remains in the same condition, 162 LAMENESS OF HOUSES. perhaps a little worse, as it then became very diffi- cult to obtain a temporary abduction of the dislo- cation, as had been done at first. Having been allowed to walk loose in a large box stall, to wait the removal of the scabs of the blister, he was on the 15th of August, returned to a single stall and hobbles where placed upon the legs of the lateral bipeds. The dislocation was again reduced, and though he was kept in that uncomfortable position for three days, still no satisfactory result was obtained. — The case then assumed a very unfavorable aspect. The leg was becoming excessively atrophied, the animal began to loose flesh, his appetite became poor and everything seemed to indicate a failure to relieve him. It was then that the propriety of the operation of subcutaneous myotomy suggested itself, and with the sanction of the owner was performed, on the 9th of September, by Dr. Liautard. Having been given a dose of chloral, and being kept under restraint with a twitch, a small incision was made at the lower bor- der of the anterior part of the triceps femoris, and a curved blunt bistoury about three inches long intro- duced under the skin, when its sharp edge was turned on the muscle. The division of the fibres was plainly heard and when the muscle was thought to be LAMENESS OF HOUSES. 163 entirely divided, the animal was allowed to go, the patella having returned at once to its position, but to be followed again by another immediate displace- ment. After waiting a few days for the healing of the parts, which occurred with little suppuration, the owner was notified of the failure of the operation, but being undecided as to what course to pursue, the animal was still kept at the hospital. On the morning of September 26th, as the groom was entering his stall to feed him, the horse made a sudden turn, slipped and fell down; he rapidly regained his feet, and was up in a moment, and when called upon to move, was found moving the leg with perfect action, walking with a firm, steady step, although occasionally betraying a slight sharp pain in the limb, but which disappeared in a few days. After this, he was exercised every day, improving rapidly in form as well as in action, until the 14th day of October when he was discharged in his normal condition. Remarks, — Is it an error, when considering this rapid and unexpected recovery, to suppose, that the division of the muscle at the time of the operation, was imperfect, but was completed by the fall of the animal, thus confirming the propriety of the opera- tion, in cases of such long standing ? 164 LAMENESS OF HORSES. BUPTUBE OF THE FLEXOB METATAKSI. As we have before remarked, the rupture of a muscle is the result of a violent effort in which the organic fibres give way and their continuity is destroyed by a force superior to their tenacity. Though it is frequently met in some of the muscles, the flexor metatarsi, notwithstanding its powerful structure, is comparatively a common seat of this lesion. It may occur when an animal makes a violent effort to move an exceedingly heavy load to which he is harnessed, or, as we have twice witnessed it, in making a powerful struggle to avoid a sudden threatening fall. The sudden rupture of the muscular fibres under an inordinate strain is accompanied by the exhibition of symptoms too characteristic to be misinterpreted. In the words of Percivall, in relating a case of rupture of the flexor metatassi : " The action of the limb indicated the loss of power " of that muscle, as the leg could not be bent at the hock " and completely straightened behind, and he had " not power of any importance before, in opposition " to those antagonist organs, the gastrocnemii, behind. " In some of his movements, the limb appeared quite " loose about the hock, and was occasionally knocked " against the other leg. On moving him about, there " was a twitching up backwards of the leg at the hock. LAMENESS OF HORSES, 165 " and when he walked forward, it was evidently done * without the concurrence of the flexor metatarsi. t * There was a soreness in front, at about six inches '' above the hock, and also a little higher up, and the " usual tenseness and distinctness of the tendon " could not be seen. There was no apparent pain of " any importance." "Williams completes the description of the symp- toms by saying that when the animal is compelled to move, the leg is thrown upwards and backwards,with great violence, and at the same time the tendo- Achilles is seen to fall into a number of folds. These extracts accurately describe the symptoms exhibited by patients suffering from this lesion. If observed while standing quietly in his stall, the ani- mal seems to be sustaining his weight equally upon all his legs, without favoring one at the expense of the rest. But upon being compelled to move, the want of the counter motion of contraction of the gas- trocnemii, the carrying backwards of the leg in exten- sion, and the flabby condition of the tendo-Achilles easily betray the true state of the case. The question of the exact seat of the injury, and of the precise point in the course of the muscle where the rupture is to be looked for seemed for a long time to be involved in doubt. Some have located it in the tendinous section, near the origin of the muscle, and 166 LAMENESS OF HORSES. others have placed it, from the peculiarity of its action, in the muscular tissue proper. Our own views on this subject, which are the result of direct experimental inquiry, by which we consider that the etiology of the case has been well established, are expressed in a paper which was read before the United States Veterinary Medical Association, as far back as the year 1880, and which we here reproduce : " A few months ago, my friend Dr. Lockhart, took occasion to call my attention, and that of several of our colleagues to the case of a horse which pre- sented the following peculiar symptoms. While standing quietly in his stall he stood firmly on all fours ; when moving, his off hind leg dropped ; when carrying forward, the tendo- Achilles appeared en- tirely relaxed; no flexion whatever took place at the hock. There was some swelling about the hock, and some soreness on pressure. My diagnosis was made of injury of the flexor metatarsi, and I located the trouble at the lower extremity of the muscle. The animal was placed under treatment, and I believe both ends, that is, the stifle as well as the hock, received attention, and I understand that the horse recovered. I confess that at first the idea of the treatment being applied to both extrem- ities of the muscle seemed to me quite singular." A few days afterwards, also through Dr. Lockhart, LAMENESS OF HORSES. l6f I had another opportunity to see a similar case, which however was of longer standing and properly- considered, in a convalescent condition. If my memory serves me rightly, he had in running away, received several superficial cuts in the tibial region, and when I saw him, he also presented much thicken- ing in the region of the hock. His action was some- what similar to that of the first case, but in a milder form. I believe this case also terminated in recovery. Not long after, I encountered another case in my own practice. The patient was a large grey gelding, belonging to a malt house. Having hauled a very heavy load, he was found, on the following morning^ to be unable to flex his hocks. The toe of the off hind leg dragged in walking, and the characteristic relaxation of the tendo-Achilles appeared. But in this case there was no wound, no swelling and no pain in the whole extent of the tibial region of the flexor matatarsi . The horse was simply placed in slings, and after three weeks, resumed his work,with- out any apparent thickening in any part of the leg. These three cases were recorded in my note book as ruptures of the flexor metatarsi. Quite recently I examined a black gelding, belong- ing to a stable keeper of this city, and found the same symptoms presented. He was also seen by Dr. Lockhart and Mr. Budd. He had received his 168 LAMEtfESS OF HOUSES. injury by slipping backwards while in harness. He was blistered along the tendon- Achilles, and kept in slings for seven weeks, and at the present time shows no mark whatever of his hurt. On the 3d of April, 1880, I was called to see a large bay gelding, belonging to a brewery in this city. He had worked, up to that day, having on the day pre- vious hauled an ordinary load, but on the morning of the day mentioned had been found in exactly the same condition with the previous case, the relaxation of the tendo-Achilles being perhaps a little more marked, as was also the difficulty of locomotion. No pain or soreness appeared throughout the whole extent of the tibial region, no swelling at the stifle, or along the muscle, or at the hock. The same diag- nosis was made, of laceration of the flexor metatarsi. When called upon to treat him, the question which presented itself for my decision was " what point shall I select for my external applications — one end, and if either, which; or in the middle of the muscle?" Careful examination failed to furnish any intimation and I decided to have recourse to the same treatment which I had considered so peculiar before, and which had been followed by Dr. Lockhart. A strong blis- ter was applied over the stifle joint, and another all around the hock, and the horse was placed in slings, and as far as possible, immobilized. After four LAMENESS OF MOUSES. 169 weeks of treatment, the blisters having produced their proper effect, and the scabs cleaned off, the animal was released from the strings, and backed of his stall. But judge of my disappointment, on discovering when he had walked a few steps that there was not the slightest improvement. The actual cautery, in fine, deep points, with severe blistering, was then re- sorted to, the application being made to the hock, principally in front, while a strong blister was placed over the stifle. Another month was allowed to elapse and another disappointment followed. At the begin- ning of the third month a third blister was applied, over the hock only, and at the end of this third term Of treatment I was no further advanced toward success —my patient walked as badly as ever. I kept him a few days longer, and about one hundred days after my first visit, the patient was destroyed. It is quite unnecessary to say that I had made up my mind to make a careful post-mortem examination The three cases first related, with this last one, were the only ones I had seen in this country, and though each diagnosis had been correct, it had also been incomplete, and this important fact rendered the treatment uncertain. I had given directions to my assistant to have the leg severed from above the stifle, amputation to be made about the lower third of the femur, for the purpose of securing both of 170 LAMENESS OF BOUSES. the two attachments of the muscle, but through some misunderstanding, the leg was cut off, in the bone yard, at about the middle of the tibia, and thus we lost one of our opportunities, and the post- mortem was imperfect. My assistant, Dr. Coates, however, took charge of this part of the leg, and made a careful inspection of what remained of the flexor metatarsi muscle. As the result of his exami- nation, the entire structure, with the exception of some serious exudation, proved to be healthy, both the fleshy and the tendinous portions, with all their four lower insertions, being entirely free from disease. The literature of this subject is somewhat incom- plete, and I therefore improve the occasion to-day to offer these few remarks." Percivall, in his valuable work on lameness, mentions two cases, in one of which the patient recovered and resumed work after two months. He remarks that it "was probably due to a rupture of the flexor metatarsi muscles, or its tendon, and most likely, of the latter." The second case, after being three weeks under treatment, was pronounced to be incurable. Professor Williams reports a case in the history of an aged horse which was not considered of suffi- cient value to repay treatment, and was destroyer, LAMENESS OP MORSES. 171 and it was found at the post-mortem examination that " the flexor metatarsi was lacerated across its " whole thickness : its fibres were pale, and when " examined under the microscope, their transverse " stria? nearly, and in some places entirely wanting "thus showing that the sarcous elements were " undergoing degeneration. ' ' Gourdon, in his Chirurgie Veterinaire, says that " the tendinous cord of this muscle may give after violent efforts," and again," this affection gets well spontaneously in the majority of cases." But few observations of the seat of the rupture have been made. Bouley Jr. has seen it at a point correspon- ding with the middle portion of the tibia, and Gonbeaux has found it at the point of attachment in the cavity of the femur. The Archives Veterinaires for May, 1880, contains an excellent synopsis of the statistics of twenty-one cases of rupture of the metatarsi. The causes are divided as follows : In two instances it occured while the animals were being secured in the stocks to be shod ; One occured after a fall while being shod, and held in the usual manner ; One took place during the same operation, through the mere resistance of the man holding the foot, from the violent efforts of the horse to free himself ; 172 LAMENESS OF HORSES. Five resulted from kicking backwards and having the leg caught and held by the shaft of the wagon ; Four were caused by falling or slipping with the leg extended backwards ; One was occasioned by the falling of a heavy load on the lumber region, the animal having given way under the weight ; One was due to muscular contraction arising from the resistance of the animal while being cast for an operation ; Three cases are classed as unknown; In three others the etiology was incomplete. In respect to the results of post mortem exami- nation, Mr. Bouley Jr. found " the cord of the muscle ruptured in its totality on a level with the diaphysis of the tibia," and Mr. Gonbeaux found a rupture of the tendon common to the extensor pedis and the flexor metatarsi at its origion in the inferior cavity of the femur. The character of the prognosis as reported was far from being serious, a notable improvement taking place in from fifteen to twenty days, and after fifty or sixty days, a complete recovery in each of the twenty-one cases recorded. The problem of the true seat of the lesion seems still to be undetermined, though most of the writers are inclined to locate it in the tendons. LAMENESS OF HORSES. 173 In August, 1880, we operated on an old horse by making a subcutaneous division of the tendinous cord of the flexor metatarsi and extensor pedis, just below its passage through the groove between the external and anterior tuberosities of the superior extremity of the tibia, and when he was allowed to rise to his feet, the animal presented all the manifes- tations which I had witnessed in all the cases I had previously seen. Two weeks later, in experimenting fuither upon the same animal, an incision was made on the out- side and a little in front of the tibia, the anterior extensor pedis was drawn forward, the lateral exten- sor of the phalanges pushed outward, the tendon of the flexor metatarsi well exposed, and a division made down to the bone at the widest and thickest portion of the fleshy part of the muscle. Some hemorrhage occurred. The wound being closed, and the animal allowed to rise, he walked away from his bed with a perfect action. The leg was carried for- ward without any difficulty, the hock being well flexed, and the only alteration apparent in his gait appearing on the opposite leg, which had been the seat of operation two weeks previously. He was then returned to his bed and again thrown down on his off side, for further experiment. An incision was now made immediately above the tibio- 1U LAMENESS OF HORSES. tarsal joint, the tendon of the anterior extensor pedis, well isolated, and the mnscle divided, through its entire structure, which is at this point mostly tendi- nous, the two portions being here on the point of sub- dividing into their quadrifur cation. The animal was then allowed to rise, whereupon the characteristic symptoms became immediately manifest. He drag- ged his toe with much difficulty, knuckling consider- ably at every step; the relaxation of the tendo- Achilles seemed somewhat more marked than on the other side, where the muscular portion had been left intact, and by its unison with the tendon was able to trans- mit to it a portion of its power. The action of turning on the near leg, the seat of the last operation, was more difficult than on the other, the leg being carried more in adduction. Still he stands firmly on both legs, and when in the stall, appears to be in perfect health. As the result of the observations and experiments thus detailed, we have arrived at the following con- clusion : First, the symptoms recorded are not due to rup- ture of the fleshy portion alone of the flexor metatarsi. Second, the rupture, laceration or divison of the tendinous portion alone, at its upper part, from its origin to the point of union with the muscular fibres, may cause the difficulty of flexion at the hock. LAMENESS OF HORSES. 175 Third, the rupture, or division of the lower portion of the muscle, or of any part of it where the tendinous and fleshy structures are united, may also give rise to the same symptoms, but probably more marked, and with greater difficulty of flexion at the hock, and with impaired co-ordination of the movements. *" The prudent practitioner will always make a guarded prognosis in injuries of the flexor metatarsi, inasmuch as though many patients do recover, there will still remain a sufficient fraction to justify a reserved opinion. The treatment is comparatively simple. The most essential of all conditions of the reunion and repair of the divided structure, is doubtless rest and consequently, the first incident of treatment should in our judgment, be the placing of the animal in slings, and in a narrow stall, where lateral motion will bo limited as much as possible. The application of blisters over the parts which the swelling seems to indicate as the seat of injury, is recommended by leading authorities, but we have our fear that the benefit that might attend their employment is likely to be more than neutralized by the movement of the limb induced by the irritation accompanying the action of the vesicant. The confinement of the leg by * American Veterinary Review. 1880. 176 LAMENESS OE HOUSES. bandaging, or by putting it in splints, as in cases of fracture, is also in our view, objectionable, as being likely to be an incumbrance rather than an advantage. The forced flexion of the hock r if the repugnance of the patient to the necessary restraint could be overcome, would more than any other measure facil- itate a cure by retaining the coaptation of the sepa- rated muscular fibres. But the judgment to which we have been led by not a little experience is that in general, additional manipulations of the limb is more likely to result in injury than in benefit, and at the present time our sole reliance is uniformly placed in simple rest. And we sum up the matter by declaring that from six weeks to two months of perfect immobility has almost never failed to give us full satisfaction in cases of rupture of the flexor metatarsi. THE HOCK JOINT. The consideration of the diseased conditions which affect this complicated articulation will naturally in- volve a subdivision of the general subject, corres- ponding with the forms and names of the various lesions which will call for an examination. "We shall thus refer to spavins as a disease of the bony struc- ture: blood-spavin amdthoroughpin as hydrarthrosis of the joint : capped-hock as hygroma ; curbs as lesions LAMENESS OF HORSES. 177 of ligaments and of the sheathes of the surrounding tendons, and spring-halt as a disease of which the etiology has not yet been clearly demonstrated. SPAVIN. This term is usually understood to apply to the exostosis, or bony enlargement which is often found on the inner side and in front of the hock joint. But as a definition it is imperfect. For if in the present condition of our knowledge of the pathology of the hock joint, a spavin can only be considered as one of the various diseased conditions to which the hock joint is subject, other and different lesions, of the same bones may claim the same designation, and periostitis, and ulceration and anchylosis may each receive the same title, until every one of the various diseases of the joint in time becomes a spavin, with perhaps such varying qualifications as may be sug- gested by their nature, location, etc. It is thus, no doubt that we have such designations as "bone" spavin, applied to the ordinary exostosis of the antero-internal portion of the hock, close to the metatarsis ; of "high" spavin, or the exostosis of the lower end of the tibia, and extending perhaps to the inner malleolus, or internal tuberosity of the astragalus, described by the French under the name of "jarde" ; or "outside"' spavin, when the exostosis 178 LAMENESS OF HOUSES. is formed on the outside of the hock joint, on the external surface of the cuboid, the "courbe" of the French ; and of "occult" spavin, or that diseased condition of the bones of the lower row of the tarsus, which are any chy lose d, with possibly too small an amount of bony deposite on their surface to admit of detection by mere external examination. The term spavin, then, must be here understood to signify any one of the various manifestations of disease of the bones of the hock, from an attack of simple periostitis to the several lesions of arthritis, articular ulceration and anchylosis. The confident location of lameness in the hock is often therefore equivalent to a prediction that sooner or later the hock will ultimately become the seat of spavin, under one or other of its various forms. Pathology. Williams, in his excellent work on Surgery, says of this disease : " Bony spavin consists of inflamation excited in the " cuneiform bones, or in the cuneiforms and large met- " atarsal, and sometimes the inner small metatarsal " either from concussion applied to the bones them- i l selves, or extension of inflamation of the inter- " osseous ligaments, which are implicated in the " morbid process We think it may be also said, " from injury to the ligaments of the inner side of " the hock joint, which by their laceration or LAMENESS OF HOMES. 179 " sprained condition may be accompanied by local " periostitis." And again. " The inflamation of the bones (ostitis) " originates in the cancellated structure of their inter- " ior : an exudation is gradually thrown out between " them and their cartilage, perverting the nutrition " of the latter, whereby it ulcerates and is removed, " leaving the exposed surfaces of the bones in contact " with each other, and their cancellated structures in " opposition thus enabling their vessels to com- " municate with each other, as we have found in 11 anchylosis. Concomitant with the destructive " process, going on in the interior of the bones, an *' exudate is formed upon their periosteal surface, " extending from one diseased bone to another, bind- " ing them together by a band of lymph— ultimately "converted into bone — which locks them firmly " together, and prevents further motion." The bony tumor which constitutes a spavin may proceed from the periosteum and the cellular tissue, and is then characterised as epiphysar. It has at first only the resistance of fibrous tissue, and only assumes that of a bony structure subsequently, when the osseous material has been deposited through its substance. By maceration of a hock thus diseased the spavin is found to be formed of a sdrt of stalac- tiform deposite on the surface of the tarsal or meta- 180 Lameness op horses tarsal bones, sometimes containing grooves of various depths, adapted to the reception and movement of tendons and ligaments. In other instances the growth is parenchymatous, and proceeds from the bones themselves, and the articulations which they form become also involved in the same inflammatory process. This condition is attended with severe pain, manifested by acute lameness. In these cases, the surfaces become more reddened from the beginning, the periosteum thick- ens, and sooner or later, exostosis and anchylosis follow.-Among the lesions frequently encountered in the various forms of spavin, are bony deposites : an intimate union of some of the bones ; alterations in the articular surfaces, which have become roughened by the ulcerative process ; and a greater or less destruction of the cartilages. Symptoms. — In the estimation of many, two symp- toms are considered essential to the formation of a spavin, to wit, the existence of the bony de- posits or exostosis, and the fact of lameness. And still either of these symptoms may be comparatively absent, without invalidating the diagnosis of spavin. We say comparatively absent, since the bony growth may be so slight as to be discoverable by only the closest inspection with the sound hock. And again, Lameness of horses. isi tKe degree of lameness may be too insignificant for detection under ordinary scrutiny. It is an observation of Percivall's that " lameness, though the ordinary, is not the necessary conse- quence of spavin." When present, moreover, it may be manifested under two different types, the inter- mittent and the continued.— And there is a peculiar manifestation accompanying the intermittent cases, in the fact that it is apt to be more marked when the animal is in, opposite conditions, and is either cold or warm. This circumstance has suggested the distinction observed by certain authors between what they denominate chronic and acute spavin. The posture of the spavined horse, while standing still, is that of resting the foot upon the toe in such a manner as to incline the front face of the wall for- ward, with the fetlock and hock in semi-flexon ; a position which causes the diseased leg to be carried slightly in abduction, while he frequently rests the heels upon the front of the wall of the opposite foot. If while in the stall, the animal is made to move sidewise, the movement is comparatively, easily made, if executed in the direction of the lame leg, but if made towards the opposite or sound side, the soreness is rendered more manifest, and the appear- ance of the lameness becomes more characteristic. The lameness is rendered more manifest when the 182 LAMENESS 01 HORSES. animal is put in action, especially in trotting, except in excessively developed cases. The hock is affected with a certain stiffness, which is* sometimes accom- panied by a spasmodic flexion of the tibio-tarsal joint or spring halt, but with a more marked alternate, dropping and elevation of the hip. This stiffness is so evident that the first few steps are taken with the foot resting on the toe alone, but as motion continues, the flexibility of the joint appears to increase, until at length, almost the entire surface of the sole is brought in contact with the ground. In many ani- mals, and especially in those in which the exostosis is the principal lesion,the stiffness and lameness abate, and often seem to disappear entirely, while they are kept in motion. But upon being brought to a stand- still, and again left for a certain period without ex- ercise, there is also a return of the stiffness and lameness, which will moreover, be more noticeable on the day following that on which the labor was performed, than immediately after ceasing from the effort. This is what is understood as a manifestation of " intermittent' ' lameness, after becoming cold. But in another class of cases, in which the stiffness of the hock exist but in a trifling degree, it is only when the animal has been subjected to a certain amount of severe labor that the lameness begins to develop. But when it becomes manifest, it shows a LAMENESS OF HORSES. 183 a confirmed tendency to increase in degree and per- sistency and only again disappears after another con- siderable period of rest and idleness. It may seem to be almost wholly subdued, but may be relied upon to renew its attack immediately upon its resumption of the exercise. We look upon these phenomena as resulting from a diseased condition of the articular surfaces, quite independently of the presence of the exostotic growth, in relation to which they furnish no proof, either affirmative or negative. It is this species of lameness which is recognised as contradis- tinguished from that of the previous paragragh, as the "warm" intermittent. It may also be encoun- tered in diseases of other articulations. There are other and special conditions of spavined hock which are said to exist without lameness. But we question the correctness of such a claim, and hold that there is always a certain degree of irregularity and defect in the motion of such a joint, which is sufficient to constitute the essential condition of lameness, even though the proofs of its existence may be so slight as to elude discovery by any but the most minute and careful scrutiny. In cases like these the comparative or apparent absence of lame- ness may be accounted for by the location of the morbid growth, which from its situation at the su- perior extremity of the metatarsus, cannot, to any 184 LAMENESS OF HOUSES. appreciable extent, involve any other bone of the joint. In this we have the true metatarsal spavin of Bouley, by whom it was so named in order to distin- guish it from the tarso-metatarsal variety, which he considered as extending over both the tarsal and metatarsal bones. We assume then, the existence of lameness, and perhaps in a very severe form, without any discerna- ble enlargement, a condition by which the diagnosis becomes greatly embarrassed. But though embar- rassing, it is not necessarily baffling to the expert veterinarian, who may still be able to detect an increase of heat, especially after labor ; a degree of sensibility on the inside of the joint ; and perhaps a little thickening, referable to the periostitis ; all of which will furnish him with enough of symptomatic data for a satisfactory solution of the difficulty. Another method of its discovery and recognition is a survey of the joint from each direction, forward, backward, and at the side successively, and especial- ly if the inspection is acccompanied by the delicate taxis of the educated fingers of the expert, trained in the exploration of sound and healthy joint?, and readily detective of any departure from the normal contour and outline of the anatomy of the animal. In addition to the two principal symptoms by which the lameness, due to spavin is usually made LAMENESS OF HOUSES. 185 manifest, there is another, described by Hertwig, which is of material assistance in the differential di- agnosis of that cause of the lesion, as compared with others. He recommends that the foot of the diseased leg be raised and held, with the hock well extended, as in the position in which it is held by the farrier while nailing on a shoe, and that the horse be made to trot briskely immediatly upon being released, when, if the spavin be present, the lameness will be so aggravated by the effort that for a short distance, the animal will travel on his three sound legs alone. This statement may be easily confirmed by an observation of the gait of spavined animals when leaving the shop of the farrier after being shod. Atrophy of the muscles of the gluteal region is a common occurence in old cases of spavin, and should be taken into account as one of the sequelae of that disease, and of other varieties of lameness as well. Prognosis. — Diseases of the hock joint of the char- acter of spavin have always a serious aspect, from the futility of any just expectation of perfect recov- ery. Complete restoration is impossible. An exos- tosis once established, becomes a permanence, although it may sometimes occur that judicious palliative measures may be so far successful that the patient may be restored to a degree of convalescence 18G LAMENESS OF HORSES. which is not incompatible with his return to his accustomed labor. Yet there always remains a condition of disease which must be accepted as fatally inconsistent with any assumed claim to a certificate of technical soundness, in the accepted sence of this term. The best result that can reason- ably be hoped for in lameness of the hock due to articular disease or to occult spavin, and indeed, that which it is usually the principal desire of the surgeon to establish, is anchylosis of the joint. Causes. — These may be divided into the two classes of exciting and predisposing. Among the first, which are ordinarily of the external kind, may be enumerated violent efforts of every description. Heavy draughts, rapid work, any excessive labor or sudden strain, or any concentra- tion of force bearing upon the joint and tending to cause a sprain or laceration of the ligaments, or to hurt the bone — any of these causes may be followed by spavin as its ultimate effect. Jumping, fast running or trotting, especially in young animals, and such accidents as sudden slipping upon smooth surfaces, may all be attended with laceration of the ligaments and inflammation of the periosteum, with their consequences. Direct contusions from blows and kicks have been sometimes numbered among the exciting causes, but LAMENESS OF HORSES. 187 in our judgment, considering the ordinary seat of a spavin, there is no warrant for this either in probability or fact. If a known case of spavin could be directly referred to such a cause, it would be one of a peculiarly and remarkably exceptional nature. In respect to the predisposing causes, the most generally admitted is heredity. Though this is to some extent a contested theory, yet it finds accep- tance both with the authorities on veterinary subjects, and in the ranks of the more practical horse breeders. Whether the transmitted predisposition is due to the sprained condition of the parents, or to a constitutional malformation of their hocks, of a transmissable nature, involves questions still amen- able to discussion. AccordiDg to Zundel, " horses with long canons, long and bended hocks, are more easily predisposed to spavin," and Williams says that " hereditary predisposition is not always due to "peculiarity of conformation, as many breeds or " families of horses with well formed hocks often " become unsound from this cause. Peculiarity of "conformation is nevertheless, not only hereditary, " but of itself a predisposing cause of spavin." A question is often asked of young practitioners in reference to the malformed hocks to which the name of " coarse " has been applied. While it cannot be 188 LAMENESS OF HORSES. denied that many animals with largely developed coarse hocks are quite exempt from lameness, it is nevertheless an acknowledged fact that hocks characterized by that peculiarity of conformation are not only predisposed to disease, but are already in a diseased state, and although they may appear at first quite able to perform their accustomed labor, free from any apparent irregularity of action, but a short time will elapse untill their disability, caused by the extensive diseased process which is present, remands them to the category, of positively spavined horses. Constitutional diseases, or predispositions, have in some instances found place among the alleged causes of spavin, which has thus been credited to existing diatheses of rachitism, scrofula, glanders and osteo- porosis, and the like. But the effects, in cases of this nature are not inclusive in respect to spavin alone, but include to all the developments of exostosis in common. Treatment — Probably no condition of the extrem- ities to which lameness can be attributed has engaged the attention of empirics or encountered the ingenuity of the makers of specifics to such an extent as the one we are considering. The veteri- nary pharniacopia is running over with quack and other spavin cures, all of which are mere modifica- LAMENESS OF HORSES. 189 tions and pseudo-improvements of old and estab- lished modes of treatment. With many, even at the present time, the removal of the projection or enlargement which constitutes the spavin proper forms the principal indication of treatment, and this will account for the suggestion which sometimes meets with favor, that the best of prescriptions, the theory of extirpation being accep- ted, is that which involves the employment of the chisel and the saw. Our knowledge of the extent to which the lesion may attain, and the easy possibility that instead of its being a simple epiphysar-exostosis, it may be a form of disease which extends within the joint, and may involve in its complications the articular surface itself, affords sufficient argument against such an interference, and suggests ample reason for avoiding the dangers necessarily involved in the kind of surgery alluded to. The operation of periostotomy, as practised by Profesor Sewell in the treatment of splints, either by simple subcutaneous section of the periosteum or, as occasionally resorted to, by the introduction of setons under the skin, has many advocates. But we are compelled to say that in our own experience this treatment has not been followed by the good results which some other authors have described. The relief ordinarily secured, and which has 190 LAMENESS OF HORSES. often proved to be of a permanent character, by the use of counter irritants, recommends itself to all prac- titioners, as evidence that the correct philosophy of treatment has not been missed. This is specially true in respect to the acute form of the disease, when the periostitis alone is present, or while the resultant exostosis is still possibly controlable. Blisters of cantharides, and the various preparations of iodine and of mercury, when prescribed in the acute stage, have many times controlled the develop- ment of the growth, and in the estimation of some practitioners, by duly exciting the absorbent action effected its removal. The potential caustics, such as the compounds of mineral acids, or corrosive sublimate, bichromate of potash, tartarized anti- mony etc., which form the basis of many of the patented spavin cures, should be wholly ignored in practice. The actual cautery, or firing, as it is the oldest, we hold to be also the best adapted and most suc- cessful, judging from practical results, of all known methods of promoting recovery from this form of lameness. While many make the application in lines, we consider the most successful and satisfactory mode to be that of points, or dots. Deep cauteriza- tion, with penetrating points, needle firing, as re- commended principally by French veterinarians, has LAMMESS OF HORSES. 191 proved itself in our hands, to be an excellent means of relief. If done at all it must be done thoroughly and severely, and in many cases it may become neces- sary to repeat the operation. Several instances have occurred within our knowledge, in which relief was obtained only after the second, and even a third application of the iron. A combination treatment of firing and blistering, which is common amongst American veterinarians, is advantageous in preven- ting the possibility of extensive blemishes, although the results are not rendered less favorable by a dis- regard of that consideration. Our personal experi- ence satisfies us that more real advantage would follow the use of the actual cautery, if practitoners would less frequently allow themselves to be deterred by the interference of timid owners, from resorting to it at the initial manifestation of the growth. But while counter irritation, however produced, is known in numerous instances to be of essential advantage in relieving the lameness resulting from spavin, there is another requirement, connected with it which must in no wise be overlooked. It may even be claimed that when good results ensue upon whatever other treatment may have been, pursued or even a cure accomplished, the success has been, in fact, conditioned upon the observance of this requirement. "We refer to the element of rest. 192 LAMENESS OF BOUSES. But while counter irritation, however produced, is known in numerous instances to be of essential advantage in relieving the lameness resulting from spavin, there is another requirement, connected with it which must in no wise be overlooked. It may even be claimed that when good results ensued upon whatever other treatment may have been pur- sued, or even a cure accomplished, the success has been, in fact, conditioned upon the observance of this requirement. "We refer to the element of rest. And it must consist in something besides mere idleness in a stable, whether m a single or a box stall. It must consist in giving the animal his liberty, and letting him alone. A genuine rest, of six weeks, or even a long period, has in many instances, in our experience, proved to be advan- tageous in the highest degree. If we are not in error in our view on this subject, the main purpose of any course of treatment for spavin, is to establish a permanent condition of anchylosis of the diseased joint. Such is the evident tendency of the medica- tion usually adopted, and it may be accounted specially successful when the counter irritation has accomplished its object in exciting the process of resolution and absorption. It then becomes easy under such circumstances, to appreciate and estimate the value of time and the natural and beneficial LAMENESS OF HOUSES. 193 effects of protracted and undisturbed quiet, until the necessary physiological processes in progress are completed, and the bones have become adapted to their changed condition by passive and natural motion, only to be obtained voluntarily and by moderate degrees. The unmolested freedom of the pasture will afford a genuine rest which cannot be enjoyed in the stable, either when tied up in a narrow stall, or walking around in a loose box. These methods of treatment, with the result sought for in the anchylosis, are principally indicated when the seat of disease is in the articular surface. But there are cases which are quite beyond their scope, and in which they are contra-indicated by their mere inadequacy, if for no other cause. Among these intractable cases are those in which the exostosis has become of extraordinary size, and the lameness is increased by the pressure caused by the over-stretched condition of the internal branch of the quadrifurcation of the tendon of the flexor meta- tarsi near its point of insertion to the small cuneiform bone in the inside ol the hock. Here, passing over the enlargement and its periosteal covering, it can be easily detected running at the bottom of the groove which can be felt on the upper part of the tumor, In these cases the division of the tendinous band — tarsal tenotomy — has been often recommended, and 194 LAMENESS OF MOUSES. has been performed with good results. Still, although favored by Abildguard of Copenhagen, seconded by Lafosse, Mandel, Brogniez and others, it has not been uniformly successful, and as Bouley remarks, cannot be relied upon in cases of spavin complicated with anchylosis, or disease of the articular surface. The instruments necessary for the operation are a pair of scissors, a convex bistoury, forceps, a blunt curved and grooved tenaculum, and a tenotomy knife. In the operation, the patient being thrown on the side of the lame leg, and secured in such a manner as to expose the affected hock, the hair is closely cut over the course of the tendon. This is readily identified by the groove which it has made on the upper part of the tumor, which it seems to divide into two parts? a superior and an inferior. An incision about three inches in length is then made, posterior to the saphena vein, either along the line, or, as we prefer it, obliquely to the course of the tendon. This is follow- ed by a slight capillary hemorrhage, which is easily suppressed. The dissection of the subcutaneous cellular tissue soon exposes the fibres of the tendon which are readily traced, crossing the incision of the skin, and running from before backwards and down- wards, A small quantity of synovial fluid sometimes escapes upon the exposure of the tendinous band The tenaculum, or an aneurism needle, which answers LAMENESS OF SOUSES. 195 the purpose as well, is then introduced under the tendon, which is carefully raised and divided, the division being made, if possible, at the point where it passes over the most prominent part of the exostosis and accomplished by pushing the knife along the groove of the tenaculum. The edges of the wound are then brought together by two or three stitches, and the horse is permitted to rise. The improvement is sometimes immediate, though ordinarily it is only after the laps of several days that it becomes apparent. In other cases it is not discoverable at all. The division of the plantar nerves just above the point of the hock is another operation which has been recommended by some authors, but it has not been attended with the degree of benefit sometimes claimed for it. HYDRARTHROSIS OF THE HOCK. Under this variety of hock joint disease must be considered the dropsical condition of the articular and the tendinous synovial sacs, known also by the popular designation of blood spavin and thorough- pin. But believing that there should be a division of the latter term, and a distinction should be observed between the hydrarthrosis of the joint and that of the tendinous sac, we propose to treat the 196 LAMENESS OF HORSES. subject under the two divisions of " articular " and " tendinous " thoroughpin. The designation of "blood" spavin, with its synonym of " bog " spavin, is applied to a peculiar condition of the joint, in which the saphena vein acquires an unusual prominence at the point of its passage over that part of the front of the hock where the distended synovial capsule of the joint becomes almost subcutaneous. The bog spavin is situated on the anterior and innerside of the hock, and may be described as a soft, elastic, fluctuating tumor, varying in size and consistency. Its formation is attended with symp- toms of acute inflammation, such as heat and sore- ness, with a more or less serious degree of lameness as a sequel. In its chronic form, the changed condition of the joint, principally through its large increase in size constitutes a condition of unsound- ness quite sufficient to interfere effectually with the ability of the animal to continue in the performance of his accustomed labor. The articular thoroughpin usually accompanies the bog spavin. They both result from a dropsical collection in the tibio-tarsal synovial sac, the latter, as we have said, being found in the front, while the former occurs in the hollow of the hock, or the angle formed by the lower end of the tibia and the os calcis. LAMEttESS OF BOUSES. 19? In this situation the enlargement occurs either as a single tumor, placed on one side, or possibly in the form of a double growth, having one portion on each side of the joint, that which occupies the inner side being the larger, but both comprising in fact but a single tumor, possessing the same external character with the bog spavin. There is evident inter-com- munication, pressure on one part producing disten- tion in another, with common fluctuation throughout. The tendinous thoroughpin, or dropsical condition of the tarsal sheath consists of a soft tumor of the same nature with the foregoing, having for its location the posterior part of the tibia, between that and the tendo-Achilles, and at the superior part of the hock. It is of a more elongated form, and of more varying dimensions, but is more commonly found protruding on both sides of the hock. The general history of these affections, with their symptomatology, pathology, duration and termina- tions, together with the various indications of treat- ment adapted to each form of lesion, have been duly considered in our generalization of the subject of hydrarthrosis in preceecling pages, (201, 202), to which we refer the reader. 198 LAMENESS OF BOUSES. HYGROMA OF THE HOCK. — CAPPED HOCK. The formation of a soft tumor, of indefinite size, as the result of a dropsical condition of the subcutan- eous sac at the point of the hock, constitutes the lesion denominated the capped hock. As with the kindred affection of capped elbow, which we have already considered, it is a hygroma of the point of the hock, and in many respects resembles its con- geners of the olecranon. The most common origin of these affections is of a traumatic nature, and they are traceable in most cases to external hurts. Bruises against a wall, or the sides of the stall, or other self-inflicted contus- ions by kicking in animals addicted to that fault, with other kindred causes, are usually chargeable with the injury. The peculiar posture assumed by some horses while lying down, with the hock held in extreme flexion, may often be included among the developing causes, and the same is true of horses confined in inconvenient quarters during long jour-, neys by rail or on shipboard. It may be induced by excessive flexion of the hock from overwork in young animals ; by the overworking of saddle horses ; by leaping; by slipping on smooth pavements, or indeed, by any sufficiently violent strain or extra effort that may implicate the hock or the tendinous LAMENESS OF HORSES. 199 cord belonging to it. Narrowness of the joint, defects of formation, and any weakness of structure may also be regarded as pre-disposing causes* Symptoms.— The tumor is situated quite on the summit of the oscalcis, and sometimes extends on both sides of the joint, in which case the hock becomes so enlarged and rounded as to present just such an appearance as it would exhibit if fitted and covered with an artificial cap — whence its designa- tion. Being soft and painless, and susceptible of free movement in all directions, it cannot be regarded as an important hindrance to the labor of the animal, otherwise than when in extreme cases it may obstruct the perfect flexion of the joint by its con- sistency or its unusual bulk. But beyond such a degree of embarrassment to locomotion as may arise from this circumstance, it may be safely said that it seldom causes lameness per se. It is painful, with a rise of temperature, only in exceptional cases, and those of recent occurence. In some rare instances suppuration, and even ulceration may supervene and give rise to complications which may involve serious consequences, and in a very few cases the cyst may assume a chronic character, and undergo the changes which have been considered while treat- ing the subject of capped elbow. Prognosis.— The prognosis of capped hock is not 200 LAMENESS OF HORSES. usually a very serious one. Yet in view of the fact that it is not always tractable under treatment, and that it is liable to leave a record of its visitation in the form of a perpetual blemish and disfigurement, which may largely impair the market value of the animal, a cautious opinion will always be a safe one. The complications which have followed a course of heroic treatment in this comparatively mild disease have sometimes brought about the utter failure of a too confident favorable prognosis. Treatment. — A recent case, manifested by pain and heat, but with no fluctuation in the tumor, may be dissipated by rest and the applicatian of local sedatives. But when it betrays a tendency to become chronic, treatment of a more energetic character becomes necessary, though it is still not unusual to find it unsatisfactory. Counter irritants, artificial bandages and blisters are often recommended. Cantharidal ointment and iodurated iodide of potassa have in many instances proved signally serviceable. English veterinarians put much faith in an ointment of biniodicle of mercury. Simple puncture of the tumor with a bistoury, or the discharge of its con- tents by means of the aspirator needle has aided many cases, especially when they have been sup- plemented by a vigorous blister, or accompanied by an injection of tincture of iodine, which last measure, MMENESS OF HORSES. 201 however, is not always unaccompanied by danger arising from the possibility of inducing severe arthritis. Opinions conflict in respect to the appli- cation of the actual cautery, and it is confidently advocated as well as earnestly opposed. In our own practice we have witnessed excellent results from the needle cautery, applied somewhat super- ficially, and would unhesitatingly prefer that treat- ment to the introduction of setons or deep punctures with the hot iron. Prophylactic measures are recommended, and not without great propriety, by Percivall. In view of the bad habit which animals sometimes acquire, of kicking or rubbing their hocks against the par- titions of their stalls, and in that manner exciting the disease, he suggests the plan of covering the partitions or the heel part of the stall with padding of some soft material, which will effectually protect the horse from such self-inflicted injury. In lieu of this means of protection and in case of its failure, he would place fetters or hobbles upon one or both extremities of the animal, and in the event of the failure of this plan, would replace it by the applica- tion of a wooden log or iron weight appended to a chain and secured above the fetlock, on the leg with which the animal performs his kicking, the idea of this contrivance originating in a theory of self- 202 LAMENESS OF HORSES. instruction, by which the animal is supposed in the exercise of his natural sagacity to cure himself of his injurious habit by the self-inflicted punishment to which he is subjected by its indulgence. CURB. Upon the posterior border of the os calcis, and reaching from the upper extremity of that bone to the cuboid, and to the head of the external small metatarsal, is the calcaneo-metatarsal ligament, one of the means of union of the two rows of tarsal bones. This, under some peculiar circumstances of sprains, becomes the seat of the disease which from the special form and appearance which it imparts to the posterior part of the hock, is known by the name of curb. The vertical line which in a healthy joint extends from the point of the os calcis down to the fetlock, is altered, and in its place there is a bulging or prominence backwards, which may extend more or less from a little below the point of the hock down below the tarso-metatarsal articulation. In other words, a curb means a prominence situated at the back of the hock joint, varying in size from that which causes a slight deviation or convexity of the vertical line of the posterior part of the hock, to that of a well marked and conspicuous enlargement, Lameness of bouses. 203 spreading not only from above downwards, but from without inwards. The true causes of this lesion is subject to ques- tion and may be correctly classed among those of doubtful diagnosis. The French term, literally translated, defines it as a disease of the bony struc- ture of the hock, on the outside of the joint. Perci- vall, and with him the English veterinarians, consider it to consist in a lesion of the cellular tissue, or of the annular ligament which passes over the tendons and binds them downwards, or even of the tendon itself. Our view is in accord with that of Williams, and with him, we consider the lesion to be of a ligamentous nature, having the calcaneo-metatarsal ligament for its seat. The fact cannot be ignored, however, that in some cases the tendons, the annular ligament and the surrounding cellular tissue may all alike become invoked. There can be no doubt in respect to the cause of this injury, and under the name of sprain under whatever circumstances it may generally occur, the fact of the existence of a curb can be readily under- stood. In one case the patient may be an animal which has been compelled to exert his strength beyond the resisting power of the ligamentous structure of the joint, as often occurs in young racing horses, in the hunter, and in the jumper. In another 204 LAMENESS OF HOUSES. case it may be the the result of a congenital defor- mity of the bones themselves, in which the line drawn from the point of the hock down to the fetlock curves from the perpendicular, or the animal may possess that peculiar and special description of hock already suggestively denominated " curby." "Whatsoever may be the cause, the difficulty is easy of discovery. Standing on one side of the animal, and looking at him in profile, the bulging of the back of the hock is readily detected. An inspec- tion from this point is far preferable to that from behind, from which the change may easily be overlooked. The tumor, thus observed, presents according to its various stages of progress, all the manifestations of inflammation, from the acute symptoms of heat and soreness to the small, hard nodule, cool and painless, and having no worse character than that of a disfigurement. The lameness which accompanies curb exists in varying degrees, according to its state of progress, as well as its form, as being acute or chronic, though not in such a mode as to form a very satisfactory criterion of its severity. In our own observation we have seen a very considerable degree of lameness, associated with a mild form of the lesion, and on the other hand, cases in which the deformity was com- paratively excessive, with scarcely any perceptible LAMENESS OF HOUSES. 205 alteration in the gait of the animal, either in walking or in trotting. When the lameness exists, it may be denominated intermittent while warm : in the lang- uage of Percival, " usually, a curbed horse is too lame " to work, or is kept from work by growing lamer "every time he is made to perform it. Repose " always benefits this lameness ; exercise or exertion " always does him harm." Prognosis. — So far as the removal of the lameness is concerned, with the possibility of restoring the patient to his ability to labor, the prognosis of curb may be considered as favorable, and as a rule, the disease may be said to be amenable to treatment. But the fact that it is likely to leave a record of its existence in the form of an ineffacable blemish, which must constitute a permament eye-sore, should always qualify a professional dictum in respect to the final termination of the case, since the suspicion of unsoundness will never cease to be predicable, while such an appearance is visible, upon that alone. Treatment. — The treatment of curb varies in no essential particulars from that of other lesions of tendinous and ligamentous structures. The neces- sity of rest while the operative process is in progress, and the restoration of the disordered functions is in a course of accomplishment, is an obvious and 206 LAMENESS OF HORSES. principal indication. And in respect to positive medication, topical applications of various kinds are offered, according to the predilections and the experience of practitioners. Cooling, anodyne and alterative preparations are variously recommended. Vesicants, in a variety of forms, including canthar- ides, and iodine with its various compounds, the potential cautery with alteratives, such as the largely used solution of corrosive sublimate in dilated alcohol, (one part to eight), with similar prescrip- tions, according to individual predilection, have their place in the armaments of different practitioners. "With one class of operators nothing should precede or displace the actual cantery. Of this class again, one portion prefer the feather or line method, while on our part, we give precedence, when we resort to the hot iron, to the fine puncture or needle style of firing, which, in our experience, yields better results of a positive kind, as well as being followed by less blemish in the sequel. A high heeled shoe is recommended by English surgeons, both as a preventive when there is a predisposition to curb, and to horses already under treatment for the disease. Care is necessary to guard against the accident of wearing the shoe too long. LAMENESS OF HOUSES. 207 SPRINGHALT OR STUINGHALT. This is the designation ( the terms are nsecl con- vertibly ) of the involutary and convulsive action of one or both of the hind legs, by which the hock is suddenly flexed, with a more or less violent jerk, by the sudden and clonic contraction of the voluntary muscles, without any lesion or deformity of the affected member. With no sign of its existence while the animal is in a state of rest, it suddenly manifests itself when the act of walking takes place, as entirely an aberration of motion, by the spasmodic flexion of the hock, in which at the instance of raising the foot from the ground, it springs upward, to a greater or less height from the ground, sometimes to a degree and with a force which brings the front part of the hoof in violent contact with the abdomen, striking it at every step, and returning the foot to the ground with equal violence. The action is usually more pronounced at the period of leaving the stable, or when the horse is first moved in the morning after a night's repose. While it is commonly observed as the animal is moving in a straight line, it often becomes necessary to turn him from right to left, or from left to right, in order to obtain a free exhibition of the symptoms, which only occurs daring action. In moderately developed cases, it may be so modified 208 LAMENESS OF HOUSES. by exercise as to be, if not removed, at least so abated as to escape detection after a few steps. Though springhalt is a condition not to be over- looked while examining an animal for soundness, and may continue stationary in degree for years, there also is a class of cases which become rapidly aggravated, until the subject becomes totally unfitted for labor. This is more apt to take place when both legs are equally and simultaneously affected. The causes in which this peculiar habit originates are admittedly unknown, though there is no lack of theories on the subject. English veterinarians seem to agree in locating it in the nervous centres, and considering the sudden flexion to be merely a resulting reflex motion. Percivall fixes its seat in the spinal marrow, a location which he says he "was first led to adopt from having observed a " broken backed horse exhibit all the characteristic " signs of springhalt, which in his case was clearly "only an accompanying symptom of the former disease." Youatt, and principally Spooner, adopted the conclusion from many post mortem examinations, that it arises from the sciatic nerve, the existence of which a careful dissection always revealed, while Professor Dick, quoted by Williams, was of opinion that "it was due to the presence of tumors in the "lateral ventricles of the brain," Williams himself, LAMENESS OF HORSES 209 however, classifying it under the head of choreic affection, and holding that it may in many instances be due to reflex nervous action, however that might be caused. French veterinarians are more inclined to attribute it to disease of the bones of the hock, and for that reason have given it the name of eparvin sec. Erosions of the articular surfaces, principally in lines parallel with the trochlea of the astragalus, have been found by Eey, and others account for it by the presence of ulceration at the bottom of the astragalian trochlea. According to Kigot, the spring- halt of the hinder extremities is accompanied by erosions of the tibio-tarsal articular surfaces, while that of the fore leg is connected with those of the humero-radial joint?. Goubaux and Barrier have found lesions in various articulations ; in the feruoro- tibial, in the tibio-tarsal — in all the joints of the hind leg, except the coxo-femoral ; while again, nothing abnormal could be found either in the bones or their cartilages, or the muscles, tendons, aponeu- rosis, synovial membranes, blood vessels, or nerves. Bouley considers it but an exaggeration of a physio- logical fact. He says, " the hinge of the tibio-tarsal "joint is so perfect, that there is something autom- " atic in the movements which it executes ; viz. " that when they are once begun in the direction of 210 LAMENESS OF BOUSES. "flexion or extension, they terminate by themselves. " When, for instance, the tibio-tarsal joint is half "flexed, and that in consequence the astragalus " corresponds to the tibia by the summit of its curve, " the flexion is continued by itself on account of the "inclination of the articular surfaces. In other " words, when the pulley of the astragalus has passed " or gone a little beyond half of its course, the move- " ment has a tendency to continue mechanically, in " one direction or in the other, only by the mechanism "itself of the inclination of the surfaces upon which " the sliding takes place." Dickerlioff considers that springhalt is due to the retraction of the aponeurosis cf the tibial or of the antibrachial region, as it takes place either in the hind or the fore leg. Tn Mr. Montagnac's view, the spring motion of the hock is but a manifestation of the sudden relaxation of the lower pare of the extremity, accompanying an interference with the flexion of the leg as the con- traction of the heels. Whatever may be the essential nature of the lesion which gives rise to that infirmity, the place of spring- halt must be consigned to the list of incurable dis- orders, and rational treatment can scarcely be recom- mended unless it is considered that some advantage may perhaps be expected from simple rest, if sufn- LAMENESS OF HOUSES. 211 ciently undisturbed and long enough continued. In one case, in which it was associated with bone spavin, "Williams divided the tibial nerves, but without any- resulting benefit. Boccar, Delwart and Brogniez have successfully divided the tendon of the lateral extensor of the phalanges. The operation is simple. " The animal being thrown, a small incision is made " in the skin covering the tendon, a little below the " hock and close to its union with the anterior " extensor and a bistoury introduced under the ten- " don, allows its entire division, and a piece of about " one inch is then cut off. Sometimes, when the " animal is allowed to get up, the springhalt still " remains for a few days after the operation. In " this case, daily exercise is necessary to break up " the abnormal adhesions which the tendon may " have formed in its course." Dickerhoff claims to " have obtained good results by the same process, but " he prefers and performs with more success " the " subcutaneous section of the branch of the aponeu- " rosis of the leg which runs alongside of the anterior " extensor of the phalanges, and that of the termin- " ating tendon of the lateral extensor. To perform " this operation, the animal is thrown on the opposite " side of the lame one. The leg is encircled above the " hock with a cord or elastic ligature, as a temporary " hemostatic, and also to render the aponeurosis 212 LAMENESS OF HORSES, '- easier to reach. The operator divides the skin " below the hock at the passage of the terminating " tendon of the lateral extensor. A blunt tenotomy " knife is then introduced over the aponeurosis, " which is then cut. Then a sharp and pointed " tenotome is passed under the tendon of the lateral " extensor, which is divided across. "When allowed " to get up, the animal flexes down and carries his " fetlock forward, but after a few steps rests firmly " on the ground. A simple antiseptic dressing is " then put on the wound." A rest of several months is necessary before the animal can resume his work, Mr. Montagnac claims to have obtained excellent results from the application of a "Watrin" shoe, which is made with little caulks on the inside of each branch of the shoe, close to the heels, upon which they rest, and which they spread. CHAPTEE V. DIGITAL REGION. The subjects to which the present chapter will be appropriated are : Interfering, as a lesion of the skin or of the cellular tissue of the fetlock ; Splints, Bingbones and Sidebones, as injuries of the bony structure ; Windgalls and Cystic Tumors, as Hydrarthroses and Hygromas of the fetlock ; and Sprains, or injuries of the tendons, under which title we shall consider the deformity of the meta- corpo or metatarsophalangeal joint known as Knuckling. INTERFERING. This is the action of the animal when, while travelling, the hoof of the moving leg of either of the biped sets, whether the anterior or the posterior, is brought in contact, more or less violently, with the opposite member, then momentarily at rest. Of course the injuries which result from this irregular 214 LAMENESS OF HORSES. contact will vary greatly in degree with the amount of force which accompanies the stroke. Thus, when the contact is very light and the mark which follows it, is but faintly discerned, if not in fact imperceptible to the sight without careful inspection of the parts, the animal is said, merely, to touch — this being the first and least serious degree of the evil — and from this point there is a progression in the forms and stages of injury, until the animal is said to cut. Nor is this the limit of the evil, still other varieties of wound appearing as the natural results of the per- sistent and long continued infringement of a hard upon a soft vital structure, until that which begins as a simple superficial injury of the skin may reach the proportions of a lesion, which, unremedied, may well nigh destroy the value of an otherwise useful animal, by the extent to which his capacity for labor has become impaired. Etiology. — There are of course various causes in which this condition of things may originate, and a rigid inspection is incumbent on the part of the veterinarian who would insist upon a full compre- hension of his case, and who strives for the best attainable success in his encounter with an inter- fering patient. The causes of interfering may be considered under the following heads. LAMENESS OF HORSES. 215 1°. — Weakness of the Subject— Re may be pre- disposed to the habit by a constitutional lack of the muscular force necessary for the performance of the labor usually exacted from him, even while seeming to possess a perfect bodily conformation, and betray- ing, while inactive and at rest, no defector irregularity of attitude or appearance. This condition is princip- ally illustrated in animals which have suffered from long, debilitating sickness, and in others which have been overworked by being subjected to excessive and exhaustive toil either during their immature youth or after passing the maturity of their powers. Or the debility may be attributed to poor feeding, in which the natural stamina has failed to find its ne- cessary support form the provender furnished. Or, in the same line of observation we may include ex- cessive labor, however so rendered, or any cause, in short, which may derange the equilibrium of forces and requirements which contributes to the conserva- tion of the elements of which the due correlation and action are expressed by the general term of "sound- ness. " The general result is that the action of the muscles becomes deficient, and the legs, instead of being freely thrown forward, become affected with the lateral movement of oscillation, which brings them in collision, more or less hurtfully, according to the existing degree of debility. 216 LAMENESS OF HOUSES. The same phenomenon may be the result of a pathological region. In horses which are weak in the lumbar region, or which are suffering from par- tial paralysis, or perhaps recovering from it, it is easy to understand the impossibility of performing the movements required by the legs in the locomotive act, with the strength, freedom and regularity which attend the actions of a strong and healthy animal. A nearly similar, though somewhat modified action occurs in an animal suffering from severe acute lame- ness of one foot. But in this case it is the diseased leg which impinges upon the healthy member, and sometimes, with the effect of seriously complicating the result in both the new injuries which have thus supervened. 2°. — Defective Conformation. — Abnormal defects in form, characterized by narrowness of the chest or of the pelvis, must necessarily become a cause of interfering, through the undue approximation of the extremities in either or both of the bipeds. The trouble in such cases may be aggravated by the rapid movements of animals of high breeding, as in the racer, in which that peculiarity is specially apt to appear. 3°. — Imperfection in the Direction of the Legs, and the Method of Standing. — Normally, the various parts LAMENESS OF HOUSES. 21? of the legs, from the knee or the hock down, should follow such a direction that a vertical line drawn from the middle of the anterior face of each of the joint would divide the lower half of the leg into equal parts. But in animals whose legs are crooked, whether curving inwardly or outwardly, with the toes turned in either direction, and correspondingly causing the heels either to approach or separate, this condition does not exist. In both instances there is a reduction of the space normally provided for the free motion of the foot, either in front or behind, and interference becomes an inevitable consequence, though varying in respect to the part of the foot with which the contact is effected. Thus, when the toes are turned outwards, the inside of the heel will inflict the blow, and on the other hand, with the toe turned inwardly, that point itself or the quarter of the wall will perform the striking. This formation of the knee, sometimes also denominated " cow-knee " is occasionally complicated with another malformation, consisting in an excessive length of the phalanges, the term "long-jointed" being also applied to this class of animals. The deviations in the direction of the bony levers, and in the mode of standing, which characterize these cases, are under these circum- stances, greatly increased, with a corresponding aggravation of the predisposition to interfere. 218 LAMENESS OF HOUSES. 4°o — Irregularity in the Action of the Joints. ■ — When the movement of an articulation, instead of taking place on the normal plane, parallel to the central axis of the body, deviates from the vertical line, the result is that all the the bony levers situated below it, are carried in the same direction, and instead of moving forwards in a straight line are inclined towards those of the opposite side. Here again, interfering is the result, in a greater or less degree, as the erroneous action of the joint is more or less marked. Horses addicted to a high knee action, or contrariwise, those whose habit it is to travel close to the ground, are equally disposed to interfere. In these cases the disproportion existing between the length of the fore arm and that of the cannon constitutes the cause of the defect. 5°. — Swelling of the Leg. — A swelling existing at the lower part of the leg, whether diffuse, or limited to the region of the fetlock, and especially when the prominence is of a considerable size, must, if only for mechanical reasons, invite the lesion, and those whose joints have become in any degree deformed by chronic trouble of the kind must expect recurrences of the attack whenever circumstances become propitious. 6°. — Condition of the Feet. — A tendency to interfere may be looked for in feet excessive in size or irregular in shape, as when they exceed the nor. LAMENESS OP BOUSES. 219 mal standard in their weight or their transverse diameter. An increased liability to interfering may occur also when the foot is deformed by having the external quarter higher than the internal, with an inward deviation of the fetlock from this direction, and it may be looked for also from flat, broad feet, or the deformed feet of chronic laminitis. 7°. — Shoeing. — "We must look to the shoe for the most common and influential of the predisposing causes of interfering,and may recognize it as belonging at once to the producing and predisposing elements. As a general fact any horse which is shod has his lia- bility to interfere increased in at least one particular, by the circumstance that when the shoes have become polished and smoothed by continued friction, the feet have by the same process lost a portion of their holding power upon the ground. This is especially so on certain slippery roads and peculiar kinds of pavement, in travelling over which the animal is often compelled, in order to maintain his equilibrium to shift and cross the feet so hastily and rapidly that blows and cuts must almost necessarily follow, inflicted by either foot upon the other, and resulting in wounds and injuries of a serious and painful character. Excessive length in a foot, with its proportionally increased weight and that of the shoe superadded 220 LAMENESS OF HORSES. may be included with the predisposing causes, since the elongation of the foot is necessarily and naturally associated with that of the lever power represented by the phalanges, there constituting together an irregularity of action which cannot otherwise than result in interfering. But when the injurious effect of shoeing in this respect is most fully realized, it is when the shoe has been improperly fitted or the hoof improperly pared. The shoes which cause trouble are those which are top wide ; those in which the heel of the inside is too long or too prominent; those which are too heavy ; those in which the nails have been left too long and too prominent : or where the quarters of the wall are uneven, one being higher than the other — all of which are points and sug- gestions of too great pertinence and too much importance to be allowed to escape the most careful and through examination. Symptoms. — The symptoms characteristic of inter- fering vary with the violence and duration of the originating cause. If the animal simply " touches " himself there will be no other evidence than a slight devitation in the direction of the hair covering the spot where the touch has occured, or perhaps a trifling mark of dirt or mud. In injuries of a severer character the regions may become the seat of infil- tration, more or less circumscribed, with heat and LAMENESS OF HORSES. 221 pain, the trouble passing off, however, unless there should be a renewal of the cause, but under its repetition and continuance, forming a wound of vary- ing depth and extent, proportioned to the amount of violence inflicted. The lesion may be a mere superficial excoriation; a cut through the dermis of the skin, or even penetrating beyond it, especially if the aggressive spot or point be hard or sharp. The violence with which the impinging body strikes will of course determine the severity of the wounds which it inflicts The fore leg at any point from the coronet to the knee, may become the seat of this lesion, but in the hinder legs, the danger is principally confined to the region of the fetlock. Once established, they may then assume any degree of severity, and range from a simple excoriation of the skin to a pronounced exhibition of gangrene, with the accompanying access of serious infiltration, diffused purulent accumulation, the sloughing of large portions of skin or extensive plastic exudations which, in the form of callous, establish a permanent deformity on the inside of the fetlock. The lameness which accompanies interfering varies greatly in degree, and it may occur suddenly and under embarrassing circumstances, as when the animal, while working or travelling suffers a sudden 222 LAMEtttiSS OF HOUSES. pang which causes instantly to halt him or to hop On three legs for several steps, or until the pain vanishes. This is a frequent occurence on our city pavements and especially so among horses working on the, street railroads. There are cases in which the lameness seems to be suspended until the return of the horse to the stable, the inflammatory process appearing to wait until then before developing its activity. It may thus be of an intermittent or occasional character, or if it be continuous, it will be because of the repetition of the contusions and the maintained severity of the lesion In whatever degree of severity the result of interfer- ing may be manifested, the seat and character of the lesion are too specific in their nature and history to admit of a doubt as to their identity and their cause. But while the point upon which the impinging force falls may always be easily recognized, it is at once more difficult and more important to determine with accuracy just the aggressive point from which the blow comes — the spot which actively hits the readily seen other spot which is passively smitten for upon this knowledge depends the decision upon the proper indications of the treatment which is to cure or palliate the too obvious evil. A careful scrutiny of the direction of the legs will often assist the surgeon in this, but he will frequently encounter LAMENESS OF HORSES. 223 cases in which a resort to artificial tests will be necessary in order to secure a solution of the problem. At this point he will obtain good results by covering the striking foot with substances which will not only leave a mark upon the opposite leg, but receive another in exchange, thus by a reciprocal betrayal discovering both needed facts at once. An effectual method of securing a satisfactory diagnosis may thus be secured by smearing the foot with tar, or grease and chalk, in this mode, discovering by a single process both from whence the blow comes and where it falls. Prognosis. — In considering the injury under dis- cussion, and the various causes to which it may be referred, it becomes obvious that the question of prognosis is one that must receive various solutions. The same remark is true upon the point of the indications of treatment. In a case in which the trouble is due to a temporary weakness, which time and good care are adequate to relieve, the prognosis need not be a serious one. But if the origin of the evil is found in a malformation of the legs, or indeed a malformation of any part, a correct prognosis can only be" reached as the result of the critical and skillful investigation of each case on its own merits by the accomplished veterinarian, and all the more, as it will be all the more important, if the case should 224 LAMENESS OF HORSES. involve the danger and possibility of complications which may comprehend chronic lesions of a serious character. Treatment. — The indications for the curative treat- ment of the various lesions which are observable in connection with the vice of interfering are readily appreciable, and must vary in accordance with the special manifestations pertaining to each case as it occurs, whether it be of simple contusion, diffused inflammation, purulent collection, cutaneous slough, or chronic plastic exudation. In their general scope they consist in allaying inflammatory action, facilitat- ing the suppurative process, accelerating the separa- tion of mortified skin, and the cicatrization of the remaining wound, or in stimulating the absorption of the plastic organization which may follow. But the most important part of the treatment in any case of interfering is preeminently the prophylactic, and the means of preventing, removing, or diminish- ing the existing tendency to the habit must therefore rest essentially upon our knowledge of the causes which originate the trouble. In well formed horses interfering can only be the result of a condition of debility. The indications in such a case is to treat them leniently, or rather justly respect to their burdens, by carefully avoiding the imposition of exactions which may overtax their LAMENESS OF HORSES. 225 strength, and l>y apportioning liberal rations of nourishing fodder to maintain their stamina and spirit. Then due provision should be made for the protection of the legs by suitable pads, boots and bandages; and the most studied and careful attention should be bestowed on the shoeing, in doing which special caution should be exercised in order to avoid any disturbance of the equilibrium and symetry, and consequent bearing and general condition of the joints and ligaments. And it may show wisdom, not a little, to avoid recourse to some of the extra- ordinary mode of shoeing sometimes " certified " for their wonders of performance — which, however, may occasionally have their value in cases belonging to another category. More frequent shoeing, the care- ful paring of the hoof, and a judicious shortening of the foot will be of advantage, so long as there is no impairment of the conformation of the foot. A flat, smooth shoe, with the internal branch not beyond the quarter, and the heel even resting a little inside of it, will often meet and fully satisfy the existing requirements. When the interfering is caused by a defective conformation of the trunk and of the legs, the question to be solved is how to keep the legs suffici- ently separated one from another to escape the. contact which constitutes the trouble, According 226 LAMENESS OF HORSES. to Bouley, there are two ways of accomplishing this. The first is to give to the articular levers of the region which receives the blow a direction contrary, to that which approximates it to the part which inflicts it. The second is to render the blow as little harmful as possible, a result which can be obtained either by diminishing the thickness of the part with which it strikes, Or in conferring upon the leg to which this belongs, when it enters into action a diverging movement which will carry it from rather than towards, the wounded member. It must not be forgotten that an exceedingly minute lack of space is sufficient to render the injurious contact possible, while the narrowest space for a miss is in like manner sufficient to obviate the danger — it is the " miss-and-mile " proverb exemplified. S hoes of two patterns, quite differing in their forms are recommended. One gives an obliquity to the foot from above downwards, and from within outwards the other, on the contrary, has the obliquity from without inwards. In the first mode, the foot is pared in such a manner that the internal quarter is more elevated than the external, and the shoe has the inner branch thicker than the outer. At the same time, the prominence of the internal circum- ference of the quarter is reduced by the rasp towards the point which strikes, while the internal branch is LAMENESS OF MOUSES. 227 placed a little on the inside of the external contour of the wall. In Zundel's opinion, this is probably the most important part of the preparation of the foot, and must be carefully and skilfully performed, with reference to the part of the wall with which the animal interferes, careful examination being required in order to determine whether the interference occurs at the inside toe, the quarter or the heel of the foot these being the points at which the changes in the thickness of the shoe must be made. In the second method, which is recommended by Garsault, Laf osse Moor croft, and others, the reduction by paring, and the changes in the thickness of the shoe are affected on the outside, with the rasping on the inside of the wall. There are, however, conditions of interfering which are not amenable to prevention by any methods of shoeing. The indication in such cases is to have recourse to the use of suitable pads, or boots, and of these the variety and quality are great and variable. It is needless to say that when any of these are used, there must be a careful experimental adjustment in each individual case. SPLINTS. A splint is an exostosis, developing in the meta- carpal or metatarsal region, usually upon the inner LAMENESS OF HORSES. side and upon the fore leg, but also occurring, though rarely, on the outer side and upon the hinder leg. Percivall designates them as the simple and the double, the foimer consisting in a small tumor, situated along the cannon bone, at the point of articulation with the small peroneus, and the latter, also known as the pegged, being formed by two pro- jections, one on the inside of the leg, and directly corresponding with it another on the outside, as if pinned or pegged together. The splint is also called & fusee, when two similar growths are united at the ends, one above the other. "While it is usually encountered in the middle region of the cannon bone, the splint may also be found in close proximity with the knee joint, in which case they are more or less likely to interfere with the free action of the carpo-metacarpal articulation. Occupying the lateral part of the middle meta- carpus, where its situation precludes it from any material interference with the action of the leg, the simple splint does not usually become an evil of very serious magnitude. The pegged splint is, however, less innocent in its possible effects, since it is not uncommon to find it united with exostosis on the posterior part of the metacarpal bone, and hence involving the danger of interference with the function of the suspensory ligament. The most dangerous LAMENESS OF HORSES. 229 condition of tlie splint is that which arises from its location, when that is near enough to the knee joint to involve possible interference, by its own develop- ment, with the freedom of that articulation. While the general causes of exostosis may be referred to, in accounting for the existence of splints, there is one which is probably oftener effective than any other, in the irritation which may take place in the inter-articular fibro cartilage which unites the articular surfaces of the small and large cannon bones. This irritation is a condition specially likely to occur in young and undeveloped animals, as the result of undue labor and violent exercise, particu- larly when the stress falls on the inside of the leg, and in general whenever the strength has been over- taxed and the vital resources are prematurely reduced. Diagnosis. — There is little, if any, difficulty attend- ing the diagnosis of an ordinary case of this nature, where the sensible phenomena are few and so obvious. The splint is a hard, painless tumor of the middle metacarpus, varying as to size and prominence. When not visible to the eye under ordinary observa- tion, it may be detected by tracing its course with the finger tips longitudinally along the bone, where it may be distinguished as a simple eminence or irregularity. In this stage of its progress it seldom 230 LAMENESS OF BOUSES causes lameness, except possibly by some peculiarity of situation, and little if any apprehension need be felt of injurious consequences from its existence. But prior to the development of the osseous forma- tion, and while the acute periostitis alone exists, the diagnosis may be attended with some degree of dif- ficulty, although the inflammatory manifestations of heat and soreness on pressure may, from the first, suggest a correct suspicion of the truth to the expert and experienced veterinarian. The lameness itself may be present in fact, as the accompanying result of the acute process in progress, existing there, as we believe, in the intermittent form. It is then perhaps that it is most easily detected, when in the warm stage, though again we have also observed it when cold, j)ossibly from the fact that in this case the bony deposit had begun its formation. Prognosis. — However this may be, the prognosis of splints is not a serious one, since the worst conse- quence that can usually follow will be a blemish which may do no harm beyond offending the eye ; and it is only under very exceptional circumstances that the services of the surgeon are likely to be demanded. Treatment. — The treatment indicated for splints is that which, on general principles, is applicable to other exostosis. Local topics, anodyne and sedative ; LAMENESS OF HOUSES. 231 alteratives and counter irritants; all have their advocates, and all modes of treatment may be followed by satisfactory results. Excision and removal by the saw and chisel is recommended by some, and English veterinarians consider that perios- totomy is often advantageous. BINGBONES AND SIDEBONES. Ringbones and Sidebones are the formes of the French and the leiste of the Germans, by which terms they describe a bony tumor which developes in the phalanges of the horse at the coronet region. They may be exostosis of the os suffraginis ; or the os coronae; or of the os pedis, or its cartilages, the name of sidebone being principally applied to this last form ; while that of ringbone is always limited to the periostitis with bony deposits of the phalanges proper. At whatever point it may be established ; and it is immaterial as to which of the phalanges may be its seat ; when the complete period of its ossification has been accomplished, its existence will be betrayed by the tumefaction of the region, more or less developed according to the dimensions of the growth. It is rendered more discernible by the eye in some situations than in others, not only by its size, but by the greater or less degree of thickening of the skin covering it. It may be deter- 232 LAMENESS OF BOUSES. mined both by contrasting its form with the normal outline of the affected limb, and by a comparison of that with the unaffected member. Tested by the taxis, it presents a tumor of varying size and form, and of hard consistency, having all the characteristic hardness of the bony substance proper. It is situat- ed on the surface of the bone, or near the articular surfaces, passing under the tendons, or in the interior of the horny box. When located in the cartilage of the os pedis, and its calcification has been completed it is detected by a certain bulging of the region, accompanied by a loss of its proper flexibility, which has become exchanged for an inelastic hardness, and yet keeping the peculiar form of the characteristic cartilages. But however easy it may be to decide a case in which the ringbone or sidebone has completed its formation, it is a task of quite a different nature to certify the fact with accuracy while the diseased process is yet in its first or formative stage. For, while the surgeon, guided perhaps by the presence of a little tumefaction, or a degree of soreness or pressure, with more or less heat adjacent and sur- rounding, may easily fix upon the coronet as the seat of the lameness, these appearances do not constitute sufficient data to determine conclusively whether the trouble which he has encountered is an acute and local periostitis, or some other, and undefined injury LAMENESS OF HORSES. 233 of some other part of the complicated anatomical structure of the region involved. Under these cir- cumstances, the surgeon may derive important aid from his observation of the pain and its characteris- tics, as is sometimes manifested by the patient while under examination. If the trouble exists under the extensor tendon, this is exhibited when pressure is applied to the top of the foot, over the region of the cartilages, or by the forced flexion of the foot. On the contrary, if its seat is under the flexors, or possibly under the ligaments, it will be excited by excessive extension. The lameness in these cases varies in character in different stages of the disease. In the begining, while only the periostitis, and the deposite of bony matter is in progress, it is either not always present or it is not yet discernible. It may also happen that the morbid process may still be accomprnied by a degree of lameness more or less marked, notwith- standing the fact of its being undiscovered and apparently undiscoverable. It has also something of an intermittent character attending it, and is generally more marked after the animal has been subjected to labor, having for this reason been mistaken, at times, for a case of articular disease, such as navicularthritis. But when the bony deposite has become established, the lameness which 234 LAMENESS OF HORSES. is the result is both continuous in its nature, and distinctly manifest, and more generally intermittent in its cold condition, or when the animal is first put to work. It often occurs, too, that the pain is less the result of the inherent disorder present than of mechanical causes, as when the bony deposite inter- feres with the play of the tendons or ligaments, or, which is the more common case, with the motion of the joint, when it approaches too near the articular surface. In these peculiar cases, a serious compli- cation may in time be brought on by the retraction of the tendons, and the resulting inability of the foot to perform properly its mormal function of standing squarely on the flat sole. As a consequence of this there will be atrophy of the frog, with an abnormal elevation of the heels, with a distorted condition. Prognosis. — The prognosis of these peculiar affec- tions is always a serious one, since, although they do not invariably incapacitate the patient from labor, they quite frequently have that effect in utter defiance of any form of treatment within the scope of surgical skill. Nor is the size of the growth always the true measure of the severity of a case. It may happen that a larger tumor may interfere less with the motion of a joint than one of smaller dimensions, which is more acutely sensitive or has found a more unfortunate lodgment. LAMENESS OF HORSES. 235 A more serious forecast should be given in respect to animals requiring activity and quickness of motion than for those employed in labor of the opposite kind. With the latter, indeed, a moderate degree of lameness does not appear to be a disqualification from heavy draught work. Etiology. — Among the more frequent causes of this form of exostosis are to be reckoned blows and bruises, with other kinds of external injury, which have been followed in their order, by phlegmonous inflammation, abcess, and as consequence by perios- titis. The bruises of the cartilages are commonly followed by chronditis, and this ends in calcification of this fibro- cartilage ; and as in fact, this peculiar tissue possesses a natural tendency to this alterna- tive process, it becomes easily obvious that but a slight inflammatory impulse will be needed in order to establish the change. Pressure, sprains of the ligaments and tendons, and their laceration from their periosteal attach- ments, as they are commonly suffered from badly paved streets and rough roads, and slippery tracks, are more commonly accompanied by first, a local phalangeal periostitis, and subsequently, by the ringbone or bony deposit, of slow growth. The exposure, if not the easier liability of young animals to these injuries is greater than -that in older ones — 266 LAMENESS OF HORSES. a fact aptly illustrated by their frequency among the colts designed and put under training for the race tract — and short jointed animals may be added to the same list from the fact of the more vertical direction of the phalanges, which renders them more apt to receive the concussions of locomotion or the weight of the body more directly than if the obli- quity of the bones had been more marked. These exostosis are frequently among the conse- quences of arthritis in one or other of the phalangeal joints, or they may appear as the sequelae of trau- matic lesions of the foot, such as cartilaginous quittor, complicated toe ur quarter crack, suppurative corn, or punctured wounds of the foot. It is our belief that navicular disease is very commonly associated with exostosis of the phalanges, though during life it very often escapes observation. They are also among the sequelae of lesions of the bones, fractures of the phalanges being always complicated by the development of ringbones, without reference to the point where the fracture has been, with or without displacement. "While refering to the causes of ringbone, that of heredity, unquestioningly admitted into the category by old hippiatrics, must not be overlooked. And while the influence of this cause may have been unduly exagerated, our own observation of the LAMENESS OF HORSES. 237 transmissibility of this and other qualities, through the natural generation channels have at least brought us to a conviction of the wisdom and policy of ex- cluding animals affected with ringbone from the stud. Some German authors have strongly advocated the exclusion of drinking water containing an undue proportion of calcareous elements, as part of the prophylaxy of the case, but opinions are not yet settled upon the point thus suggested. Treatment. — The discovery of periostitis of the phalanges, when established beyond a doubt, should be promptly followed by active treatment, compre- hending local applications, such as cold bandages, and anodyne and sedative embrocations, such as a mixture of tincture of aconite and iodine in equal parts, applied by means of compresses. An active soreness is often relieved by these and kindred measures and appliances. But in our own view, and our conviction has become established by long experience, the actual cautery offers the most satis- factory of known means for checking the formation of the bony deposits, and possibly promoting the absorption of such as have already formed. The application of cauterization in points, and principally the needle method has in our hands proved most of any successful. The danger of extensive sloughing of the skin, apprehended by Zundel, is an exaggerated 238 LAMENESS OE HORSES. one, and is a complication which in a large practice of many years we have not yet encountered. But as in other exostosis of joints, in bone spavin, for example a single firing may not in every instance prove sufficient, and a repetition may become necessary after an in- terval of four or five weeks from the first firing. Many practitioners recommend counter irritation by cantharides, or with preparations of iodine or mercury. This treatment offers at least the advantage of facility of repetition, and of avoiding subsequent visible blemishes, which the hot iron cannot always promise. The operation of periostotomy can be regarded with but little satisfaction, being certainly often useless, and at times involving great danger to the patient. The extirpation of the sidebone may sometimes be undertaken with advantage, but the operation is not without danger, and must be recommended with caution, except when with calcification, there is also necrosis of the cartilage. When performed it will be the same complicated, operation of removal which is practiced in cases of quittor. "When the lameness resists, every other form of treatment, the operation of neurotomy may be ad- vantageously resorted to. This subject has recently awakened an interest among coutemporary French writers, and both the value of the operation itself LAMENESS OF HORSES. 23$ and the question of the modus operandi have been largely discussed, the contention principally refering to the comparative merits of the high operation and che low We have ourselves given a large amount of study personally to the subject and have operated very fequently, and we have always practised the high operation in preference to the other mode. The result has been, in our hands, very generally success- ful, and as regards the frequent complications which by some practitioners are accounted so many object- ions to this treatment, we have had the good fortune entirely to escape them. We have operated on both sides of the fetlock, and on that point, must wholly dissent from the opinion of that class of practitioners who insist upon the necessity of an interval of six weeks between the several operations on either side. It is quite true, however, that a certain interval of rest between the operations is always of advantage to the patient when more than one leg is to be operated. HYDRAKTHEOSIS. WINDGALLS. The fetlock joint and the synovial surface which assist in the gliding of the flexor tendons upon the sesamoid pulley have a tendency to become the seat of certain abnormal dilatations, known as ivindgalls, which are farther described as articular or tendinous, U6 LAMENESS OF HORSES. with reference to their situation within the articular or the tendinous synovial sac. "When the synovia contained in the capsules of the metacarpo 01 metatarsophalangeal joints is secreted in an abnormal quantity the excessive secretion becomes the cause of certain tumors, quite uniform in their situation. Strongly confined in front of the joint by the capsular, and on its side by the lateral ligaments, the synovial sac can only expand on the posterior part of the joint, between the posterior face of the cannon bone, and the anterior face of the suspensory ligament, where it extends its superior cul de sac ; or below the great sesamoids, between the posterior face of the os suffraginis and the middle inferior sesamoid ligament. It is in these two direct- ions that the excess of the synovial fluid accumulates, and expands each cul de sac, as it is formed by the synovial capsules. By the principle of their forma- tion ; these projections, formed by the distended sacs, are only accurately defined as they extend above the sesamoids to the border of the cannon bone and behind the prominent branches of the suspensory ligament. They then appear under the form of small tumors, tense and elastic when the leg is at rest and the synovia pushed backwards, but soft and reducible under pressure when the foot is raised and the fetlock flexed. LAMENESS OF HORSES. 241 With time these tumors may enlarge until they attain the dimensions of a hen's egg. Sometimes they will acquire a more or less bosselated surface, on account of the uneven resistance of the walls of the cavity which determines their shape. And as they extend upwards sufficiently, between the bone and the suspensory ligament in front of which they are situated, they will continue to contract in size with the lessening space which contains them. As they reach a degree of development which in- dicates that they have become filled to the limit of the capacity of their cavity, the inferior cul de sac of the capsule, which has a tendency to form a hernia below the sesamoids, exhibits, behind the first phalanx, at the side of the middle and superficial inferior sesamoid ligaments hard nodosities, very tense when the foot is at rest, but also easily redu- cible when it is flexed. With age, a pathological change takes place in the articular windgall, and it assumes a fibrous texture, through the exudation of plastic lymph in its meshes, and subsequently becomes infiltrated with calcareous deposites, when it is distinguished as an indurated windgall. The synovial capsule of the fetlock cannot long continue subject to these various degrees of pressure without exhibiting some alteration in the symmetry 242 LAMENESS OF HOUSES. of the articular levers, and they do in fact, in due time after undergoing the necessary amount of con- tineous force, succumb to the slow operation of the aggressive violence, and yield the evidence of its effects in a greater or less degree of change of direction of the joint. The mode of deviation which this persevering pressure of the incompressible fluid finally effects is that which has a tendency to straighten them on each other, and, as a consequence, we are presented with a case of the first degree of knuckling. In the tendinous windgall it is the synovial bursse of the flexor tendons which acquires this abnormal dilatation and exaggerated fullness, the tendinous capsule being larger than the articular, as well as less restrained by its surrounding tissues, the tumors which result from its distention being therefore of correspondingly greater size than those of the articular variety. They reach their greatest devel- opment above the sesamoids, where the capsule is least protected. They first appear as small, soft tumors, elongated in the direction of the tendons, and a little outwards from the tendon of the deep flexor of the phalanges, immediately above the sesamoids, and as they develope, they extend up- wards, projecting more and more outwardly, with increasing power of resistance to pressure, and LAMENESS OE HOUSES. 243 extending backwards over the tendons, as if about to envelope them. When the synovial bursa?, at a later period, has reached their maximum distention, they assume the form of quite prominent oval tumors, which offer considerable resistance to pres- sure when the foot is on the ground ; the surface is irregular, and surrounding both the tendons, they extend from the button of the small cannon bone, a point beyond which they seldom pass to down- wards, when they extend to the sesamoid pulley, where the aponeurosis, which bounds the flexor tendons, binds them firmly and apparently separates them from the inferior tendinous windgalls, of which they are in fact but the continuity, the synovial bursa? obviously extending to the os corona?. The tendinous windgalls never assume dimensions below the sesamoids equal to those which they possess at the sesamoid cul de sac, being prevented by the apeneurotic apparatus surrounding the ten- dons and the phalanges. But there are two points, immediately below the sesamoids, where a diminu- tion of resistance permits a certain dilatation of the bursa?, and here their appearance becomes altered to that of two small, softish tumors, more easily detected by the touch than by the eye, and com- municating with the superior sesamoid tendinous windgalls. 244 LAMENESS OF HORSES. This class of tumor assumes at times a condition of induration, but is subject to this change only above the sesamoids, and like the articular dilata- tions, it also possesses a tendency to impair the symmetry of the parts, though not to the same extent. A hydrarthrosis of the fetlock is rarely in itself a direct cause of lameness, and it can only become so through the mechanical obstruction which the tumor offers to the free action of the joint, or when its functions are interfered with by some pathological change of structure. Or again, when the joint has become the seat of a recent acute inflammatory attack, to be diagnosticated in the usual way by rise of temperature of the parts and other evidences of tenderness and pain, to be detected by pressure. The causes of the hydrarthrosis itself may be again enumerated, like those of most of the articular lesions of a similar kind, as excessive labor, violent exertions, slipping or other misstepping, wrenching the joint, etc. Lameness or other disability in one leg may also cause it, indirectly, in the sound one, by throwing upon the latter a disproportionate share of labor. And probably a predisposing habit may have its influence in lymphatic subjects, or in animals reared in overdamp and marshy grounds. According to some authors, the disappearance of LAMENESS OF HOUSES. 245 a windgall may be sometimes looked for as the result of rest, the resolution of all the symptoms, and the absorption of the excessive synovial secre- tion. But their most common termination, in fact, is the attainment of a permament chronic form, with the exhibition, during the remaining life of the patient, of all the concomitant symptoms and cha- racteristics attendant on the case, and unaffected by the consideration of any changes of structure in the affected region, which, if present, exists only as independent phenomena. Prognosis. — When the most serious effect of a wind- gall is to constitute a disfigurement in the limb of the affected animal, without materially interfering with his power to labor, the prognosis cannot be of a very serious character. But we must except from so lenitive a judgment the cases which involve certain peculiar conditions of mechanical interference with the free motion of the joint, and we must emphasize the unfavorable view which a large experience has compelled us to adopt, and to repeat the opinion that their removal is very seldom successfully accomplished, except under special circumstances, and by a very special form of treatment yet to occupy our attention. Treatment. — In view of the fact that peculiar hygienic conditions have, admittedly, an important 246 LAMENESS OF MOUSES. causative connection with the origin of these dropsies of the synovial sacs, the indications in respect to the prophylactic portion of the subject at once suggests the question of better breeding, with the study and adaption, and change, when necessary, of climate ; the quality of the food and drinking water ; the kind and amount of labor, with reference to strength, age and build ( a most important study) ;. and briefly, all the conditions and requisites of sound and healthy conception, vitality and growth. In respect to curative treatment, pressure, probably because of the facility with which the means can be applied, is the method most popularly and frequently employed. And it cannot be doubted that the application of bandages of various forms has in many instances proved, if not positively curative, at least largely palliative : if it has not extirpated the disease, it has at least retarded its progress and checked its indefinite increase. Local applications, when the parts are in an inflammatory condition, consisting of astrigent and stimulating frictions, counter irritation with blisters of cantharides, or alteratives of iodine and mercury — all these have their advocates and are largely employed. We have already said, in reference to the treatment of other joints similarly affected, that we prefer the early use of the actual cautery, and we repeat our conviction. In some cases firing LAMENESS OF HORSES. 247 in lines, and in others the method by points, or with the needle iron, will secure the best results, and most efficiently correct the growth and remove the lameness. A simple puncture with the bistoury or the trocar, either subcutaneously or directly through the skin, the puncture and emptying of the sac, followed by the injection of a weak solution of tincture of iodine, galvanic electricity, or galvano-puncture, are, all of them, recommended and practised, But all these modes of treatment having already passed under our notice in preceeding pages, in which we have con- sidered the general treatment of hydrarthrosis, a further reference here to their characteristic effects and relative values would be needlessly repetitious. SPEAINS. SPRAINS OF THE FLEXOR TENDONS. The lesion ordinarily known as clap of the back sineivs, or broken dozen, is an injury of the general nature of sprain of the fibrous structure of the posterior part of the cannon region. It may be either metacarpal or metatarsal, and consists in a diseased condition of either the tendons of the phalangeal flexors or their sheath, or, according to Williams, of the reinforcing ligamentous band which, situated below the knee and hock, extends from the 248 LAMENESS OF HORSES. posterior fibrous covering of those joints to the tendons of the flexor perforans. Etiology. — Among the causes from which this con- dition most commonly arises are those to which lacerations of the fibrous textures are commonly due by reason of their forcible over extension. As a natural consequence, animals engaged in hard and heavy hauling, which involves the extensive stretch- ing of these inelastic fibres, are the most frequent sufferers from sprains of this class. A single misstep, a sadden slipping on an icy or oily surface, may be sufficient to cause the lesion ; its sudden appearance in the racer, either while training, or while engaged in the struggle for which his training is designed to prepare him, is a sufficiently common occurence to suggest the true solution of the phenonemon. The hunter and the steeple chaser, as they are exposed to the danger at its maximum, become the best examples and evidences of the methods most liable to produce this variety of sprained legs. Symptoms. — The symptoms of these lesions are usually sufficiently distinct and intelligible. Lame- ness is commonly present, sometimes in a very marked and at others in a very slight degree, as determined by the amount of the violence to which it is due. On passing the hand over the parts, a swelling may be felt, which may be perhaps but a slight and single LAMENESS OF HORSES. 249 bulging backwards, or it may be a diffused enlarge- ment along the track of the tendons, with a develop- ment of heat and pain ranging in degree from the slightest to the severest. The attitude of the horse, as he stands with the lame foot flexed and resting on the toe, with the heels elevated, sufficiently suggests the true state of things to the mind of the experienced and observant surgeon. When the sprain of the metacarpal or metatarsal region becomes a serious matter — and it is seldom otherwise — it is, however, less a lesion per se, than from a consideration of the peculiar resulting condition in which it may leave the tendons and ligaments. A chronic thickening of the parts, with a gummy condition of the leg may be included in this, and there is a plastic infiltration which alters the general aspect of the back sinews and interferes with their general functions by rendering them adherent one to the other. It is from this chronic condition of the lesion that serious trouble is to be apprehended. The tendons being prevented from exercising their proper functions, become retracted, and then follows the peculiar change which is designated as knuckling at the fetlock — an evil of serious character, and which not only demands the application of skilful surgery, but too often fails to become amenable to its benefits. 250 LAMENESS OF HORSES. The treatment indicated for sprains of this region, and it is one which nearly all writers agree in recommending, consists in local applications, by some of hot and by others of cold water — and hot fomentations, often repeated and aided by warm bandages, are indeed, in many cases, followed by excellent results. By others, howe\er, showering with cold water, cold douches and cold water band- ages are preferred. Local topical treatment has, without doubt, its important advantages but what- ever these may be, they are seldom, if ever, effective in preventing the exudation through the meshes of the injured structure, which, though a natural necessity for the repairing process, must, if possible, be kept under such control as will prevent the extensive chronic alterations which have a tendency to supervene. It is for this reason that early resort should be had to remedial measures. These, as nearly all the writers agree, consist in counter irritation by means of blisters or alterative ointments, to be followed, if ineffectual, by firing and operation, which, in the opinion of many, furnishes the only means by which good horses, under such circum- stances can preserve their usefulness and value. It is Per ci vail who says — " By the firing iron have " horses originally worth their hundreds of pounds " sterling, been raised fiom knacker's price to their LAMENESS OF MORSES. 251 ft former Value. By the firing iron has many a broken "down hunter and many a racer been joyously " restored to his station and rank in the field where " his proudest laurels have been won." But with all these various therapeutic indications, there are two others which the attending surgeon cannot afford to overlook and, when necessary, to insist upon. The first is proper shoeing. If a low, thin heeled shoe is a predisposing condition of the development of sprain of the back sinew, the indica- tion for its prevention will be to look for relief in a high heeled shoe, in order to keep the tendon in a state of relaxation. The second is long rest. It must not be for- gotten or overlooked that from the structure of the tissues involved in the repairing process, the work of complete cicatrization is a slow and tedious one. BUPTURE OF THE SESAMOID LIGAMENTS. We are disposed to think that much that has been uttered by authors as particularly applicable to this species of injury has been, in some measure, unnecessarily written, and that much that has been said on the subject of sprains of the tendons applies equally to those of the superior sesamoid ligament. Of similar structure, the composition of both being the same white, inelastic, fibrous tissue, though 252 LAMENESS OF MOUSES. having, it is true, a different function, yet, as they both act as supporting and strengthening elements of the fetlock, they must need be exposed to similar injuries, arising from the same causes, and their manifestations should become, therefore, of very much the same character. The principal difference lies in the circumstances that the location of the swelling, when limited to the ligament, is a little more forward and in front of the tendons, and varies therefore from that which occurs when the tendon is the immediate seat of injury. There is also a peculiar lesion of this ligamentous apparatus, which we have frequently met with, especially in American horses, consisting in a com- plete rupture of one or both branches of this ligament, as they are inserted at the apex of the sesamoids. We cannot accept the theory that this is essentially a lesion of the suspensory ligament, as held by some authors, since the same kind of accident may and does, in fact, occur by the giving way of the inferior sesamoid ligament. The first mention of this disease of the ligament- ous structure of the fetlock was made by our friend, Professor A. Large, in an appendix to an American edition of Stonehenge on " The Horse, in the Stable and the Field," published about twenty years ago. The disease is a peculiar one, and the suddenness LAMENESS OF HORSES. 253 of its appearance, with its occurence in different feet separately and without discernible cause, proves that the parts have been the seat of some latent disorder or some change which must have been for some unknown time in progress. No class of animals appears to be specially subject to attack, although there are circumstances of peculiar liability, as for example the protracted stabling of animals which are long kept unemployed, as racing horses, kept from their accustomed exercise during the discontinuance of racing and in inclement weather. Although the history of these cases is a uniform one, there is still some difference in individual cases, in the manner in which the symptoms make their appearance. In some of these the lameness will sud- denly manifest itself in one or both feet of a biped, either fore or hinder, quite in the absence of any known cause, as a misstep or the like, and it may either appear in a very severe form, or only become discoverable by a slight irregularity or uncertainty of gait while walking, much resembling in this respect the action characteristic of an acute attack of laminitis. Though closely examined throughout the entire extremity, the parts fail to reveal any well marked changes. A little swelling, perhaps , a slight perceptible heat at the fetlock, and often an increase of pain on lateral pressure over the sesamoidal 254 LAMMESS OF MOUSES. region, may be all. In the stall, the patient may be observed to prefer the recumbent position, and can only with difficulty be made to support himself on his feet, and when compelled to stand upright, betrays the pain which it occasions by the swaying movement of the body as he shifts his weight from side to side. The manner of the access of the disease is some- times quite a surprise to the inexperienced. The animal has perhaps been kept at rest in the stable, in consequence of his lameness, and has been for an indefinite period under treatment, without any dis- tinctly marked symptoms or external manifestations, when at some unexpected moment he is found lying helpless in his stall, with one or both of the fetlocks apparently fractured. The standing position has become impossible — the foot no longer rests on the sole, but rather on the back of the heels — the toes point upward, the fetlock is almost in contact with the ground. Nor is it very unusual to encounter this same state of collapse under other circumstances, and without the preliminary or premonitous lame- ness. But when this occurs, it is while the animal is performing his usual labor that the collapse takes place. For example, although he may neither be at heavy work, nor moving rapidly, but simply travel- ing at an ordinary and moderate gait, such as he has long been accustomed to, a change may suddenly LAMENESS OF HOMES. 255 Occur in his movements ; his step will shorten, and he will suddenly stop, apparently attacked with sharp and excruciating pains. He betrays great uneasiness, becomes evidently unable to stand, and falls on the spot. If urged to rise he makes a violent effort to regain his feet, and this completes the trouble; it is the final struggle, and it ends in lacerating the remaining fibres of the ligaments, and causing the foot to assume the peculiar appearance alluded to, by the lowering of the fetlocks and upward pointing of the toes. From the numerous post mortem examinations we have made of injuries of this class, we have become convinced that the true seat of disease is not, strictly, the ligaments alone, from the fact that in the many legs we have dissected for purposes of inspection, we have never failed to discover fragments of bony tissue at the points of insertion of the ligaments, where they had been torn from the bone. If the superior sesamoid ligament had been the seat of the lesion, the fragments would belong to the apex of the large sesamoid bones, but if, on the contrary, the lesion was upon the inferior ligaments, the frag- ments would be from the base of the bones, or the portion of the fibrous pad, which occupies the posterior face and superior extremity of the os corona, upon which they were inserted. 256 LAMENESS OF HORSES. Great care is demanded in the diagnosis of these cases. If the truth is to be discovered, the inves- tigation must be of the most rigid character, and in point of fact all that can be assuredly determined under any circumstances amounts only to the dis- covery of grounds for a reasonable suspicion and a conditional hypothesis, which can only be settled absolutely by the final test of the upturned toes, and then the chances of successful treatment will all have passed away. But little can be said in respect to the treatment of this lesion. Splints and bandages, or other artificial supports may be employed to keep the foot in proper condition, and to support the fetlock, and the patient may be shod with high heeled shoes, or may be put in slings, if he will stand. But although these appliances are indicated, we are constrained to say that our own experience has been so discourag- ing in our attempts to overcome the evil and the results so uniformly negative, that we have been at length driven to the theory that a report of a case of injury of the suspensory ligament and a record of a mistaken diagnosis form but a single variorum statement of the same incident, and can be easily subjected to a double or single interpretation, at pleasure. Cases have occured in our own practice, in which LAMENESS OF HORSES. 257 we have made a diagnosis of incipient rupture of the ligaments of the fetlock, and after keeping our patients under treatment for weeks and months, have ordered their discharge in an apparently improved condition, only to see them break down the very first time their fetlock joints were subjected to the stress of a performance of their normal physio- logical functions. Quite evidently the period which marks the com- pletion of the breaking down process marks also the end of the possibilities of curative surgery, while at the same time it indicates the moment when it becomes a duty to call upon the knacker to terminate the miseries of the incurable sufferer. SPKAIN OP THE FETLOCK JOINT. The fetlock joint is an angular ginglymus, or perfect hinge, in which but two normal movements, those of flexion and extension, can occur. Lateral motion is extremely limited, almost entirely wanting, in fact, on account of the resistance of the lateral ligaments, which unite together the four bones which compose the joint. When a sprain of this articulation occurs, it is as the result of either excessive flexion or extension, or of some violent force applied laterally. There may also be tearing, a partial laceration, and even a complete rupture of the 258 tAMENXSS OP HOMES. fibrous apparatus, by which the bones are bound in their place. If the excessive motion has taken place at the moment of the flexion of the joint, the sprain will be on the anterior part of the articulation, and will be so designated; or posterior when occuring on that side, or lateral external or lateral internal, according to circumstances of location, otherwise. In a sprained fetlock the pain becomes at once manifest, and its seat maybe ascertained immediately after the injury has been received. The inflam- mation rapidly supervenes, and the development of the symptoms which accompany it will correspond with the severity of the injury. The intensity of the pain is greatly aggravated by the increase cf the inflammation, and this again is soon followed by a large swelling of the part, which may soon indeed become sufficiently extensive so entirely to surround the joint so as to render it a matter of difficulty positively to define the extent or even to determine the true nature of the lesion. The soreness is excessive, and its expression may be taken as a measure of the severity of the existing injury. A slight tenderness, rapidly passing off, indicates nothing worse than a simple distension of the articular apparatus, comparatively harmless ; a severer and more continuous pain implies over- LAMENESS OF HORSES. 259 stretching, with, partial laceration of ligamentous fibres : a pain at once severe and increasing will usually indicate an injury of a character correspond- ingly serious. The lameness by which the various degrees of pain are manifested may vary in its expression from a mere timidity and caution in placing the foot on the ground to its complete disuse, when the animal carries it in the air and hops on his three sound limbs. The swelling which exists in a sprained fetlock is at first oedematous and warm, and comparatively painless. It surrounds the joint and extends more or less below or above it, but before long may be observed to extend from the subcutaneous cellular tissue, where it was first limited, to the synovial membrane, (articular or tendinous), where there is an accumulation of synovial fluid, which fills up the joint, increases the pain and forms especially on each side, above and below the sesamoids, true windgalls, hard, more or less elastic and compress- ible and very painful, not only upon pressure, but sometimes to the mere touch. While the fetlock is the seat of this highly inflammatory condition, the pain endured by the patient will, according to its degree, be evidenced by the position in which the diseased leg is held, by the manner in which it is placed on the ground, and often by the general 260 LAMENESS OF HOUSES. condition of the patient. In serious cases the leg is carried in semi-flexion, in order that it may be relieved from contributing its share of support to the weight of the body, which is then of course carried by the three sound limbs ; or if possibly the pain exists in a degree too slight to interfere materially with the act of locomotion, the limb will be used, but only with great hesitancy, and will be lifted with an unusual quickness. In cases of mitigated severity an antero-posterior motion or balancing of the leg may be sufficient to relieve the possible pressure of the tendons upon the distended synovial sac. The general symptoms will vary with the severity of the local trouble and with the impressionable suscepti- bility of the patient. The terminations common to all inflammations occur also in sprains of the fetlock. They end in resolution or suppuration, or lapse into the chronic state. The first, in cases of various degrees of severity, is the most common. "When the lesion is but slight, the inflammation and swelling soon subside, and the limb soon resumes its ability to carry weight and perform freely its proper and normal movements. The same stages of recovery occur in severer cases, but with less rapidity, proportioned to the degree of the injury and the recuperative power of the patient's constitution, LAMENESS OF HORSES. 261 But suppuration is comparatively a rare result, not generally observed, except when the sprain is com- plicated with some lesion differing from that of the ligaments, as a fracture or some special injury of the bones, in which cases all the symptoms of suppurative arthritis soon appear. But if suppuration is rare, the establishment of the chronic condition is not. Serious alterations of all the tissues of the joint may be expected to follow severe cases of sprain of the joint itself, the liability including all the consti- tuents of the articulation, comprehending the bones, the ligaments and the synovial membranes, with both th 3 suspensory and the motor apparatus. The bones may undergo an enlargement of their articular ex- tremities, and sometimes of the first, or even the second phalanx, the ligaments suffer induration, with morbid hypertrophy at their points of insertion and the tendons undergo tumefaction in their own structure, with induration of their cellular tissue or of that which surrounds them. These various changes are slow in their development, and it is only after the subsidence of the acute inflammation that their existence can be accurately ascertained. When the chronic character has become established, it will also have brought with it a permanent lame- ness, varying in degree and character, according to the nature and intensity of the lesions which interfere 262 LAMENESS OF HORSES. with the regular functions of the several elements of the joint. Even when the inflammation has terminated by resolution, a sprain of the fetlock is always a serious evil. The joint becomes permanently weakened, tender, and painful, in varying degrees, corresponding to the intensity of the symptoms attending the original injury, with a predisposition to swelling and soreness, and inability, frequently, to tolerate even the moderate and regular exercise to which it has long become accustomed; and the lameness becomes permanent. As with sprains otherwise located to which we have alluded elsewhere, those of the fetlock occur principally as the result of missteps; sudden slipping, outwardly or inwardly, resting the leg in a strained or contorted position, as on an oblique surface ; and more particularly, as the result of an excessively rapid gait, as in training, racing, hunting or steeple chasing, and the like. Among the most efficient causes are badly constructed roads, especially such as are excessively convex on the crown and sloping at the sides, and on which it is impossible for the animal to preserve the proper vertical position in the bony columns of the leg, or the requisite direct- ness in the pull of the muscles. A sprain may also easily follow the violent struggling of an animal to LAMENESS OF BO&SES. 263 liberate an entangled foot from the obstruction of a broken pavement or frozen rut which has en- trapped it and it is an ooccurrence common enough where there are street rail tracks waiting to crash the feet of beast. They are often received while traveling rapidly on rough and irregular roads, or when carrying, a heavy rider or moving a heavy load, and they sometimes occur though a predispo- sition, arising from some abnormality of action oi conformation, as, for example, in an animal affected with a tendency to knuckling. The various degrees and lesions of sprained fetlock are of course suggestive of a like variety of indications as to modes of treatment applicable to the different classes of lesion which must be encountered. In the matter of treatment the first indication is the prevention of the development of excessive in- flarnation, by the use of cooling applications, repeated and continued, in the form of baths, and bandages kept constantly wet. The agent employed is either simply water or medicated compresses,* or salted water, with the addition of acetate of lead, or sulphate of iron, or perhaps phenic acid. Massage of the joint is often strongly commended. This treatment consists of various manipulations by the hand, applied with repetition from simple friction to severe press- ing and continued for hours, and followed by pro- 2G4 LAM&NMSS OF HOUSES. during more or less passive motion in the affected parts. It is a prudent measure however, to follow it with a supplementary application of supporting bandages snugly adjusted. The parts are sometimes previously wrapped in soft pads of oakum, either dry or moistened with some medicated mixtures. But the application of dry compressive bandages, with splints of firm pasteboard, or gutta percha, or the various preparations of dextrine, as used in human surgery is a better and wiser measure. The padded compressive bandage of Vatel, moistened with Goulard's extract, or poultices of astringent material, will be found very beneficial. Zundel's excellent prescription cannot easily be improved. It consists in an immovable plaster, composed of one ounce of pulverised burnt alum, mixed with the whites of half a dozen eggs, carefully and thoroughly applied j in order to form a mould, as in a case of fracture. This soon consolidates over the parts and insures a solid and symmetrical pressure upon the joint, and by precluding all possible motion contributes one of the most essential conditions of recovery in a most efficient manner, and to any desirable extent. The continuance of the appliance for a week will frequently end in perfect recovery, and if that period should be insufficient, it is but required to extend the time a little, to accomplish the result. This part of the LAMENESS OF HORSES. 265 treatment may be safely left to the direction of the " nurse. " Blisters, or strong liniments, such as the oil of cantharides, may be employed with similar effect though varying in their mode of action. They are indicated in severe cases, after the subsidence of the inflammation, and are not only serviceable through their salutary influence as counter-irritants, but also by performing the functions of bandages or other restraining dressings, by means of the crusts or scabs which they form by mixing with the serosity which exudes from the skin and dries in the form of an ex- temporised moulding envelope, or pseudo splint. The emollient treatment recommended by German veterinarians cannot appeal to any lengthy record of accomplished successes for a favorable verdict, or general adoption. The good results claimed for it are not frequently or tangibly present, and it is quite too apt to lead or assist the formation of the suppurative termination, which we are well aware is a complication altogether too likely to become the precursor of the most unfavorable of results, to be risked by a prudent practitioner. When all milder means have been attended by failure, and the disease has attained the chronic character, more energetic treatment must of course be instituted. In this the alteratives and absorbents m LAMENESS OF SOUSES. must be given a place among topical applications, and among these again the ointment of iodide of mercury is conspicuously advantageous. But above them all, the actual cautery, in lines or points — as we have repeatedly urged in respect to kindered ailments of the horse holds the preeminence, in the certainty of its beneficient effects. Bouley pronounces it to be the remedy par excellence against the chronic articular swellings which follow the sprain^ of joints : a renewal of the application, may however, be some- times necessary. KNUCKLING. This deformity consists in a deviation from their normal direction of the bones of the fetlock joint, caused by their straightening. It can scarcely be considered a genuine disease of that part of the leg, however, since it almost always occurs as the result of disorders affecting other parts of the digital region- Among the diseased processes of a chronic nature of which it becomes the consequence and sequel, may be enumerated ruptures of tendons and ligaments, with swelling and plastic infiltration ; hydrarthrosis of large size ; large windgalls ; and chronic affections of the phalangeal region, such as ringbones ; or it may complicate and supplement severe surgical operations upon the foot — or it may result from old LAMENESS OF HOUSES. £67 diseases or deep punctured wounds of that member. All of these constitute conditions involving the same result and effect, in the long rest to which the tendons and ligaments are subjected, and the gradual retrac- tion of their substances culminates at length in the pronounced immobility of the joint. All these may be fairly characterized as traumatic or symptomatic causes. But there are other causes as well, to which the idiopathic designation may be applied. Among these may be included a predispos- ing tendency or malformation, as when the pasterns are already disposed to assume a too upright direct- ion ; or an improper shoeing, which may facilitate their development by increasing the strain upon the tendons ; or again, it may be induced by some peculiarity in the kind of labor to which the animal is subjected, which causes a special or excessive strain upon the resisting power of the fibrous tissues, beyond their ability to sustain. The deformity is slow in establishing itself, but is not without certain progressive steps or degrees; before reaching its completed growth. The respect- ive duration of these progressive periods, varying with different patients and cases, admits of the arrangement of the process into three degrees or stages of growth. The first of these stages or degrees exhibits all 268 LAMENESS OF HOUSES. the bony levers of the digital region, the cannon bone the os suffraginis and os coronae,in a nearly straight vertical line, or it may be an aggravated condition of the upright pastern. In the second degree the articular levers unite to form a very obtuse angle opening backwards, with the apex turned forward at the centre of the articulation. In the third degree the first phalanx is greatly inclined from before backwards, and with the cannon bone with which it articulates, forms almost a- right angle, opening backwards in such a manner that a line drawn vertically from the apex of the angle, or centre of the joint, would pass down in front of the toe, on which then the foot generally rests. There is in this case an almost total dislocation of the fetlock joint, the natural coaptation of the articular surfaces as it exists under normal circum- stances, existing no longer. From this description of the case, with the attend- ant circumstances, it will be readily seen that the symptomatology of knuckling at the fetlock is very simple. But aside from the deformity already described, there are other accompanying conditions to be noticed. Among these is the peculiarity in the appearance of the tendons, which in some instances can be located only at one given point of their length, LAMENESS OF HOUSES. 269 while in others they may be traced throughout, from the knee or the hock, quite down to the fetlock. This consists in a hard swelling painful on the pressure, even when of long standing, and the more so when the tendons alone are involved than when it has its seat in the suspensory ligament. "While at rest, the leg is spared from its share of the duty of sustaining the weight of the body, but when put to work the hesitancy diminishes and the foot is at once placed on the ground with some degree of confidence and firmness. But there is still a peculiarity visible in the gait, which betrays an irregularity, and a liability to stumble, essentially characteristic of the case, and which is either occasioned by the soreness resulting from the disease which originally caused the knuck- ling or may be merely a mechanical effect of some interference or partial immobility attending the contact of the articular surfaces. The peculiarity is principally in the method of planting the foot, and the limited action of the knuckling joint, dependent upon the degree in which the deviation from the normal symmetry of the bony levers has become established. The animal which is knuckled at the fetlock is in a continual state of fatigue and suffering, and when the disease exists in both legs of the same biped can only with difficulty maintain a standing posture, except 270 LAMENESS OF MORSES. for a limited period. And when lying down, it is only by compulsion that he can be brought to forego the comfort of the recumbent position, and to throw his weight once more upon his crippled legs. The prognosis of this diseased condition of the fet- lock, however it may have originated, is never other- wise than serious, as must be readily inferred from a consideration of the important relation borne by the disordered articulation towards the great general function of locomotion, and the danger of the impair- ment, or even of the total loss, of this essential endowment. Much discrimination consequently is necessary in the exercise of the judgment with which the probable measure of the injury is to be determ- ined. An important point in the examination of a case is the discovery of the originating cause of an attack, since it is generally true that the knuckling which is of an idiopathic type is more amenable to treatment than that which is due to an attack of chronic periostitis, navicular disease, contraction, or other disorders which are themselves of a sufficiently formidable character, and in fact too frequently prove wholly intractable to treatment. Two indications are present in the treatment of knuckled fetlock. The first is to prevent the deviation from their normal direction of the articular levers, when possible, and the second is to rectify the LAMENESS OF HORSES. 271 deformity, if practicable, when it has established itself. The indication is thus simply to choose between the preventive and the remedial. Prevention. — In an animal predisposed to knuckling by peculiarity of conformation, the first point which it is necessary to establish is the relation which may exist between the labor he is required to perform and his ability to perform it. This latter may be wholly lacking, and it may be necessary to discover some other mode of continuing his useful- ness and preserving his value, by a change in the nature of his work. If the cause which tends to produce it cannot be found in the condition of the tendinous structure, it must be sought for elsewhere. In other words, the symptomatic knuckling must be reached by indirect means, and if exostosis or a windgall is the primary lesion, the treatment must take that direction, in order to reach the knuckling. The theory is a very simple one — to remove the cause, helps to cure the disease. If the cause is inherent in the tendinous structure itself, and it has become painful from the pathologi- cal changes which it has undergone, the first indication which presents itself is as much as possible to relieve the tendons from the probably unequal strain which is imposed upon them while 272 LAMENESS OF HOUSES. supporting and displacing the weight of the body. One of the best means for the fulfilment of this requirement is found in a methodical and scientific mode of fitting and adapting the shoe. There are large probabilities, perhaps unth ought of by many, of palliative benefit, in this suggestion. Bouleys recommendation in connection with this compre- hends " shortening the wall as much as possible* " especially at the toe, and to put on the foot a " shoe thicker at the heels, or better provided " with high heeled caulks, The shorter the toe " will be, the higher the heels will be raised ; " the greater the relief of the tendons. " The application of a peculiar shoe is sometimes advan- tageous — one having a very wide and thin web in front, with gradually narrowing branches, and increasing backwards in thickneness, the heels being much thicker than the toe. It is made to project forward, beyond the front of the toe, and this affords a decided relief to the tendons while the animal is travelling. This peculiar shoe, however, is not the only one capable of affording relief in a case of knuckling, nor does it occupy the first place in the estimation of veterinary practitioners in respect to adaptability and value among other designs of the kind. These methods of treating knuckling, with the advantages derived from their adoption are LAMENESS OF HORSES. 273 constantly illustrated by results in the field of practice. Curative Treatment — In essaying the treatment of the swelling which characterizes externally the lesion proper of the suspensory tendons, the first condition to be fulfilled is to relieve them as much as possible, by means of the shoeing just refered to, from the strain, and the pain resulting from it. When this has been accomplished, and the pain has been in a sufficient degree reduced, vesicatory applications, to the extent of the ability of the skin to tolerate them, are indicated, the patient being meanwhile turned loose in a box-stall, and permitted to assume any mode of standing he may prefer. The swelling and tenderness of the tendons may in the beginning be relieved by this treatment. But to secure a satisfac- tory result, the animal must be permitted a long and uninterrupted rest, as the only security against a relapse, while the only exercise that can under any circumstances be allowed, is that of moderate walk- ing — and the wearing of a high heeled shoe must be perseveringly continued. In the second degree of knuckling, or when the swelling of the tendons has greatly increased in dimensions, hardness, and duration, this revulsive treatment will be of no avail, and resort must be had to the cautery, with blistering. The firing must be 274 LAMENESS OF HORSES. performed in lines or in points, and there is a possi- bility of a successful result. But the remark already made must be repeated, that the prognosis is always one of a very serious character, and the disease is never otherwise than exceedingly refractory to treat- ment. The curative treatment of the symptomatic form of knuckling must be indicated by the nature of the diseases in which it originates, and will necessarily vary in correspondence with the primary disorder. When the knuckliog has reached the third degree of its manifestation, as characterized by the partial dislocation of the first phalanx, the resources of veterinary surgery will have been reduced to such mere possibilities of relief as may pertain to the operation of tenotomy, or the division of the tendons in their continuity, in order to permit the straight- ening of the phalanges. The section of the flexor tendons, performed by the subcutaneous process, has proved very useful, especially in cases in which the disease had not yet reached too advanced a stage. It is contra-indicated when the two tendons are united, and there can be no possibility that the stumps of the divided tendons will permit the foot to rest on the ground on its plantar surface. Nor will an operation be of any avail in cases which have LAMENESS OP &6&SM 275 originated in exostosis or other chronic disease of the foot. The space which remains between the divided ends of the tendons after the section soon becomes filled by a thick, yellowish, homogeneous substance, which soon becoming organized, and constituting a tendi- nous callus, furnishes in that form a new means of elongation to the shortened tendon, and restores it again to its normal proportions. A week may suffice for the formation of the callus, but its organization will require twice that period, and only after a con- solidating and perfectiEg process for which months will be necessary, can the animal be considered fit for the resumption of his accustomed labor. Nor should he for a still longer period of time be subjected to an equal amount of labor or fatigue with a robust and uninjured animal, relapses are easy and frequent. In the operation of plantar tenotomy by the subcutaneous method, two bistouries, otherwise designated as tenotomes, specially adopted to the case, are required, one having a narrow blade and a sharp point, the other being blunt at the end, will a curved blade, and sharpened on its concave edge. The safest position for the animal during the per- formance of the operation is undoubtedly the decubital, the leg being placed in forced extension by ropes secured above the knee and below the fetlock, 276 LAMENESS OF HOMES. and pulled in opposite directions . Bearing accurately in mind the disposition and dimensions of the synovial sacs, which are found occupying the upper and lower thirds of the region of the cannon, the point will be indicated where the puncture — with the straight tenotome — can be safely made, which is the middle of the region. The importance of avoid- ing the infliction of accidental injury upon the nerves or blood vessels which run in close proximity with the course of the tendon, is a point which must not be overlooked. But this, according to Gourdon, may be easily avoided by the simple expedient of introducing the instrument upon the same side with the nerves and vessels, instead of towards them. Hence, the indication to operate on the inside for the anterior, and on the outside for the posterior legs. The line of separation of the tendons being made out, (provided they are not found closely united by plastic exudation) the straight tenotome is introduced perpendicularly between them until its point is felt on the opposite side, the puncture of the skin at that point being carefully avoided. The blade of the curved tenotome is then introduced through the opening and the tract thus made, and the straight instrument is withdrawn. Once in place, if it is the division of the perforans which is indicated the sharp edge is turned forward LAMENESS OF SOUSES. 277 against it, and in its tense and rigid condition a slight sawing movement easily effects its separation. On the other hand, if it is the perforatus which is to be divided, the edges of the tenotome must be turned backward, with a similar manipulation, the other details being the same. The same steps are to be observed when a double tenotomy is to be performed. Watchfulness and caution must also be exercised, least at the moment of severing the nervous structures, the pain should excite a struggle so sudden and violent as to cause the instrument to slip backward and divide the skin through and through, giving then rise to a severe complication of the operation. The subsequent care of the patient involves only the simple and ordinary attentions. The wound readily heals, and the complications which are likely to follow, such as hemorrhages, or the division of nerves aTe not of an alarming kind. Those which might result from excessive cutaneous division, or injury of the synovial sacs, however, would be of a much more serious character. A condition of excessive extension of the fetlock is possible, but in many instances becomes amenable to treatment, by proper shoeing and otner appliances. The most serious complication, is a recurrence of the original trouble, by a return of the knuckling, in consequence of the 278 LAMENESS OF WORSES. retraction of the newly formed cicatricial tissue. This is a condition which can, generally, only be remedied by a second resort to tenotomy, with a diminished prospect of satisfactory results in the perspective, unless some undiscovered means should become known by which the sustaining and recuper- ative resources of the patient could he so augmented as to enable him to bear a second debilitating and exhaustive ordeal better than the first. CHAPTER VI. DISEASES OF THE FOOT. A discussion which purports to comprehend the subject of lameness in the horse — practically of course, a matter of inquiry into its causes and remedies — but which fails to include a suitable reference to the kindred subject of the diseases of the foot of the same animal, must be judged as being neither adequate or complete, if not indeed, effect- ually a solecism, since a portion only of the cases of mctor disability which demand attention from the veterinarian are in fact attributable to accidental or traumatic causes. If any plea might avail, and we were disposed to offer one, for so important an exclusion, it would be sought by the present writer in the form of a reference to the translation heretofore made and published by him, from the excellent Dictionary of Zundel, of the diseases of that portion of the motor apparatus — and to which we beg leave, just at this point, to refer the reader. If our work is to prove unsatisfactory and incomplete either in our own view 280 LAM2NESS OF HOttSM. or that of our readers, it shall not be because any part of its rightful contents have been relegated to another book. Accordingly, the present chapter will be appropriated to a survey, sufficiently ample, of the subjects included in the phrase which forms its title. "We have besides, become impressed with the interest attached to that point of the case which suggest its examination from the standpoint of comparative anatomy and pathology, and have been specially drawn to regard the observation of the similarities and correspondences of equine and human disease as in some degree a study of parallell and analogous phenomena. We feel quite sure that a comparative study of diseases of animals in association with similar lesions in the human finger would be of interest and value to veterinarians, and we would therefore call the attention of the reader to the consideration of the subject of PARONYCHIA. as modified by its appearance in animal and man respectively; and herein we confess to have been partly moved and inspired by the suggestions that we received from the writings of Dr. C. Aubrion. The diseases of the foot of the horse have received a large share of attention from veterinary authors, among whose writings may be found many disserta- LAMENESS OF HOUSES 281 tions of great value and interest. They have all found their raison d'etre in the practical physiological importance of the pedal regions, in the varying forms of the lesions met with and the danger of permanent disability to which the diseased animal is always subjected by the pathological changes which might remain in the surrounding structures as well as in the foot itself Each of the various diseases of the foot proper have become the subject of separate and special attention by various authors in turn, and to this circumstance may be attributed the more or less scientific terms by which they are now familiarly known. But might not a change in this respect become an improvement, and would not a better system of definitions and a clearer classification result from a mode of designation which would refer to existing correspondences between the forms of disease as they mutually exist in men and the lower animals- That this would be the case, and that it would make far more simple and intelligible, and therefore more practically useful, the terminology of the class of diseases in question, by thus conforming it to that of the human finger, and considering the whole under the general and comprehensive title which we have proposed, we cannot doubt. To realize more satisfactorily the propriety of this M LAMENESS OP B6%B$S. suggestion we must consider it from the standpoint comparative — pathological — anatomy, and observe well the closeness of the parallel between the related ailments of man and the soliped. Viewed anatomically, but little difference appears in the essential structure of the digital regions of these mammalia. Three short bones similar in structure and in general aspect, are found in each, the only important differences in their osteology consisting principally,^^, in the fact that in solipeds there is found posterior to the articulation of the . second and third phalanges, a small spongio — bony structure, of great physiological value, the small navicular bone ; and second, in addition to the lateral wings of the third phalanx, of an apparatus of an elastic nature, known as the lateral cartilage of the foot, which forms a kind of belt to the region to which they belong, and are a part of another structure, (the plantar cushion) which we find less developed at the same point in man, consisting of the pulp of the finger. The articulations formed by there bones in all species are of the same kind. They are diarthrodial and allow a similar motion, more or less limited, of flexion and extension. Besides the means of union provided for these joints, we also find that the active organs of locomotion which aid their movements are similar in man and the horse, and we also find in both LAMENESS OF HORSES. 283 that ilie place of the extensors of the phalanges is the anterior face of the bone, while the flexors are inserted on the posterior or palmar surface The anatomical arrangement, thus corresponding internal- ly in both man and the soliped, is also similar in the aspect presented by a view of the superficial regions. Surrounding the bones and the joints which they form, and the muscles or tendons by which they move the anatomist also encounters not only the cellular tissue and the tendinous sheathing, but the elastic apparatus, composed of the plantar cushion and lateral cartilages in the horse's foot, represented by the ( cellulo-adipose ) digital pulp of the human finger — the whole being enveloped in a skin having a highly vascular dermis, excessively sensitive in man and possibly still more so in animals, where the podophyllous and the velvety tissue take its place — the principal difference being that while the epidermic secretion of the nail is incomplete in man, it surrounds the entire lower part of the digital region in the soliped, and constitutes the hard, protective horny box which envelopes aDcl contains the whole. It would be remarkable, indeed, if so complete an analogy of anatomical structure could exist without also involving a similarity of tendency to morbid action and its resulting lesions. Yet, although the resemblance may not be instantly obvious between 284 LAMENESS OF HORSES. the felon which tortures the man, and the founder, the corn, the quittor, or the puntured wound of the foot which torments the horse, it will require but little reflection to establish the conviction that if there is any real difference discoverable between these forms of diseased processes, it is exceedingly slight, and of no great practical inportance. paronychia, or whitlow, is an inflammation of the digital structure in man, and is divisible, according to its development and degree of manifestation, into four species, reference being had to the tissues specially involved in each case. And what then is the nature of this inflammation in the soliped ? What is laminitis or founder, but a congestion and inflam- mation of the dermis, with its various changes and stages ? And what is a corn resulting from a bruise and complicated with suppuration, and involving the surrounding region with a greater or less extent of serious lesion ? What is quittor — what is a complicated punctured wound of the foot, with diseased cartilage — and what of necrosis of the plantar cushion ; the slonghing of tendons ; synovitis ; arthritis, and the rest ? A general arrangement of the diseases of the human finger suggests their classification into four varieties and yields, first, paronychia ungualis, or superficial whitlow ; second, p, cellulosa, or phlegmonous ; third, p t LAMENESS OF HORSES. 285 tendinosa ; fourth, p, osseosa. These forms are all found in the horse, and in addition, a fifth, which may be denominated the cartilaginous. We shall now subject the whole to a review from the point of comparative pathology, with what result will be readily apparent. P. Ungualis, the first, is also probably the sim- plest form of the disease. It is characterized by a superficial inflammation of the dermis, with the pos- sible accompaniment of the suppurative process and purulent accumulation. Its seat is usually the root of the nail and it is attended with violent pain, and followed upon recovery by a greater or less degree of deformity of the nail itself. If now it be duly considered that in horses the keratogenous apparatus is not limited to a coronary band or an external matrice, but has added to it the podophyllous and velvety tissues; and if it be remembered that a similar congestion and inflam- mation occur in both human and equine patients, how can we avoid the conclusion which identifies the manifestations which we observe in laminitis, such as the difficulty of locomotion, the lancinating pain, and even the disturbance of the general organism with that which may be observed in the human patient while suffering from the visitation of a con- firmed felon ? 286 LAMENESS OF HOUSES. And why may not that common cause of foot lame- ness known as the corn, be also appropriately assigned to a place with the paronychia ungualis ? Though while looked upon as merely a blow, or a simple bruise, or only a contusion, such a hurt may excite no alarm and awake no interest, it has only to reach the suppurative stage and receive the name of a subungeal whitloiv to become a new witness and furnish another testimony of the existence and the effect of the analogy we are referring to. The only noticeable difference being that which is caused by the special arrangement and design which results in the construction of the complete nail in the soliped. As a second specification, we may refer to the comparative view of the subcutaneous or cellulous paronychia in man, with its characteristic tendency to suppuration of the subcutaneous cellular tissue, with liability to mortification and sloughing of tissues in various degrees. The severe injuries known as caulking; the furuncle of the frog ; the deep penetrating wounds arising from punctures from pricks, and nails, and otherwise, as well as the com- plicated suppurative corn; all will natuarlly fall into the category of affections the characteristic accompaniments of which are so frequently seen in the suppuration, mortification and sloughing of LAMENESS OF HOUSES. 287 portions of the skin, in the keratogenous structure and at the elastic pad of the equine foot. Our third reference is to the tendinous paronychia of man, when the morbid process has involved the tendons, if, in fact, it has not begun as a primary inflammation of the sheets of these organs. The severe wounds produced by caulking, which we encounter on. the front of the foot, just above the coronary band, when both the skin and the tendon of the extensor pedis will sometimes slough away ; and again the deep punctured wound of the middle zone of the plantar surface of the foot of the soliped, injuring the broad aponeurosis of the deep flexor of the phalanges, with the intensity of the suffering attendant upon the diseased process, and the length of time required for their recovery; all these features concur in establishing the strength of the resemblance which proves the mutual relation- ship of the morbid members of this third division- Our fourth comparative review brings us to the consideration of the osseous form of paronychia p. osseosa in which it is characterized by an acute inflam- mation of the periosteum which so often terminates in necrosis of the third phalanx. "We cannot in any case fail to find between this very severe form of lesion and a similar condition in the horse in the various traumatic injuries affecting his feet, and which are 28$ LAMENESS OF EOitSfiS. accompanied with necrosis and caries of the os pedis, a correspondence too obvious to permit it to be over-looked. The fifth item, or the p, cartilaginosa, may be considered as representing our common cartilaginous quittor, but can hardly claim to have a perfect analogue in man. Yet we may still recognize its radical connection with the form of previously con- sidered types, if we do but bear in mind the peculiar- ities of its anatomical site and structure, and of the manifestations to which it gives rise while a diseased condition prevails. The general similarity of pathological character in diseases which are common both to man and to solipeds is traceable more in their general manifest- ations than perhaps in some of the extreme niceties of pathognomonic details. But who amongst observ- ing veterinarians, who have critically studied the varieties of lameness, with its distinctive phases of pain, from the most acute lancinating paroxysms to the most persistent and besieging aches, as expressed by the animal by change of posture and other instinctive movements aiming at relief, besides the general disturbance of the organism throughout including even tremblings, sweatings, groaning and tears who, it may be repeated can fail to recognize similar conditions in human sufferers for cognate ail- LAMENESS OF HORSES. 280 merits, with their loss of sleep and of appetite, and intelligent statement of their own sensations? But we need not pause at this point while in look- ing for the correspondences we are noting. When we consider the matters of diagnosis, of indication, and of treatment, the resort to antiphlogistic appli- ances, and to stimulating embrocations ; the topical use of heat, of poultices and of vesicants ; with the use of the lancet and bistoury for the liberation of purulent and other collections, and of the sharp instrument for the removal of mortified structures ; the application of the tenotome ; the amputation of parts ; the injection of mild caustics into capsular cavities — in a word, when we carry out the parallel in diagnosis, in lesion, and in result, so easily traceable between the two classes of patients, we are compelled to allow the fact of the correspon- dences between the human and the equine races, in the analogous ailments common to both. Assuming this to be as we have tried to prove and illustrated it, the question presents itself whether a change in the nomenclature of some of the diseases common both to horse and his rider, is not desirable, and if the following new system of terminology is not quite worthy of acceptance and adoption by veterinarians. 290 LAMENESS OF HORSES. PARONYCHIA. CLASS I. — P.UNGUALIS. 1. Superficial Caulking. — 2. Laminitis. — 3. Simple Corn. — 4. Suppurative Corn. CLASS II. — P. CELLULOSA. 1. Severe Caulking, with slough of the skin and abscess at the coronary band. — 2. Superficial punc- tured wound of the foot. — 3. Punctured wounds by- nails etc. — 4. Abscess of the frog. CLASS III. — P. TENDINOSA. 1. Severe Caulking, with necrosis of tendons. — 2, Furuncle of the frog, with slough of plantar cushion. ' — 3. Punctured wound of the foot down to the plantar aponeurosis. CLASS IV. — P. CARTILAGINOSA. Cartilaginous Quittor. CLASS V. — P. OSSEOSA. 1, Deep punctured wound of the foot, to the navicular bone. — 2, Pricks by nail to the os pedis. — 3, Severe caulking, with periostitis, ostitis and arthritis, terminating with the sequelae of necrosis, exostosis or anchylosis. APPENDIX. In order to bring our work to a symmetrical ending and at the same time to give due prominence among the causes of lameness in the horse to two important and interesting subjects, we have thought proper to assign a distinct place under a separate head to the consideration of sprains of the loins and embolisms, in connection with the general subject upon which we have been engaged. SPKAINS OF THE LOINS. This term is applied to several diseases, varying in their nature and differing in their forms of lesion, but alike liable to give rise to the general disturb- ance of the functions of locomotion which, under its various subdivisions, we have been considering. Among these are often included sprains, due to muscular injuries; certain nervous affections : attacks of arthritis, and diseases of the spinal cord. Symptoms. — Sprain of the loins, or as it is some- times denominated, lumbago, is accompanied by loss of rigidity in the spinal column, from the withers to 292 LAMENESS OF HORSES. the croup, and forms a condition which is always destructive of the harmony of movement which nor- mally subsists between the anterior and posterior extremities. In consequence of this while in the standing posture, the normal habit is changed, especially in the hind legs, which are held farther apart than is natural ; and the vertebral column is more or less arched, with perhaps a lateral cur- vature. Movement is difficult and painful. The animal lies down with difficulty and groans in the act, and in rising, only succeeds in the endeavor after repeated attempts, still betraying the suffering he experiences as all his movements require repeated efforts for their accomplishment, The abnormal flexibility of the spinal column is demonstrated not only by the fact of its actual excessive flexion ; as shown in various motions of the body and extremities; but it may be detected also as he is standing motion- less, in his regular attitude, by mechanically forcing the hind quarters into lateral oscillation by pushing him sidewise to which he yields without any violent effort to produce them, and apparently without suffering pain. It is however when in motion that the weakness of the vertebral column becomes most conspicuously noticeable. Walking is performed with a sideling, balancing action of the extremities which is in fact a LAMENESS OF HOUSES. 293 stagger, and when the weight falls on the leg down squarely it is subjected to a sort of swing which causes the point of the hock to turn outward and the toe of the foot inward, the hinder feet being but slightly lifted and the flexion of the hock very limited. These irregularities of the hinder parts are yet more marked in the action of trotting, when the control of the legs seems - to be nearly lost, and the patient interferes to such an extent as to expose him con- stantly to the danger of tripping himself, and he does in fact, at times drop suddenly on his hind quarters, though soon with an effort, recovering himself. To be suddenly halted while in rapid motion, as in trotting, causes acute pain and prompts him to a quick and violent flexion of the hocks, and exposes him to the danger of a fall. In advanced cases the backing power is almost wholly gone, and he con- sequently loses his ability to resist the weight of burdens pressing from behind, while descending a declivity. This disability increases with the advance of the disease. In attempting the act of backing, it is accomplished, if at all not with a direct rearward motion, but in an oblique direction, and the deliber- ate and steady action of health and vigor is exchanged for a feeble, violent, sudden and jerky impulse. In turning about, though the fore legs may act freely enough, the hinder continue motionless, serving only 294 LAMENESS OE HORSES. as a pivotal support, and at length acting suddenly and instinctively, from the necessity of avoiding a fall; the whole movement being involuntary and automatic. In turning in a circle, (as in turning on his own axis) especially if it be one of small diameter the vertebral column becomes curved, both vertically and laterally, and the horse moves as if flexed later- ally upon himself, and if during the experiment the speed of the motion is accelerated there will be im- minent danger of a fall, from the inability of the hinder leg which forms the pivot on which the body revolves, ( as in the former case ) to rotate with suf- ficient rapidity to maintain the general equilibrium. A burden placed directly on the back, of course increases the difficulty of walking, and in some instances renders it impossible ; it is, indeed, very easy for a horse with sprained loins to fall under the mere weight of his rider. Sometimes local tumefaction, with pain, accom- panies the sprain. There is then a special sensibility of the region under the mere pressure of the hand though there seems to be no abnormal appearance, owing probably to the chronic character and the deep seated situation of the disease. Pathological Anatomy. — The lesions which a post- mortem examination reveals in animals which have LAMENESS OF HORSES. 295 during life exhibited the symptoms which we have described are as might be expected of an essentially serious character, and affect various portions of the vital apparatus. Bouley speaks of their presence in the vertebral column; in its muscular structure; in the posterior aorta; in the coxo- femoral joint, and in the femoral nerves. But again the symptoms of that disease have also been observed in chronic affections of the spinal cord; in diseases of the kidneys ; and connected with the existence of large neoplasms in the sub-lumbar region. Yet there are cases where no really characteristic lesion can be found, and the disease is certainly of a rheumatic nature ; a true lumbago, in fact, or rheumatism of the loins. Its most common seat is the vertebral column, where it may be found both in the intervertebral articulations and the vertebrae themselves. In the first situation it may be found in various degrees of manifestations. In one case the intervertebrate menisci will become distended, or possibly lacerated in their continuity ; in another the fibro-cartilages of the articular surfaces will have undergone a process of resorption, in a portion of their extent, and possibly to such a degree as to involve the bony structure itself in the disease, under which circum- stances, a form of arthritis may result ; and even anchylosis may supervene as a final termination. 296 LAMENESS OF HORSES. Again, a peripherical periostitis may have appeared as the vertebral articulation had become affected, in the form of an irregular bony deposite — and it is not an uncommon circumstance to meet this variety of anchylosis, involving at once several of the vertebra?. Specimens are numerous in which not only the lumbar, but the dorsal vertebrae are united in a long and solid rod, from which all signs of intervertebral articular ligaments have vanished. Injuries of the muscles may exist, associated with those of the bones, as well as independently. Thickening of the ilio-spinalis, lesions of the psoas from simple degeneration, and purulent collections- are also to be included in this category. The lesions met with in the posterior aorta will be considered in another place, when our attention will be directed to embolisms of that artery and its branches. In respect to lesions of the coxo-femoral articula- tion, Eigot reports a case in which he found "a recent " rupture of two internal ligaments of that joint, " without displacement of the articular surfaces or " laceration or distention of the synovial or of the capsular ligament". Causes. — Sprains of the back will naturally most frequently occur among animals which are compelled to bear heavy burdens, or from any cause undergo LAMENESS OF HORSES. 297 severe strains in that region of the body. Heavy cavalry and draught horses are consequently the most frequent sufferers from this lesion. Under normal circumstances, in consequence of the arched form of the vertebral column, the weight which it is required to sustain becomes evenly distributed among the bones composing it. But this equality of pressure cannot always be assumed. A weight in excess of the strength of the animal will at times overcome the curvature of the spinal arch, and the inter-articular ligaments become stretched, and sometimes lacerated and ruptured. Heavy work, over rough and irregular roads, and the wrenching motion which accompanies the effort to first put an excessive burden in motion are mostly responsible for the existence of the injury. Traveling upon slippery ground, with shoes worn smooth, should also be placed among the causes which may be enumerated. And again, an unusual length of body, with breadth across the loins, may be recognized as probably predisposing causes. It has been cited also as having a connection with the act of casting for surgical treatment, either at the moment of throwing the animal, or as resulting from his struggles while under the surgeon's knife. But though we must usually look for traumatic injuries as mainly implicated, we must by no means ignore the effects of pain inherent in the muscular system, 298 LAMENESS OF HORSES. and the dorso lumbar region particularly, as pertaining to the etiology of lumbago. Nor can exposure to cold, a sudden arrest of perspiration or the influence of the rheumatic diathesis be omitted from the list of possible originating causes. Diagnosis and Prognosis. — The prognosis of the disease will of necessity be modified by the patho- logical lesion which accompanies the morbid process. Thus if it be lumbago, it may offer a more favorable promise than would be afforded by a simple muscular sprain, which will also be of a less serious character, considered in reference to its disabling effect upon tho value of the animal as a laborer, than an anchy- losis, which in the same relation, is less unfavorable than when the lesion is of such a nature as to involve the integrity of the circulating apparatus. The im- portance of great thoroughness, then, in searching for the correct solution of the various phenomena which properly constitute the case is obvious, though it is to be feared that many cases of professed investigation have been performed with but scant scrutiny, and correspondingly unsatisfactory results. The symptoms described are to be recognized as the manifestations of a simple sprain, simple both in its nature and its pathology. But if this is associat- ed with a more serious lesion, such as an extensive injury cf the articulations and of their structures, LAMENESS OF HORSES. 2D9 their significance will become more marked, and a correspondingly closer inspection of all the details should follow. We may thus be led to a better com- prehension of the condition of the vertebral column, which will be found to have become more sensitive to pressure and with the lateral flexion more marked, as shown by the oscillating and staggering motion of the animal, as these become confirmed and aggravated. In sprains confined to the muscular structures alone, the symptoms are less marked, the loins are sensitive and flexible, and there is a greater degree of general rigidity. When the lesions are in the coxo-femoral joint, there is rigidity at the back and excessive oscillation of the hind legs in the act of walking. The appearances due to embolism will be consider- ed as we advance further in our study of the subject. According to Bouley. when the irregularity of the posterior action occurs as the result of lesions of the femoral nerves, serious in degree, though not sufficiently severe to terminate in paralysis, a peculiar manifestation presents itself during the act of walking due to the excessive flexion or humping of the back, and suggestive of the idea of a shortening of the hind quarter, causing the contour of the spine to resemble that of hyena. A case of genuine lumbago will be recognized by 300 LAMENESS OF MORSES. the gradual subsidence of the symptoms, and their: disappearance under judicious treatment. The serious general affections in which the symp- toms under consideration originate, are too evidently associated with their distinguishing signs and the changes, and functional disorders of the implicated regions, as well as the economy at large, to be easily mistaken for the results of a simple sprain. Treatment. — Though it is quite evident, from the considerations which have occupied our attention, that the radical recovery of patients laboring under the diseased conditions which we have been examin- ing is not a matter of very common occurrence, or very easily accomplished by the appliances of human skill, yet there will always be certain indications of treatment within reach of the experienced and accomplished practitioner, which cannot justifiably be omitted, or depreciated, especially in the presence of an indeterminate or doubtful diagnosis. The prime, and in every case indispensable in- dication is rest, as perfect and undisturbed as possible The next, and closely auxiliary, is the abatement of pain. For this purpose, when the season renders them proper and allowable, the cold douche or bath may be resorted to. Irritating frictions and charges, or even repeated blisters are beneficial, as by the rigidity which they impart to the affected region, LAMENESS OF HOUSES. 301 especially if the animal is kept in a condition of quiet by being prevented from lying down, or is secured in slings. The actual cautery in lines is often re- commended in old cases, as a final resort, but must be applied while the animal is on his feet, since the effect of his resistance of the violence necessary to cast him could not be otherwise than injurious, to a dangerous degree, by aggravating his lameness. A resort to electricity in attacks evidently due to a rheumatic diathesis is a plan of treatment which is not without its advocates and endorsers. In cases due to disease of the blood vessels, there seem to be no therapentic resources upon which to draw with any fair prospect of obtaining means of relief. EMBOLISMS. Internal arteritis, or the diseased condition of the membrane which coats the inner surface of the blood vessels, is frequently complicated by the presence of clots of blood in the vascular cavity, which have been formed in the capillaries, (or aneuvrisms when present) or in a vein, or even the heart, and are borne along by the circulating current until they lodge in an artery and obstruct or close its channels. The effect of such a lodgement of these migratory masse3, or embolisms, is a disturbance of function more or less 302 LAMENESS OE HORSES. serious, varying in its features according to the artery in which it has been developed. But the symptoms are in all cases recognized by the mortifications which are observed in the myotility, the sensibility, the circulation, and the calorification of the region supplied by the artery , the serious character of the changes of myotility being proportioned to the degree of obstruction securing in the duplicated vessel. If the arterial cavity has become wholly occluded, the muscular force is so nearly destroyed that the inter- ference becomes practically equivalent to paralysis of the parts. In a case of partial or imperfect obli- teration, there may, during rest, be no appearance of change in the manner in which the muscular function is performed, but the stimulus of exercise is no sooner felt upon the circulation than the effect becomes evident in an access of the lameness, with its special characteristics, which follows. The interference with the action of the muscles is very marked, and the affected leg almost wholly loses its power, and drags on the ground, the impossibility of bearing weight on it continuing until under the influence of rest the circulation becomes quieted, and the comparatively normal functions of the muscular apparatus return. Attending the appearance of these muscular dis- turbances there are evident signs of severe suffering on the part of the patient. His entire countenance LAMENESS OF HORSES. 803 betrays the fact. There is a contraction of the face • dilatation of the nostrils; acceleration of the respi- ration ; abundant perspiration, with unsteadiness of posture and violent movements both while on his feet and when lying down. All the signs of intense pain are present. These appearances manifest themselves suddenly, and become more and more striking as the animal is kept in motion, to subside sooner or later and more or less gradually, perhaps to cease entirely, under the influence of rest and quiet. With the obliteration of the large arteries of a region there is either a retardation or cessation of the arterial circulation beyond the point of oblitera- tion, but the condition is different in front of it where the vessels are evidently in an enlarged form, in consequence of the reversed and reactive pressure of the retarded current, and the pulsation becomes correspondingly fuller and stronger at that point. There is also some change in the temperature of the parts over which the obliterated vessel had been distributed. In a normal and healthy condition the temperature of the whole body is increased under the influence of exercise and an acceleration of the circulation, But the effect A a diseased artery upon the region which it is its province to nourish is to leave it cold and dry, and destitute of perceptible pulsations. 304 LAMENMS8 OF HOMES. Such, concisely, is the general symptomatology of internal arteritis, and we are next to consider the subject in its special features, as it more immediate- ly relates to the subject of this volume and bears upon the question of lameness. EMBOLISM OF THE POSTERIOR AORTA. This disease is a common one among those which afflict horse flesh. Its seat is in the lumbar region, and especially near and on a level with the aortic quadrifurcation. The extent and degree of the obstruction furnishes the measure of the intensity of the symptoms, which vary much in different cases. The first degree is characterised by an irregularity of motion in the hind quarter, caused by rigidity in the extremities. The muscles act with diminished power and strength, and the result is a staggering gait, hesitancy in the action forward, and irregular- ity in the mode of resting. In other words, there is a loss of harmony and synchronism between the ex- tremities in their respective action. The symptoms are the same that we have observed after violent distension ofnthe vertebral column ; in lacerations of the ligaments of the back ; in injuries of the dorso lumbar muscles — in brief, such as we have described in the preceding paragraph as pertaining to sprains of the loins, But the differential diagnosis of the LAMENESS OE HORSES. 305 two cases is easily determined by a reference to the symptoms which characterise that of embolism, to wit. First, the aggravation of the symptoms under the stimulus of exercise, an effect which can be carried far enough to render the animal liable at any moment to fall as if paralized. Second, the diminution of the temperature of the hind legs and the dryness of the skin covering them while every other portion of the body is covered with prespiration. Third, the absence of pulsation, as detected by rectal examination. In a more advanced stage of arteritis of the aorta, or when the obstructing clots have extended into the muscular branches of that vessel, the irregularities of locomotion become still more noticeable, and the symptoms of pseudo-paralysis are sooner induced under the influence of exercise. Another symptom appears in the relative development of the lameness in different legs. As there is not usually the same degree of obstruction on both sides, one leg will be more affected than its oppsite, and the method of halting becomes more significant from that circum- stance, until the induced motion ends in causing complete inertia of the limb. The association of these phenomena with a reduction of the temperature 306 LAMENESS OF llORS&S. and the absence of arterial pulsation in the parts cannot fail to establish and verify the diagnostic identity of the case, as distinguished from any other. The occlusion and its extent are variable in different cases. It may involve the aorta at its posterior ex- tremity, or it may extend to one or several of the branches which form its quadrifur cation, and numer- ous cases of partial or complete obliteration of the internal and external iliacs and their divisions are recorded in veterinary papers. EMBOLISMS OF THE ARTERIES OF THE EXTREMITIES. The arteries of the posterior are more frequently subject to these affections than those of the anterior extremities, and it is not an unusual occurrence to encounter lesions of this kind in the femoral artery and its subdivisions which have extended to the popliteal, and even below it. Many reports of these cases have appeared in the various veterinary journals, of which we have ourselves contributed a number to the pages of the American Veterinary Review, some in which the lesions have extended in the femoral artery and its subdivisions, way down to below the popliteal. We are indebted to Bouley, Jr. for the first mention of the subject, in 1885, and since then many other reports have appeared, all of which present the same history and record the same LAMENESS OF HORSES. 307 manifestations. These may be thus summed : lame- ness, increasing in its degree and intermittent in its character ; aggravated by labor or exercise ; diminish- ing or disappearing with more or less facility with rest and inactivity ; causing during its access, excru- ciating pain, mostly of a lancinating character; inability to bear weight on the affected leg, amount- ing even, when the occlusion is perfect and extensive, to the inability of the animal to continue on his feet, and subjecting him to sudden falls ; absence of arterial pulsation; diminished heat of the affected extremity ; dryness of the skin below the seat of the lesion, and in general, symptoms of severe constitu- tional disturbance. As with the embolism itself, the disease in which it originates, the internal arteritis, is less common in the anterior than in the posterior regions, and a majority of cases have their seat in the hinder limbs. The first recorded case was reported in 1851 by Henry Bouley, who gives its history substantially as follows : The animal was not at first lame in walking, but after a few minutes began to favor the near fore leg, and the continuance of the exercise was accompanied by an increasing lameness, to a point when bearing the weight of the body on the diseased limb became impossible, and the extremity was dragged on the 308 LAMENESS OF HORSES. ground in a semi-flexed position, as if the extensor muscles of the fore arm had become paralyzed. If attempts were made to compel him to move, they were resisted, and he would throw himself on the ground rather than attempt a single step. "When at rest his countenance betrayed signs of the severest suffering, shown by the contraction of the features and the acceleration of the respiration. There were weakness and instability of the extremities, and sometimes, while in violent motion he exhibited signs of suffering such as accompany the presence of violent abdominal pain. The surface of the body was covered with perspiration, with the exception of tbe diseased leg, which was from the fore arm down- ward, dry and cold. These symptoms would con- tinue for a period of from twenty minutes to half an hour, when every thing would return to its normal condition — but only to undergo a repetiton of the disturbance if again subjected to exercise as before. The post-mortem examination revealed a large an- eurism at the origin of the left brachial trunk and its axillary portion, with embolisms in the following arteries — the sus and sub-scapular, the humeral, pre humeral, external and internal collateral of the elbow, and anterior and posterior radial. The prognosis of these affections can seldom if ever be a favorable one. The fact that they totally LAMENESS OF HORSES. 309 unfit the animal for labor of all description sufficiently determines the case and subjects the suffering patient to the final humane and fatal verdict, equally irre- pealable and unimpeachable. The obvious fact is that embolisms are generally incurable : a clot formed in a blood vessel can seldom be removed from the circulation. It is true that with time an anastomatic circulation may be estab- lished, and the collateral channels may by an increased development in the capacity of the vessels facilitate the flow of the blood to the parts which have been deprived of the sustenance which under normal circumstances would be theirs. But in this there is only theory and hypothesis, which can never come into practical realization, except perhaps in vessels of diminutive calibre and insignificant importance, and which do not find a place among the organs or functions whose aberra- tions are to be studied among the accompaniments or causes of lameness. Long rest, the free use of alkaline alteratives, stimulating frictions, hydrotherapy, electricity, and even vesicating applications : all these are recom- mended, but with what wisdom and practical benefit, must be left for future determination. CONTENTS. CHAPTER I. Pages. Descriptive definition. — Synonimy — Importance — Varieties of lameness — Etiology — Symptoma- tology and Diagnosis— Designation of the diseased limb — Determination of the seat of the disease — The nature of the lameness — Treatment 1 — 31 CHAPTER II. GENERAL CONSIDERATIONS RELATING TO THE DISEASES OF THE VARIOUS ORGANS OF LOCOMOTION. DISEASES OF BONES. Periostitis — Ostitis — Osteomyelitis — Exostosis . . . 31 — 44 DISEASES OF JOINTS. Arthritis — Synovitis — Hydrarthrosis — Hygroma Wounds of joints 44 — 69 DISEASES OF MUSCLES. Myositis — Neurosis — Atrophy — Hyperthrophy Degeneration — Solutions of continuity — Para. sites 69 — 75 DISEASES OF TENDONS. Inflammation or tenositis — Degeneration — Solution of continuity 75— 81 112 CONTENTS. Pages. CHAPTER III. SPECIAL DISEASES OF THE EXTEEMITIES. SHOULDER JOINT. ANTERIOR LEG. Lesions of the skin and cellular tissue — Galls— Ulcers Acnea — Cold abscess 82 — 91 Lesions of muscles, ligaments and bones — Sprains. . 92 — 104 ELBOW JOINT. General injuries — Sprains— Arthritis — Capped elbow — Shoe boil 104—117 KNEE JOINT. Carpitis — Broken knees — Hygroma of the knee Capped knee — Hydrarthrosis of the knee — Ten- dinous Synovitis — Tendinous Thoroughpin Speedy cut — Sprung knees 118 — 139 CHAPTER IV. SPECIAL DISEASES OF THE EXTREMITIES (Continued), HIP JOINT. POSTERIOR LEG. Difficulties of diagnosis — Sprain — Morbus Coxarius Lesions of muscles, bones and ligaments — Treat- ment 140—148 STIFLE JOINT. Sprains and lacerations of ligaments — Hydrarthrosis Hygroma — Cramps of the patellar muscle3 Luxation of the patella — Rupture of flexor metatarsi 148—176 CONTENTS. 113 Pages. HOCK JOINT. Division of diseased process — Spavins — Hydrar- throsis — Blood spavin — Articular and tendinous thoroughpin — Hygroma of the hock — Capped hock — Curb — Springhalt 176—212 CHAPTER V. DIGITAL KEGION. Division — Lesion of skin or of the cellular tissue Interfering — In j uries of bones — Splints — Ring- bones and side bones — Diseases of joints proper Hydrarthrosis and hygroma — Windgalls — Cystic Tumors — Injuries of tendons — Sprains of the fetlock — Knuckling — Breaking down of sesamoid ligaments 213—278 CHAPTER VI. DISEASES OF THE FOOT. Reference to our translation of A. Zundel— Paronichia P. Ungualis — P. Cellulosa — P. Tendinosa P. Osseosa — P. Cartilaginosa : . . . . 279—290 APPENDIX, Sprains of the loins — Embolisms — Embolisms of posterior aorta — Embolisms of the arteries of the extremities 291—309 v. |H§i LIBRARY OF CONGRESS 002 863 735 4