Chapter 49

I made a post-mortem examination on a typical case of this disease, in which the animal had died on the fourth day after being found on the range slightly lame. The suffering had been intense, yet the only external evidences of the disease consisted in the shedding of the hoof from the right fore foot and a limited swelling of the leg to the knee. The sloughing of the hoof took place two or three hours before death, and was accompanied with but little suppuration and no hemorrhage. The skin from the knee to the foot was thickened from watery infiltration (edema), and on the inside quarter three holes, each about one-half inch in diameter, were found. All had ragged edges, while but one had gone deep enough to perforate the coronary band. The loose connective tissue beneath the skin was distended, with a gelatinous infiltration over the whole course of the flexor tendons and to the fetlock joint over the tendon in front. The soft tissues covering the coffin bone were loosened in patches by collections of pus which had formed beneath the sensitive laminæ. The coffin and pastern joints were inflamed, as were also the coffin, navicular, and coronet bones, while the outside toe of the coffin bone had become softened from suppuration until it readily crumbled between the fingers. The coronary band was largely destroyed and completely separated from the other tissues of the foot. The inner lateral cartilage was gangrenous, as was also a small spot on the extensor tendon near its point of attachment on the coffin bone. Several small collections of pus were found deep in the connective tissue of the coronary region; along the course of the sesamoid ligaments; in the sheath of the flexor tendons; under the tendon just below the fetlock joint in front; and in the coffin joint.

But all cases of tendinous quittor are by no means so complicated as this one was. In rare instances the swelling is slight, and after a few days the lameness and other symptoms subside, without any discharge of pus from an external opening. In most cases, however, from one to half a dozen or more soft points arise on the skin of the coronet, open, and discharge slowly a thick, yellow, fetid, and bloody matter. In other cases the suppurative process is largely confined to the sensitive laminæ and plantar cushion, when the suffering is intense until the pus finds an avenue of escape by separating the hoof from the coronary band, at or near the heels, without causing a loss of the whole horny box. When the flexor tendon is involved deep in the foot, the discharge of pus usually takes place from an opening in the follow of the heel; if the sesamoid ligament or the sheath of the flexors are affected, the opening is nearer the fetlock joint, although in most of these cases the suppuration spreads along the course of the tendons until the navicular joint is involved, and extensive sloughing of the deeper parts follows.

_Treatment._--The treatment of tendinous quittor is to be directed toward the saving of the foot. First of all an effort must be made to prevent suppuration; if the patient is seen at the beginning, cold irrigation, recommended in the treatment for cutaneous quittor, is to be resorted to. Later, when the tumor is forming on the coronet, the knife must be used, and a free and deep incision made into the swelling. Whenever openings appear, from which pus escapes, they should be carefully probed; in all instances these fistulous tracts lead down to dead tissue which nature is trying to remove by the process of sloughing. If a counter opening can be made, which will enable a more ready escape of the pus, it should be done at once; for instance, if the probe shows that the discharge originates from the bottom of the foot, the sole must be pared through over the seat of trouble. Whenever suppuration has commenced the process is to be stimulated by the use of warm baths and poultices. The pus which accumulates in the deeper parts, especially along the tendons, around the joints, and in the hoof, is to be removed by pressure and injections made with a small syringe, repeated two or three times a day. As soon as the discharge assumes a healthy character and diminishes in quantity, stimulating solutions are to be injected into the open wounds. When the tendons, ligaments, and other deeper parts are affected, a strong solution of carbolic acid--1 to 4--should be used at first; or strong solutions of tincture of iodin, sulphate of iron, sulphate of copper, bichlorid of mercury, etc., may be used in place of the carbolic; after this the remedies and dressings directed for use in simple quittor are to be used. In those cases in which the fistulous tracts refuse to heal it is often necessary to burn them out with a saturated solution of caustic soda, equal parts of muriatic acid and water, or, better still, with a long, thin iron, heated white hot.

But no matter what treatment is adopted, a large percentage of the cases of tendinous quittor fail to make good recoveries. If the entire hoof sloughs away, the growth of a new, but soft and imperfect hoof may be obtained by carefully protecting the exposed tissues with proper bandages. When the joints are opened by deep sloughing, recovery may eventually take place, but the joint remains immovable ever after. If caries of a small part of the coffin bone takes place, it may be removed by an operation; but if much of the bone is affected, or if the navicular and coronet bones are involved in the carious process, the only hope for a cure is in the amputation of the foot. This operation is advisable only when the animal is valuable for breeding purposes. In all other cases in which there is no hope for recovery the patient's suffering should be relieved by death. In tendinous quittor much thickening of the coronary region, and sometimes of the ankle and fetlock, remains after suppuration has ceased and the fistulous tracts have healed. To stimulate the reabsorption of this new and unnecessary tissue, the parts should be fired with the hot iron, or, in its absence, repeated blistering with the biniodid of mercury ointment may largely accomplish the same results.

SUBHORNY QUITTOR.

This is the most common form of the disease. It is generally seen in but one foot at a time, and more often in the fore than in the hind feet. It nearly always attacks the inside quarter, but may affect the outside, the band in front, or the heel, where it is of but little consequence. It consists in the inflammation of a small part of the coronary band and adjacent skin, followed by sloughing and suppuration, which in most cases extends to the neighboring sensitive laminæ.

_Causes._--Injuries to the coronet, such as bruises, overreaching, and calk wounds, are considered as the common causes of this disease. Still, cases occur in which there appears to be no existing cause, just as in the other forms of quittor, and it seems fair to conclude that subhorny quittor may also be produced by internal causes.

_Symptoms._--At the outset the lameness is always severe, and the patient often refuses to use the affected foot. Swelling of the coronet close to the top of the hoof causes the quarter to protrude beyond the wall. This tumor is extremely sensitive, and the whole foot is hot and painful. After a few days a small spot in the skin, over the most elevated part of the tumor, softens and opens or the hoof separates from the coronary band at the quarter or well back toward the heel. From this opening, wherever it may be, a thin, watery, often dark, offensive discharge escapes, at times mixed with blood and always containing a considerable percentage of pus.

Probing will now disclose a fistulous tract leading to the bottom of the diseased tissues. If the opening is small, there is a tendency upon the part of the suppurative process to spread downward; the pus gradually separates the hoof from the sensitive laminæ until the sole is reached, and even a portion of this may be undermined.

As a rule, the slough in this form of quittor is not deep, and if the case receives early and proper treatment complications are generally avoided; but if the case is neglected, and, occasionally, even in spite of the best treatment, the disease spreads until the tendon in front, the lateral cartilage, or the coffin bone and joint as well are involved.

In all cases of subhorny quittor much relief is experienced when the slough comes away, and rapid recovery is made. If, however, after the lapse of a few days, the lameness remains and the wound continues to discharge a thin, unhealthy matter, the probabilities are that the disease is spreading, and pus collecting in the deeper parts of the foot. In Zundel's opinion, if the use of the probe now detects a pus cavity below the opening, a cartilaginous quittor is in the course of development.

_Treatment._--Hot baths and poultices are to be used until the presence of pus can be determined, when the tumor is to be opened with a knife or sharp-pointed iron heated white hot. The hot baths and poultices are now continued for a few days or until the entire slough has come away and the discharge is diminished, when dressings recommended in the treatment for cutaneous quittor are to be used until recovery is completed. In cases in which the discharge comes from a cleft between the upper border of the hoof and the coronary band, always pare away the loosened horn, so that the soft tissues beneath are fully exposed, care being taken not to injure the healthy parts. This operation permits of a thorough inspection of the diseased parts, the easy removal of all gangrenous tissue, and a better application of the necessary remedies and dressings. The only objection to the operation is that the patient is prevented from being early returned to work.

When the probe shows that pus has collected under the coffin bone the sole must be pared through, and, if caries of the bone is present, the dead parts cut away. After either of these operations the wound is to be dressed with the oakum balls, saturated in the bichlorid of mercury solution, as previously directed, and the bandages tightly applied. Generally the discharge for the first two or three days is so great that the dressings need to be changed every 24 hours; but when the discharge diminishes, the dressing may be left on from one to two weeks. Before the patient is returned to work, a bar shoe should be applied, since the removed quarter or heel can only be made perfect again by a new growth from the coronary band.

Tendinous or cartilaginous complications are to be treated as directed under those headings.

CARTILAGINOUS QUITTOR.

This form of quittor may commence as a primary inflammation of the lateral cartilage, but in the great majority of cases it appears as a sequel to cutaneous or subhorny quittor. It may affect either the fore or hind feet, but is most commonly seen in the former. As a rule, it attacks but one foot at a time, and but one of the cartilages, generally the inner one. It is always a serious affection for the reason that, in many cases, it can only be cured by a surgical operation, requiring a thorough knowledge of the anatomy of the parts involved, and much surgical skill.

_Causes._--Direct injuries to the coronet, such as trampling, pricks, burns, and the blow of some heavy falling object which may puncture, bruise, or crush the cartilage, are the common direct causes of cartilaginous quittor. Besides being a sequel to the other forms of quittor, it sometimes develops as a complication in suppurative corn, canker, grease, laminitis, and punctured wounds of the foot. Animals used for heavy draft, and those with flat feet and low heels, are more liable to the disease than others, for the reason that they are more exposed to injury. Rough roads also predispose to the disease by increasing liability to injury.

_Symptoms._--When the disease commences as a primary inflammation of the cartilage, lameness develops with the formation of a swelling on the side of the coronet over the quarter. The severity of this lameness depends largely upon the part of the cartilage which is diseased, for if the disease is situated in that part of the cartilage nearest the heel, where the surrounding tissues are soft and spongy, the lameness may be very slight, especially if the patient is required to go no faster than a walk; but when the middle and anterior parts of the cartilage are diseased, the pain and consequent lameness are much greater, for the tissues are less elastic and the coffin joint is more liable to become affected.

Except in the cases to be noted hereafter, one or more fistulous openings finally appear in the tumor on the coronet. These openings are surrounded by a small mass of granulations which are elevated above the adjacent skin and bleed readily if handled. A probe shows these fistulous tracts to be more or less sinuous, but always leading to one point--the gangrenous cartilage. When cartilaginous quittor happens as a complication of suppurative corn, or from punctured wounds of the foot, the fistulous tract may open alone at the point of injury on the sole.

The discharge in this form of quittor is generally thin, watery, and contains pus enough to give it a pale-yellow color; it is offensive to the sense of smell, due to the detachment of small flakes of cartilage which have become gangrenous and are seen in the discharge as small, greenish-colored particles. In old cases it is not unusual to find some of the fistulous openings heal at the surface; this is followed by the gradual collection of pus in the deeper parts, forming an abscess, which in a short time opens at a new point. The wall of the hoof, over the affected quarter and heel, in very old cases becomes rough and wrinkled like the horn of a ram, and generally it is thicker than the corresponding quarter, owing to the stimulating effect which the disease has upon the coronary band.

Complications may arise by an extension of the disease to the lateral ligament of the coffin joint, to the joint itself, to the plantar cushion, and by caries of the coffin bone.

_Treatment._--Before recovery can take place all the dead cartilage must be removed. In rare instances this is effected by nature without assistance. Usually, however, the disease does not tend to recovery, and active curative measures must be adopted. The best and simplest treatment, in a majority of cases, is the injection of strong caustic solutions, which destroy the diseased cartilage and cause its discharge, along with the other products of suppuration. In favorable cases these injections will secure a healing of the wound in from two to three weeks. While the saturated solution of sulphate of copper, or a solution of 10 parts of bichlorid of mercury to 100 parts of water, has given the best results in my hands, equally as favorable success has been secured by others from the use of caustic soda, nitrate of silver, sulphate of zinc, tincture of iodin, etc. No matter which one of these remedies may be selected, however, it must be used at least twice a day for a time. The solution is injected into the various openings with force enough to drive it to the bottom of the wound, after which the foot is to be dressed with a pad of oakum, held in place by a roller bandage tightly applied. While it is not always necessary, it is often of advantage to relieve the pressure on the parts by rasping away the hoof over the seat of the cartilage; the coronary band and laminæ should not be injured in the operation.

If the caustic injections prove successful, the discharge will become healthy and gradually diminish, so that by the end of the second week the fistulous tracts are closing up and the injections are made with much difficulty.

If, on the other hand, there is but little or no improvement after this treatment has been used for three weeks, it may reasonably be concluded that the operation for the removal of the lateral cartilage must be resorted to for the cure of the trouble. As this operation can be safely undertaken only by an expert surgeon, it will not be described in this connection.

THRUSH.

Thrush is characterized by an excessive secretion of unhealthy matter from the cleft of the frog. While all classes of horses are liable to this affection, it is more often seen in the common draft horse than in any other breed, owing to the conditions of servitude and not to the fault of the breed. Country horses are much less subject to the disease, except in wet, marshy districts, than are the horses used in cities and towns.

_Causes._--The most common cause of thrush is the filthy condition of the stable in which the animal is kept. Mares are more liable to contract the disease in the hind feet when filth is the cause, while the gelding and stallion are more liable to develop it in the fore feet. Hard work on rough and stony roads may also induce the disease, as may a change from dryness to excessive moisture. The latter cause is often seen to operate in old track horses, whose feet are constantly soaked in the bathtub for the purpose of relieving soreness. Muddy streets and roads, especially where mineral substances are plentiful, excite this abnormal condition of the frog. Contracted heels, scratches, and navicular disease predispose to thrush, while by some a constitutional tendency is believed to exist among certain animals which otherwise present a perfect frog.

_Symptoms._--At first there is simply an increased moisture in the cleft of the frog, accompanied with an offensive smell. After a time a considerable discharge takes place--thin, watery, and highly offensive, changing gradually to a thicker puriform matter, which rapidly destroys the horn of the frog. Only in old and severe cases is the patient lame and the foot feverish--cases in which the whole frog is involved in the diseased process.

_Treatment._--Thrushes are to be treated by cleanliness, the removal of all exciting causes, and a return of the frog to its normal condition. As a rule, the diseased and ragged portions of horn are to be pared away and the foot poulticed for a day or two with boiled turnips, to which may be added a few drops of carbolic acid or a handful of powdered charcoal to destroy the offensive smell. The cleft of the frog and the grooves on its edges are then to be cleaned and well filled with dry calomel and the foot dressed with oakum and a roller bandage. If the discharge is profuse, the dressing should be changed daily; otherwise it may be left on two or three days. Where a constitutional taint is supposed to exist, with swelling of the legs, grease, etc., a purgative, followed by dram doses of sulphate of iron, repeated daily, may be prescribed. In cases where the growth of horn seems too slow a Spanish-fly blister applied to the heels is often followed by good results. Feet in which the disease is readily induced may be protected in the stable with a leather boot. If the thrush is but a sequel to other disease, a permanent cure may not be possible.

CANKER.

Canker of the foot is due to the rapid reproduction of a vegetable parasite. It not only destroys the sole and frog, but, by setting up a chronic inflammation in the deeper tissues, prevents the growth of a healthy horn by which the injury may be repaired. Heavy cart horses are more often affected than those of any other class.

_Causes._--The essential element in the production of canker is the parasite; consequently the disease may be called contagious. As in all other diseases due to specific causes, however, the seeds of the disorder must find a suitable soil in which to grow before they are reproduced. It may be said, then, that the conditions which favor the preparation of the tissues for a reception of the seeds of this disease are simply predisposing causes.

The condition most favorable to the development of canker is dampness--in fact, dampness seems indispensable to the existence and growth of the parasite; the disease is rarely, if ever, seen in high, dry districts, and is much more common in rainy than in dry seasons. Filthy stables and muddy roads have been classed among the causes of canker; but it is very doubtful whether these conditions can do more than favor a preparation of the foot for the reception of the disease germ.

All injuries to the feet, by exposing the soft tissues, may render the animal susceptible to infection; but neither the injury nor the irritation and inflammation of the tissues which follow are sufficient to induce the disease.

For some unknown reason horses with lymphatic temperaments--thick skins, flat feet, fleshy frogs, heavy hair, and particularly with white feet and legs--are especially liable to canker.

_Symptoms._--Usually, canker is confined to one foot; but it may attack two, three, or all of the feet at once; or, as is more commonly seen, the disease attacks first one then another, until all may have been successively affected. When the disease follows an injury which has exposed the soft tissues of the foot, the wound shows no tendency to heal, but instead there is secreted from the inflamed parts a profuse, thin, fetid, watery discharge, which gradually undermines and destroys the surrounding horn, until a large part of the sole and frog is diseased. The living tissues are swollen, dark colored, and covered at certain points with particles of new, soft, yellowish, thready horn, which are constantly undergoing maceration in the abundant liquid secretion by which they are immersed. As this secretion escapes to the surrounding parts, it dries and forms small, cheesy masses composed of partly dried horny matter, exceedingly offensive to the sense of smell. When the disease originates independently of an injury, the first evidences of the trouble are the offensive odor of the foot, the liquid secretion from the cleft and sides of the frog, and the rotting away of the horn of the frog and sole.

In the earlier stages there is no interference with locomotion, but later the foot becomes sensitive, particularly if the animal is used on rough roads, and, finally, when the sole and frog are largely destroyed the lameness is severe.

_Treatment._--Since canker does not destroy the power of the tissues to produce horn, but rather excites them to an excessive production of an imperfect horn, the indications for treatment are to restore the parts to a normal condition, when healthy horn may again be secreted. In my experience, limited though it has been, the old practice of stripping off the entire sole and deep cauterization, with either the hot iron or strong acids, is not attended with uniformly good results.

I am of the opinion that recovery can generally be effected as surely and as speedily with measures which are less heroic and much less painful. True, the treatment of canker is likely to exhaust the patience, and sometimes the resources, of the attendant; but after all success depends more on the persistent application of simple remedies and great cleanliness than on the special virtues of any particular drug.

First, then, clean the foot with warm baths and apply a poultice containing powdered charcoal or carbolic acid. A handful of the charcoal or a tablespoonful of the acid mixed with the poultice serves to destroy much of the offensive odor. The diseased portions of horn are to be carefully removed with sharp instruments, until only healthy horn borders the affected parts. The edges of the sound horn are to be pared thin, so that the swollen soft tissues may not overlap their borders. With sharp scissors cut off all the prominent points on the soft tissues, shorten the walls of the foot, and nail on a broad, plain shoe. The foot is now ready for the dressings, and any of the many stimulating and drying remedies may be used; but it will be necessary to change frequently from one to another, until finally all may be tried.