Chapter 15

This name is employed to designate an infectious inflammation of the lateral cartilage and adjoining structures. The disease is characterized by a slowly progressive necrosis and by a destruction of more or less of the cartilage and by the presence of fistulous tracts.

Etiology and Occurrence.--The disease is due to the introduction of pus producing organisms into the subcoronary region of the foot under conditions which favor the retention of such contagium and extension of infection into contiguous tissues.

Morbific material is introduced into the region of the lateral cartilage by means of calk wounds and other penetrant injuries of the foot. A sub-coronary abscess which, because of lack of proper care or because of virulency of the contagium or low vitality of the subject, is quite apt to result in cartilaginous affection and its perforation by necrosis follows.

Symptomatology.--Quittor is readily diagnosed on sight in many instances. Where there is dependable history or other evidence of the chronicity of an infectious inflammation of the kind, quittor is easily identified. If no positive evidence of the disease exists, by means of careful exploration of sinuses with the probe, one may distinguish between true cartilaginous quittor and superficial abscess formation that is often accompanied by hyperplasia.

Lameness depends upon the extent of the involvement as it affects the structures contiguous to the cartilage. A variable degree of lameness is manifested in different cases.

Treatment.--Two general plans of handling this disease are in vogue. One, the more popular method, consists in the injection of caustic solutions of various kinds into the fistulous openings with the object of causing sloughing of necrotic tissue and the stimulation of healthy granulation of such wounds. The other mode consists in either complete surgical removal of the cartilage or its remaining portions, or removal of the diseased parts of curettage.

When quittor has not extensively damaged the foot and the lateral cartilage is not partly ossified as it is in some old chronic cases, the complete removal of the lateral cartilage by means of the Bayer operation or a modification thereof is indicated. A complete description of the Bayer operation as well as Merillat's operation for this disease (the latter consisting in part, in the removal of diseased cartilage with the curette) are given in Volume three of Merillat's "Veterinary Surgical Operations."

Treatment by injection of caustic solutions has many advocates and because of the fact that, in many instances the condition is such that they are not desirable surgical cases and also because some animals may be put in service before treatment is completed, the injection method is popular.

The mode of treatment advocated by Joseph Hughes, M.R.C.V.S., constitutes a very successful manner of handling quittor and we can do no better than quote Dr. J.T. Seeley[33] on his manner of using this particular treatment.

Preparation.--First remove the shoe, have the foot pared very thin and balanced as nicely as possible. Moreover, all loose fragments of horn must be detached and all crevices cleaned thoroughly.

Next, have the leg brushed and hair clipped from the knee or hock to the foot and scrubbed with ethereal soap and warm water, after which the foot must be scrubbed in like manner. The foot is then placed in a bichlorid bath several hours daily, for from two to five days, depending upon whether or not soreness is shown. The bichlorid solution is 1 to 1,000 strength.

On removing the horse from the bath a liberal layer of gauze is soaked in 1 to 1,000 bichlorid solution and placed so as to cover the entire foot. On discontinuing the bath, cover the foot with gauze saturated with a 1 to 1,000 bichlorid solution. This is to be covered with absorbent cotton and a gauze bandage, and over all is placed an oil cloth or silk covering. This pack is kept moist with bichloride solution for forty-eight hours. The foot is then ready for injection.

Preparation of the Injection Fluids.--Have on hand a pint of a one per cent aqueous solution of formaldehyd made under cleanly conditions, even to a clean bottle and cork, and a clean container when ready to use the liquid. Prepare also a bichlorid of mercury solution as follows: Hydrarg. Chlor. Corros. 3IV; Acid Hydrochlor. 3Iss.; Aqua Bulliens, Oij. This should be thoroughly triturated, and then filtered into a clean bottle, when it is ready for use.

Injection.--The patient should be laid on a table, if one is available, or cast, and the foot securely fixed. Then, with an ordinary one-ounce hard rubber syringe, with a good plunger (tried first to note whether or not any fluid works around between the barrel and the plunger), introduce one syringe full of the formaldehyd solution, then thoroughly probe the quittor to determine the number of sinuses. This done, inject each sinus. If two sinuses open on the surface, close one with cotton while filling the other so that if there is a connection the solution will come in contact with all tissues involved. Irrigate with the full pint of formaldehyd solution first, then follow with six or eight ounces of the bichlorid solution. Never probe the foot nor allow it to be tampered with except in the manner prescribed.

After-Treatment.--Put on a pack saturated with a solution of bichlorid of mercury 1 to 1,000 and let it remain two days. Remove pack, and once daily afterwards wipe off with cotton the secretion which accumulates on the outside, and apply a dry dressing or healing oil composed of phenol, camphor gum and olive oil.

When Dangerous to Inject.--Never inject a quittor in the acute stage. Never inject a quittor if considerable lameness is present. On injecting a solution of formalin, hold cotton tightly around the nozzle of the syringe, when the plunger is down, then withdraw the syringe gently and note particularly if the fluid returns through the opening; if none returns cease operations at once, as it is dangerous to proceed farther, it indicates that the sinus is not well defined and the fluid retained will cause much trouble and often the death of the patient.

Experience has taught that, if extensive destructive changes of the foot exist, the Bayer operation is not indicated. In the country, where quittors are not so frequently met as in urban practice, the Merillat operation is preferable in all cases. However, the cost of the protracted period of idleness, which convalescent surgical patients require, renders the Hughes method more satisfactory in the hands of the general practitioner, especially in the city.

Nail Punctures.

Nail punctures, as herein considered, embrace all penetrant wounds of the solar surface of the horse's foot due to trampling upon street nails. This does not include accidental nail pricks occasioned in shoeing. In city practice, in some stables, these cases are of frequent occurrence; and, generally speaking, nail punctures are observed more frequently in urban horses than in animals that are kept in the country.

Occurrence and Method of Examination.--This condition, then, is a rather common cause of lameness and in no case, where cause of the claudication is not obvious, is the practitioner warranted in concluding his examination without careful search for the possible existence of nail puncture of the solar surface of the foot.

In occasional instances there co-exists an obvious cause for supporting-leg-lameness and an occult cause--a nail puncture. Where such complications are met, the practitioner is not necessarily guilty of neglect or carelessness when the nail puncture is not discovered at once, nevertheless, an examination is not complete until practically every possible cause of lameness has been located or excluded in any given case.

In a search for nail puncture it is necessary to expose to view every portion of the sole and frog in such manner that the existence of the smallest possible wound will be revealed. This necessitates removal of the shoe, if, after a preliminary examination, a puncture is not found, when there is good reason to suspect its presence. However, where it is readily possible to locate and care for a wound without removal of the shoe, allowing the shoe to remain materially facilitates retaining dressings in position and relieves the solar surface of contact with the ground. If extensive injury or infection exists, it is of course necessary to remove the shoe and leave it off. By removing a superficial portion of all of the sole and frog, thus carefully and completely exposing to view all parts of the solar surface of the foot, and with the aid of hoof-testers one is enabled to positively determine the existence of nail punctures. Because of the tendency of puncture wounds of the foot to close, and since the superficial portion of the solar structures are usually soiled, it is absolutely necessary to conduct examinations of this kind in a thorough manner.

Symtomatology.--Not all cases of nail puncture cause lameness during the course of the disturbance and in many instances no lameness is manifested for some time after the injury has been inflicted--not until infection has been the means of causing considerable inflammation of sensitive structures. Nevertheless, this lack of manifestation occurs only in cases where serious injury has not taken place and the degree of lameness is a constant and reliable indicator of the character and extent of nail punctures within twenty-four hours after injury has been inflicted.

The position assumed by the affected animal inconstantly varies with the location and nature of the injury and is not of particular importance in establishing a diagnosis. The subject may support some weight with the affected member and stand "base-wide" or "base-narrow," or no weight may be borne with the foot or the animal may point or keep the extremity in a state of volar flexion. In cases where extensive injury has been inflicted, and great pain exists, the foot is kept off the ground much of the time and it may be swung back and forth as in all painful affections of the extremity.

Nail punctures cause typical supporting-leg-lameness and in some cases certain peculiarities of locomotory impediment are worthy of notice. Punctures of the region of the heel, which directly affect or involve the deep tendon sheath, cause a type of lameness wherein pain is augmented, when dorsal flexion of the extremity occurs as well as when weight is borne. Wounds in the region of the toe of the hind feet sometimes cause the subject to carry the extremity considerably in advance of the point where it is planted and, just before placing the foot on the ground, it is carried backward a little way--ten or twelve inches.

However, diagnosis of nail puncture is based on the finding of the characteristic wound or resultant local changes.

Course and Prognosis.--The nature of the progress and the manner of termination of these cases are variable. If the coffin joint has been invaded, and a septic arthritis exists, the condition is at once grave. An open and infected tendon sheath, while not so serious, constitutes a condition which is distressing, and recovery is slow even under the most favorable conditions. Where a heavy, rigid and sharp nail enters the foot, in such manner that fracture of the third phalanx (os pedis) occurs, this complication makes for a protraction of the condition. Experience teaches that the natural course and termination in these cases are modified by the location and depth of the injury, virulency of the contagium and resistance of the subject to such infection.

Prevention.--In all horses which are kept at such work that exposure to nail punctures is frequent, a practical means of prevention of such injuries consists in the employment of heavy sole leather or suitable sheet metal to cover the sole of the foot and, at the same time, confine oakum and tar in contact with the solar surface to prevent the introduction of foreign material between the foot and such protecting appliances. Further, if drivers and owners could be impressed with the serious complications which so frequently attend wounds of this kind, undoubtedly many cases which are now lost, because of ignorance or neglect on the part of the teamsters or proprietors of horses, would be saved by prompt and rational treatment.

Treatment.--The treatment of this condition falls so largely within the dominion of surgery that we can give little more than an outline here.

In cases where there exists no evidence of open joint or open tendon sheath as judged by the site of the puncture and degree of lameness present (after having thoroughly cleansed the solar surface of the foot and enlarged the opening in the nonsensitive sole) a little phenol is introduced into the wound. In such cases, where it is possible for the antiseptic to contact every part of wound surface to the extreme depths of the puncture, infection is prevented when such treatment is promptly administered. This may be considered as first aid, or emergency care, and is indicated in all wounds of the foot whether the injury be serious or almost insignificant.

Subsequently one of two general courses may be pursued in the treatment of cases of nail puncture. One, by the employment of means to keep the wound patent and injection of suitable antiseptics, or agents that are more or less caustic in conjunction with strict observance of asepsis and wound protection. The other method consists in prompt establishment of drainage by surgical means and includes exploration and curettage.

The first method is better adapted to the use of the average general practitioner and he would do well to keep the opening in the nonsensitive structures patent. By introducing equal parts of tincture of iodin and glycerin daily, good results will follow in most instances. The wound is protected in unshod horses, either by completely bandaging the foot and retaining, in contact with the wound, cotton that is saturated with iodin and glycerin, or, if a minor injury exists, the moderately enlarged opening in the nonsensitive sole or frog, which has been moistened with the antiseptic, is packed with a very small quantity of cotton. A little practice in this mode of closing benign puncture wounds will enable the practitioner to successfully protect the sensitive parts in the treatment of such cases in unshod country horses.

When the condition progresses favorably the wound may be dressed every second day or twice weekly, and in the course of from two to six weeks recovery should be complete.

If the practitioner is somewhat proficient as a surgeon, and has at his command facilities for doing surgery, the second method is preferable in many cases. By using a local anesthetic on the plantar nerves and confining the subject on an operating table, restraint should be perfect. The solar surface of the foot is first thoroughly cleansed, the puncture wound is enlarged in the nonsensitive structures and the parts are then moistened with phenol or other suitable antiseptics. By means of a small probe the puncture is explored and, depending on the character of the wound and the structures involved, surgical intervention is varied to suit the case. If necessary, all of the insensitive frog is removed, and in wounds affecting the region of the heel the tissues may be incised from the puncture outward dividing all of the tissues outward and backward to the surface. A suitable surgical dressing is then applied.

If, on the other hand, the puncture extends into the navicular bursa, the radical operation is perhaps indicated, though not until one is sure that infection of the bursa and serious consequences are to follow if this operation is not performed. Detailed description of the technic of this operation belongs to the realm of surgery and a good discussion of it is to be found in William's work on veterinary surgical and obstetrical operations.

One may summarize the discussion of treatment of nail puncture by saying that emergency care as herein described is of first consideration. In every case an immunizing dose of anti-tetanic serum should be given. Subsequently, the method employed must suit the character of the wound, existing facilities for handling the subject and the skill and aptitude of the practitioner.

FOOTNOTES:

[Footnote 5: Manual of Veterinary Physiology, by Major-General F. Smith, page 590.]

[Footnote 6: Manual of Veterinary Physiology by Major-General F. Smith, page 589.]

[Footnote 7: Regional Veterinary Surgery and Operative Technique, Jno. A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 765.]

[Footnote 8: Dr. Roscoe R. Bell in the Proceedings, N.Y. State Veterinary Medical Society, 1899.]

[Footnote 9: American Veterinary Review, Vol. 35, P. 456.]

[Footnote 10: "Radial Paralysis and Its Treatment by Mechanical Fixation of Knee and Ankle," Geo. H. Berns, D.V.S. Proceedings of the American Veterinary Medical Association, 1912, p. 219.]

[Footnote 11: As quoted by Berns, in Radial Paralysis, etc., Proceedings of the A.V.M.A., 1912.]

[Footnote 12: Veterinary Surgical Operations, by L.A. Merillat, V.S., p. 507.]

[Footnote 13: A paper presented before the Illinois Veterinary Medical Assn. by Dr. H. Thompson of Paxton, Ill., American Veterinary Review, Vol. 15, p. 134.]

[Footnote 14: "Fractures in Foals," by Dr. Wilfred Walters, M.R.C.V.S., American Journal of Veterinary Medicine, Vol. 8, p. 669.]

[Footnote 15: American Veterinary Review, Vol. 26, p. 1068.]

[Footnote 16: Fractures, by H. Thompson, Paxton, Ill., American Veterinary Review, Vol. 15, p. 134.]

[Footnote 17: Veterinary Surgical Operations, by L.A. Merillat, Vol. 3, p. 198.]

[Footnote 18: Wilfred Walters, American Journal of Veterinary Medicine, Vol. 8, p. 606.]

[Footnote 19: J.N. Frost, assistant professor of Surgery, Veterinary Dept., Cornell University, in "Wound Treatment," page 159.]

[Footnote 20: Open Joints and Their Treatment in my practice, by J.V. Lacroix, American Journal of Veterinary Medicine, Vol. 5, page 203.]

[Footnote 21: Regional Veterinary Surgery Möller--Dollar, page 605.]

[Footnote 22: Extract from Receuil de Médecine Vétérinaire in Ameircan Veterinary Review, Vol. 23, p. 893.]

[Footnote 23: Fracture of All the Sesamoid Bones, by R.F. Frost, M.R.C.V.S., A.V.D., Rangoon, Burmah, in American Veterinary Review, Vol. 5, p. 362.]

[Footnote 24: The Anatomy of the Domestic Animal, by Septimus Sisson, S.B., V.S.]

[Footnote 25: Traité De Thérapeutique Chirurgicale Des Animaux Domestique, par P.J. Cadiot et J. Almy, Tome Second, page 547.]

[Footnote 26: Anatomie Regionale Des Animaux Domestique, page 695.]

[Footnote 27: Manual of Veterinary Physiology, by Major-General F. Smith, C.B., C.M.G., page 678.]

[Footnote 28: Möller's Regional Veterinary Surgery, by Dollar, page 630.]

[Footnote 29: Edinburgh Veterinary Review, Vol. VI, page 616.]

[Footnote 30: Equine Laminitis or Pododermatitis, by R.C. Moore, D.V.S., American Journal of Veterinary Medicine, Vol. XI, page 284.]

[Footnote 31: American Journal of Veterinary Medicine, Vol. XI, page 318.]

[Footnote 32: The Shoeing of a Dropped Sole Foot by Dr. David W. Cochran, New York City, The Horse Shoers Journal, March, 1915.]

[Footnote 33: Quittor and Its Treatment by the Hughes Method, J.T. Seeley, M.D.C., Seattle, Washington, Chicago Veterinary College Quarterly Bulletin, Vol. 9, page 27.]

SECTION IV.

LAMENESS IN THE HIND LEG.

Anatomo-Physiological Consideration of the Pelvic Limbs.

The pelvic bones as a whole constitute the analogue of the scapulae with respect to their function as a part of the mechanism of locomotive and supportive apparatus of the horse. The manner of attachment or connection between the ilia and the trunk is materially different from that of the scapulae, however, and the angles as formed by the long axes of the ilia in relation to the spinal column are maintained by two functionally antagonistic structures--the sacrosciatic ligaments, and the abdominal muscles by means of the prepubian tendon. The sacro-iliac articulations are such that a very limited amount of movement is possible; free movement, however, is unnecessary because of the enarthrodial (ball and socket) femeropelvic joint.

The various muscles which exert their effect upon the pelvis in changing their relationship between the long axes of the ilia and spinal column, are concerned but little more in propulsion and weight bearing than are the pectoral muscles. A general treatise on the subject of lameness does not properly include such structures any more than it does the various affections of the dorsal, lumbar and sacral vertebrae or inflammation of the abdominal parietes. Involvement of such parts cause manifestations of lameness but the matter of establishing a diagnosis is difficult in many instances and in some cases impossible.

The femeropelvic articulation is formed by the hemispherical head of the femur and the acetabulum; the latter constituting a cotyloid cavity which is deepened by the cotyloid ligament.

The round ligament (ligamentum teres) is the principal binding structure of the hip joint and it arises in a notch in the head of the femur and is attached in the subpubic groove close to the acetabular notch. Another ligament, peculiar to Equidae--the accessory (pubiofemoral)--is attached to the head of the femur near the round ligament and passes through the cotyloid notch and along the under side of the pubis. It is inserted or blends with the prepubic tendon. This ligament prevents extreme abduction of the leg. The joint capsule encompasses the articulation and is attached to the brim of the acetabulum and the edge of the head of the femur.

The stifle joint is analagous to the knee joint of man and is to be considered an atypical ginglymus (hinge) articulation formed by the femur, tibia and patella. The ligaments are femerotibial, femeropatellar and capsular.