Chapter 46

The maxim that "an ounce of prevention is worth a pound of cure" fits the present case very neatly. A horse whose hocks have a somewhat puffy look and whose skin on the front of the hock is loose and flabby, justly subjects himself to a suspicion of addictedness to this bad habit, but a little watching will soon establish the truth. If, then, the verdict is one of conviction, precautions should be immediately adopted against a continuance of the evil. The padding of the sides of the stall with straw mats or mattresses and covering the posts with similar material, in such manner as to expose no hard surface with which to come in contact, will reduce the evil to its minimum. The animal may jar his frame when he kicks, but even then there will be less force in the concussion than if it impinged upon the solid plank, and cuts and abrasions can not be inflicted by a properly made cushion. Hobbles are also rightly recommended with a view to the required restraint of motion, so applied as to secure the leg with which the kicking is performed, or even both hind legs, in such manner as not to interfere with the movement of lying down and rising again and yet preventing that of kicking backward. Boots similar in pattern to those which are used for the prevention of shoe boil are also prescribed. These are placed above the hock and retained by straps tightly fastened. We apprehend, however, that the difficulty of retaining them in the proper place without the danger of chafing from the tightness of the straps may form an objection to their use. Notwithstanding all precautions, hocks will be capped in the future as in the past, and the study of their treatment will always be in order.

The mode of dealing with them will, of course, be greatly influenced by the condition of the parts. When the inflammation is excessive and the swelling large, hot, and painful to the touch, the application of warm water will be very painful. The leg should be well fomented several times a day, for from 15 to 20 minutes each time, a strong decoction of marsh-mallow leaves being added to the water, and after each application swathed with flannel bandages soaked in the same warm mixture. A few days of this treatment will usually effect a resolution of the inflammation; if not complete, at least sufficiently so to disclose the correct outlines of the hygroma and exhibit its peculiar and specific symptoms. The expediency of its removal and the method of accomplishing it are then to be considered, with the question of opening it to give exit to its contents. If the fluid is of a purulent character, the indication is in favor of its immediate discharge. No time should be lost, and it should be by means of a small opening made with a narrow bistoury. If, however, the fluid is a serosity, we prefer to remove it by punctures with a very small trocar. Our reason for special caution in these cases is our fear of the possibility of the existence of diseased conditions of a severe character in the pseudo joint. For the same reason we prefer the treatment of those growths by external applications. In the first stages of the disease a severe and stiff blister, such as the cantharidate of collodium, entirely covering the cyst, perhaps not yet completely formed, when the inflammation has subsided, will be of great benefit by its stimulating effect, the absorption it may excite, and the pressure which, when dry, it will maintain upon the tumor. If, however, the thickening of the growth fails to diminish, it should be treated with some of the iodin preparations in the form of ointments, pure or in combination with potassium, mercury, etc., of various strengths and in various proportions. My opinion of setons is not favorable, but the actual cautery, by deep and fine firing, in points--needle cauterization--I believe to be the best mode of treatment, and especially when applied early.

A very satisfactory way to treat these cases is to burst the swelling by pressure from without. A strap or strong linen bandage is placed about the hock, pressing on the bursa, while the affected leg is on the ground, the other hind foot being lifted up. When the bandage is in place the leg should be released, and the horse will violently flex the bandaged limb and produce pressure on the bursa, with consequent bursting and discharging of its contents.

Whatever treatment may be adopted for capped hock, patience must be one of the ingredients. In these parts absorption is slow, the skin is very thick, and its return to a soft, pliable, natural condition, if effected at all, will take place only after weeks added to other weeks of medical treatment and patient waiting.

INTERFERING, AND SPEEDY CUTS.

These designations belong to certain special injuries of the extremities, produced by similar causes, giving rise to kindred pathological lesions with allied phenomena, requiring about the same treatment and often followed by the same results, to wit, a blemish which may not only subject the animal to a suspicion of unsoundness, but in some special circumstances may interfere with his ability to labor. It is known as "interfering" when the location of the trouble is the inside of the fetlock of either the fore or hind leg. It is called "speedy cut" when it occurs on the inside of the fore leg, a little below the knee, at the point of contact of that joint with the cannon. It is always the result of a blow, self-inflicted, of varying severity, and giving rise to various lesions. (See also p. 399.)

_Symptoms._--At times the injury is too slight to be seriously noticed, the hair being scarcely cut and the skin unmarked. At other times the skin will be cut through, partly or wholly, and it may for the time cause sufficient pain to check the motion of the animal and induce him to suspend his labor through his inability to use the wounded limb, traveling meanwhile for a short space on three legs only. Sometimes a single blow will suffice, or again there will be a repetition of lighter strokes. In the latter case the parts will become much swollen, hot, and so painful to the touch that the motion of the knee or the fetlock will be sufficiently disturbed to cause lameness of a degree of severity corresponding to that of the lesion. Following the subsidence of this diffused and edematous swelling is sometimes the formation of a tumor, either at the knee or the fetlock. This may be soft at first or become so by degrees, with fluctuation, its contents being at first extravasated blood, and later a serosity; or, if there has been a sufficient degree of inflammation, it may become suppurative. The result of the fault of interfering may thus be exhibited, whether at the knee or at the fetlock, as characterized by all the pathological conditions which have appeared as accompaniments of capped knee or capped hock. If, in consequence of the force of the blow or blows, the inflammation has been usually severe, a mortification of the skin may become one of the consequences, a slough taking-place, succeeded by a cutaneous ulcer on the inside of the fetlock or when the greater number of the original wounds are inflicted. If the interfering has been often repeated it may be followed by another condition, which has been considered in our remarks upon other affections. It is a plastic exudation or thickening of the parts, which are commonly said to have become "callous," and the effect of it is to destroy the regularity of the outlines of the joint to an extent which constitutes a serious blemish, which will be permanent, and according to the degree of the aberration from the natural and symmetrical lines will inevitably depreciate the commercial value of the animal.

An animal in interfering may thus exhibit a range of symptoms which from the simplest form of a mere "touching," may successively assume the serious characters of an ugly cicatrix, a hard, plastic swelling, or perhaps, as witnessed at the knee, of periostitis with its sequelæ.

If a single and constantly recurring cause--a blow--is the starting point in interfering, we may now consider the subject of the predisposition which brings such serious results upon the suffering animal, and the conditions which lead to and accompany it. These are numerous, but the first in frequency and importance is peculiarity of conformation in the animals addicted to it. The first class will include horses, whose chests are narrow and whose legs do not stand straight and upright, but are crooked and pigeon-toed in and out. The second class includes those whose legs are weak, either from youth or hard labor, or from severe attacks of sickness. Another class is made up of those having abnormally developed feet, or which have been badly shod with unnecessarily wide or heavy shoes. Another class consists of those that are affected with swollen fetlocks or chronic, edematous swelling of the leg. Another is formed of animals with a peculiar action, as those whose knee action is very high, and it is these that furnish most of the cases of speedy cut.

_Prognosis._--The prognosis of interfering is never a very serious one. However violent the blow may be it is rarely that subsequent complications of a troublesome nature occur. The principal evil attending it is a liability to be followed by a thickened or callous deposit which is not only an eyesore and a blemish, but constitutes a new and increased predisposition. The remark that "an animal which has interfered once is always liable to interfere," is often confirmed and sanctioned by a recurrence of the trouble.

_Treatment._--Another point in which there is a resemblance between this lesion and others which we have considered is in its responsiveness to the same treatment with them. Indeed, the prescription of warm fomentations, soothing applications, and astringent and resolvent mixtures, in a majority of cases, is the first that occurs all through the list. If the swelling assumes the character of a serous collection, pressure, cold water, and bandages will contribute to its removal. If suppuration seems to be established and the swelling assumes the character of a developing abscess, hot poultices of flaxseed or of boiled vegetables and the embrocations of sedative ointments, those of basilicon, or vaseline, impregnated with preparations of opium or belladonna--all these recommend themselves by their general adaptation and the beneficial results which have followed their administration, not less in one case than in another. When an abscess has formed and is fluctuating, it should be carefully but fully opened to evacuate the pus. If it is a serous cyst, some care is necessary in emptying it, and the possibility of the extension of the inflammation to the joint must be taken into consideration. When the cavities have been emptied and have closed by filling up with granulations, or if, not being opened, the contents have been reabsorbed, and there remains in either case a plastic exudation and a tendency to the callous organization that may yet exist, blisters under their various forms, including those of cantharides, of mercury, and of iodin, are then indicated, principally in the early stages, as it is then that their effects will prove most satisfactory. The use of the actual cautery, with fine points, penetrating deeply throughout the enlargement, has in our hands, when used in the very early stages of its formation, nearly always brought on a radical recovery with complete absorption of the thickening.

STRINGHALT.

This is an involuntary movement of one or both hind legs, in which the foot is suddenly and spasmodically lifted from the ground much higher than it is normally carried, with excessive flexion of one bone upon the other. This peculiarity is usually prominent, although it may disappear with work, only to reappear after a short rest. Sometimes it is most apparent at a trot, sometimes at a walk, and other times only when turned around; or it may not be affected by the gait of the horse. It does not seem to be influenced by the horse's age, young and old being alike affected. Its first manifestations are sometimes very slight. It has been noticed as occurring in an animal when backing out of his stable and ceasing immediately after. In some animals it is best seen when the animal is turning around on the affected leg, and it is not noticed when he moves straight forward. That this peculiar action interferes with facility of locomotion and detracts from a horse's claim to soundness can not for a moment be denied.

_Cause._--Veterinarians and pathologists are yet in doubt in respect to the cause of this affection, as well as to its essential nature. Whether it results from disease of the hock, of an ulcerative character; whether it springs from a malformation; whether it is a shortening of the ligaments, a chronic inflammation of the sciatic nerve, or a disease of the spinal cord; whether it is purely a muscular or purely a nervous lesion, or a compound of both--it still continues, if an etiologist is bound to possess universal knowledge within the scope of his special studies, to be his reproach and his puzzle.

_Treatment._--When there is a known or suspected cause the treatment should be directed toward this factor. If due to local inflammation of the hock or foot, only this local lesion should be treated. If it remains after the local lesion has healed, or if we have no assignable cause, the best results have followed the sectioning of the lateral extensor of the foot. A competent veterinarian alone should undertake this operation.

THROMBOSIS.

There are certain forms of lameness which are very peculiar in their manifestation, and which to the nonprofessional mind must appear to belong to the domain of mystery or theory instead of occupying a well-established position among the subjects of equine pathology. Yet they are no less susceptible of actual demonstration and of positive comprehension than many facts which, plain and familiar to the general understanding now, were once ranked among things occult and unsearchable. A thrombus, considered as a cause of lameness, may find a place among these understood mysteries.

_Cause._--Under certain peculiar conditions of inflammation of the blood vessels, and also in aneurisms, clots of blood are sometimes formed in the arteries and find their way in the general circulation. At first, while very small, or sufficiently so to pass from one vessel to another, they move from a small vessel to a larger, and from that to one still larger, constantly increasing in size until at some given point, from their inability to enter smaller vessels, their movement is finally arrested. The artery is thus effectually dammed, and the clot in a short time cuts off completely the supply of blood from the parts beyond. This is thrombosis, and it often gives rise to sudden and excessive lameness of a very painful character.

_Symptoms._--Thrombi may form in any of the arteries, and doubtless have been the cause of many cases of lameness which could never be accounted for. If they exist in small arteries their diagnosis will probably fail to be made out with certainty, but when situated in the larger trunks a strong suspicion of their presence may be excited. In some cases they may even be recognized with positive accuracy, as when the vessels which supply the posterior extremities are affected by the blocking up of the posterior aorta or its ramifications.

The existence of thrombosis of the arteries of the hind leg may always be suspected when the following history is known: The general health of the animal is good, but symptoms of lameness in one of the legs have been developed, becoming more marked as he is worked, and especially when driven at a fast gait. But the disturbance is not permanent, and the lameness disappears almost immediately after a rest. There is an increase of the difficulty, however, and, though the animal may walk normally, he will, when made to trot, very soon begin to slacken his pace and to show signs of the trouble, and if urged to increase his speed will become lamer and lamer; an abundant perspiration will break out; he will refuse to go, and if forced he shows weakness behind, seems ready to fall, and perhaps does fall. While on his feet the leg is kept in constant motion, up and down, and is kept from the ground as if the contact were too painful to bear. If undisturbed this series of symptoms will gradually subside, sometimes very soon, and occasionally after a few hours he will return to an apparently perfect condition. A return to labor will lead to a renewal of the same incidents.

A history like this suggests a strong suspicion of a thrombus in an artery of the hind leg, and this suspicion will be confirmed by the external symptoms exhibited by the animal. The total absence of any other disease which might account for the lameness, and a manifest diminution of heat over a part or the whole of the extremity, when compared with the opposite side or with any other portion of the body; a sensation of cold attendant on the pain, but gradually subsiding as the pain subsides, and the circulation, quickened by the rest, has been reestablished throughout the extremity; all these are confirmatory circumstances. Still, it is thus far only a suspicion, and absolute certainty is yet wanting. To establish the truth of the case the rectal exploration must be resorted to. The hands then, well prepared and carefully introduced into the rectum, must explore for the truth, first feeling for the large blood vessels which, divided at the aorta, separate to supply the right and left legs. These must be compared in respect to the pulsation and other particulars. The artery which is healthy will, of course, exhibit all the proper conditions of that state. On the other hand, if the vessel appears to the feel hard, more or less cordy, and pulseless, or giving a sensation of fluttering, as of a small volume of blood with a trickling motion passing through a confined space, the difference between the sides will make the case plain. The first will be the full flow of the circulation through an unobstructed channel, the other a forced passage of the fluid between the thrombus and the coats of the artery. In such case the prognosis is necessarily a grave one and the disease is more liable to grow Worse than better.

_Treatment._--No form of treatment can be advised; the suffering or a helpless and useless animal can only be terminated by that which ends all.

Cases occur, however, where this condition of the blood vessels exists in a much less degree, and the diseased condition is not sufficiently pronounced for final condemnation. There may even be a possibility of the absorption of the clot, or that an increase of the collateral circulation may be sufficient to supply the parts with blood. In such cases spontaneous recovery may follow moderate exercise in the pasture, field, or stable, or continuous light work may be given, but too much hope should not be placed in such treatment.

SPRAINS OF THE LOINS.

This is an affection which suggests to the mind the idea of muscular injury, and is difficult to distinguish from many similar cases. If the animal shrinks from the slightest pressure or pinching of the spine in the region of the loins, he is by many pronounced to be "lame in the loins," or "sprained in the loins," or "weak in the kidneys." This is a grave error, as in fact this simple and gentle yielding to such a pressure is not a pathological sign, but is normal and significant of health. Yet there are several conditions to which the definition of "sprains of the loins" may apply which are not strictly normal.

_Cause._--The muscles of the back and those of the loins proper, as the psoas, may have been injured, or again there may be trouble of a rheumatic nature, perhaps suggestive of lumbago. Diseases of the bones of the vertebral column, or even those of the organs of circulation, may give rise to an exhibition of similar symptoms.

_Symptoms._--The symptoms are characteristic of a loss of rigidity or firmness of the vertebral column, both when the animal is at rest and in action. In the former condition, or when at rest, there is an arched condition of the back and a constrained posture in standing, with the hind legs separated. In the latter there is a lateral, balancing movement at the loins, principally noticeable while the animal is in the act of trotting--a peculiar motion, sometimes referred to as a "crick in the back," or what the French call a "tour de bateau." If, while in action, the animal is suddenly made to halt, the act is accompanied with much pain, the back suddenly arching or bending laterally, and perhaps the hind legs thrown under the body, as if unable to perform their functions in stopping, and sometimes it is only accomplished at the cost of a sudden and severe fall. This manifestation is also exhibited when the animal is called upon to back, when a repetition of the same symptoms will also occur.

If a slight pressure on the back or the loins is followed by a moderate yielding of the animal, it is, as before remarked, a good sign of health. With a sprain of the loins pressure of any kind is painful, and will cause the animal to bend or to crouch under it more or less, according to the weight of the pressure. Heavy loads, and even heavy harnessing, will develop this tenderness. In lying down he seems to suffer much discomfort, and often accompanies the act with groaning, and when compelled to rise does so only with great difficulty and seldom succeeds without repeated efforts.

Sprains of muscles proper, when recent, will always be accompanied with this series of symptoms, and the fact of their exhibition, with an excessive sensibility of the parts, and possibly with a degree of swelling, will always justify a diagnosis of acute muscular lesion, and especially so if accompanied with a history of violent efforts, powerful muscular strains, falls, heavy loading, etc., connected with the case. If the symptoms have been of slow development and gradual increase, it becomes a more difficult task to determine whether the diagnosis points to pathological changes in the structure of the muscles or of the bones, the nervous centers, or the blood vessels of the region. And yet it is important to decide as to which particular structure is affected in reference to the question of prognosis, as the degree of gravity of the lesion will depend largely upon whether the disabled condition of the animal is due to an acute or a chronic disease.

_Treatment._--The prescription which will necessarily first of all suggest itself for sprains of the loins is rest. An animal so affected should be immediately placed in slings, and none of his efforts to release himself should be allowed to succeed. Hot compresses, cold-water douches, sweating applications, stimulating frictions, strengthening charges, blistering ointments of cantharides and the actual cautery, all have their advocates, but in no case can the immobility obtained by the slings be dispensed with. In many cases in which the weakness of the hind quarters was caused by disease of the nervous centers electricity has also yielded good results.

FOOTNOTES:

[2] This bandage consists of a cloth drenched in warm water or a dripping bandage laid around the diseased part, then covered by several layers of woolen blanket or cloth, which is in turn covered by parchment paper, rubber cloth, or other impervious material. Heat, moisture, and pressure are obtained by such a bandage if water is poured upon it several times daily.

DISEASES OF THE FETLOCK, ANKLE, AND FOOT.

By A. A. HOLCOMBE, D. V. S.,

_Veterinary Inspector, Bureau of Animal Industry._

ANATOMICAL REVIEW OF THE FOOT.