Chapter 32

_Treatment._--Applications of cold water to check the inflammatory processes is indicated for the first few days in aseptic periostitis, followed by hot fomentations to hurry resorption of fluids. Massage should then be given with camphor ointment, mercurial ointment, soap liniment, or Lugol's solution. In the chronic form point firing or a biniodid-of-mercury blister will be found beneficial.

PURULENT PERIOSTITIS follows wounds which reach the periosteum and become infected, as observed in compound fractures, or it may result from advancing purulent conditions in neighboring structures, as in foul foot. It may also occur in the course of an infectious disease, when small abscesses are formed under the periosteum (subperiosteal abscess). It may lead to necrosis of the bone or a fistulous tract from the bone to the surface. There is usually much pain and fever, and the odor from the wound is offensive.

_Treatment._--In this form of periostitis the periosteum should be freely incised, followed either by continuous irrigation or frequent injection of the wound with antiseptic solutions.

FIBROUS PERIOSTITIS.--This form of the disease consists in the thickening of the outer layer of the periosteum from the inflammation reaching it from neighboring structures. This newly formed fibrous tissue may become ossified or may transmit the inflammation to the deeper bony structures. It is frequently seen in cases in which there has been an intense inflammation of the skin close to an underlying bone.

_Treatment._--The treatment should be the same as that recommended for aseptic periostitis.

OSTEOMYELITIS.

This term refers to an inflammation of the bone marrow, which is most commonly seen following the bacterial infection of a compound fracture and usually results in pus formation. The bone is melted away and pus escapes from the bone under the periosteum, involving the soft tissues. It is principally confined to the long bones and seldom affects more than one.

_Treatment._--The bone should be opened for the purpose of curetting out the diseased portion of the marrow cavity and removing all the necrotic pieces of bone. This should be undertaken only by a competent veterinarian. The after-treatment consists in tamponing the wound with pledgets of iodoform gauze or a mixture of iodoform 1 part and glycerin 4 parts. The wound in the soft tissue should be kept open until the cavity in the bone has filled with granulation tissue.

RICKETS.

This disease, also called "rachitis," is an inflammatory affection of young, growing bones, and mostly involves the ribs and long bones of the legs. It consists in a failure of the organism to deposit lime salts in bone, and for this reason the bones do not ossify so rapidly as they should. The cartilaginous ends of the bones grow rapidly, but ossification does not keep pace with it. The bones become long and their ends bend at the joints, the legs become crooked, and the joints are large and irregular. All the bones affected with this disease are thicker than normal, and the gait of the animal is stiff and painful. A row of bony enlargements may be found where the ribs articulate with the cartilages connecting them with the breastbone and is called the "beaded line." A catarrhal condition of the digestive tract is usually observed. The disease may result from an inherited weakness of constitution, poor hygienic surroundings, or improper diet. Calves and foals are less frequently affected with rickets than dogs and pigs.

_Treatment._--The affected animal should have nourishing feed containing a proper quantity of lime salts. Outdoor exercise and plenty of fresh air are indispensable. Limewater should be given once daily for drinking purposes and ground bone meal mixed with the food. Phosphorus, one-fortieth of a grain, and calcium phosphate, 1 dram, given twice daily to a 2-month-old calf, and proportionally increased for older animals, has proved efficacious in this disease. In some cases the long bones of the limbs are too weak at birth to support the weight of the animal, and temporary splints, carefully padded and wrapped on with some soft bandages, become necessary.

OSTEOMALACIA (CREEPS).

This is a condition of bone brittleness or softening of bone found usually in adult life. It consists in the decalcification of mature bone, with the advancing diminution of the compact portion of bone by absorption. The periosteum strips very easily from the bone. This disease is seen in milch cows during the period of heavy lactation or in the later stages of pregnancy, and the greater the yield of milk the more rapid the progress of the disease. Heifers with their first calves are frequently affected, as these animals require a considerable quantity of mineral salts for their own growth and for the nourishment of their offspring.

_Symptoms._--In marked cases there is a gradual emaciation and symptoms of gastrointestinal catarrh, with depraved appetite, the animal eating manure, decayed wood, dirt, leather, etc. Muscular weakness is prominent, together with muscle tremors, which simulate chills, but are not accompanied with any rise of temperature. The animal has a stiff, laborious gait; there is pain and swelling of the joints, and constant shifting of the weight from one leg to another. The restricted movements of the joints are frequently accompanied with a crackling sound, which has caused the name of "creeps" to be applied to the disease. The coat is dull and rough and the skin dry and hidebound. The animal is subject to frequent sprains or fracture of bones without apparent cause, as in lying down or turning around, and when such fractures occur they are difficult to unite. The bones principally involved are the upper bones of the legs, the haunch bone, and the middle bones of the spinal column. The disease in this country is confined to localized areas in the Southwest, known as the "alkali districts," and in the old dairy sections of New York State. The cause of this affection is the insufficiency of lime salts in the food, also to feeding hay of low, damp pastures, kitchen slops, and potatoes, or to overstocking lands. It occurs on old, worn-out soil poor in lime salts, and has also been observed to follow a dry season.

_Treatment._--This should consist in a change of feed and the artificial feeding of lime salts, such as magnesium and sodium phosphate. Feed rich in mineral salts may be given, such as beans, cowpeas, oats, cottonseed meal, or wheat bran. Cottonseed meal is one of the best feeds for this purpose, but it should be fed carefully, as too large quantities of it are injurious to cows. Phosphorus may also be given in one-fourth grain doses twice daily, together with a tablespoonful of powdered bone meal or crude calcium phosphate at each meal. Ordinary lime dissolved in drinking water (limewater) will also be found efficacious in combating this disease, and can be provided at slight expense. A change of pasture to a locality where the disease is unknown and a free supply of common salt and bone meal will be the most convenient method of treating range cattle.

SPRAINS.

The most common accident occurring to bones and joints is a sprain of the ligaments uniting the bones, or the tendons uniting the muscles and bones. A sprain is the result of a sudden forcing of a joint in an unnatural direction, or, if in a natural direction, beyond the power of the ligament or tendon to restrain it properly, so that part of the fibers of either are ruptured. When such an accident occurs pain is immediately inflicted, varying in degree with the extent of the injury, which is soon followed by swelling, with more or less heat and tenderness. If the seat of the injury be in any of the limbs, lameness is likely to result. Of the causes of sprain, slipping on ice or a wet floor, playing, and fighting with another animal are the most common.

SPRAIN OF THE SHOULDER JOINT.--This is liable to occur from any of the causes mentioned above or from the animal slipping suddenly into a rut or hole. When such an accident occurs, sudden lameness will attract attention. The animal will be noticed to drag the leg when walking and to carry it in a circular direction, outward and forward, at each step. The leg should be carefully examined, pressure over the joint causing the animal to evince pain. If the person making the examination is in doubt, it is well to make a comparison between the shoulders by pressing first on one and then the other. After such an accident the animal should be tied up so as to limit so far as possible the use of the injured joint.

Soft feed should be given with a view of keeping the bowels acting freely.

_Treatment._--During the first three days the treatment should consist of cold-water irrigation to check the inflammation and relieve the pain. Hot fomentations may then be applied to hasten the absorption of the inflammatory fluids. When the pain has somewhat abated, equal parts of mercurial ointment and green soap may be rubbed into the swollen tissue. Should lameness continue after the tenth day, good results will be obtained from the application of a blister. This may be done by carefully clipping off the hair over the joint, including a surface of 4 or 5 inches in circumference, and rubbing in the following preparation:

Powdered cantharides dram 1 Biniodid of mercury do 1 Vaseline ounce 1

The animal's head should be carefully tied until the third day, to prevent its licking the blister. The blistered surface should then be smeared with lard or vaseline every other day until the scabs fall off. Gentle exercise should be allowed after the fourth or fifth day from the application of the blister. If the lameness still remains the blister may be repeated in three weeks or a month.

SPRAIN OF THE FETLOCK.--This may occur from misstep when the animal is moving rapidly, and the twisting or wrenching of the foot is sufficient to rupture partially the ligaments which bind the bones together at that part. Such an accident also frequently occurs by the foot getting fastened in a hole in the floor; the wrenching is the result of the animal's attempt to liberate it. Lameness, followed by swelling of the joint and pain when it is handled, or when the animal moves the joint, and heat, are the more noticeable symptoms. If the sprain is very severe, the animal occasionally does not bear its weight on the limb.

_Treatment._--The most important consideration in the treatment of this affection is rest, which is best enforced by keeping the animal in the stall and placing strong, muslin bandages about the inflamed joint. As in the sprain of the shoulder, cold water in the form of douches, continuous irrigation with hose or soaking tub, or finely chopped ice poultices are indicated for the first three days. Following this apply a Priessnitz bandage[2] moderately tight about the joint, which not only conduces to rest, but also favors absorption. Massage with stimulating liniments, such as soap or camphor, may later be applied to the affected parts.

If the lameness has not disappeared by the tenth day, the blister advised for the sprain of the shoulder should be applied and the same precautions observed as to tying the animal's head and subsequent smearing with vaseline. When a blister is applied in this locality, the back part of the heel should be first filled with lard or vaseline, and care taken to prevent any of the blistering preparation from coming in contact with the skin of that part. If this precaution is not observed, scratches may ensue and prove troublesome.

SPRAIN OF THE HIP.--This is liable to result from the animal's slipping in such way as to spread the hind feet wide apart. The patient goes stiff in the hind legs, or lame in one hind leg, walking with a straddling gait and swinging the leg outward as it is carried forward. Tenderness may occasionally be detected on pressure, but owing to the heavy covering of muscles outside the joint this test is not always reliable.

In the acute cases give rest and cold local applications. After the fourth or fifth day the blister mentioned for sprain of the shoulder may be applied with advantage, and if this proves insufficient, as a last resort we may fire in points over the joint.

SPRAIN OF THE BACK.--Sprain of the back, particularly in the region of the loins, is not an uncommon accident among cattle. It is liable to occur from the animals slipping with both hind feet sidewise so as to twist the back, or from slipping violently backward so that great stress is thrown on the loins. The patient moves with difficulty, using the hind parts in a guarded manner, as if afraid of causing severe pain. Occasionally, if the sprain is severe, the animal will rise with difficulty. Pressure on the back in the immediate region of the loins causes pain. Such cases may be mistaken for paralysis, and, in fact, in severe cases, during the early stages of the injury, although the nerve supply is not interfered with, the injury to the muscles and resulting pain is so great that the condition is almost equal to paralysis, although liable to be attended with more favorable results. Hot applications, such as blankets wrung out of hot water and changed often, will be likely to afford relief during the earlier stages. Afterwards the blister mentioned for sprain of the shoulder may be applied with advantage.

FRACTURES (BROKEN BONES).

Bones may be accidentally broken in many ways and from different causes. Fractures in general are liable to be produced by external force suddenly and violently applied, either directly to the part or at a distance, the force being transmitted through the stronger bones until it expends itself by breaking a weaker one remote from the seat of the injury. Occasionally violent contraction of muscles is sufficient to break a bone. Certain bones, those of the limbs in particular, owing to their exposed position, are more liable to fracture than others. Owing to certain predisposing causes, such as age, habit, or hereditary constitutional weakness, the bones of some animals are more easily fractured than those of others. The bones of an animal advanced in years are more subject to fracture because of the preponderance of inorganic matter rendering them more brittle. They are also occasionally rendered liable to fracture by a previously existing diseased condition. Fractures are divided into four classes--partial, simple, compound, and comminuted.

PARTIAL FRACTURES.--Partial fractures are those which are liable to occur in a young animal in which the preponderance of animal matter or the semicartilaginous condition of the bone renders it tough, so that even when considerable force is applied the bone bends, breaking on the side opposite that to which the force was applied, after the manner in which a green stick bends and breaks.

SIMPLE FRACTURES. Simple fracture is one in which the bone is severed in two parts, transversely, longitudinally, or obliquely, without serious injury to the adjoining structures.

COMPOUND FRACTURES.--Compound fracture is one in which there is an open wound permitting the air to communicate with the ends of the broken bones.

COMMINUTED FRACTURES.--Comminuted fracture is one in which the bone is shattered or divided into a number of fragments.

COMPLICATED FRACTURES.--Complicated fracture is one in which other structures surrounding the bones are injured.

GENERAL SYMPTOMS OF FRACTURE.--When a fracture of one or more of the large bones of a limb occurs, symptoms are sure to be well marked. After the accident the animal refuses to touch the foot to the ground and, if compelled to move, does so with great pain and reluctance. There is more or less shortening of the limb, with trembling of the muscles in the vicinity of the injury; deformity, and increased mobility, so that, instead of the natural joints of the limb and the natural, muscular control of their motion, a new joint, over which the animal has no control, is formed where the fracture occurred. As the leg, shortened by the ends of the bones being forced past one another from the muscular contraction which invariably takes place, hangs dependent from the body it swings in an awkward and unnatural manner, permitting the toe and foot to assume positions in their relations to other parts of the body which otherwise would be impossible. If the fractured bone is so situated that the parts may be moved one upon another, a grating sound, known as crepitus, will be heard.

GENERAL TREATMENT OF FRACTURES.--When a fracture occurs, the advisability of attempting treatment must first be determined. If the animal is young, valuable, and of reasonably quiet temperament, and the fracture is not too great in extent, the chances of recovery are fair. On the other hand, if the animal should be of little value, irritable, advanced in years, and the fracture is a serious compound or comminuted one, the wiser course would generally be to put the creature out of its misery.

Having determined to attempt treatment, no time should be lost in restoring the parts as nearly as possible to their natural position and retaining them there. If the ends of the bones have been drawn one past the other, they should be drawn out by firm and continuous tension, until they again assume the position in which they were before the accident. All this can better be done before the swelling (which is sure to result) takes place. If the swelling has occurred before the injury is noticed, do not attempt to treat it, but proceed at once to treat the fracture as though the swelling were not present, for no step can be taken toward recovery until the ends of the bone have been restored to their proper position. When that is done and proper appliances have been used to prevent them from being again misplaced, the swelling, which is the result of irritation, will be relieved. In selecting the appliances to be used in the treatment of fracture the judgment and ingenuity of the operator are of much importance. Splints, made of wood shaped to fit the limb and padded with soft material where they come in contact with bony prominences, and held in position by means of bandages, are the oldest method, and with some are still most popular. The fracture pads used in human surgery, and for sale in surgical depots, are very convenient. After being dipped in water they may be molded to fit the limb and be retained by means of bandages. Heavy sole leather is also used after being soaked in warm water and molded to the shape of the limb and holes cut in it to fit over any sharp irregularities in the natural shape of the bones. Gutta-percha sheets are also used and answer well. They are prepared and used in the same way as the leather.

Another and perhaps the simplest of all methods is the application of a plaster-of-Paris bandage, which is made as follows: Strips of thin cheesecloth 3 inches wide and 8 or 9 feet long are laid flat on a board and on them is spread a layer of plaster of Paris about one-eighth of an inch thick; then, starting at one end, roll carefully so as to gather the plaster in between the layers of the bandage. It is of course important that the cloth be thin and the plaster of Paris fresh and active. After preparing four or five of such bandages the operator is ready to dress the fracture, which, after the parts have been brought into position, should be done by covering all that part of the limb to which the plaster-of-Paris bandage is to be applied with a single layer of the dry bandage, letting it extend both above and below the part to which the plaster bandage is to be applied and including under the folds of the dry bandage at each end a layer of absorbent cotton, which is intended to form a pad to prevent the ends of the plaster bandage from chafing the skin beneath. When this is done one of the plaster bandages should be placed in a vessel of water and allowed to remain till the air bubbles have ceased to rise from it, which will generally indicate that it is soaked through. Then, taking it in the hand, wind it carefully around and around the limb, unrolling the bandage as it is wound around the limb, occasionally smoothing down the plaster of Paris. Should it form roughly or in ridges the hand may be dipped in water to impart increased moisture to it. When about finished with one bandage, place another one in the water, so that the winding operation may be continued without delay. The bandages should be applied till the cast is from one-half to three-quarters of an inch thick, then gently restrain the animal for one-half or three-quarters of an hour till the plaster is hardened. Any of the appliances used should be so manipulated as to prevent absolutely any motion of the detached parts. If the fracture is near a joint, it is generally best to include the joint in the appliance. The part of the limb below the bandage should be carefully and firmly wrapped with an ordinary cotton bandage all the way from the plaster bandage down to the hoof. This last bandage will tend to prevent swelling, which is liable to occur, the result of the dependent position in which the animal is forced by nature to keep the injured limb.

When plaster-of-Paris bandages are applied to a compound fracture the injured part may be previously dressed with a small, thick pad of cotton immediately over the wound. In applying the bandage the operator may with a little care so arrange it as to keep the folds of the bandages off the cotton, or have only a thin layer over it, which may be easily cut out and the cotton removed, leaving a convenient opening through which to dress the wound without removing the bandage. The ends of the bandage or other appliance should be carefully watched to see that the skin does not become chafed, particularly at the lower end. If the bandage should become weak or broken at any part, it may be strengthened without removal by applying other bandages immediately over it. If swelling has taken place before the bandage has been applied, there is liable to be some loosening as it disappears, and even without the swelling there may be a tendency of the bandage to slide downward. This may be overcome by fastening it to a suspender attached to a surcingle or passed over the body and attached to the opposite leg. If the looseness can not be overcome in this way, the space may be filled by pouring in a thin paste of plaster of Paris. A better method, however, is to remove the bandage and apply another. Owing to the hardness of the bandage it will be removed with some difficulty. A deep groove should be cut down completely through it on the opposite sides. This may be done with a chisel and a small hammer if the bandage is carefully held by an assistant so that the concussion of the blows is not transmitted to the injured bones. The patient should have a roomy stall, and should be tied by the head to prevent any attempts to move around. In some cases slings have been used. Ordinarily, however, they are not satisfactory in cattle practice, and if applied should be for only a few days at a time, and with a view to lessen the animal's disposition to lie down, rather than to prevent it. When they are used continuously the pressure on the abdomen may interfere with digestion and the general health of the animal.