Special Report on Diseases of the Horse Part 44

HIP LAMENESS.

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 pa.s.sing from one region to the other in a description of its anatomy, its physiology, and its pathology would be a subst.i.tution 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 repet.i.tion to cover again the ground over which we have so recently pa.s.sed 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, periost.i.tis, ost.i.tis, 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 circ.u.mstances, 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 advis.e.m.e.nt, in respect to the formidable affection known as morbus c.o.xarius, 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 c.o.xarius, 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 pa.s.sive motion. This will probably cause pain when the leg is made to a.s.sume 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 circ.u.mflex 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 a.s.sumed by the disease, but of the permanence of the disability resulting from it.

Exostosis and ulcerative arthritis are sequelae which often resist every form of treatment.

_Treatment._--As before intimated, this is little more than a repet.i.tion 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.

SPRAINS OF SUSPENSORY LIGAMENTS AND OF FLEXOR TENDONS OR THEIR SHEATHS.

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 circ.u.mstances 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 s.h.i.+fted 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 pa.s.sive 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 hors.e.m.e.n 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 a.s.sumed 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 ma.s.sage consists of equal parts of blue ointment and green soap, with double the quant.i.ty of vaseline. The action of blisters in these cases depends chiefly upon the ma.s.sage 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 ma.s.s resting upon the back part of the cannon bone.

KNUCKLING OF FETLOCK.

As a consequence of the last-mentioned lesion of the tendons, a new condition presents itself in the articular disposition, const.i.tuting 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 a.s.sumes 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 a.s.suming 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 a.s.sume 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.

SPRUNG KNEES.

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 princ.i.p.al 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 p.r.o.nounced 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.

CURB.

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 pa.s.ses 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, coa.r.s.e, 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 const.i.tutes, 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 const.i.tute 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 a.s.sumed 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.

LACERATED TENDONS.

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 "thras.h.i.+ng" 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 pa.s.sing 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 appet.i.te unimpaired.

The effect upon the general organism of compound lacerated wounds of tendinous structures, or those which are a.s.sociated 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 acc.u.mulated 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 circ.u.mstances 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 embarra.s.sment to the pract.i.tioner 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 a.s.sume 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.

RUPTURE OF THE FLEXOR METATARSI.