FIG. 107.—RESECTION OF TERMINAL PORTION OF THE PERFORANS. The horny sole and the horny frog stripped from off the sensitive structures. a, The plantar cushion; b, b, the plantar aponeurosis, or terminal portion of perforans; c, the navicular bone; d, interosseous ligaments of the pedal articulation; e, e, semilunar crest of the os pedis; f, inferior surface of os pedis; g, g, the sensitive laminæ of the bars; h, h, bearing surface of the wall; i, i, the sensitive sole; k, the sensitive frog.
When at all diseased the glenoidal surface of the navicular bone should be curetted, even to the extent of the removal of the whole of the cartilage. A healthy, granulating surface is thus insured.
The above figure from Gutenacker's 'Hufkrankheiten' explains shortly the position of the operation wound and the structures involved, rendering further description unnecessary here.
The operation ended, the dressing follows. Upon this depends very largely the ultimate recovery of the patient, for it is only by careful attention and suitable dressings that effectual repair of the injured structures may be brought about.
A light shoe is first tacked on to the foot, and those portions of the horny sole that have been allowed to remain dressed with Venice turpentine, tar, or other thickly-adherent antiseptic.
The exposed soft tissues are then dressed with pledgets of tow[A] soaked in alcohol and carbolic acid. This dressing must be allowed to remain in position, and is kept there by means of a bandage, or the shoe with plates (Fig. 55) and a bandage over it. No pressure is needed; consequently, the pledgets of tow must not be too thick.
[Footnote A: When using tow in the form of a pad, it is well to remember that many small balls of the material rolled lightly in the palm of the hand and afterwards massed together are far better than one large pad of the tow taken without this preparation. The irregularities of the wound are better fitted, and the whole dressing easier remains in situ (H.C.R.).]
In the after-dressing of the wound careful attention must be paid to the granulating surface. Where tending to become too vigorous in growth it should be held in check by suitable caustic dressings. At the same time it must be remembered that the granulating process of repair is always more rapid upon the plantar cushion and fleshy sole than upon the bone, or upon tendinous or cartilaginous structures. As a result of this we have a wound showing various aspects of cicatrization. Healthy granulation may be profuse in one spot, while in another it may be checked either by a flow of synovia from the still open bursa, or by fragments of bone or of tendon still acting as foreign bodies in the wound. These latter may be readily detected by their standing out as dark and uncovered spots in the healthy granulation around, and should be at once removed.
The time that an operation wound of this description takes to heal—and that without complication—is from one to two or three months. Continuation of pain and intensity of lameness are not to be taken as indications of failure. The reparative inflammation in the synovial membrane is quite sufficient to induce pain severe enough to prevent the animal from placing his foot to the ground for some weeks, even though the progress of the case, all unknown, may be all that is desired. So long as a great amount of pain is absent, and so long as appetite remains and swellings in the hollow of the heel fail to make their appearance, so long may the progress of the case be deemed satisfactory.
Recorded Case of the Treatment.—A cart-horse, aged six years, was sent to the Alfort School by a veterinary surgeon for having picked up a nail in the hind-foot. Professor Cadiot, judging the necessity for the complete operation, performed it on January 14, and spared the plantar cushion as much as possible. In consequence of the plantar aponeurosis being extensively necrosed, it was advisable to scrape the navicular bone and a part of the semilunar crest. The wound having been washed with a 1 per cent. solution of perchloride of mercury, it was dusted with iodoform and packed with gauze, and covered with a cotton-wool dressing, kept in position by means of a suitable shoe.
On January 16 there was no snatching up of the limb when the horse was made to put weight upon it; he ate his food well, and his condition improved every day. On January 21 the dressing was removed; the wound appeared pinky and granular, and there was no suppuration. The clot remaining from the hæmorrhage after the operation was removed, the wound was irrigated with a hot solution of sublimate, and then dusted with iodoform and covered with a dressing of iodoform gauze and absorbent wool. At this date the horse could stand on the injured limb. On January 31 a second dressing was made, and the animal almost walked sound. On February 7 the wound had almost closed up, save in its central part, where there was a small cavity, and the lameness had disappeared. On February 15 the wound had completely healed, and its borders were covered by a layer of thin horn. As the animal was sound it was sent to work.
The author directs attention to the rapidity with which a large and complete wound cicatrizes after the operation for gathered nail.[A]
[Footnote A: Veterinary Record, vol. XV., p. 226 (Jourdan).]
In the case of Penetrated Navicular Bursa, unaccompanied by the formation of any large quantity of pus, and uncomplicated by necrosis of the aponeurosis, our aim must be to maintain the wound in that happy condition. This is doubtless best done by keeping the foot continually in a cold bath, rendered strongly antiseptic by the addition of sulphate of copper and perchloride of mercury. Should there be intervals when the bath must be neglected, the foot in the meantime must be kept clean by antiseptic packing and bandaging, and a clean bag over all. This treatment should be continued so long as the character of the discharge denotes that synovia is running. If, in spite of our precautions, the discharge becomes purulent, then the track made by the penetrating object should be syringed twice daily with a 1 in 1,000 solution of perchloride of mercury.
During the treatment it will be wise to shoe the animal with a high-heeled shoe. We do not know as yet the full extent of the injury. The navicular bone may be tending to caries; or necrosis of the plantar aponeurosis, all unknown, gradually becoming pronounced. This calls for a relief of tension on the perforans, and is only to be brought about by the high-heeled shoe.
The result of the inflammatory changes in the tendon, aided possibly by the use of the high-heeled shoe, is to afterwards bring about contraction. Where this has occurred, and the animal walks continuously on his toe, the shoe with the projecting toe-piece (Fig. 84) must be applied. When the continual use of the toe-piece appears inadvisable, the shoe devised by Colonel Nunn may be used in its stead (see Fig. 108).
The toe-piece is screwed into the toe of the shoe when the horse is about to be exercised, and forms a powerful point of leverage with which to stretch the contracted tendon, and the shoe, being thin at the heels, admits of this. The advantage of this form of toe-piece over the ordinary form of fixed toe-lever is that it can be removed when the horse is in the stable; while the curved point diminishes the danger of the horse hurting itself—a danger always present if it is on a hind-foot. (See also Treatment of Purulent Arthritis in Chapter XII.)
COLONEL NUNN'S SHOE WITH DETACHABLE TOE EXTENSION.
FIG. 108.—COLONEL NUNN'S SHOE WITH DETACHABLE TOE EXTENSION.
Should a Sinuous Wound remain in the region of the Lateral Cartilage, it should be explored, and its depth and likely number of branches ascertained. Should this exploration denote that the cartilage itself is diseased, or that the wound is not able to be sufficiently drained from the sole, then we know that we have on our hands a case of quittor. The treatment necessary in such a case will be found described in Chapter X.
When the Complication of Purulent Arthritis has arisen, the surgeon has to admit to himself, reluctantly no doubt, that the case is often beyond hope of aid from him. Nothing can be done save to order continuous antiseptic baths and antiseptic irrigation of the wounds with a quittor syringe, and to attend to the general health and condition of the patient. At the best it is but a sorry look-out both for the veterinary attendant and the owner of the animal. Even with resolution incurable lameness results, and the animal is afterwards more or less a walking exhibition of the limitations of surgery, while the owner, unless the animal is valuable for the purpose of breeding, finds himself encumbered with a life that is practically useless. (See Treatment of Purulent Arthritis, Chapter XII.)
In the case of Lameness Persisting after the healing of all appreciable lesions, then neurectomy is followed by good results. The animal, apparently recovered, is for a long time useless. Lameness persists for several months, as if the nail had at the moment of its penetration caused lesions, which doubtless it sometimes does, similar to those of navicular disease. Examination of the foot in this case reveals no lesion, and the pain has evidently a deep origin. The lameness caused by it is subject to variation. Frequently it becomes lessened during rest, and increased by hard work, while sometimes it is very much more pronounced at starting than after exercise.
It is here that neurectomy is called for. The operation does nothing to impede the work of healing going on, and allows free movement of the foot and pastern to take place. At the same time suffering and emaciation cease, and the animal is rendered workable.[A]
[Footnote A: Veterinary Record, vol. ii., p. 371.]
1. Acute.
Definition.—Under the heading of simple coronitis in its acute form we intend to describe those inflammatory conditions of the skin and underlying structures of the coronet occurring without specific cause. Specific coronitis will be found described in Chapter IX.
Causes.—This condition is almost invariably set up by an injury—either a bruise or an actual wound—to the coronet. By far the most common among such injuries are those inflicted by the animal himself by means of the shoes.
That known as 'tread' is caused by the shoe on the opposite foot, and may happen in a variety of ways. More often than not it is met with in the feet of heavy draught animals, and is there caused by the calkin, either when being violently backed or suddenly turned round. It may also occur in horses with itchy legs, as a result of the animal rubbing the leg with the shoe of the opposite limb. The irritation in this case is nearly always due to parasitic infection (Symbiotes equi), and becomes sometimes so unbearable as to render the animal unmindful of the injury he may be inflicting so long as he experiences the relief obtained by the rubbing.
Self-inflicted tread is also sometimes met with when horses are worked abreast at plough. The animal in the furrow, with one foot sometimes in and sometimes out of the hollow, is caused to make a false step, and so brings the injury about.
Animals worked in pairs are further liable to receive a tread from the foot of their companion. This is commonly seen in heavy animals at agricultural labour in fields, where the walking is uneven, and abrupt turning constant. It is not uncommon either in animals at work in vans in town, and is occasionally met with in the feet of carriage-horses.
'Overreach' is the term used to indicate the injury inflicted on the coronary portion of the heel of the fore-foot by the shoe of the hind. Ordinarily, overreach occurs when the animal is at a gallop, and is thus met with in its severest form in hunters and steeplechasers. It can only occur when the fore-foot is raised from the ground and the hind-foot of the same side reached right forward. When the feet separate the injury takes place. In its movement backwards the inner border of the shoe of the hind-foot catches the coronet of the fore, and tears it backwards with it. Quite frequently a portion of the skin is removed entirely, but often it hangs as a triangular flap. The flap in such a case is always attached by its hindermost edge, and indicates plainly enough that the direction of the blow that cut it must have been from before backwards.
Although ordinarily inflicted at the gallop, the same injury may, nevertheless, be caused by allowing a fast trotter, and one with extreme freedom of action behind, to push forward at the utmost limit of his pace. The outside heel is the one most subject to the injury.
While the common form of injury to the coronet is, as we have described, that occasioned by the animal's own shoe, or that of a companion, it is evident that the foot is also open to similar injuries from quite outside sources. Falls of the shafts when unyoking animals from a heavy cart, blows or wounds from the stable fork, wounds resulting from the foot becoming fixed in a gate or a fence, either may equally well set up the mischief.
Apart from severe injury, a particularly troublesome form of coronitis may arise from the condition of the roads. We refer to the conditions attendant on a thaw after snow. The animal is called upon to labour in, or perhaps stand for long periods in, a mixture of snow and water, or snow and mud. That this must have a prejudicial effect upon the structure of the coronet is plain. The circulation of the part, already predisposed to sluggishness by reason of its distance from the heart, is farther impeded by the action of the cold. Small abrasions of the skin, so small as to scarce be noticeable, are in this case freely open to infection with the septic matter the mud contains. Necrosis and consequent sloughing of the skin is bound to follow, and an extensive ulcerous wound, or a spreading suppuration of the coronary cushion is the result.
Symptoms.—We will take first the case in which no actual wound is observable. Here the first indication of the trouble is the appearance of an inflammatory swelling, confined usually to one side, but extending sometimes to the whole of the coronet. Always the part is hot and tender, and with it the patient is lame—so much so, in many cases, as to be unable to put the foot to the ground, the toe alone being used.
In a mild case, uncomplicated by septic infection, these symptoms rapidly subside, and resolution occurs.
Always, however, the presence of septic infection must be suspected and looked for. When this has occurred, the inflammatory swelling becomes larger and more diffuse, and the animal fevered. This is then followed by a slough of the injured part. A portion of the skin first becomes gray, or even black, in appearance, and around it oozes an inflammatory exudate, or even pus. The skin immediately adjoining the spot of necrosis is swollen and hyperæmic, and extremely painful and sensitive. Later, the necrosed portion becomes cast off, and an open wound remains. This as a rule marks the turning-point in the case. The pain and other symptoms rapidly abate, and the wound, with proper attention, is not more than ordinarily difficult to treat.
In the case of an actual wound the symptoms are probably less severe. The injury is, in this instance, the sooner detected, and remedial measures put into operation. In this manner the formation of septic material is often checked, and nothing but the treatment of a simple wound demands attention.
There are, however, complications.
Complications—(a) Diffuse Purulent Inflammation of the Sub-coronary Tissue.—This condition is brought about by the spread into the loose tissue of the coronary cushion of the septic material introduced by the tread. The whole coronet in this instance becomes excessively swollen, hot, and painful, and the dangerous nature of the complication is evident enough when the structure and situation of the parts involved is considered. The amount of tendinous and ligamentous material in the neighbourhood offers a strong predisposition to necrosis, and the necrosis, with its attendant formation of pus, offers a further danger when the close proximity of the pedal articulation and the unyielding character of the horny box is considered with it.
The pus formed in this condition may remain confined to the coronet and break through the skin as an ordinary abscess, or it may, before so doing, burrow beneath the wall, and invade the sensitive laminæ. In this case, whenever portions of the secreting layer of the keratogenous membrane are destroyed, or perhaps only temporarily prevented from fulfilling their horn-producing functions, then corresponding cavities in the horn are the result (see Fig. 109).
(b) Purulent Arthritis.—Only too readily the pus so formed tends to penetration of the articulation and the causation of an incurable arthritis (see Chapter XII.).
MESIAL SECTION OF A HOOF ILLUSTRATING THE CONDITIONS FOLLOWING UPON CORONITIS.
FIG. 109.—MESIAL SECTION OF A HOOF ILLUSTRATING THE CONDITIONS FOLLOWING UPON CORONITIS. a, Cavity in the horn of the wall; b, enlargement of the coronet and the horn of the wall following sub-coronary suppuration; c, cavity in the wall following purulent inflammation of the sensitive laminæ; d, hollow in the horn of the sole consequent upon suppuration of the sensitive sole.
(c) Necrosis of the Extensor Pedis.—This may arise either as a result of spreading purulent infection of the coronary cushion, or as a result of direct injury immediately over it. The close relation of the terminal portion of this tendon with the pedal articulation, and the incomplete protection from outside injuries here afforded to the joint by the horny box, sufficiently points out the gravity of the condition.
(d) Penetration of the Articulation.—This also may be a result either of the inroads made by pus, or of an actual wound. When occurring from the latter, it is seen more often than not in the hind-foot, being there caused by the calkin of the opposite foot. Where a wound in this position is characterized by an excessive flow of synovia, the condition should be suspected, and, if the wound be large enough, the little finger should be introduced in order to ascertain. Needless to say, the injury is a grave one.
(e) Sand-crack.—Sand-crack is likely to result from tread when an injury is inflicted in the region of the quarter by a severe overreach. Treads, too, especially with the calkin of the hind-shoe, are especially apt to end in this way. In this latter instance the sand-crack usually has its origin in a nasty jagged tear at the top of the wall of the toe.
(f) Quittor.—In one respect any suppurating wound at the coronet may be deemed a quittor. By indicating quittor as a complication of coronitis, however, we denote the more serious form of this disease, in which the wound has taken on a sinuous character, and conducted pus to invasion of the lateral cartilage. It is one of the worst complications we are likely to meet with in this condition, and will be found fully described in Chapter X.
(g) False Quarter.—This complication of coronitis occurs when the injury or after-effect of the formation of pus has been severe enough to destroy outright a comparatively large portion of the papillary layer of the coronary cushion. To this condition we devote Section D of this chapter.
Prognosis.—In giving a prognosis in a case of coronitis, attention should be paid to the manner in which the condition originated, and the extent, when present, of the wound.
When the inflammatory swelling has arisen from bruising alone, without actual division of the skin, when the weather is that of winter, and the swelling showing a marked tendency to spread, then the prognosis must be guarded. As we have seen, this state of affairs is probably ushering in a condition of spreading suppuration of the coronary cushion, and considerable gangrene and sloughing of the skin. We have here no intimation as yet of how far the suppurative process may run, nor what important structures it may involve. Consequently, the guarded prognosis we have mentioned is imperative.
Where an actual wound is to be seen, and where advice is sought early, then a more favourable opinion may be advanced. In this case antiseptic measures, commenced early and persisted in, may prevent the rise of further mischief.
It goes without saying that, should there arise any other of the complications we have mentioned (viz., Arthritis, Necrosis of the Extensor Pedis, Sand-crack, Quittor, and False Quarter), the fact should be pointed out to the owner, and the prognosis regulated thereby.
Treatment—Preventive.—Seeing that at any rate the majority of cases of coronitis result from injuries inflicted by the shoes, we may look at once to that particular for a means of prevention.
Take first the case of 'treads'. There is no doubt that they are most common in animals shod with heavy shoes and with high and sharp calkins. This suggests at once that a preventive is to be found in substituting a calkin that is low and square.
Where the injury is an overreach, and where, on account of the animal's pace and manner of gait it is in risk of being constantly inflicted, the shoeing should be seen to at once.
We have already pointed out that it is the inner border of the lower surface of the toe of the hind-shoe which, in the act of being drawn backwards, inflicts the injury. (See Fig. 110).
In this case prevention may be brought about either by shoeing with a shoe whose ground surface is wholly concave, or by bevelling off the sharp border (see Fig. 110, a, p. 236). When the tendency to overreach is not excessive, prevention may in many cases be effected by simply placing the shoe of the hind-foot a trifle further backwards than would ordinarily be correct, thus allowing the horn of the toe to project beyond the shoe. This at the same time does away with the annoyance of 'forging' or 'clacking,' which, as a rule, accompanies this condition.
While recognising the value of shoeing in these cases, we must not forget that a great deal may be brought about by careful horsemanship. The animal should be held together and kept well up to the bit, but should not be allowed to push forward at the top of his pace. With many animals of fast pace and free action overreach is more an indiscretion of youth than any defect in action or conformation, and his powers should therefore be husbanded by the driver until the animal has settled down into a convenient and steady manner of going.
UNDER SURFACE OF THE TOE OF A HIND-SHOE.
FIG. 110.—UNDER SURFACE OF THE TOE OF A HIND-SHOE. a, Marks the portion of the inner margin that inflicts overreach.
THE INNER MARGIN OF THE INFERIOR SURFACE OF THE HIND-SHOE BEVELLED TO PREVENT OVERREACH.
FIG. 111.—THE INNER MARGIN OF THE INFERIOR SURFACE OF THE HIND-SHOE BEVELLED TO PREVENT OVERREACH.
Curative.—Although in some cases it is so small as to go undetected, we may take it that in all cases of coronitis there is a wound, with consequent danger of septic infection of the surrounding parts. Therefore, after attention to the shoeing and removal of the cause, the first indication in the treatment will be to render the parts aseptic. This is best done by removing the hair from the coronet and soaking the whole foot in a cold antiseptic solution. After removal from the bath, the coronet may be dressed with a moderately strong solution of carbolic acid or perchloride of mercury. When the injury is slight and recent, such is sufficient to effect resolution.
When marked swelling persists, however, and the increase in heat and tenderness denotes the formation of pus, recovery is not so easily obtained. In this case the application of hot poultices or hot baths is called for. By these means suppuration is promoted and induced to early break through in the most favourable position—namely, the softened skin of the coronet. The pus so escaping is always more or less blood-stained, and contains both large and small pieces of broken down and decomposed tissue. After discharge of the pus, the cavity remaining should be mopped out with an antiseptic solution, and a pledget of antiseptic tow or other material left in position. All that is then needed is constant dressing in a suitable manner. We prefer in this instance washing some three or four times a day with hot water until a perfectly clean wound is obtained, and, after the washing, painting the raw surface with a strong solution (1 in 200, or 1 in 100) of perchloride of mercury.
When the abscess we have described as forming is extremely large, or where it is more than ordinarily slow in 'pointing,' the likelihood of its having burrowed for some distance below the upper margin of the wall must be suspected. Here it is sometimes wise to thin the wall with the rasp immediately below the point of greatest swelling of the coronet. This will serve to lessen pressure on the sensitive structures beneath.
Immediately the abscess contents have found exit at the coronet, the cavity formerly occupied by the pus should be explored. If to any extent it is found then to have 'pocketed' beneath the upper border of the wall, a counter-opening should be made where the horn of the wall has been thinned with the rasp.
When it so happens, either from extensive bruising or from the action of excessive cold, that we have or suspect the condition of sloughing, then the first indication is to aid the live tissues to throw off the necrosed portion. In spite of what is sometimes urged to the contrary, a hot poultice is, perhaps, the best means of bringing this about. Directly the necrosed piece is shed, a wound remains which, so far as treatment is concerned, may be regarded exactly as that left by the formation of pus. Hot water applications, some three or four times daily, will serve both to cleanse the wound and also to maintain vitality in the tissues immediately surrounding it. After each washing, the use of a strong antiseptic solution to the wound is again beneficial.
In the case of an actual wound, whether, as in overreach, affecting the coronet alone or involving destruction of part of the wall, or, as in the case of toe-tread, penetrating the pedal articulation, the treatment to be followed is simple enough, in theory, if not always easy to carry out. It consists solely in maintaining a rigid asepsis of the parts until healing is well advanced or complete. The whole foot, including the coronet, should first be thoroughly washed in warm water. At the same time there should be used some agent that will tend to remove the natural grease of the parts. In this manner cleansing will be rendered more thorough, and penetration of the antiseptic solution to be afterwards applied made the more certain. The most ready way of effecting this is to use the ordinary stable 'water'-brush, and plenty of a freely-lathering soap.
This done, the foot should be rinsed in cold water, and afterwards constantly soaked in a cold antiseptic bath. Where it is inconvenient or impossible to have the constant bathing carried out, a dry antiseptic dressing may be tried in its stead. In this case the foot should first be thoroughly washed and dressed as before. Afterwards an antiseptic powder in the shape of a mixture of iodoform 1 part, boracic acid 10 parts, should be freely dusted on the wound, a pledget of carbolized tow or cotton-wool placed over it, and the whole maintained in position with a bandage previously soaked in a 1 in 500 solution of perchloride of mercury. Once on, this dressing should be allowed to remain until healing is complete. Should the animal manifest pain, however, by constantly pawing, or should swelling and heat of the parts be suspected, the bandage should be removed, and the condition of the wound ascertained.
An excellent example of the value of this method of treatment is that given below:
'I call to mind a valuable hunter in my practice a few seasons since, who, whilst hunting, we suppose, struck himself in the way we suggest. He not only removed the superior portion of the inner heel, but tore about 3 inches of the hoof from the top nearly to the bottom. This was clapped back by the owner, tied with a handkerchief, and the horse removed home. When the handkerchief was removed, I confess I did not think the horse looked at all like hunting again. The heel was fairly pulled down, the portion of the hoof that was hanging to it I could easily have wrenched off. The parts were fomented, however, with warm water which was slightly carbolized. I then removed a great portion of the heel and the lateral cartilage, which was split; placed the portion of hoof again on the laminæ, smothered the wound with iodoform pulv., covered it with cotton-wool packing, and all the boracic acid I could get it to hold. A piece of linen bandage was then tightly wrapped a few times round, and the lot enclosed in a plaster-of-Paris bandage. I did not undo it for a fortnight, when, to my great pleasure, the heel and hoof presented a highly satisfactory appearance. I did it up in much the same way for another ten days, then put the sand-crack clamps into the hoof and fixed it to the sound part. The hoof remained in position while the new horn grew from the top, and the horse hunted again the same season.'[A]
[Footnote A: Veterinary Record, vol. ix., p. 501 (Bower).]
Sequels.—Either of the complications we have mentioned—as, for instance, Arthritis, Sand-crack, or Quittor—may persist and remain as sequels to the case. In addition to these, there may be left behind a cavity in the horn of the wall (see Fig. 109), or a loss of the horn-substance of the wall proper, as that depicted in Fig. 112, or described under the heading of False Quarter.
HOOF WITH A CAVITY IN THE SUBSTANCE OF THE WALL FOLLOWING UPON 'TREAD' TO THE CORONET.
Fig. 112.—HOOF WITH A CAVITY IN THE SUBSTANCE OF THE WALL FOLLOWING UPON 'TREAD' TO THE CORONET.
The treatment of Arthritis, Sand-crack, Quittor, False Quarter, and Seedy-toe, will be found in the chapters devoted to their consideration.
2. Chronic.
Definition.—Coronitis in which, owing to the persistence of the cause, inflammatory phenomena continue, resulting in the growth of large fibrous tumours about the coronet.
Causes.—In many cases it is possible, of course, that abnormal large growths in this position may have an origin similar to that of neoplasms elsewhere—that is to say, an origin as yet undiscovered. There is no doubt, however, that the majority of the huge enlargements about the coronet have their starting-point in one or other of the diseases to which the foot is liable, in which the cause remains, and a low type of inflammation persists.
In chronic and neglected suppurating corn, in untreated quittor, and in long-standing complicated sand-crack, for instance, we have conditions in which pus and other septic matters find ready entrance into the sub-coronary tissues. Should either of these be neglected, or should the pus formation from the onset take on a slow but gradually spreading form (in other words, should either of these cases run a chronic rather than an acute course) then, with the persistence of the inflammatory phenomena so caused, is bound to result a steady and increasing growth of inflammatory fibrous connective tissue. This, as it grows, becomes in its turn penetrated by the ever-invading pus, and, under the stimulus thus caused, itself throws out new tissue. And so, constantly excited, the tumour-like mass tends to steady increase in size, until enlargements are formed which one may sometimes truly term enormous.
Symptoms.—The appearance of the growth is, of course, immediately evident. Usually these swellings are slow in forming, so that the size of the enlargement depends entirely upon its age. We may thus meet with growths of this description, varying in weight from 4 or 5 pounds to the almost incredible size of 33-1/2 pounds. In the majority of cases a discharging sore is to be found upon it—in some cases several. Explored, these sores reveal their true nature. Their lip-like openings, and the ready manner in which they may be searched by the probe, show them to be sinuses.
In a few cases, however, the outer surface of these tumours is intact. When this is the case, it is possible that the growth is a true fibroma—that is to say, a non-inflammatory new growth of fibrous connective tissue. On the other hand, it may have resulted from one or other of the causes we have enumerated, and its exact diagnosis have been impossible until operative measures had been proceeded with. In this case, small and encysted foci of inspissated pus scattered more or less throughout the growth indicate its true nature.
Pain as a rule is absent, and, unless the growth, on account of its size, interferes with progress, the animal walks perfectly sound. Here the patient may, without offending the dictates of humanity, be put to slow work.
Treatment.—In very many cases, possibly on account of the decreased circulation and vitality of the parts, these growths occur in aged animals. Here treatment is not economic, and may for that reason be put out of the question. Further, the growths are more common in heavy cart animals of a lymphatic type than in those of a lighter breed. Couple this with the fact that the tumour is often unattended with pain, and we see that the animal is still able to perform his accustomed labour. Here, again, treatment is contra-indicated.
For still another reason surgical treatment, which is the only treatment likely to be of benefit, must not be undertaken rashly. A large and open wound is bound to be left behind. So large is it in many cases that the complete covering of the exposed surface with epidermal growths from the circumference cannot possibly be looked for. There is then left a large and horny-looking scar, which is an even worse eyesore than was the original enlargement.
When the patient is a young and otherwise valuable animal, however, and when the case, judged either by the size of the swelling or its outside appearance, promises a fair measure of success, operative measures may be determined on.
In this case the author's practice has been, after casting the animal, to apply a tourniquet to the limb and proceed to excision. A lozenge-shaped incision, extending to near but not quite the circumference of the swelling, should be made with a large knife right through the skin and deeply into the growth. The whole is then removed, proceeding in an excavating manner under the thickened skin at the margin. Hæmorrhage, though proceeding from several apparently large vessels in the structure of the tumour, and oozing generally over the whole of the outer surface, is rarely profuse enough to interfere with the operation, and is easily controlled by cold water douches and the application of the artery forceps to one or more of the larger vessels. The operation completed, the larger bleeding-points should be secured by exerting torsion with the artery forceps, and the surface oozing stayed by frequent dashing with cold water.
When the hæmorrhage has sufficiently ceased, an ordinary flat firing-iron should be passed over the whole of the cut surface, and an effectual eschar formed.
Following this, and before removing the tourniquet, the wound should be filled with pledgets of carbolized tow, and the whole tightly secured by a stout and broad linen bandage of not less than 6 yards in length.
Reported Case.—'The patient, a middle-aged cart mare, had a pair of fore-feet the like of which I never saw. As the result of long-standing and imperfectly-treated quittor all over the seat of side-bone on the outer side of each fore-foot, beginning pretty far forward, and extending to the heel on the inner side, filling up the hollow and reaching nearly to the fetlock, was a big, bulging, hard, calloused enlargement or tumour standing out 3 or 4 inches all round, covered with thick horny skin and stubby hair, and having on its surface the small openings of several sinuses leading deeply down to the ossified and diseased cartilage underneath. And yet with all this diseased undergrowth the mare, strangely enough, walked and trotted sound. I was told that this mare had been troubled with suppurating corns and quittor, that many unsuccessful attempts had been made at cure, but that, getting worse instead of better, these tumours had formed.
'After casting and anæsthetizing, a strong rubber tourniquet was placed above the knee and the operation commenced. With a surgeon's amputating knife all the big fibrous mass which I could safely remove was cut and sliced off, and the coronet and pastern reduced as nearly as possible to its natural dimensions. The diseased cartilage, or side-bone, gave some trouble, a considerable portion having to be cut and scraped, and the sinus in it gouged out; but its complete removal did not appear to be called for.
'There was little if any hæmorrhage until release of the tourniquet, when the whole broad surface became deluged with blood, three or four small arteries spurting and veins flowing in all directions, so much so that I was glad to refix the clasp, and with the firing-iron seal up the vessels, searing gently all over the surface.
CHRONIC CORONITIS FOLLOWING 'TREAD.'
FIG. 113.—CHRONIC CORONITIS FOLLOWING 'TREAD.'
'A good dusting with antiseptic powder, a thick pad of carbolized wool, and two long calico bandages wound tightly round, completed the work.
'The other, the near-leg, was then dealt with in the same way.
'The mass removed weighed a little over 9-1/2 pounds—5 pounds from the off-foot and 4-1/2 pounds from the near. Its structure was fibrous tissue, almost as firm and hard as cartilage, and with no appearance of malignancy.
'The after-treatment consisted simply of fresh dry dressings—copper, sulphate, zinc sulphate, and calamine, equal parts—applied every third or fourth day, after first bathing the feet in a shallow tub of warm antiseptic water.
'At the end of eight or ten weeks a fairly presentable appearance existed. The greater part of what had been raw surface was covered with healthy skin, and the remainder had become dry and horny.'[A]
[Footnote A: Veterinary Record, vol. xiv., p. 201 (C. Cunningham, M.R.C.V.S.).]
A further form of chronic coronitis is that shown in Fig. 113.
This condition is commonly the result of a severe and jagged tread with the calkin, and takes the form of an ulcerous and excessively granulating wound. As time goes on the granulations become hard and horny-looking, and their fibrous tissue as hard and unyielding as tendon or cartilage.
These if treated in the early stages with repeated dressings of caustic, or, if very exuberant, the use of the knife, usually yield to treatment. If neglected until the condition depicted in the figure is arrived at, then treatment, as a rule, is of no avail. Neither is treatment of any use if any great loss of the coronary cushion has occurred.
Definition.—False quarter is the term applied to that condition of the horn of the quarter in which, owing to disease or injury of the coronet, the wall is grown in a manner that is incomplete.
Symptoms.—This condition of the foot appears as a gap or shallow indentation, narrow or wide, in the thickness of the wall, with its length in the direction of the horn fibres. By this we do not mean that the sensitive laminæ are bared and exposed. Horn of a sort there is, and with this the sensitive structures are covered. Running down the centre of the incomplete horn is usually a narrow fissure marking the line of separation in the papillary layer of the coronary cushion, which, as we shall later see, is responsible for the malformation.
On either side of the indentation, as if wishing to aid further than ordinarily it should in bearing the body-weight, the horn takes on an increased growth, and stands above the level of the horn surrounding it. It may, as perhaps it really is, be regarded as a form of hypertrophy, brought about by the increased work that the loss of substance in the region of the false quarter puts upon it.
So long as the sensitive structures are protected the animal remains sound. Sometimes, however, from the effects of concussion or of the body-weight, a fissure appears in the narrow veneer of horn that covers them. Into this, which, of course, is but a form of sand-crack, gravel and dirt penetrate, and so set up inflammatory changes in the keratogenous membrane. As a result suppuration ensues, and the animal is lame.
Causes.—False quarter may result from any disease of the foot that involves destruction of a portion of the coronary cushion. As we may see from a reference to Chapter III., it is from the papillæ of this body that the horn tubules of the wall are secreted. Destruction of any portion of it necessarily results in a corresponding loss of horn in that position. The disease occasioning this more often than any other is perhaps quittor. It may also result from suppurating corn, from a severe tread or overreach, or from the effects of a slowly progressing suppurating coronitis.
Treatment.—A radical treatment of false quarter is not to be found. Once destruction of the secreting layer of the coronary cushion has occurred, the appearance of the fissure in the wall will always have to be reckoned with. A false quarter, therefore, not only renders the horse liable to occasional lameness, but also renders weaker that side of the hoof in which it occurs.
The only method of treatment that can be practised, therefore, is that of palliation. Seeing that the trouble the veterinary attendant will have to deal with is loss of a portion of the weight-bearing surface, his attention is immediately directed to the shoeing. As with sand-crack, so with false quarter, the frog and the bars must be called upon to take more of the body-weight than commonly they do with the ordinary shoe. The indication, then, is a bar shoe. At the same time, the bearing of the wall on the shoe on either side of the fissure should be eased by slightly paring it, and the hypertrophied horn on the outer surface of the wall removed with the rasp.
In cases where penetration of the sensitive structures has occurred, complicated with the formation of pus, the same treatment as for complicated crack is to be followed. The foot should be poulticed for several days with hot antiseptic dressings, and thorough cleansing of the infected parted brought about. Afterwards strong solutions of suitable antiseptics should be applied daily until such time as the horny covering has renewed itself. This done and the bar shoe applied, the fissure may be plugged with any effectual stopping. Either a mixture, such as Percival's, of pitch 2 parts, tar 1 part, and resin 1 part, melted and mixed together, or one of the artificial hoof-horns may either be used with advantage.
Causes.—Seeing that this accident to, and consequent severe wounding of, the keratogenous membrane nearly always occurs in but one way, it is worthy of special mention. So far as we are able to ascertain, it is an accident peculiar to horses continually engaged in shunting operations either in pits or station-yards. At the moment the animal is released from the waggon he has been pulling, and should turn to the right or the left in order to allow it to pass him, the shoe either becomes wedged in between two converging rails, or is trapped by the wheel of the waggon. Either the approaching waggon with the added weight its impetus gives it then pushes the animal suddenly away, leaving a part of his foot still fixed to the rails, or the animal himself, feeling securely held, makes a sudden effort to release himself, and draws his foot cleanly out of the imprisoned horny box.
The author calls to mind a case in which entire removal of the horn of the foot of an ox occurred through the passing over it of the wheel of a heavily-laden cart. It is therefore quite conceivable that the same accident might occur to the horse. As a matter of fact, we find one case on record where one-half of the horny box was thus removed.[A]
[Footnote A: Veterinary Record, vol. xiii., p. 129.]
So far as we are able to gather, it is more a result of imprisonment of the shoe than of the foot. It appears, further, to be always a result of the animal being newly shod, and the clinches firmly secured; so much so that it would be probable, with imperfectly secured clinches, that the animal would draw the hoof from the clinches and the shoe rather than the foot from its horny covering.
Therefore, as the author of one of the cases we shall afterwards relate suggests, it should be proposed as a preventive that the shoe-nails of animals regularly engaged in work on the metals should not be clinched in the regulation manner, but should have their points merely screwed off, and the nails afterwards rasped level with the wall.
These cases are particularly interesting as illustrating the rapid manner in which a new hoof is afterwards formed, and the way in which the exposed sensitive laminæ take their share in adding to, though not forming the bulk of, the horn of the wall.
From the cases we are able to record it will be seen that this accident need not be looked upon as fatal, nor the injury itself beyond hope of repair. Dependent largely upon the temperament of the animal, the amount of pain that is caused, and the way in which the animal bears it, recovery may be looked for. Even from the very commencement of the accident, however, the pain may be so acute and the animal so violent with it that slaughter becomes necessary.
Treatment.—This consists in applying an antiseptic and sedative dressing to the injured parts (for example, Carbolized Oil and Tincture of Opium, equal parts) and afterwards bandaging.
From the only data we are able to work on, it appears that this dressing should be repeated daily, the bandage being removed, each time, the foot well bathed in warm water, and the dressing and bandage afterwards replaced. On first sight, it would appear that once cleansed and bandaged the dressings might be left in situ for several days. Seeing, however, that suppuration, if once set up, would add further to the intense pain the animal is already suffering, and considering the always constant exposure of the foot to infection, it is perhaps wise to persist in daily changing of the dressings.
At the same time, the general health of the animal should be attended to. Suitable febrifuges should be administered, either in the shape of a dose of physic, or salines and liq. ammonia. acetatis; and the pain, if appearing unbearable, allayed by doses of choral and hypodermic injections of morphia.
Recorded Cases.—1. 'A short time ago I was called to see a horse which had had his hoof torn off in a railway "point." When I arrived at the stable the injury had been done two hours, and the horse had been led from the railway to a loose-box nearly half-a-mile off. On going to this box I was surprised and horrified to find the poor animal mad with pain, rolling and dashing himself about. When on his back he would struggle and kick the walls with the injured foot, as though unconscious of pain. Not one moment was he still, and as I could see that the sensitive structures were much damaged by his violence, I obtained a gun and put him out of his pain.
'The accident happened in this way. The horse was employed in shunting coal-waggons, and had just drawn four loaded trucks up to a point at which they diverged to the left, and the horse, being unhooked, ought to have turned to the right. Here, unfortunately, the near fore-foot became wedged in between two converging railway plates, one of which formed a part of the waggon-way, on which the trucks were running. The horse was a big animal, and freshly shod with heavy shoes, on which a toe-piece and calkins were used. The shoe was roughly but strongly nailed on with eight nails, the clinches of which were all firm. This shoe was fitted wide at the heels, and when the foot was fixed in the points (toe downwards) it protruded over the face of the rail. When the trucks reached it they pressed it down, and, the horse leaning forward, the hoof was drawn off like a glove. The hoof was almost as clean inside as if taken off by maceration—only towards the toe was a small portion of the coffin-bone and some torn laminæ left inside the hoof.
'As soon as possible after the accident, so I was told, the foot was bound up with tow and a bandage; then a sack was cut up and placed over all, and the horse slowly led to his loose-box. He "carried" the leg all the way, limping along on the three sound ones. Almost immediately after reaching the box he lay down, but only for a short time. The standing position was not long maintained—profuse perspiration set in, and the alternations of position became more rapid and violent, till plunging and rolling were added to the other signs of excruciating pain. I was also told that the groaning of the poor animal was almost constant, and at times so loud and prolonged as to amount to a shriek.
'I have no experience of a similar case, and I should not have supposed that this accident would have caused such acute suffering and violent symptoms. I think I have heard of such cases making a complete recovery; but I feel sure that, in this case, I only anticipated death by, at most, a few hours.'[A]
[Footnote A: Veterinary Record, vol. iv., p. 127.]
2. 'The case I am about to give you an account of, being one of rare occurrence, I thought would not prove uninteresting to the members of the Veterinary Medical Association. It is an instance of complete removal of the hoof by mechanical force.
'Our patient was a brown mare, five years old, the property of Messrs. Crawshaw and Co., railway contractors on the Sheffield and Manchester line.
'On June 20 the mare was, as usual, working on the line, drawing one of the waggons for the removal of soil from one place to another, and, as was the custom, the pace is generally increased at about the distance of from sixty to eighty yards from where the unloading takes place, in order to add to the velocity, so that the contents of the waggons might roll down so great a precipice. It was at this increased action, when the mare was being removed from the waggon, that she stepped between the ends of two iron rails, sufficiently apart to admit the foot only, when one end of the rail inserted itself between the sole and toe of the shoe, the other at the top and in front of the crust.
'The mare, finding herself fixed, endeavoured to disengage herself, and, in doing so, got in front of the waggon, which, coming at a great pace, forced her down into the pit, leaving behind the off fore-hoof, which was only removed from its situation between the two rails by a large hammer, it being so firmly wedged in. The shoe and hoof were bent in a very peculiar manner, as the accompanying cuts will show, the inside heel being completely raised from above the level of the frog, not one of the nails being unclenched, or in the slightest degree having given way to so large an amount of force imposed upon them, although the toe of the shoe was raised from the sole by the rail being immediately under it (see Fig. 114). The mare had been shod the day before, and, having a good sound foot, the shoe was firmly put on.
'Being a mile from home, she was with some difficulty made to travel that distance. On her arrival, my preceptor, Mr. Taylor, was immediately sent for, who found her, as I have before stated, with the off fore-foot hoofless.
'Proceeding to examine the foot, he ascertained that it had bled considerably, which, however, was stopped by bandages to the foot and a ligature round the coronet. The laminæ on one side and a small portion of the sensitive sole, though not to any great extent, were lacerated. The coffin-bone was not at all injured. The bleeding having nearly ceased, she was put into slings, the foot carefully washed with warm water, and immediately bound up with pledgets of tow saturated with the simple tincture of myrrh and tincture of opium, of each equal parts.