One of the essentials of treatment, and probably an indispensable condition when recovery is in any wise attainable, is the suspension of the patient in slings. He should be continued in them so long as he can be made to submit quietly to their restraint.
Dislocations and luxations are interchangeable terms, meaning the separation and displacement of the articulating surfaces of the bones entering into the formation of a joint. This injury is rarely encountered in our large animals on account of the combination of strength and solidity in the formation of their joints. It is met with but seldom in cattle and less so in horses, while dogs and smaller animals are more often the sufferers.
Cause.—The accident of a luxation is less often encountered in the animal races than in man. This is not because the former are less subject to occasional violence involving powerful muscular contractions, or are less often exposed to casualties similar to those which result in luxations in the human skeleton, but because it requires the cooperation of conditions—anatomical, physiological, and perhaps mechanical—present in the human race and lacking in the others, which, however, can not in every case be clearly defined. Perhaps the greater relative length of the bony levers in the human formation may constitute a cause of the difference.
Among the predisposing causes in animals may be enumerated caries of articular surfaces, articular abscesses, excessive dropsical conditions, degenerative softening of the ligaments, and any excessive laxity of the soft structures.
Symptoms and diagnosis.—Three signs of dislocation must usually be taken into consideration. They are: (1) An alteration in the shape of the joint and in the normal relationship of the articulating surfaces; (2) an alteration in the length of the limb, either shortening or lengthening; (3) an alteration in the movableness of the joint, usually an unnatural immobility. Only the first, however, can be relied upon as essential. Luxations are not always complete; they may be partial; that is, the articulating surfaces may be displaced but not separated. In such cases several symptoms may not be present. And not only may the third sign be absent, but the mobility of the first be greatly increased when the character of the injury has been such as to produce extensive lacerations of the articular ligaments.
In addition to the above signs, a luxation is usually characterized by pain, swelling, hemorrhage beneath the skin from damaged or ruptured blood vessels, and even paralysis, when important nerves are pressed on by the displaced bones.
Sometimes a bone is fractured in the immediate vicinity of a joint. The knowledge of this fact requires us to be able to diagnose between a dislocation and such a fracture. In this we generally have three points to assist us: (1) The immobility of a dislocated joint as against the apparently remarkable freedom of movement in fracture; (2) in a dislocation there is no true crepitus—that peculiar grating sensation heard as well as felt on rubbing together the rough ends of fractured bones; however, it must be remembered that in a dislocation two or three days old the inflammatory changes around the joint may give rise to a crackling sensation similar to that in fracture; (3) as a rule, in luxations, if the ligamentous and muscular tissues about the joint are not badly torn, the displacement, when reduced, does not recur.
Prognosis.—The prognosis of a luxation is comparatively less serious than that of a fracture, though at time the indications of treatment may prove to be so difficult to apply that complications of a very severe character may arise.
Treatment.—The treatment of luxations must, of course, be similar to that of fractures. Reduction, naturally, will be the first indication in both cases, and the retention of the replaced parts must follow. The reduction involves the same steps of extension and counter extension, performed in the same manner, with the patient subdued by anesthetics.
The difference between the reduction of a dislocation and that of a fracture consists in the fact that in the former the object is simply to restore the bones to their true, normal position, with each articular surface in exact contact with its companion surface, the apparatus necessary afterwards to keep them in situ being similar to that which is employed in fracture cases, and which will usually require to be retained for a period of from 40 to 50 days, if not longer, before the ruptured retaining ligaments are sufficiently firm to be trusted to perform their office unassisted. A variety of manipulations are to be used by the surgeon, consisting in pushing, pulling, pressing, rotating, and, indeed, whatever movement may be necessary, until the bones are forced into such relative positions that the muscular contraction, operating in just the right directions, pulls the opposite matched ends together in true coaptation—a head into a cavity, an articular eminence into a trochlea, as the case may be. The "setting" is accompanied with a peculiar, snapping sound, audible and significant, as well as a visible return of the surface to its normal symmetry.
Special dislocations.—While all the articulations of the body are liable to this form of injury, there are three in the large animals which may claim a special consideration, viz:
We mention this displacement without intending to imply the practicability of any ordinary attempt at treatment, which is usually unsuccessful, the animal whose mishap it has been to become a victim to it being disabled for life. The superior head of the arm bone as it is received into the lower cavity of the shoulder blade is so situated as to be liable to be forced out of place in four directions. It may escape from its socket, according to the manner in which the violence affects it—outward, inward, backward, or forward—and the deformity which results and the effects which follow will correspondingly differ. We have said that treatment is generally unsuccessful. It may be added that the difficulties which interpose in the way of reduction are nearly insurmountable, and that the application of means for the retention of the parts after reduction would be next to impossible. The prognosis, from any point of view, is sufficiently grave for the luckless animal with a dislocated shoulder.
This joint partakes very much of the characteristics of the humero-scapular articulation, but is more strongly built. The head of the thigh bone is more separated, or prominent and rounder in form, and the cup-like cavity, or socket, into which it fits is much deeper, forming together a deep, true ball-and-socket joint, which is, moreover, reenforced by two strong cords of funicular ligaments, which unite them. It will be easily comprehended, from this hint of the anatomy of the region, that a luxation of the hip joint must be an accident of comparatively rare occurrence; yet cases are recorded in which the head of the bone has been affirmed to slip out of its cavity and assume various positions—inward, outward, forward, or backward.
The indications of treatment are those of all cases of dislocation. When the reduction is accomplished the surgeon will be apprised of the fact by the peculiar, snapping sound usually heard on such occasions.
This is not a true dislocation. The stifle bone is so peculiarly articulated with the thigh bone that the means of union are of sufficient strength to resist the causes which usually give rise to luxations, yet there is sometimes discovered a peculiar, pathological state in the hind legs of animals, the effect of which is closely to simulate the manifestation of many of the general symptoms of dislocations. This condition originates in muscular cramps, the action of which is seen in a certain change in the coaptation of the articular surfaces of the stifle and thigh bone, resulting in the exhibition of a sudden and alarming series of symptoms which have suggested the phrase of "stifle out" as a descriptive term.
Symptoms.—The animal so affected stands quietly and firmly in his stall, or perhaps with one of his hind legs extended backward, and resists every attempt to move him backward. If urged to move forward he will either refuse or comply with a jump, with the toe of the disabled leg dragging on the ground and brought forward by a second effort. There is no flexion at the hock and no motion at the stifle, while the circular motion of the hip is quite free. The leg appears to be much longer than the other, owing to the straightened position of the thigh bone, which forms almost a straight line with the tibia from the hip joint down. The stifle joint is motionless, and the motions of all the joints below it are more or less interfered with. External examination of the muscles of the hip and thigh reveals a certain degree of rigidity, with perhaps some soreness, and the stifle bone may be seen projecting more or less on the outside and upper part of the joint.
This state of things may continue for some time and until treatment is applied, or it may spontaneously and suddenly terminate, leaving everything in its normal condition, but perhaps to return again.
Cause.—Pseudo-dislocation of the patella is liable to occur under many of the conditions which cause actual dislocation, and yet it may often occur in animals which have not been exposed to the ordinary causes, but which have remained at rest in their stables. Sometimes these cases are assignable to falls in a slippery stall, or perhaps slipping when endeavoring to rise; sometimes to weakness in convalescing patients; sometimes to lack of tonicity of structure and general debility; sometimes to relaxation of tissues from want of exercise or use. A straight leg, sloping croup, and the young are predisposed to this dislocation.
Treatment.—The reduction of these displacements of the patella is not usually attended with difficulty. A sudden jerk or spasmodic action will often be all that is required to spring the patella into place, when the flexion of the leg at the hock ends the trouble for the time. But this is not always sufficient, and a true reduction may still be indicated. To effect this the leg must be drawn well forward by a rope attached to the lower end, and the patella, grasped with the hand, forcibly pushed forward and inward and made to slip over the outside border of the trochlea of the femur. The bone suddenly slips into position, the excessive rigor of the leg ceases with a spasmodic jerk, and the animal may walk or trot away without suspicion of lameness. Though this may end the trouble for the time, and the restoration seem to be perfect and permanent, a repetition of the entire transaction may subsequently take place, and perhaps from the loss of some proportion of tensile power which would naturally follow the original attack in the muscles involved the lesion might become a habitual weakness.
Warm fomentations and douches with cold water will often promote permanent recovery, and liberty in a box stall or in the field will in many cases insure constant relief. The use of a high-heeled shoe is recommended by European veterinarians. The use of stimulating liniments, with frictions, charges, or even severe blisters, may be resorted to in order to prevent the repetition of the difficulty by strengthening and toning up the parts.
This term expresses a more or less complete laceration or yielding of the fibers of the muscles, tendons, or the sheaths surrounding and supporting them. The usual cause of a sprain is external violence, such as a fall or a powerful exertion of strength, with following symptoms of soreness, heat, swelling, and a suspension of function. Their termination varies from simple resolution to suppuration, and commonly fibrinous exudation difficult to remove. None of the muscles or tendons of the body are exempt from liability to this lesion, though naturally from their uses and the exposure of their situation the extremities are more liable than other regions to become their seat. The nature of the prognosis will be determined by a consideration of the seat of the injury and the complications likely to arise.
Treatment.—The treatment will resolve itself into the routine of local applications, including warm fomentations, stimulating liniments, counterirritation by blistering, and in some cases even firing. Rest, in the stable or in a box stall, will be of advantage by promoting the absorption of whatever fibrinous exudation may have formed, or absorption may be stimulated by the careful persevering application of iodin in the form of ointments of various degrees of strength.
There are many conditions in which not only the muscular and tendinous structures proper are affected by a strain, but, by contiguity of parts, the periosteum of neighboring bones may become involved, with a complication of periostitis and its sequelæ.
The frequency of the occurrence of lameness in the shoulder from sprains entitles it to precedence of mention in the present category, for, though so well covered with its muscular envelope, it is often the seat of injuries which, from the complex structure of the region, become difficult to diagnosticate with satisfactory precision and facility. The flat bone which forms the skeleton of that region is articulated in a comparatively loose manner with the bone of the arm, but the joint is, notwithstanding, rather solid, and is powerfully strengthened by tendons passing outside, inside, and in front of it. Still, shoulder lameness or sprain may exist, originating in lacerations of the muscles, the tendons or the ligaments of the joint, or perhaps in diseases of the bones themselves. "Slip of the shoulder" is a phrase frequently applied to such lesions.
The identification of the particular structures involved in these lesions is of much importance, in view of its bearing upon the question of prognosis. For example, while a simple superficial injury of the spinatus muscles, or the muscles by which the leg is attached to the trunk, may not be of serious import and may readily yield to treatment, or even recover spontaneously and without interference, the condition is quite changed in a case of tearing of the flexor brachii, or of its tendons as they pass in front of the articulation, or, what is still more serious, if there is inflammation or ulceration in the groove over which this tendon slides, or upon the articular surfaces or their surroundings, or periostitis at any point adjacent.
Causes.—The frequency of attacks of shoulder lameness is not difficult to account for. The superficial and unprotected position of the part and the numerous movements of which it is capable, and which, in fact, it performs, render it both subjectively and objectively preeminently liable to accident or injury. It would be difficult and would not materially avail to enumerate all the forms of violence by which the shoulder may be crippled. A fall, accompanied with powerful concussion; a violent muscular contraction in starting a heavily loaded vehicle from a standstill; a misstep following a quick muscular effort; a jump accompanied with miscalculated results in alighting; a slip on a smooth, icy road; balling the feet with snow; colliding with another horse or other object—indeed, the list may be indefinitely extended, but without profit or utility.
Symptoms.—Some of the symptoms of shoulder lameness are peculiar to themselves, and yet the trouble is frequently mistaken for other affections—navicular disease more often than any other. The fact that in both affections there are instances when the external symptoms are but imperfectly defined, and that one of them especially is very similar in both, is sufficient to mislead careless or inexperienced observers and to occasion the error which is sometimes committed of applying to one disease the name of the other, erring both ways in the interchange. The true designation of pathological lesions is very far at times from being of certain and easy accomplishment, and, owing to the massive structure of the parts we are considering, this is especially true in the present connection. Still there are many cases in which there is really no reasonable excuse for an error in diagnosis by an average practitioner.
Shoulder lameness will, of course, manifest itself by signs and appearances more or less distinct and pronounced, according to the nature of the degrees and the extent of the originating cause. We summarize some of these signs and appearances:
The lameness is not intermittent, but continued, the disturbance of motion gaging the severity of the lesion and its extent. It is more marked when the bones are diseased than when the muscles alone are affected. When in motion the two upper bony levers—the shoulder blade and the bone of the upper arm—are reduced to nearly complete immobility and the walking is performed by the complete displacement of the entire mass, which is dragged forward without either flexion of extension. The action of the joint below, as a natural consequence, is limited in its flexion. In many instances there is a certain degree of swelling at the point of injury—at the joint, or, more commonly, in front of it, or on the surface of the spinatus muscle. Again, instead of swelling there will be muscular atrophy, though, while this condition of loss of muscular power may interfere with perfect locomotion, it is not in itself usually a cause of shoulder lameness. "Sweenied" shoulders are more often due to disease below the fetlock than to affections above the elbow.
During rest the animal often carries his leg forward, somewhat analogous to the "pointing" position of navicular disease, though in some cases the painful member drops at the elbow in a semiflexed position. The backing is sometimes typical, the animal when performing it, instead of flexing his shoulder, dragging the whole leg without motion in the upper segment of the extremity.
The peculiar manner in which the leg is brought forward in the air for another step in the act of walking or trotting is in some instances characteristic of injuries of the shoulder. The lameness also manifests itself in bringing the leg forward with a circumflex swinging motion and a shortening in the extension of the step. The foot is carried close to the ground and stumbling is frequent, especially on an uneven road.
With the utmost scrutiny and care the vagueness and uncertainty of the symptoms will contribute to perplex and discredit the diagnosis and embarrass the surgeon, and sometimes the expedient is tried of aggravating the symptoms by way of intensifying their significance, and thus rendering them more intelligible. This has been sought by requiring the patient to travel on hard or very soft ground and compelling him to turn on the sound leg as a pivot, with other motions calculated to betray the locality of the pain.
Treatment.—It is our conviction that lameness of the shoulder will in many cases disappear with no other prescription than that of rest. Provided the lesions occasioning it are not too severe, time is all that is required. But the negation of letting alone is seldom accepted as a means of doing good, in the place of the active and the positive forms of treatment. This is in accordance with a trait of human nature which is universal, and is unlimited in its applications; hence something must be done. In mild cases of shoulder lameness, then, the indications are water, either in the cold douche or by showering, or by warm fomentations. Warm, wet blankets are of great service; in addition, or as alternative, anodyne liniments, camphor, belladonna, either in the form of tincture or the oils, are of benefit, and at a later period stimulating friction with suitable mixtures, sweating liniments, blistering compounds, subcutaneous injections over the region of the muscle of 1-1/2 grains of veratrin (the variety insoluble in water) mixed in 2 drams of water, etc., will find their place, and finally, when necessity demands it, the firing iron and the seton.
The duration of the treatment must be determined by its effects and the evidence that may be offered of the results following the action of the reparative process. But the great essential condition of cure, and the one without which the possibility of relapse will always remain as a menace, is, as we have often reiterated in analogous cases, rest, imperatively rest, irrespective of any other prescriptions with which it may be associated.
Causes.—This injury, which fortunately is not very common, is mostly encountered in cities among heavy draft horses or rapidly driven animals which are obliged to travel, often smooth shod, upon slippery, icy, or greasy pavements, where they are easily liable to lose their foothold. The region of the strain is the posterior part of the shoulder, and the affected muscles are those which occupy the space between the posterior border of the scapula and the posterior face of the arm. It is the muscles of the olecranon which give way.
Symptoms.—The symptoms are easily recognized, especially when the animal is in action. While at rest the attitude may be normal, or by close scrutiny a peculiarity may perhaps be detected. The leg may seem to drop; the elbow may appear to be lower than its fellow, with the knee and lower part of the leg flexed and the foot resting on the toe, with the heel raised. Such an attitude, however, may be occasionally assumed by an animal without having any special significance, but when it becomes more pronounced in motion the fact acquires a symptomatic value, and this is the case in the present instance. A rapid gait becomes quite impossible, and the walk, as in some few other diseases, becomes sufficiently characteristic to warrant a diagnosis even when observed from a distance. An entire dropping of the anterior part of the trunk becomes manifest, and no weight is carried on the disabled side in consequence of the loss of action in the suspensory muscles. There are often heat, pain, and swelling in the muscular mass at the elbow, though at times a hollow, or depression, may be observed near the posterior border of the scapula, which is probably the seat of injury.
These hurts are of various degrees of importance, varying from mere minor casualties of quick recovery to lesions which are of sufficient severity to render an animal useless and valueless for life.
Treatment.—The prime elements of treatment, which should be strictly observed, are rest and quiet. Prescriptions of all kinds, of course, have their advocates. Among them are ether, chloroform, camphor, alcoholic frictions, warm fomentations, blisters, setons, etc. Unless the conclusions of experience are to be ignored, my own judgment is decisive in favor of rest, judiciously applied, however, and my view of what constitutes a judicious application of rest has been more than once presented in these pages. There are degrees of this rest. One contemplates simple immobility in a narrow stall. Another means the enforced mobility of the slings and a narrow stall as well. Another a box stall, with ample latitude as to posture and space, and option to stand or lie down. As wide as this range may appear to be, radical recovery has occurred under all of these modified forms of letting our patients alone.
The etiology of injuries and diseases of the hip is one and the same with that of the shoulder. The same causes operate and the same results follow. The only essential change, with an important exception, which would be necessary in passing from one region to the other in a description of its anatomy, its physiology, and its pathology would be a substitution of anatomical names in reference to certain bones, articulations, muscles, ligaments, and membranes concerned in the injuries and diseases described. It would be only a useless repetition to cover again the ground over which we have so recently passed in recital of the manner in which certain forms of external violence (falls, blows, kicks, etc.) result in other certain forms of lesion (luxation, fracture, periostitis, ostitis, etc.), and to recapitulate the items of treatment and the names of the medicaments proper to use. The same rules of diagnosis and the same indications and prognosis are applicable equally to every portion of the organism, with only such modifications in applying dressings and apparatus as may be required by differences of conformation and other minor circumstances, which must suggest themselves to the judgment of every experienced observer when the occasion arrives for its exercise.
An exception is to be made, while considering the subject in connection with the region now under advisement, in respect to the formidable affection known as morbus coxarius, or hip-joint disease; and leaving the detail of other lesions to take their place under other heads, that relating to the shoulder, for instance, we turn to the hip joint and its ailments as the chief subject of our present consideration.
Symptoms.—In investigating for morbus coxarius, let the observer first examine the lame animal by scanning critically the outlines of the joint and the region adjacent for any difference of size or disturbance of symmetry in the parts, any prominence or rotundity, and on both sides. The lame side will probably be warmer, more developed, and fuller, both to the touch and to the eye. Let him then grasp the lower part of the leg (as he would in examining a case of shoulder lameness) and endeavor to produce excessive passive motion. This will probably cause pain when the leg is made to assume a given position. Let him push the thigh forcibly against the hip bone, and the contact will again probably cause a manifestation of pain. If the horse is trotted, the limited action of the hip joint proper and the excessive dropping and rising of the hip of the opposite side will be easily recognized. Usually the animal does not extend the foot so far as customarily and picks it up much sooner.
The abductive or circumflex motion observed in shoulder lameness is also present in hip lameness, but under special conditions, and the test of the difficulty, either by traveling on soft ground or in turning the horse in a circle, may here also contribute to the diagnosis, as in testing for lameness in the anterior extremity.
Prognosis.—The prognosis of hip lameness is at times quite serious, not only on account of the long duration of treatment required to effect good results, and because of the character which may be assumed by the disease, but of the permanence of the disability resulting from it. Exostosis and ulcerative arthritis are sequelæ which often resist every form of treatment.
Treatment.—As before intimated, this is little more than a repetition of the remarks upon the lameness of the shoulder, with slight modifications occasioned by the muscular structure of the hip, and we are limited to the same recommendations of treatment. The advantages of rest must be reaffirmed, with local applications, of which, however, it may be said that they are more distinctly indicated and likely to be more effective in their results than in shoulder lameness, and may be more freely employed, whether in the form of liniments, blisters (singly or repeated), firing, or setoning.
The fibrous structure situated behind the cannon bones, both in the fore and hind legs, is often the seat of lacerations or sprains resulting from violent efforts or sudden jerks.
Cause.—The injury may be considered serious or trifling, according to the circumstances of each case as judged by its own history. Among the predisposing causes are a long, thin fetlock and a narrow knee or hock as viewed from the side, with the flexor muscles tied in just below the joint. The longer and more oblique the pastern the greater is the strain on the flexor tendons and suspensory ligaments; hence a low quarter, a toe calk, and no heel calks, or a thin calk placed at the tip under the toe, and leaving the quarters long abnormally stretches the back tendons and causes a great strain upon them just before the weight is shifted from the foot in locomotion. In runners and hunters the disease is liable to be periodic. In driving horses it is most common in well-bred animals of nervous temperament. Draft horses suffer most frequently in the hind legs.
Symptoms.—The injury is readily recognized by the changed aspect of the region and the accompanying local symptoms. The parts which in health are well defined, with the outlines of the tendons and ligaments well marked, become the seat of a swelling, more or less developed, from a small spot on the middle of the back of the tendon to a tumefaction reaching from the knee down to and even involving the fetlock itself. It is always characterized by heat, and it is variously sensitive, ranging from a mere tenderness to a degree of soreness which shrinks from the lightest touch. The degree of the lameness varies, and it has a corresponding range with the soreness, sometimes showing only a slight halting and at others the extreme of lameness on three legs, with intermediate degrees.
The lameness is always worse when the weight is thrown on the foot and is most marked toward the end of the phase of contact with the ground. Either passive irritation of the leg or turning the animal in a circle causes pain as in diseases of the joints. Sometimes the horse likes to get the heels on a stone or some elevation so as to relieve the weight from the flexor tendons. Finally, in cases of long standing, a shortening of the tendons occurs, resulting in the abnormal flexion of the foot known by horsemen as "broken down," or a more upright position of the foot may follow, producing perhaps knuckling or the so-called clubfoot.
Prognosis.—It may be safely assumed on general principles that a leg which has received such injuries seldom returns to a perfect condition of efficiency and soundness, and that as a fact a certain absolute amount of thickening and deformity will remain permanent, even when the lameness has entirely disappeared.
Treatment.—The injured member should receive the earliest attention possible, not only when the inflammatory condition is present, but when it is subsiding and there is only the thickening of the ligaments, the tendons, or the sheath.
The most important remedy is rest, and the shoes should always be removed. During the first three days cold in the form of immersion or continuous irrigation is indicated. Then warm moisture and continuous pressure are advised. The latter is best applied by placing two padded splints about the thickness of the thumb along the two sides of the tendon and binding them in place with even pressure by bandage. Frequent bathing with warm soap suds is also beneficial. The absorption of the exudate may be promoted and the work of restoration effected by frictions with alcohol, tincture of soap, spirits of camphor, mild liniments, strong, sweating liniments, and blisters. An excellent ointment to apply with massage consists of equal parts of blue ointment and green soap, with double the quantity of vaseline. The action of blisters in these cases depends chiefly upon the massage used in applying them and upon the continuous pressure of the swollen skin on the inflamed tendons. In old cases more beneficial results will follow line firing. In these cases shoeing is very important. Leave the quarters long, shorten the toe, give the shoe rolling motion, and either put short heel calks on the branches or thicken the branches. Although this line of treatment is efficacious in many cases, there are others in which the thickening of the tendons refuses to yield and the changed tissues remain firmly organized, leaving them in the form of a thick mass resting upon the back part of the cannon bone.
As a consequence of the last-mentioned lesion of the tendons, a new condition presents itself in the articular disposition, constituting the deformity known as the knuckling fetlock. (See also p. 400.)
By this is meant a deformity of the fetlock joint by which the natural angle is changed from that which pertains to the healthy articulation. The first pastern, or suffraginis, loses its oblique direction and assumes another, which varies from the upright to the oblique, from before backward, and from above downward; in other words, forming an angle with its apex in front.
Causes.—This condition, as we have seen, may be the result of chronic disease producing structural changes in the tendons, and it may also occur as the result of other affections or some peculiarity independent of this and situated below the fetlock, such as ringbones, sidebones, or traumatic disease of the foot proper. Animals are sometimes predisposed to knuckling, such, for example, as are naturally straight in their pasterns, or animals which are compelled to labor when too young. The hind legs are more predisposed than the fore to this deformity, in consequence of the greater amount of labor they are required to perform as the propelling levers of the body.
Symptoms.—The symptoms of knuckling are easily recognized. The changes in the direction of the bones vary more or less with the degree of the lesion, sometimes assuming such a direction that it almost becomes a true dislocation of the pastern.
The effect of knuckling upon the gait also varies according to the degree of the deformity. As the different degrees of the shortening of the leg affect the motion of the fetlock, the lameness may be very slight or quite extreme. Another consequence of this shortening is such a change in the position of the foot that the heels cease to come in contact with the ground and assume a greater elevation, and the final result of this is soon witnessed in the development of a clubfoot.
Treatment.—To whatever cause the knuckling may be ascribed, it is always a severe infirmity, and there is but little room for hoping to overcome it unless it be during the very first stages of the trouble, and the hope dwindles to still smaller dimensions when it is secondary to other diseases below the fetlock. If it is caused by overworking the animal, the first indication, of course, will be rest. Line firing has proved very efficacious in these cases. The animal must be turned loose and left unemployed. Careful attention should be given to the condition of his feet and to the manner of shoeing, while time is allowed for the tendons to become restored to their normal state and the irritation caused by excessive stretching has subsided. A shoe with a thick heel will contribute to this. If no improvement can be obtained, however, and the tendons though retracted have yet been relieved of much of their thickening, the case is not a desperate one, and may yet be benefited by the operation of tenotomy, single or double—an operative expedient which must be committed to the experienced surgeon for its performance.
Though not positively the result of diseases of the tendons acting upon the knees, we venture to consider this deformity in connection with that which we have just described. It consists in such an alteration in the direction and articulation of the bones which form the various carpal joints that instead of forming a vertical line from the lower end of the forearm to the cannon bone they are so united that the knee is more or less bent forward, presenting a condition caused by the retraction of two of the principal muscles by which the cannon bone is flexed.
Cause.—This flexion of the knee may be a congenital deformity and have continued from the foaling of the animal; or, like clubfoot, it may be the result of heavy labor which the animal has been compelled to perform when too young. It may also be due to other diseases existing in parts below the knee joint.
Symptoms.—This change of direction largely influences the movement of the animal by detracting from its firmness and practically weakening the entire frame, even to the extent of rendering him insecure on his feet and liable to fall. This condition of weakness is sometimes so pronounced that he is exposed to fall even when standing at rest and unmolested, the knees being unable even to bear their portion of the mere weight of the frame. This results in another trouble—that of being unable to keep permanently upright. He is liable to fall on his knees, and by this act becomes presently a sufferer from the lesion known by the term of "broken knees."
Treatment.—Whatever may be the originating cause of this imperfection, it detracts very largely from the usefulness and value of a horse, disqualifying him for ordinary labor and wholly unfitting him for service under the saddle without jeopardizing the safety of his rider. If, however, the trouble is known from the start, and is not the result of congenital deformity or weakness of the knee joint, or secondary to other diseases, rest, with fortifying frictions, may sometimes aid in strengthening the joints; and the application of blisters on the posterior part of the knee, from a short distance above to a point a little below the joint, may be followed by some satisfactory results; but with this trouble, as with knuckling fetlocks, the danger of relapse must be kept in mind as a contingency always liable to occur.
This lesion is the bulging backward of the posterior part of the hock, where in the normal state there should be a straight line, extending from the upper end of the point of the hock down to the fetlock.
Cause.—The cause may be a sprain of the tendon which passes on the posterior part of the hock, or of one of its sheaths, or of the strong ligament situated on the posterior border of the os calcis.
Hocks of a certain conformation seems to possess a greater liability to curb than others. They are overbent, coarse, and thick in appearance, or may be too narrow from front to back across the lower portion. This condition may therefore result as a sequence to congenital malformation, as in the case of horses that are "saber-legged." It often occurs, also, as the result of violent efforts, of heavy pulling, of high jumping, or of slipping; in a word, it may result from any of the causes heretofore considered as instrumental in producing lacerations of muscular, tendinous, or ligamentous structure.
Symptoms.—A hock affected with curb will present at the outset a swelling more or less diffuse on its posterior portion, with varying degrees of heat and soreness, and these will be accompanied with lameness of a permanent character. At a later period, however, the swelling will become better defined, the deformity more characteristic, the prominent, curved line readily detected, and the thickness of the infiltrated tissue easily determined by the fingers. At this time, also, there may be a condition of lameness, varying in degree, while at others, again, the irregularity of action at the hock will be so slight as to escape detection, the animal betraying no appearance of its existence.
A curb constitutes, by a strict construction of the term, an "unsoundness," since the hock thus affected is less able to endure severe labor, and is more liable to give way with the slightest effort. Yet the prognosis of a curb can not be considered to be serious, as it generally yields to treatment, or at least the lameness it may occasion is generally easily relieved, though the loss of contour caused by the bulging will always constitute a blemish.
Treatment.—On the first appearance of a curb, when it exhibits the signs of an acute inflammation, the first indication is to subdue it by the use of cold applications, as intermittent or constant irrigation or an ice poultice; when these have exhausted their effect and the swelling has assumed better defined boundaries, and the infiltration of the tendons or of the ligaments is all that remains of a morbid state, then every effort must be directed to the object of effecting its absorption and reducing its dimensions by pressure and other methods. The medicaments most to be trusted are blisters of cantharides and frictions with ointments of iodin, or, preferably, biniodid of mercury. Mercurial agents alone, by their therapeutic properties or by means of the artificial bandages which they furnish by their incrustations when their vesicatory effects are exhausted, will give good results in some instances by a single application, and often by repeated applications. The use of the firing iron must, however, be frequently resorted to, either to remove the lameness or to stimulate the absorption. We believe that its early application ought to be resorted to in preference to waiting until the exudation is firmly organized. Firing in dull points or in lines will prove as beneficial in curb as in any other disease of a similar nature.
This form of injury, whether of a simple or of a compound character, may become a lesion of a very serious nature, and will usually require long and careful treatment, which may yet prove unavailing in consequence either of the intrinsically fatal character of the wound itself or the complications which have rendered it incurable.
Cause.—Like all similar injuries, they are the result of traumatic violence, such as contact with objects either blunt or sharp; a curb-stone in the city; in the country, a tree stump or a fence, especially one of wire. It may easily occur to a runaway horse when he is "whipped" with fragments of harness or "flogged" by fragments of splintered shafts "thrashing" his legs, or by the contact of his legs with the wagon he has overturned and shattered with his heels while disengaging himself from the wreck.
Symptoms.—It is not always necessary that the skin be involved in this form of injury. On the contrary, the tegument is frequently left entirely intact, especially when the injury follows infectious diseases or occurs during light exercise after long periods of rest in the stable. Again, the skin may be cut through and the tendons nearly severed. A point a little above the fetlock is usually the seat of the injury. But irrespective of this, and whether the skin is or is not implicated, the symptoms resemble very much those of a fracture. There is excessive mobility, at least more than in a normal state, with more or less inability to carry weight. There may be swelling of the parts, and on passing the hands carefully along the tendon to the point of division the stumps of the divided structure will be felt more or less separated, perhaps wholly divided. The position of the animal while at rest and standing is peculiar and characteristic. While the heels are well placed on the ground, the toe is correspondingly elevated, with a tendency to turn up—a form of breaking down which was described when speaking of the fracture of the sesamoids. Carrying weight is done only with considerable difficulty, but with comparatively little pain, and the animal will unconsciously continue to move the leg as if in great suffering, notwithstanding the fact that his general condition may be very good and his appetite unimpaired.
The effect upon the general organism of compound lacerated wounds of tendinous structures, or those which are associated with injuries of the skin, are different. The wound becomes in a short time the seat of a high degree of inflammation, with abundant suppuration filling it from the bottom; the tendon, whether as the result of the bruise or of the laceration, or of maceration in the accumulated pus, undergoes a process of softening, and necrosis and sloughing ensue. This complicates the case and probably some form of tendinous synovitis follows, running into suppurative arthritis, to end, if close to a joint, with a fatal result.
Prognosis.—The prognosis of lacerated tendons should be very conservative. Under the most favorable circumstances a period of from six weeks to two months will be necessary for the treatment, before the formation of the cicatricial callus and the establishment of a firm union between the tendinous stumps.
Treatment.—As with fractures, and even in a greater degree, the necessity is imperative, in the treatment of lacerated tendons, to obtain as perfect a state of immobility as can be obtained compatibly with the disposition of the patient; the natural opposition of the animal, sometimes ill-tempered and fractious at best, under the necessary restraint causing at times much embarrassment to the practitioner in applying the necessary treatment. Without the necessary immobility there can be no close connection of the ends of the tendons. To fulfill this necessary condition the posterior part of the foot and the fetlock must be supported and the traction performed by them relieved, an object which can be obtained by the use of the high-heeled and bar shoe, or possibly better accomplished with a shoe of the same kind extending about 2 or 2-1/2 inches back of the heels. The perfect immobility of the legs is obtained in the same way as in the treatment of fracture, with splints, bandages, iron apparatus, plaster of adhesive mixtures, and similar means. So long as the dressings remain in place undisturbed and no chafing or other evidence of pain is present, the dressings may be continued without changing, the patient being kept in the slings for a period sufficient to insure the perfect union of the tendons. For a compound lesion when there is laceration of the skin some special care is necessary. The wound must be carefully watched and the dressings removed at intervals of a few days or as often as may be needful, all of which additional manipulation and extra nursing, however indispensable, still adds to the gravity of the case and renders the prognosis more and more serious. When the tendons have sloughed in threads of various dimensions, or if in the absence of this process of mortification healthy granulations should form and fill up the wound, still very careful attention will be required, the granulating ends of the tendons having a tendency to bulge between the edges of the skin and to assume large dimensions, forming bulky excrescences or growths of a warty or cauliflower appearance, the removal of which becomes a troublesome matter.
The union of the tendons will at times leave a thickening of varying degree near the point of cicatrization, the absorption of which becomes an object of difficult and doubtful accomplishment, but which may be promoted by moderate blistering and the use of alterative and absorbent mixtures or perhaps the fire iron. A shoe with heels somewhat higher than usual will prove a comfort to the animal and aid in moderating and relieving the tension of the tendons.
This is a muscle of the anterior part of the shank. It is situated in front of the tibia, and is of peculiar formation, being composed of a muscular portion with a very powerful tendon, which are at first distinct and separate, to be intimately united lower down, and terminating at the lower end by a division into four tendinous bands. It is a powerful muscle of the hinder shank bone, and also acts as a strong means of support for the stifle joint; that is, of the articulation of the thigh and shank bone, in front and outside of which it passes. Its situation and its use cause it to be liable to severe stretching and straining, and a rupture of some of its fibers is sometimes the consequence.
Cause.—This injury may be the result of a violent effort of the animal in leaping over a high obstacle; in missing his foothold and suddenly slipping backward while powerfully grasping the ground with the feet in striving to start a heavily loaded vehicle; in making a violent effort to prevent a probable fall; or in attempting to lift the feet from miry ground.
Symptoms.—The accident is immediately followed by disability which will vary according to the true seat of the injury and the period of its duration. This rupture will not prevent the horse from standing perfectly and firmly on his feet when kept at rest, and while no muscular efforts are required from him there is no appearance of any lesion or unsoundness. An attempt to move him backward, however, will cause him to throw all his weight upon his hind-quarters, and he will refuse to raise his foot from the ground. If compelled to do so, or required to move forward, the hock being no longer capable of flexion, the muscle which effects that movement being the injured one, the opposite muscles, the extensors, acting freely, the entire lower part of the leg, from the hock down, will be suddenly, with a jerk, extended on the tibia or shank bone, and simultaneously with this the tendo Achillis, the cord of the hock, the tendons of the extensors of the hock will be put in a wrinkled and relaxed condition. The leg is behind the animal and the toe rests on the ground. Examination of the fore part of the shank from the stifle down to the hock may reveal soreness, and possibly some swelling and heat at the seat of the lesion.
Treatment.—Our experience with injuries of this form convinces us that, generally speaking, they are amenable to treatment. Provided a sufficient time has been allowed for union to take place, very few instances in which radical recovery has not been effected have come to our knowledge. The more flexed the leg can be kept, the quicker will it heal.
In these cases, as in those of simple laceration of tendons, already considered, the indications resemble those which apply in the treatment of fractures, as near as coaptation of the lacerated ends is possible, with immobility, being the necessary conditions to secure. The first is a matter of very difficult accomplishment, by bandaging alone, and some have recommended instead the application of charges or blisters in order to compel the animal to keep more quiet.
To secure the necessary immobility the animal should be placed in slings snugly applied, and kept in a narrow stall. He should also be tied short, and restrained from any backward movement by ropes or boards, and should, moreover, be kept in as quiet a temper as possible by the exclusion of all causes of irritation or excitement. Weeks must then elapse, not less, but frequently more than six, often eight, before he can be considered out of danger and able to return to his labor, which should for a time be light and easy, and gradually, if ever, increased to the measure of a thoroughly sound and strong animal. If he is used too soon the newly formed tissue between the ends of the muscle will be liable to stretch and leave the flexor muscle too long and permanently displaced.
Among these there are three which will principally occupy our attention, and, which may be considered as forming a single group. In some parts of the legs may be found certain peculiar little structures of a saclike formation, containing an oily substance designed for the lubrication of the parts upon which they are placed for the purpose of facilitating the movements of the tendons which pass over them. These little sacs or muco-synovial capsules, under peculiar conditions of traumatism, are liable to become subject to a diseased process, which consists principally in a hypersecretion of their contents and an increase in dimensions, and they may undergo peculiar pathological changes of such character as to disable an animal, and in many instances to cause serious blemishes which can but depreciate its value. These growths, which are known as hygromata, may result from external violence, as blows or bruises, and may appear in the form of small, soft tumors, painless and not inflammatory in character, but, by a repetition of the cause or renewal of violence, liable to acquire increased severity. Severe inflammation, with suppuration, may follow, which, filling up the cavity, the walls will become thickened and hard, resulting in the formation of a tumor.
The elbow, the knee, and the hock are the parts of the body where these lesions are ordinarily found, and on account of their peculiar shape and the position they occupy they have received the denomination "capped." They will be considered in their peculiar aspect.
Capped elbow, or "shoe boil," is a term applied to an enlargement often found at the point of the elbow.
Cause.—This lesion is due to injury or pressure of the part while it is resting on the ground. The horse, unlike the cow, does not rest directly on the under surface of the sternum, or breastbone, on account of its sharp, ridge-like formation. He rests more on the side of the breastbone and chest, and consequently the leg which is flexed under the body is subject to considerable pressure. If the leg is flexed under the body so that the hoof or shoe is directly in contact with the elbow, which may occur in horses having an extremely long cannon bone or excessive length in the shoes, the greater part of the weight of the chest is concentrated at this point and the pressure may cause a bruise or an inflammation.
Symptoms.—Under these conditions the point of the elbow may become swollen and tender and exhibit heat and pain. This swelling may not only cover the point of the elbow, but sometimes reaches the axilla and assumes such proportions that there is great difficulty in using the leg, the animal showing signs of lameness even to the extent of the circumflex step, as in shoulder lameness. This edematous condition, however, does not remain stationary. It may by degrees subside or perhaps disappear. In the first instance it will become more distinctly defined, with better marked boundaries, until it is reduced to a soft, round, fluctuating tumor, with or without heat or pain. There is then either a bloody or serous tumor or a purulent collection, and following the puncture of its walls with the knife there will be an escape of blood, serum, or pus, as the case may be, in variable quantities. In either case, but principally in that of the cystic form, the tumor will be found to be subdivided by septa, or bands running in various directions.
Various changes will follow the opening of the tumor and the escape of its contents. In a majority of cases the process of cicatrization will take place, and the cavity fill up by granulation, the discharge, at first abundant, gradually diminishing and the wound closing, usually without leaving any mark. At times, however, and especially if the disease has several times repeated its course, there may remain a pendulous sac, partly obliterated, which a sufficient amount of excitement or irritation may soon restore to its previous dimensions and condition.
In other cases an entirely different process takes place. The walls of the cavity, cyst, or abscess become ulcerated and thickened, the granulations of the sac become fibrous in their structure and fill up the cavity, and it assumes the character of a hard tumor on the back of the elbow, sometimes partly and sometimes entirely covered by the skin. It is fibrous in its nature, painless to the touch, well defined in its contour, and may vary in size from that of a small apple to that of a child's head.
This last form of capped elbow is the most serious of any, resisting all known forms of mild treatment, and removable by the knife only. The other forms, even that with the inflammatory aspect and its large edematous swelling which interferes with the work of the animal, may justify a much milder prognosis, and, aside from their liability to recur, may be ranked with the comparatively harmless affections.
Treatment.—So long as the danger of recurrence is the principal bad feature of capped elbow the most important consideration is that of devising a means for its prevention. To prevent the animal from lying down is evidently the simplest method of keeping the heels and the elbow apart; but the impracticability of this prescription is apparent, since most animals are obliged to lie down when they sleep, though it is true that a few take their sleep on their feet. The question of shoeing here enters into the discussion. The shortening of the inside branch of the shoe, which is the one with which the pressure is made, may be of advantage, and especially if the truncated end of the shoe is smooth and filed over to remove all possibility of pressure and contusion upon the skin. The protection of the skin of the elbow by interposing soft tissues between that and the shoe, or by bandaging the heel with bags or covering it with boots, is considered by many the best of the preventive methods, and the advantage to be obtained by resorting to it can not be overlooked when the number of horses which develop shoe boil whenever the use of the boot is intermitted is considered. In order to prevent the animal from assuming the sternal decubitus, many give preference to the plan of fastening a piece of wood across the stall at some distance from the front wall or manger. It is a simple expedient, primitive, perhaps, but nevertheless practical, and followed by good results.
The therapeutic treatment is also important. The edematous swelling, when recognized by its external appearance and the existing inflammation, should be treated without delay. Warm fomentations, repeated several times daily, are then indicated, the degree of warmth being as high as can be borne comfortably. They are easily applied and often yield decided relief in a few hours. In some cases, however, astringents, in the form of poultices or pastes, are used in preference; these are made to cover the entire swelling and allowed to remain, drying after a short time, it is true, and perhaps falling off, but are easily renewed and reapplied. An excellent astringent for these cases is a putty made of powdered chalk and vinegar (acetate of lime), and the whole swelling is then covered with a thick coating of soft clay made into a mass with water.
These simple remedies are often all that is required. Under their use the swelling passes off by degrees and after a short interval the animal is fit for work again, but not uncommonly instead a swelling develops, puffy, not painful, and perhaps giving a sensation of crepitation when pressure is applied with the finger. It is soft, evidently contains a liquid, and when freely opened with a good-sized incision discharges a certain quantity of blood, partly liquid and partly coagulated, and perhaps a little hemorrhage will follow. The cavity should then be well washed out and a plug of oakum introduced, leaving a small portion protruding through the cut to prevent it from closing prematurely. It may be taken off the next day, and a daily cleansing will then be all that is necessary. In another case the tumor becomes very soft in its whole extent, with evident fluctuation and a well-defined form. The discharge of the fluid is then indicated, and a free incision will be followed by the escape of a quantity of thin yellowish liquid from a single sac. The wound should be kept clean and dressed frequently, in order to insure prompt healing. But if the cavity is found to be subdivided in its interior by numerous bands and the cyst proves to be multilocular the partitions should be torn out with the fingers and the cavity then treated in the same manner as the unilocular sac. In still another case the swelling may be warm and painful with indistinct fluctuation, or fluctuation only at a certain point. This indicates an abscess, and necessitates an incision to drain the pus, followed by the careful cleansing and dressing of the wound.
But cases occur in which all the treatment that has been described fails to effect a full recovery, and instead a fibrous tumor begins to develop. A change of treatment is, of course, then in order. The inflammation being chronic will necessitate stimulating treatment of the part in order to increase the process of absorption. We must again draw upon the resources of experience in the form of blisters, the fomentations, the iodin, and the mercurial ointments, as heretofore mentioned. Good results may always be insured from their judicious and timely administration. In applying the powerful mineral inunctions much patience and wisdom are required. It should be done by carefully and perseveringly rubbing in small quantities daily; it should be done softly and gently, not with force, nor with the expectation of producing an astonishing effect by heavy dosing and main strength in a few hours; it should be after the manner of a siege rather than that of a charge. The object is to induce the drugs to permeate the affected part until the entire mass is penetrated. Of course cases will be encountered which resist all forms of medical treatment. The tumor remains as a fixed fact; it continues to grow; it is large and pendulous at the elbow; its weight is estimated in pounds; it is not an eyesore merely, but an uncomfortable, burdensome mass, excoriating all the surrounding parts and being itself excoriated in turn; mild treatment has failed and is no longer to be relied on.
Resort must now be made to surgical methods, and here again we must choose between the ligature, the cautery, and the knife. Each has its advocates among practitioners. In a case like the present, one of the difficulties arises in connection with the application and retention of bandages and other dressings after the amputation has been performed. It is a somewhat difficult problem, owing to the conformation and proportions of the body of the patient, and involves the exercise of considerable practical ingenuity to adjust and retain the appliances necessary to insure a good final result.
In the long description of the treatment of the varieties of capped elbow I have thus far omitted any mention of one method which is practiced and commended by not a few. I refer to the use of setons, introduced through the tumor. My own experience and the observation of many failures from this method led me to abandon it.
The passage of the tendons of the extensor muscle of the cannon, as it glides in front of the knee joint, is assisted by one of the little bursæ before mentioned, and when this becomes the seat of dropsical collection a hygroma is formed and the knee is "capped." Though in its history somewhat analogous to the capped elbow, there are points of difference between them. Their development may prove a source of great annoyance from the fact of the blemish which they constitute.
Cause.—The capped knee presents itself under various conditions. It is sometimes the result of a bruise or contusion, often repeated, inflicted upon himself by a horse addicted to the habit of pawing while in the stable and striking the front of the stall with his knees. Another class of patients is formed of those weak-kneed animals which are subject to falling and bruising the front of the joint against the ground, the results not being always of the same character.
Symptoms.—The lesion may be a simple bruise, or it may be a severe contusion with swelling, edema, heat, and pain. The joint becomes so stiff and rigid that it interferes with locomotion and yet under careful simple treatment the trouble may disappear.
Again, instead of altogether passing off, the edema may diminish in extent, becoming more defined in form and may remain as a swelling on the front part of the knee. Resulting from the crushing of small blood vessels, this is necessarily full of blood. The swelling is somewhat soft, diffuse, not painful, more or less fluctuating, and after a few days becomes crepitant under the pressure of the hand.
Instead of being filled with blood the swelling may be full of serum, as often occurs when violence, though perhaps slight, has been frequently repeated. In that case the swelling is generally well defined, soft, and painless, with more or less fluctuation, and it may even become pendulous. In other cases the swelling may be of an acute, inflammatory nature, with heat and pain, accompanied with stiffness of the joint. This leads to the formation of an abscess. Whatever the nature of these swellings may be, either full of blood, serum, or pus, some blemish usually remains after treatment.
Prognosis.—Though simple bruises of the knee without extensive lesions are usually of trifling account, a different prognosis must be pronounced when the lesion assumes more important dimensions, and though a capped knee may be comparatively of little importance we have seen cases in which not only extensive blemishes were left to disfigure the patient, but the animals had become worthless in consequence of the extension of the diseased process to the various elements composing the joint, and giving rise to the most complicated cases of carpitis.
Treatment.—Usually the first symptom of trouble is the edematous swelling on the front of the "knee." The prevention of the inflammation and consequently of the abscess, is the prime object in view, and it may be realized by the use of warm-water fomentations or compresses applied over the swelling, which may be used either in a simple form or combined with astringents, such as Goulard's extract, alum, or sulphate of zinc. The application of warm poultices of oil meal or ground flaxseed, enveloping the whole joint and kept in place by bandages, is often followed by absorption of the swelling, or, if the abscess is in process of formation, by the active excretion of pus. If an abscess forms in spite of these precautions it may be treated surgically in several ways.
In one it should be done by a careful incision, which will allow the escape of the blood or the serum, or of the pus which is inclosed in the sac; in another it may be by means of a seton, in order that the discharge may be maintained and allowed to escape; for another we may adopt the more cautious manner of emptying the cavity by means of punctures with small trocars or aspirators. The danger attending this last method arises from the possible sloughing of large portions of the skin, while that attending the first is the hazard of the possibility of the extension of the inflammation to the capsular ligament of the knee, with the possibility of an open joint in prospect.
As we have remarked, the cavity after being emptied may rapidly close and leave in a short time but slight traces of its previous existence. But in many, if not in most cases, there will remain, after the cicatrization is complete, a thickening or organized exudation at one time round and well defined, at another spreading by a diffused infiltration, to which it will be necessary to give immediate attention, from the fact of its tendency to form into an organized and permanent body. To stimulate inflammation in this diseased structure, blisters are recommended, but chiefly for the purpose of promoting the process of absorption.
If this treatment fails, the use of iodin and mercurial preparations is recommended.
Plain mercurial or plain iodin ointment, or both in combination as iodid of mercury, are commonly used, and may be applied either moderately and by gentle degrees, as we have suggested, or more freely and vigorously with a view to more immediate effects, which, however, will also be more superficial. The use of the firing iron applied deeply with fine points is then to be strongly recommended, to be followed by blisters and various liniments. This course may generally be relied on as quite sure to be followed by satisfactory results.
While the treatment is in progress it will, of course, be necessary to secure the animal in such manner that a recurrence of the injury will be impossible from similar causes to those which were previously responsible.
A bad habit of rubbing or striking the partitions of their stalls with their hocks prevails among some horses, with the result of an injury which shows itself on the upper points of those bones, the summit of the os calcis. From its analogy to the condition of capped elbow the designation of capped hock has been applied to this condition.
Symptoms.—A capped hock is therefore but the development of a bruise at the point of the hock, which if many times repeated may excite an inflammatory process, with all its usual external symptoms of swelling, heat, soreness, and the rest of the now-familiar phenomena. The swelling is at first diffused, extending more or less on the exterior part of the hock, and in a few instances running up along the tendons and muscles of the back of the shank. Soon, however, unless the irritating causes are continued and repeated, the edema diminishes, and, becoming more defined in its external outlines, leaves the hock capped with a hygroma. The hygroma, at the very beginning of the trouble, contains a bloody serosity which soon becomes strictly serum, and this, through the influence of an acute inflammatory action, is liable to undergo a change which converts it into the usual purulent product of suppuration.
The external appearance ought to be sufficient to determine the diagnosis, but there are a few signs which may contribute toward a nicer identification of the lesion. The capped hock, whether under the appearance of an acute, edematous swelling, or as a bloody serous collection, or as a simple serous cyst, does not give rise to any remarkable local manifestation other than such as have already passed under our survey in considering similar cases, nor will it be liable to interfere with the functions which belong to the member in question, unless it assumes very large dimensions and on each side of the tendons, as well as on the summit of the bone. But if the inflammation is quite high, if suppuration is developing, if there is a true abscess, or—and this is a common complication—especially when the kicking or rubbing of the animal is frequently recurring, then, besides the local trouble of the cyst or of the abscess, the bones become diseased and the periosteum inflamed; perhaps the superior ends of the bone and its fibro-cartilage become affected, and a simple lesion or bruise, whatever it may have been, becomes complicated with periostitis and ostitis, and is naturally accompanied with lameness, developed in a greater or less degree, which in some cases may be permanent and in others increased by work. These complications, however, are not common or frequent.
Treatment.—Capped hocks are in many cases amenable to treatment, and yet they often become the opprobrium of the practioner by remaining, as they frequently do, an eyesore on the top of the hock; they do not interfere, it is true, with the work of the horse, but fixing upon him the stigma of what, in human estimation, is a most unreliable and objectionable reputation, to wit, that of being an habitual "kicker," and, worse than all, one that kicks when fed.
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.