LAMENESS OF THE HORSE VETERINARY PRACTITIONERS' SERIES, NO. 1 TEXT

stopping absorption by the surest and most harmless of intestinal astringents. Whether the astonishingly prompt and certain action of alum in this case is due wholly to its astringent action or whether alum combines with the harmful bacterial products chemically and forms an innocuous combination, I can only surmise, and it is unimportant. At any rate, when alum is administered, the onslaught of the disease is promptly stopped. Irreparable damage may already have been done if the case is a neglected one, but whether administered early or late in acute attacks, the progress of the disease is stopped immediately. The same authority may be profitably quoted in the matter of handling all cases wherein the revulsive effect of agents which diminish vascular tension are chiefly indicated or necessary as adjuvants. In this connection, Campbell says: The early and vigorous administration of aconitin in laminitis to its full physiological effect, is more logical. Assuming that laminitis is due to absorption of harmful products from the intestinal tract permitted through the deranged functioning of the organs of digestion, or assuming that it is due to an extension of the inflammation from the mucosa to the sensitive lamina, or that it is a reflex from a sudden chilling of the skin, we have in any of these conditions a disturbed circulation, and aconitin is the first and foremost of circulation "equalizers." Furthermore, in laminitis there is an elevation of the temperature, an almost invariable indication for aconitin. A speedy return of the temperature to normal, a very marked diminution of the pain and improved conditions generally, appear coincident with the symptoms of full physiological effect of aconitin when given in cases of laminitis, which constitutes assuredly an important part of its treatment. [Illustration: Fig. 35--Inferior (convex) surface of Cochran shoe.] Where lameness is not great as in cases wherein no marked structural change of the foot has occurred, proper shoeing is very beneficial. By keeping the heels as low as possible and shoeing without heel calks a more comfortable position is made possible. Thin rubber pads which do not elevate the heel are of service in diminishing concussion. Dr. David W. Cochran of New York City has attained unusual success in cases of chronic laminitis with dropped sole by the use of a specially designed shoe. [Illustration: Fig. 36--Superior surface, showing concavity or bowl, as formed by the toe and branches of the shoe, as designed by Dr. David W. Cochran.] Cochran claims that, not only are horses with dropped soles that would otherwise have to be put off the streets enabled to do a fair amount of work by means of this shoe, but that continually wearing it, meanwhile keeping the convexity of the front of the hoof rasped thin, in time brings about a marked improvement, and that after some months or years of use the animals are able to work with ordinary rubber-pad shoes, provided they are arranged to facilitate breaking over. From having been successfully used on some race horses of high value, the Cochran shoe has attained considerable notoriety and is being used by a number of practitioners. A disadvantage, however, arises from the fact that few horseshoers other than Doctor Cochran seem able to make the shoe, the peculiar shape of which offers considerable difficulty in forging. Concerning the application of the shoe Cochran[32] says: "The most important primary procedure is the preparation of the foot to receive the shoe. All excess of growth must be removed from the anterior face of the hoof. The outer face must be reduced at the toe (not shortened), but rasped down thin for the lighter the top of the foot is, the more chance the sole and coffin bone will have of resuming their former normal position. The pressure of the wall at the toe upon the exudate between wall and coffin bone, tends to force the coffin bone and sole out of their normal position. Leave the sole alone. You can lower the excess of growth at the heels. "There are many designs of shoes to relieve this condition. A great deal depends on the judgment of the shoer to meet the conditions presented, depending on the degree of the convexity and strength of the sole. In some cases we use a shoe that admits of a large amount of sole room. Again, we shoe with a shoe of wide cover. In other cases a shoe with even pressure over the whole sole. In some cases a high, narrow shoe, resting only on the wall, or the ordinary plain shoe with side calks welded close to the outside edge and the shoe dished well from these as a foundation. Then we have the air cushion pad designed after the model of the bowl shoe." In cases when slight and persistent lameness interferes sufficiently to prevent using an animal at any sort of work on hard roads, median neurectomy will relieve all lameness in most instances. This is a safe operation, moreover, in that no bad after effects are to be feared, even though lameness were to continue. Calk Wounds. (Paronychia.) Etiology and Occurrence.--Injuries of various kinds are inflicted upon the coronary region but usually they are due to the foot being trampled upon. When the foot that inflicts the injury happens to be unshod, a contusion of the injured member is occasioned, but in the majority of instances, wounds that demand attention are the result of shoe calks which have penetrated the tissues in the region of the coronary band. Often calk wounds are self-inflicted. When animals are excited and in turning crowd one another, they often perform dancing movements which frequently result in deep calk wounds of the coronet. Some horses have a habit of resting the heel of one hind foot upon the anterior coronary region of the other. While sleeping in this position, if they are suddenly awakened, the weight is abruptly shifted to the uppermost foot and the one underneath is (because of the pain attending its being wounded) quickly drawn out from under its fellow. In this way deep cuts may divide the coronary band and inflict extensive injury to the sensitive lamina as well. An infectious type of coronary inflammation occurs in some localities during the winter months, wherein the condition is enzootic. Symptomatology.--Depending upon the manner in which the injury has been produced, the appearance of the wound varies and likewise lameness is more or less pronounced. If the tissues are not divided and the wound is chiefly of the subsurface structures, there will not immediately occur pronounced local evidence of the existence of injury; but as soon as the lame animal is made to move, the peculiar character of the impediment (supporting-leg lameness with the affected foot kept well in advance of its normal position) directs attention to the extremity and all of the symptoms of acute inflammation are discovered. Where a wound is inflicted which divides, in some manner, the surface structures (skin, coronary band, or the hoof wall) one's attention is at once called to the existence of the wound. Because of the fact that there is every facility for the production of a sub-coronary and podophylous infection, these wounds should receive prompt attention. In some instances, the pastern joint is opened by calk wounds and then, of course, an infectious arthritis succeeds the injury. Treatment.--In all contused wounds of the coronary region the parts need thorough cleansing; the hair, if long is clipped and a cataplasm is applied. Or preferably, an iodin-glycerin combination of one part of iodin to four parts of glycerin is poured on a layer of cotton, and this is confined in contact with the inflamed parts by means of a bandage. Where normal resistance to infection obtains, the subject usually suffers no suppurative disturbance when the surface structures are not broken; and daily applications of the antiseptic lotion above referred to stimulates complete resolution. This may be expected in from four to ten days depending upon the extent of the injury. If a calk wound has been inflicted, the adjoining surface structures are freed of hair and the parts cleansed in the usual manner, (which in wounds recently inflicted, should be done without employing quantities of water) and after painting the wound surface with tincture of iodin and saturating its depths with the same agent, the wound is cleansed, if it contains filth, by means of a small curette. By using a small and sharp curette, one is enabled to cleanse the average wound quickly and almost painlessly. In such cases, equal parts of tincture of iodin and glycerin are employed. The wound is filled with this preparation and a quantity of it is poured upon a suitable piece of aseptic gauze or cotton and this is contacted with the wound. The extremity is carefully bandaged and this dressing is left in position for forty-eight hours unless there occurs, in the meanwhile, evidence of profuse suppuration--which is unusual. One is to be guided as to the progress made by the degree of lameness present. If little or no lameness develops, it is reasonable to expect that infection has been checked; that the wound is dry and redressing every second day is sufficiently frequent. Where cases progress favorably, recovery (unless infectious arthritis results) should occur in from ten days to three weeks. Where extensive sub-coronary fistulae result, either from lack of prompt or proper attention, the condition is then one requiring a radical operation to establish drainage and to disinfect if possible, the suppurating tissues. Corns. Etiology and Occurrence.--In horses, because of a tendency toward contraction of the heel in some subjects, together with work on hard roads and pavements, where the feet become dry and brittle, and because of neglect of the matter of shoeing, this affection is of frequent occurrence. Unshod horses are rarely affected. If conformation is faulty and too much weight is borne on the inner or the outer quarter, and the hoof wall at the quarter tends to turn inward, corns are usually present. They occur more frequently on the inner quarters of the front feet, though the outer quarters are occasionally also affected and in rare instances corns are found at the toes. They do not often affect the hind feet. As soon as injury by pressure, such as is supposed to cause the formation of corns, is brought to bear on the sensitive sole, an extravasation of blood occurs. In time when the cause remains active, this discoloration is evident in the substance of the insensitive sole and consists in a red or yellowish spot which varies in size--this is ordinarily termed dry corn. In some cases where infection of this extravasation of blood and serum occurs, instead of desiccation and discoloration of the insensitive parts, there is, in time, manifested a circumscribed area of destruction of the insensitive sole and the abscess may, where no provision for drainage exists, burrow between sensitive and insensitive laminae and perforate the tissues at the coronet. If the suppurative material discharges readily by way of the sole, no disturbance of the heel or quarters occurs above the hoof. Symptomatology.--A supporting-leg-lameness characterizes this condition; and this lameness in most instances varies in degree with the amount of distress which is occasioned by pressure upon the inflamed parts. By an examination of the sole after having removed all dirt, and exposed the horny sole to view, no difficulty is encountered in locating the cause of the trouble. Treatment.--Before suppuration has taken place and in the cases where suppuration does not occur, the horse-shoer's method of paring out the diseased tissue affords a means of temporary relief; but unless frequently done, in many cases, lameness results within about three weeks after such treatment has been given. In other instances temporary relief is not to be gotten in this manner for any great length of time or until a more rational mode of treatment becomes necessary so that the subject may experience a cessation of the inconvenience or distress. The general plan which meets with the approval of most practitioners consists in careful leveling of the foot and removing enough of the wall and sole at the quarters to make possible frog pressure by means of a bar shoe. With frog pressure, expansion of the heel follows in time, and permanent relief is obtainable in this manner. Thinning the wall of the quarter is advocated by many practitioners and is undoubtedly beneficial in chronic cases where marked contraction has taken place. The wall must be thinned with a rasp until it is readily flexible by compressing with the thumbs. There are instances, however, where corns and contraction of the heel have existed so long that they do not yield to treatment. Such cases are found in old light-harness or saddle-horses that have been more or less lame for years and where there exists marked contraction of the heels, rough hoof walls, and hard and atrophied frogs. Suppurating corns require surgical attention in the way of removal of the purulent necrotic mass and making provision for drainage. Dry dressings, such as equal parts of zinc sulphate and boric acid, may be employed to pack the cavity. After the infectious condition has been controlled, and the wound is dry, the same plan of treatment is indicated that is employed in the non-suppurating corn. Ample time is allowed, however, for the surgically invaded tissues to granulate and, if the subject is to be put in service, a leather pad, under which there has been packed oakum and tar, affords good protection. Quittor. This name is employed to designate an infectious inflammation of the lateral cartilage and adjoining structures. The disease is characterized by a slowly progressive necrosis and by a destruction of more or less of the cartilage and by the presence of fistulous tracts. Etiology and Occurrence.--The disease is due to the introduction of pus producing organisms into the subcoronary region of the foot under conditions which favor the retention of such contagium and extension of infection into contiguous tissues. Morbific material is introduced into the region of the lateral cartilage by means of calk wounds and other penetrant injuries of the foot. A sub-coronary abscess which, because of lack of proper care or because of virulency of the contagium or low vitality of the subject, is quite apt to result in cartilaginous affection and its perforation by necrosis follows. Symptomatology.--Quittor is readily diagnosed on sight in many instances. Where there is dependable history or other evidence of the chronicity of an infectious inflammation of the kind, quittor is easily identified. If no positive evidence of the disease exists, by means of careful exploration of sinuses with the probe, one may distinguish between true cartilaginous quittor and superficial abscess formation that is often accompanied by hyperplasia. Lameness depends upon the extent of the involvement as it affects the structures contiguous to the cartilage. A variable degree of lameness is manifested in different cases. Treatment.--Two general plans of handling this disease are in vogue. One, the more popular method, consists in the injection of caustic solutions of various kinds into the fistulous openings with the object of causing sloughing of necrotic tissue and the stimulation of healthy granulation of such wounds. The other mode consists in either complete surgical removal of the cartilage or its remaining portions, or removal of the diseased parts of curettage. When quittor has not extensively damaged the foot and the lateral cartilage is not partly ossified as it is in some old chronic cases, the complete removal of the lateral cartilage by means of the Bayer operation or a modification thereof is indicated. A complete description of the Bayer operation as well as Merillat's operation for this disease (the latter consisting in part, in the removal of diseased cartilage with the curette) are given in Volume three of Merillat's "Veterinary Surgical Operations." Treatment by injection of caustic solutions has many advocates and because of the fact that, in many instances the condition is such that they are not desirable surgical cases and also because some animals may be put in service before treatment is completed, the injection method is popular. The mode of treatment advocated by Joseph Hughes, M.R.C.V.S., constitutes a very successful manner of handling quittor and we can do no better than quote Dr. J.T. Seeley[33] on his manner of using this particular treatment. [Illustration: Fig. 37--Hyperplasia of right fore foot, due to chronic quittor.] Preparation.--First remove the shoe, have the foot pared very thin and balanced as nicely as possible. Moreover, all loose fragments of horn must be detached and all crevices cleaned thoroughly. Next, have the leg brushed and hair clipped from the knee or hock to the foot and scrubbed with ethereal soap and warm water, after which the foot must be scrubbed in like manner. The foot is then placed in a bichlorid bath several hours daily, for from two to five days, depending upon whether or not soreness is shown. The bichlorid solution is 1 to 1,000 strength. On removing the horse from the bath a liberal layer of gauze is soaked in 1 to 1,000 bichlorid solution and placed so as to cover the entire foot. On discontinuing the bath, cover the foot with gauze saturated with a 1 to 1,000 bichlorid solution. This is to be covered with absorbent cotton and a gauze bandage, and over all is placed an oil cloth or silk covering. This pack is kept moist with bichloride solution for forty-eight hours. The foot is then ready for injection. [Illustration: Fig. 38--Chronic quittor, left hind foot. Showing position assumed because of painfulness of the affection.] Preparation of the Injection Fluids.--Have on hand a pint of a one per cent aqueous solution of formaldehyd made under cleanly conditions, even to a clean bottle and cork, and a clean container when ready to use the liquid. Prepare also a bichlorid of mercury solution as follows: Hydrarg. Chlor. Corros. 3IV; Acid Hydrochlor. 3Iss.; Aqua Bulliens, Oij. This should be thoroughly triturated, and then filtered into a clean bottle, when it is ready for use. Injection.--The patient should be laid on a table, if one is available, or cast, and the foot securely fixed. Then, with an ordinary one-ounce hard rubber syringe, with a good plunger (tried first to note whether or not any fluid works around between the barrel and the plunger), introduce one syringe full of the formaldehyd solution, then thoroughly probe the quittor to determine the number of sinuses. This done, inject each sinus. If two sinuses open on the surface, close one with cotton while filling the other so that if there is a connection the solution will come in contact with all tissues involved. Irrigate with the full pint of formaldehyd solution first, then follow with six or eight ounces of the bichlorid solution. Never probe the foot nor allow it to be tampered with except in the manner prescribed. After-Treatment.--Put on a pack saturated with a solution of bichlorid of mercury 1 to 1,000 and let it remain two days. Remove pack, and once daily afterwards wipe off with cotton the secretion which accumulates on the outside, and apply a dry dressing or healing oil composed of phenol, camphor gum and olive oil.