Chapter 48

_Symptoms._--The most common injury to the suspensory ligament is sprain of the internal branch in one of the fore legs. The trouble is indicated by lameness, heat, swelling, and tenderness of the affected branch, beginning just above the sesamoid bone and extending obliquely downward and forward to the front of the ankle. If the whole ligament is involved, the swelling comes on gradually, and is found above the fetlock and in front of the flexor tendons. The patient stands or walks upon the toe as much as possible, keeping the fetlock joint flexed so as to relieve the ligament of tension.

When both branches are torn from their attachments to the sesamoids, or both are torn across, the lameness comes on suddenly and is most intense; the fetlock descends, the toe turns up, and, as the animal attempts to walk, the leg has the appearance of being broken off at the fetlock. These symptoms, followed by heat, pain, and swelling of the parts at the point of injury, will enable anyone to make a diagnosis.

_Treatment._--Sprain of the suspensory ligament, no matter how mild it may be, should always be treated by enforced rest of at least a month, and the application of cold douches and cold-water bandages, firmly applied until the fever has subsided, when a cantharides blister should be put on and repeated in two or three weeks if necessary. When rupture has taken place the patient should be put into slings and a constant stream of cold water allowed to trickle over the seat of injury until the fever is reduced. In the course of a week or ten days a plaster of Paris splint, such as is used in fractures, is to be applied and left on for a month or six weeks. When this is taken off, blisters may be used to remove the remaining soreness; but it is useless to expect a removal of all the thickening, for, in the process of repair, new tissue has been formed which will always remain.

In old cases of sprain the firing iron may often be used with good results. As a rule, severe injuries to the suspensory ligament incapacitate the subject for anything but slow, light work.

OVERREACH.

When the shoe of the hind foot strikes and injures the heel or quarter of the forefoot the horse is said to overreach. It rarely happens except when the animal is going fast; hence is most common in trotting and running horses. In trotters the accident generally happens when the animal breaks from a trot to a run. The outside heels and quarters are most liable to the injury.

_Symptoms._--The coronet at the heel or quarter is bruised or cut, the injury in some instances involving the horn as well. When the hind foot strikes well back on the heel of the fore foot--an accident known among horsemen as "grabbing"--the shoe may be torn from the forefoot or the animal may fall to its knees. Horses accustomed to overreaching are often "bad breakers," for the reason that the pain of the injury so excites them that they can not readily be brought back to the trotting gait.

_Treatment._--If the injury is but a slight bruise, cold-water bandages applied for a few days will remove all the soreness. If the parts are deeply cut, more or less suppuration will follow, and, as a rule, it is well to poultice the parts for a day or two, after which cold baths may be used, or the wounds dressed with tincture of aloes, oakum, and a roller bandage.

When an animal is known to be subject to overreaching, he should never be driven fast without quarter boots, which are specially made for the protection of the heels and quarters.

If there is a disposition to "grab" the forward shoes, the trouble may be remedied by having the heels of these shoes made as short as possible, while the toe of the hind foot should project well over the shoe. When circumstances permit of their use, the fore feet may be shod with the "tips" instead of the common shoe, as described in treatment for contracted heels.

CALK WOUNDS.

Horses wearing shoes with sharp calks are liable to wounds of the coronary region, either from trampling on themselves or on each other. These injuries are most common in heavy draft horses, especially on rough roads and slippery streets. The fore feet are more liable than the hind ones, and the seat of injury is commonly on the quarters. In the hind feet the wound often results from the animal resting with the heel of one foot set directly over the front of the other. In these cases the injury is generally close to the horn, and often involves the coronary band, the sensitive laminæ, the extensor tendon, and even the coffin bone.

_Treatment._--Preventive measures include the use of boots to protect the coronet of the hind foot and of a blunt calk on the outside heel of the fore shoe, since this is generally the offending instrument when the fore feet are injured. If the wound is not deep and the soreness slight, cold-water bandages and a light protective dressing, such as carbolized cosmoline, will be all that is needed. When the injury is deep, followed by inflammation and suppuration of the coronary band, lateral cartilages, sensitive laminæ, etc., active measures must be resorted to. Cold, astringent baths, made by adding 2 ounces of sulphate of iron to 1 gallon of water, should be used, followed by poultices, if it is necessary to hasten the cleansing of the wound by stimulating the sloughing process. If the wound is deep between the horn and the skin, especially over the anterior tendon, the horn should be cut away so that the injured tissues may be exposed. The subsequent treatment in these cases should follow the directions given in the article on toe cracks.

FROSTBITES.

Excepting the ears, the feet and legs are about the only parts of the horse liable to become frostbitten. The cases most commonly seen are found in cities, especially among car horses, where salt is used for the purpose of melting the snow on curves and switches. This mixture of snow and salt is splashed over the feet and legs, rapidly lowering the temperature of the parts to the freezing point. In mountainous districts, where the snowfall is heavy and the cold often intense, frostbites are not uncommon, even among animals running at large.

_Symptoms._--When the frosting is slight the skin becomes pale and bloodless, followed soon after by intense redness, heat, pain, and swelling. In these cases the hair may fall out and the epidermis peel off, but the inflammation soon subsides, the swelling disappears, and only an increased sensitiveness to cold remains.

In more severe cases irregular patches of skin are destroyed and after a few days slough away, leaving slow-healing ulcers behind. If produced by low temperatures and deep snow, the coronary band is the part most often affected.

In many instances there is no destruction of the skin, but simply a temporary suspension of the horn-producing function of the coronary band. The fore feet are more often affected than the hind ones, and the heels and quarters are less often involved than the front part of the foot. The coronary band becomes hot, swollen, and painful, and after two or three days the horn separates from the band and slight suppuration follows. For a few days the animal is lame, but as the suppuration disappears the lameness subsides. New horn, often of an inferior quality, is produced by the coronary band, and in time the cleft is grown off and complete recovery is effected. The frog is occasionally frostbitten and may slough off, exposing the soft tissues beneath and causing severe lameness for a time.

_Treatment._--Simple frostbites are best treated by cold fomentations followed by applications of a 5 per cent solution of carbolized oil. When portions of the skin are destroyed, their early separation should be hastened by warm fomentations and poultices. Ulcers are to be treated by the application of stimulating dressings, such as carbolized oil, a 1 per cent solution of nitrate of silver or of chlorid of zinc, with pads of oakum and flannel bandages. In many of these cases recovery is exceedingly slow. The new tissue by which the destroyed skin is replaced always shrinks in healing, and, as a consequence, unsightly scars are unavoidable. When the coronary band is involved it is generally advisable to blister the coronet over the seat of injury as soon as the suppuration ceases, for the purpose of stimulating the growth of new horn. Where a crevasse is formed between the old and the new horn no serious trouble is liable to be met with until the cleft is nearly grown out, when the soft tissues may be exposed by a breaking off of the partly detached horn. But even if this accident happens final recovery is effected by poulticing the foot until a sufficient growth of horn protects the parts from injury.

QUITTOR.

Quittor is a term applied to various affections of the foot wherein the tissues which are involved undergo a process of degeneration that results in the formation of a slough followed by the elimination of the diseased structures by means of a more or less extensive suppuration.

For convenience of consideration quittors may be divided into four classes, as suggested by Girard: (1) Cutaneous quittor, which is known also as simple quittor, skin quittor, and carbuncle of the coronet; (2) tendinous quittor; (3) subhorny quittor; and (4) cartilaginous quittor.

CUTANEOUS QUITTOR.

Simple quittor consists in a local inflammation of the skin and subcutaneous connective tissue on some part of the coronet, followed by a slough and the formation of an ulcer which heals by suppuration.

It is an extremely painful disease, owing to the dense character of the tissues involved; for in all dense structures the swelling which accompanies inflammation always produces intense pressure. This pressure not only adds to the patient's suffering but may at the same time endanger the life of the affected parts by strangulating the blood vessels. It is held by some writers that simple quittor is most often met with in the hind feet, but in my experience more than two-thirds of the cases have developed in the fore feet. While any part of the coronet may become the seat of attack, the heels and quarters are undoubtedly most liable.

_Causes._--Bruises and other wounds of the coronet are often the cause of cutaneous quittor, yet there can be no question that in the great majority of cases the disease develops without any known cause. For some reason not yet satisfactorily explained most cases happen in the fall of the year. One explanation of this fact has been attempted in the statement that the disease is due to the injurious action of cold and mud. This claim, however, seems to lose force when it is remembered that in many parts of this country the most mud, accompanied with freezing and thawing weather, is seen in the early springtime without a corresponding increase of quittor. Furthermore, the serious outbreaks of this disease in the mountainous regions of Colorado, Wyoming, and Montana are seen in the fall and winter seasons, when the weather is the driest. It may be claimed, and perhaps with justice, that during these seasons, when the water is low, animals are compelled to wade through more mud to drink from lakes and pools than is necessary at other seasons of the year, when these lakes and pools are full. Add to these conditions the further fact that much of this mud is impregnated with alkaline salts which, like the mineral substances always found in the mud of cities, are more or less irritating, and it seems fair to conclude that under certain circumstances mud may become an important factor in the production of quittor.[3]

While this disease attacks any and all classes of horses, it is the large, common breeds, with thick skins, heavy coats, and coarse legs that are most often affected. Horses well groomed and cared for in stables seem to be less liable to the disease than those running at large or than those which are kept and worked under adverse circumstances.

_Symptoms._--Lameness, lasting from one to three or four days, nearly always precedes the development of the strictly local evidences of quittor. The next sign is the appearance of a small, tense, hot, and painful tumor in the skin of the coronary region. If the skin of the affected foot is white, the inflamed portion will present a dark-red or even a purplish appearance near the center. Within a few hours the ankle, or even the whole leg as high as the knee or hock, becomes much swollen. The lameness is now so great that the patient refuses to use the foot at all, but carries it if compelled to move. As a consequence, the opposite leg is required to do the work of both, and if the animal persists in standing a greater part of the time it, too, becomes swollen. In many of these cases the suffering is so intense during the first few days as to cause general fever, dullness, loss of appetite, and increased thirst. Generally the tumor shows signs of suppuration within 48 to 72 hours after its first appearance; the summit softens, a fluctuating fluid is felt beneath the skin, which soon ulcerates completely through, causing the discharge of a thick, yellow, bloody pus, containing shreds of dead tissue which have sloughed away. The sore is now converted into an open ulcer, generally deep, nearly or quite circular in outline, and with hardened base and edges. In exceptional cases large patches of skin, varying from 1 to 2-1/2 inches in diameter, slough away at once, leaving an ugly superficial ulcer. These sores, especially when deep, suppurate freely, and if there are no complications they tend to heal rapidly as soon as the degenerated tissue has softened and is entirely removed. When suppuration is fully established, the lameness and general symptoms subside. When but a single tumor and abscess form, the disease progresses rapidly, and recovery, under proper treatment, may be effected in from two to three weeks; but when two or more tumors are developed at once, or if the formation of one tumor is rapidly succeeded by another for an indefinite time, the sufferings of the patient are greatly increased, the case is more difficult to treat, and recovery is more slow and less certain.

This form of quittor is often complicated with the tendinous and subhorny quittors by an extension of the sloughing process.

_Treatment._--The first step in the treatment of an outbreak of quittor should be the removal of all exciting causes. Crowding animals into small corrals and stables, where injuries to the coronet are likely to happen from trampling, especially among unbroken range horses, must be avoided as much as possible.

Watering places accessible without having to wade through mud should be provided. In towns, where the mud or dust is largely impregnated with mineral products, it is not possible to adopt complete preventive measures. Much can be done, however, by careful cleansing of the feet and legs as soon as the animal returns from work. Warm water should be used to remove the mud and dirt, after which the parts are to be thoroughly dried with soft cloths.

The means which are to be adopted for the cure of cutaneous quittor vary with the stage of the disease at the time the case is presented for treatment. If the case is seen early--that is, before any of the signs of suppuration have developed--the affected foot is to be placed under a constant stream of cold water, with the object of arresting a further extension of the inflammatory process. To accomplish this, put the patient in slings in a narrow stall having a slat or open floor. Bandage the foot and leg to the knee or hock, as the case may be, with flannel bandages loosely applied. Set a tub or barrel filled with cold water above the patient, and by the use of a small rubber hose of sufficient length make a siphon which will carry the water from the bottom of the tub to the leg at the top of the bandage. The stream of water should be quite small, and is to be continued until the inflammation has entirety subsided or until the presence of pus can be detected in the tumor. When suppuration has commenced, the process should be aided by the use of warm baths and poultices of lineseed meal or boiled turnips. If the tumor is of rapid growth, accompanied with intense pain, relief is obtained and sloughing largely limited by a free incision of the parts. The incision should be vertical and deep into the tumor, care being taken not to divide the coronary band entirely. If the tumor is large, more than one incision may be necessary.

The foot should now be placed in a warm bath for half an hour or longer and then poulticed. The hemorrhage produced by the cutting and encouraged by the warm bath is generally very copious and soon gives relief to the overtension of the parts.

In other cases it will be found that suppuration is well under way, so that the center of the tumor is soft when the patient is first presented for treatment. It is always good surgery to relieve the tumor of pus whenever its presence can be detected; hence, in these cases a free incision must be made into the softened parts, the pus evacuated, and the foot poulticed.

By surgical interference the tumor is now converted into an open sore or ulcer, which, after it has been well cleaned by warm baths and poultices applied for two or three days, needs to be protected by proper dressings. The best of all protective dressings is made of small balls, or pledgets, of oakum, carefully packed into the wound and held in place by a roller bandage 4 yards long, from 3 to 4 inches wide, made of common bedticking and skillfully applied.

The remedies which may be used to stimulate the healing process are many, and, as a rule, they are applied in the form of solutions or tinctures.

In my own practice I prefer a solution of bichlorid of mercury 1 part, water 500 parts, with a few drops of muriatic acid or a few grains of muriate of ammonia added to dissolve the mercury. The balls of oakum are wet with this solution before they are applied to the wound.

Among the other remedies which may be used, and perhaps with equally as good results, will be noted the sulphate of copper, iron, and zinc, 5 grains of either to the ounce of water; chlorid of zinc, 5 grains to the ounce; carbolic acid, 20 drops dissolved in an equal quantity of glycerin and added to 1 ounce of water; and nitrate of silver, 10 grains to the ounce of water.

If the wound is slow to heal, it will be found of advantage to change the remedies every few days.

If the wound is pale in color, the granulations transparent and glistening, the tincture of aloes, tincture of gentian, or the spirits of camphor may do best.

When the sore is red in color and healing rapidly, an ointment made of 1 part of carbolic acid to 40 parts of cosmoline or vaseline is all that is needed.

If the granulations continue to grow until a tumor is formed which projects beyond the surrounding skin, it should be cut off with a sharp, clean knife, and the foot poulticed for twenty-four hours, after which the wound is to be well cauterized daily with lunar caustic and the bandages applied with great firmness.

The question as to how often the dressings should be renewed must be determined by the condition of the wound, etc. If the sore is suppurating freely, it will be necessary to renew the dressing every 24 or 48 hours; if the discharge is small in quantity and the patient comfortable, the dressing may be left on for several days; in fact, the less often the wound is disturbed, the better, so long as the healing process is healthy. When the sore commences to "skin over," the edges should be lightly touched with lunar caustic at each dressing. The patient may now be given a little exercise daily, but the bandages must be kept on until the wound is entirely healed.

TENDINOUS QUITTOR.

This form of quittor differs from the cutaneous in that it not only affects the skin and subcutaneous tissues, but involves also the tendons of the leg, the ligaments of the joints, and, in many cases, the bones of the foot as well.

Fortunately, this form of quittor is less common than the preceding, yet any case beginning as simple cutaneous quittor may at any time during its course become complicated by the death of some part of the tendons, by gangrene of the ligaments, sloughing of the coronary band, caries of the bones, or inflammation and suppuration of the synovial sacs and joints, thereby converting a simple quittor into one which will, in all probability, either destroy the patient's life or maim him for all time.

_Causes._--Tendinous quittor is caused by the same injuries and influences that produce the simple form. Zundel believes it to be a not infrequent accompaniment of distemper. In my own experience I have seen nothing to verify this belief, but I am convinced that young animals are more liable to have tendinous quittor than older ones, and that they are much more likely to make a good recovery.

_Symptoms._--When a case of simple quittor is transformed into the tendinous variety the change is announced by a sudden increase in the severity of all the symptoms. On the other hand, if the attack primarily is one of tendinous quittor, the earliest symptom seen is a well-marked lameness. In those cases due to causes other than injuries this lameness is at first very slight, and the animal limps no more in trotting than in walking; later on, generally during the next 48 hours, the lameness increases to such extent that the patient often refuses to use the leg at all. An examination made during the first two days rarely discloses any cause for this lameness; it may not be possible even to say with certainty that the foot is the seat of the trouble. On the third or fourth day, sometimes as late as the fifth, a doughy-feeling tumor will be found forming on the heel or quarter. This tumor grows rapidly, feels hot to the touch, and is extremely painful. As the tumor develops, all the other symptoms increase in intensity; the pulse is rapid and hard; the breathing quick; the temperature elevated 3° or 4°; the appetite is gone; thirst increased; and the lameness so great that the foot is carried if locomotion is attempted. At this stage of the disease the patient generally seeks relief by lying upon the broad side, with outstretched legs; the coat is bedewed with a clammy sweat, and every respiration is accompanied with a moan. The leg soon swells to the fetlock; later this swelling gradually extends to the knee or hock, and in some cases reaches the body. As a rule, several days elapse before the disease develops a well-defined abscess, for, owing to the dense structure of the bones, ligaments, and tendons, the suppurative process is a slow one, and the pus is prevented from readily collecting in a mass.