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TUFTS UNIVERSITY LIBRARIES 
 
 3 9090 013 413 014 
 
 Webster Family Library of Veterinary Medicine 
 Cummings School of Veterinary Medicine at 
 Tufts University 
 200 Westboro Road 
 North Grafton, MA 01 536 
 
V E T E R I X A R Y PRACTITIONERS' SERIES 
 
 N O. 1 
 
 LAMENESS of the HORSE 
 
 BY 
 
 J. V. Lacroix, D. V. S. 
 
 Professor of Surgery, The Kansas City Veterinary College 
 Author of "Animal Castration" 
 
 Illustrated 
 
 Chicago 
 
 AMERICAN JOURNAL OF VETERINARY MEDICINE 
 
 1916 
 
Copyright, 1916 
 
 By 
 
 D. M. CAMPBELL 
 
PREFACE 
 
 AH that can be known on the subject of lameness, is founded 
 on a knowledge of anatomy and of the physiology of locomotion. 
 Without such knowledge, no one can master the principles of 
 the diagnosis of lameness. However, it must be assumed that 
 the readers are informed on these subjects, as it is impossible 
 to include this fundamental instruction in a work so brief as 
 this one. 
 
 The technic of certain operative or corrective procedures, has 
 been described at length only where such methods are not gener- 
 ally employed. Where there is no departure from the usual 
 methods, treatment that is essentially within the domain of sur- 
 gery or practice is not given in specific detail. 
 
 Realizing the need for a treatise in the English language 
 dealing with diagnosis and treatment of lameness, the author 
 undertook the preparation of this manuscript. That the dif- 
 ficulties of depicting by means of word-pictures, the symptoms 
 evinced in baffling cases of lameness, presented themselves in 
 due course of writing, it is needless to say. 
 
 It is hoped that this volume will serve its readers to the end 
 that the handling of cases of lameness will become a more satis- 
 factory and successful part of their work; that both the prac- 
 titioner and his clients may profit thereby; and last but by no 
 means least, that the horse, which has given such incalculable 
 service to mankind and is deserving of a more concrete reward, 
 will be benefited by the application of the principles herein out- 
 lined. 
 
 In addition to the consultation of standard works bearing on 
 various phases of the subject of lameness, the author wishes to 
 thankfully acknowledge helpful advice and assistance received 
 from the publisher. Dr. D. ]\I. Campbell ; to appreciatively credit 
 Drs. L. A. Merillat, A. Trickett and F. F. Brown for valuable 
 suggestions given from time to time. Particular acknowledg- 
 ment is made to Dr. Septimus Sisson, author, and W. B. Saun- 
 ders & Co., publishers of The Anatomy of Domestic Animals, 
 for permission to use a number of illustrations from that work. 
 
 J. V. L. 
 
 Chicago, Illinois, October, 1916. 
 
Justice shows a triumphant face at the works of 
 humane practitioners, ivho give serious thought 
 and expend honest effort, for the alleviation of 
 animal suffering. 
 
TABLE OF CONTENTS 
 
 Page 
 
 Illustrations "^ 
 
 Introduction 11 
 
 SECTION I 
 
 Etiology and Occurrence 15 
 
 Affections of Bones 15 
 
 Rarefying Osteitis, or Degenerative Changes 16 
 
 Fractures --- 16 
 
 Affections of Ligaments 20 
 
 Luxations — Dislocations 21 
 
 Arthritis 22 
 
 Affections of Bursae and Thecae 27 
 
 Affections of Muscles and Tendons 28 
 
 Affections of Nerves 30 
 
 Affections of Blood Vessels 31 
 
 Affections of Lymph Vessels and Glands 32 
 
 Affections of the Feet 34 
 
 SECTION II 
 
 Diagnostic Principles 37 
 
 Anamnesis 38 
 
 Visual Examination 39 
 
 Attitude of the Subject 41 
 
 Examination by Palpation 43 
 
 Passive Movements 47 
 
 Observing the Character of the Gait 48 
 
 Special Methods of Examination 53 
 
 SECTION III 
 Lameness in the Fore Leg 
 
 Anatomo-Physiologieal Review of Parts of the Fore Leg 55 
 
 Shoulder Lameness 61 
 
 Fracture of the Scapula 62 
 
Page 
 
 Scapulohumeral Arthritis 65 
 
 Infectious Arthritis 66 
 
 Injuries 66 
 
 Wounds 67 
 
 Luxation of the Scapuloluuneral Joint 67 
 
 Inflammation of the Bicipital Bursa 68 
 
 Contusions of the Triceps Brachii 71 
 
 Shoulder Atrophy (Sweeny) 73 
 
 Paralysis of the Suprascapular Nerve 75 
 
 Radial Paralysis _ 77 
 
 Thrombosis of the Brachial Artery 81 
 
 Fracture of the Humerus 82 
 
 Inflammation of the Elbow 84 
 
 Fracture of the Ulna _. 86 
 
 Fracture of the Radius 87 
 
 Wounds of the Anterior Brachial Region 90 
 
 Inflammation and Contraction of the Carpal Flexors 93 
 
 Fracture and Luxation of the Carpal Bones 96 
 
 Carpitis 98 
 
 Open Carpal Joint 100 
 
 Thecitis and Bursitis 104 
 
 Fracture of the INIetacarpus 106 
 
 Splints 107 
 
 Open Fetlock Joint -- 110 
 
 Phalangeal Exostosis (Ring'l)one) 118 
 
 Open Sheath of the Flexors of the Phalanges 124 
 
 Luxation of the Fetlock Joint 125 
 
 Sesamoiditis 127 
 
 Fracture of the Proximal Sesamoids 128 
 
 Inflammation of the Posterior Ligaments of the Pastern. 
 
 Proximal Interphalangeal Joint 129 
 
 Fracture of the First and Second Phalanges ...131 
 
 Tendinitis (Inflammation of the Flexor Tendons).. 135 
 
 Chronic Tendinitis and Contraction of the Flexor Tendons.. ..137 
 
 Contracted Tendons of Foals..^ 143 
 
 Rupture of the Flexor Tendons and Suspensory Ligament... 146 
 Tliecitis and Bui-sitis in the P^etloek Region 150 
 
Page 
 
 Arthritis of the Fetlock Joint 152 
 
 Ossification of the Cartilages of the Third Phalanx ....155 
 
 Navicular Disease 157 
 
 Laminitis -- IGO 
 
 Calk Wounds (Paronychia) 170 
 
 Corns -. 172 
 
 Quittor 174 
 
 Nail Punctures 178 
 
 SECTION IV 
 
 Lameness in the Hind Leg 
 
 Anatomo-Physiological Consideration of the Pelvic Limhs....l85 
 
 Hip Lameness 19'5 
 
 Fractures of the Pelvic Bones 196 
 
 Fractures of the Femur 199 
 
 Luxation of the Femur 201 
 
 Gluteal Tendo-Synovitis 203 
 
 Paralysis of the Hind Leg -204 
 
 Paralysis of the Femoral (Crural) Nerve 204 
 
 Paralysis of the Obturator Nerve 206 
 
 Paralysis of the Sciatic Nerve 208 
 
 Iliac Thrombosis - 209 
 
 Fracture of the Patella 212 
 
 Luxation of the Patella.. 213 
 
 Chronic Gonitis 217 
 
 Open Stifle Joint 220 
 
 Fracture of the Tibia 222 
 
 Rupture and AVounds of the Tendo Achillis... 224 
 
 Spring-Halt (String-Halt) ..: 225 
 
 Open Tarsal Joint 229 
 
 Fracture of the Fibular Tarsal Bone (Calcaneum) 230 
 
 Tarsal Sprains 232 
 
 Curb 233 
 
 Spavin (Bone Spavin) 235 
 
 Distension of the Tarsal Joint Capsule (Bog Spavin) 242 
 
 Distension of the Tarsal Sheath of the Deep Digital Flexor 
 
 (Thoroughpin) 246 
 
Page 
 
 Capped Hock 251 
 
 Rupture and Division of the Long Digital Extensor (Ex- 
 tensor Pedis) - 2.53 
 
 Wounds from Interfering 255 
 
 Lymphangitis 257 
 
 Authorities Cited 265 
 
 Index .- 267 
 
ILLUSTRATIONS 
 
 Page 
 
 Fig. 1 Hoof Testers 53 
 
 Fig. 2 — Muscles of Left Thoracic Limb, Lateral View 56 
 
 Fig. 3 — ]\Iiiscles of Left Thoracic Limb, Medial View 57 
 
 Fig. 4 — Sagital Section of Digit and Distal Part of Meta- 
 carpus 59 
 
 Fig. 5 — Ordinary Type of Heavy Sling 62 
 
 Fig. 6— A Sling Made in Two Parts 63 
 
 Fig. 7 — Paralysis of the Suprascapular Nerve of Left 
 
 Shoulder 76 
 
 Fig. 8— Radial Paralysis 78 
 
 Fig. 9 — Merillat's ]\Iethod of Fixing Carpus in Radial 
 
 Paralysis 79 
 
 Fig. 10 — Contraction of Carpal Flexors, "Knee Sprung".... 95 
 Fig. 11 — Pericarpal Inflammation and Enlargement Due to 
 
 Injury 99 
 
 Fig. 12 — Hygromatous Condition of the Right Carpus 100 
 
 Fig. 13 — Carpal Exostosis in x\ged Horse 101 
 
 Fig. 14 — Exostosis of Carpus Resultant from Carpitis 102 
 
 Fig. 15 — Distal End of Radius, Illustrating Effects of 
 
 Carpitis 102 
 
 Fig. 16 — Posterior View of Radius, Illustrating Effects of 
 
 Splint 108 
 
 Fig. 17 — Phalangeal Exostoses 120 
 
 Fig. 18 — Rarefying Osteitis in Chronic Ringbone 121 
 
 Fig. 19 — Phalangeal Exostoses in Chronic Ringbone 122 
 
 Fig. 20 — Contraction of Superficial Digital Flexor Tendon 
 
 Due to Tendinitis 138 
 
 Fig. 21 — Contraction of Deep Flexor Tendon Due to 
 
 Tendinitis 139 
 
 Fig. 22 — Chronic Case of Contraction of Both Flexor Ten- 
 dons of the Phalanges 140 
 
 Fig. 23 — Contraction of Superficial and Deep Flexor Ten- 
 dons ...141 
 
Page 
 Fig. 24 — Contraction of Superficial Digital Flexor and 
 
 Slight Contraction of Deep Flexor Tendon 142 
 
 Fig. 25— "Fish Knees" 145 
 
 Fig. 26 — Extreme Dorsal Flexion 146 
 
 Fig. 27 — A Good Style of Shoe for Bracing the Fetlock 148 
 
 Fig. 28 — The Roberts Brace in Operation 149 
 
 Fig. 29 — Distension of Theca of Extensor of the Digit 151 
 
 Fig. 30 — Rarefying Osteitis Wherein Articular Cartilage 
 
 Was Destroyed 153 
 
 Fig. 31 — Ringbone and Sidebone 156 
 
 Fig. 32 — Position Assumed by Horse Having Unilateral 
 
 Navicular Disease ..159 
 
 Fig. 33 — The Hoof in Chronic Laminitis 165 
 
 Fig. 34— Effects of Laminitis 166 
 
 Fig. 35 — Cochran Shoe, Inferior Surface 168 
 
 Fig. 36 — Cochran Shoe, Superior Surface 169 
 
 Fig. 37 — Hyperplasia of Right Forefoot Due to Chronic 
 
 Quittor 176 
 
 Fig. 38— Chronic Quittor, Left Hind Foot 177 
 
 Fig. 39— Skiagraph of Foot 179 
 
 Fig. 40— Sagital Section of Right Hock 186 
 
 Pig. 41 — Muscles of Right Leg; Front View 187 
 
 Fig. 42— Muscles of Lower Part of Thigh, Leg and Foot 189 
 
 Fig. 43— Right Stifle Joint; Lateral View .....190 
 
 Fig. 44— Left Stifle Joint; I\Iedial View 191 
 
 Pig. 45— Left Stifle Joint; Front View 193 
 
 Fig. 46 — Oblique Fracture of the Femur 200 
 
 Fig. 47 — Fracture of Femur After Six Months' Treatment..201 
 Fig. 48 — Aorta and Its Branches Showing Location of 
 
 Thrombi 210 
 
 Fig. 49 — Thrombosis of the Aorta, Iliacs and Branches 211 
 
 Fig. 50— Chronic Gonitis 218 
 
 Fig. 51 — Position Assumed in Gonitis 219 
 
 Fig. 52— Spring-halt -226 
 
 Fig. 53 — Lateral View of Tarsus Showing Effects of Tar- 
 
 sitis 228 
 
 Fig. 54— Right Hock Joint 231 
 
 Fig. 55 — Spavin -235 
 
Page 
 
 Fig. 56 — Bog Spavin 243 
 
 Fig. 57 — Thoroughpin 247 
 
 Fig. 58 — Fibrosity of Tarsus in Chronic Thoroughpin 248 
 
 Fig. 59 — Another View of Case Shown in Fig. 58 249 
 
 Fig. 60— "Capped Hock" 252 
 
 Fig. 61 — Chronic Lymphangitis 258 
 
 Fig. 62— Elephantiasis 259 
 
INTRODUCTION 
 
 Lameness is a symptom of an ailment or affection and is not 
 to be considered in itself as an anomalous condition. It is the 
 manifestation of a strnctural or fnnctional disorder of some part 
 of the loeomotory apparatus, characterized by a limping or halt- 
 ing gait. Therefore, any affection causing a sensation and 
 sign of pain which is increased by the bearing of weight upon 
 tbe aff'ected member, or by the moving of such a distressed part, 
 results in an irregularity in locomotion, which is known as lame- 
 ness or claudication. A halting gait may also be produced by 
 the abnormal development of a member, or by the shortening of 
 the leg occasioned by the loss of a shoe. 
 
 For descriptive purposes lameness may be classified as true and 
 false. True lameness is such as is occasioned by structural or 
 functional defects of some part of the apparatus of locomotion, 
 such as would be caused by spavin, ring-bone, or tendinitis. False 
 lameness is an impediment in the gait not caused l)y structural 
 or functional disturbances, but is brought on by conditions such 
 as may result from the too rapid driving of an unbridle- wise 
 colt over an irregular road surface, or by urging a horse to trot 
 at a pace exceeding the normal gait of the animal's capacity, 
 causing it to "crow-hop" or to lose balance in the stride. The 
 latter manifestation might, to the inexperienced eye, simulate 
 true lameness of the hind legs, but in reality, is merely the re- 
 sult of the animal having been forced to assume an abnormal pace 
 and a lack of balance in locomotion is the consequence. 
 
 The degree of lameness, though variable in different instances, 
 is in most cases proportionate to the causative factor, and this 
 fact serves as a helpful indicator in the matter of establishing a 
 diagnosis and giving the prognosis, especially in cases of some- 
 what unusual character. An animal may be slightly lame and 
 the exhibition of lameness be such as to render the cause baf- 
 flingly obscure. Cases of this nature are sometimes quite diffi- 
 cult to classify and in occasional instances a positive diagnosis 
 is impossible. Subjects of this kind may not be sufficiently in- 
 
convenienced to warrant their being taken out of service, yet a 
 lame horse, no matter how slightly affected, should not be con- 
 tinued in service unless it can be positively established that the 
 degree of discomfort occasioned by the claudication is small and 
 the work to be done by the animal, of the sort that will not 
 aggravate the condition. 
 
 Subjects that are very lame — so lame that little weight is 
 borne by the affected member — are, of course, unfit for service 
 and as a rule are not difficult of diagnosis. For instance, a frac- 
 ture of the second phalanx would cause much more lameness than 
 an injury to the lateral ligament of the coronary joint wherein 
 there had occurred only a slight sprain, and though crepitation 
 is not recognized, the diagnostician is not justified in excluding 
 the possibility of fracture, if the lameness seems disproportion- 
 ate to the apparent first cause. 
 
 The course taken by cases of lameness is as variable as the 
 degree of its manifestation, and no one can definitely predict the 
 duration of any given cause of claudication. 
 
 Because of the fact that horses are not often good self -nurses 
 at best, and that it is difficult to enforce proper care for the parts 
 affected, one can not wisely state that resolution will promptly 
 follow in an acute involvement, nor can he predict that the case 
 will or will not become chronic. Experience has proved that 
 complete or partial recovery may result, or again, that no change 
 may occur in any given case, and that in some instances even 
 where rational treatment is early administered, a decided aggra- 
 vation of the condition may follow unaccountably. 
 
 However, because of the economic element to be reckoned with, 
 it is of some value to be able to give a fairly accurate prognosis 
 in the handling of cases of lameness, as in the majority of in- 
 stances the treatment and manner of after-care are determined 
 largely by the expense that any prescribed line of attention will 
 occasion. 
 
 A case of acute bone spavin in a horse of little value is not 
 generally treated in a manner that will incur an expense equiva- 
 lent to one-half the value of the subject. The fact is always to 
 be considered in such cases, that even where ideal conditions favor 
 proi)er treatment, the outcome is uncertain. Where less than 
 
six weeks of rest can be allowed the animal, one affected with 
 bone spavin would therefore not be treated with the expectation 
 of obtaining good results, as six weeks' time, at least, is necessary 
 for a successful outcome. If the cost attending the enforced 
 idleness of an animal of this kind is considered prohibitive for 
 the employment of proper measures to affect a cure, and if lame- 
 ness is slight, the animal should be given suitable work, but in 
 eases of articular spavin in aged subjects, they should be hu- 
 manely destroyed and not subjected to prolonged misery. 
 
 A thorough knowledge of the structure and functions of the 
 affected parts is necessary to proceed in cases of lameness ; like- 
 wise, the age, conformation and temperament of the subject need 
 to be taken into consideration; the presence or absence of com- 
 plications demand the attention; the kind of care the subject 
 will probably receive directly influences the outcome; and the 
 character of service expected of the subject, too, needs to be 
 carefully considered before the ultimate outcome may reasonably 
 be foretold. 
 
 The practitioner is often confronted with the prolilem of how 
 best to handle certain cases. Will they do better under condi- 
 tions Avhere absolute quiet is enforced, or is it preferable to allow 
 exercise at will? The temperament of the animal must be con- 
 sidered in such cases, and if a lame horse is too active and play- 
 ful when given his freedom, exercise must be restricted or pre- 
 vented, as the ease may require. In cases of strains of tendons, 
 during the acute stage, immobilization of the affected parts is in 
 order. In certain sub-acute inflammatory processes or in in- 
 stances of paralytic disturbance where convalescence is in prog- 
 ress, moderate exercise is highly beneficial. 
 
 Consequently, each case in itself presents an individual jn-ob- 
 lem to be judged and handled in the manner experience has 
 taught to be most effective, appropriate and practical, and the 
 veterinarian should give due consideration to the comfort and 
 welfare of the crippled animal as well as to the interests of the 
 owner. 
 
SECTION I. 
 ETIOLOGY AND OCCURRENCE. 
 
 In discussions of pathological conditions contributing to lame- 
 ness in the horse, cause is generally classified under two heads — 
 predisposing and v.rcllinn. It becomes necessary, however, to 
 adopt a more general and comprehensive method of classification, 
 herein, which will enable the reader to obtain a better conception 
 of the subject and to more clearly associate the parts so grouped 
 descriptively. 
 
 Though predisposing factors, such as faulty conformation, are 
 often to be reckoned with, exciting causes predominate more fre- 
 quently in any given number of cases. The noble tendency of 
 the horse to serve its master under the stress of pain, even to 
 the point of complete exhaustion and sudden death, should win 
 for these willing servants a deeper consideration of their welfare. 
 Too frequently are their manifestations of discomfort allowed 
 to pass unheeded ])y careless, incompetent drivers lacking in a 
 sense of compassion. Symptoms of malaise should never be 
 ignored in any case; the humane and economic features should 
 be realized by any owner of animals. 
 
 In the consideration of group causes, lameness may be said 
 to originate from affections of bones, ligaments, thecae and bur- 
 sae, muscles and tendons, nerves, lymph vessels and glands, and 
 blood vessels, and may also result from an involvement of one or 
 several of the aforementioned tissues, caused by rheumatism. 
 Further, affections of the feet merit separate consideration, and, 
 finally, a miscellaneous grouping of various dissimilar ailments, 
 which for the most part, do not directly involve the locomotory 
 a]i]iaratus l)ut do. by their nature, impede normal movement. 
 
 AFFECTIONS OF BONES. 
 
 The bony coliuini serving as the framework and support of 
 the legs, probably constitutes the most vital element having to 
 do with weight bearing and locomotion, and therefore during 
 the acute and painful stage of bone affections, the pain becomes 
 
 15 
 
16 LAMENESS OF THE HORSE 
 
 more intense in the process and pressure of standing than when 
 the mem])er is swung or advanced. 
 
 Certain bones are so well protected by muscular structures 
 that they are not frequently injured except as a result of vio- 
 lence w'hich may produce fracture. However, there are certain 
 bones which receive the constant shock of concussion when the 
 animal is subjected to daily, rapid work on hard road surfaces. 
 Splints, ringbones and spavins are the most general examples 
 produced by these conditions. 
 
 Varying pathological developments often result from concus- 
 sion, contusion or other violent shocks to the bony structuras. 
 In such cases there either follows a simple periostitis which may 
 resolve spontaneously with no obvious outward symptom, or 
 osteitis, which may occur with tissue changes, as in exostosis; or 
 the case may produce any degree of reaction between these two 
 ])Ossible extremes. 
 
 Rarefying Osteitis, or Degenerative Changes. 
 
 Certain bone alfections, such as osteonudacia or osteoporosis, 
 are in the main, responsible for distortions and morphological 
 changes of bone, causing lameness, permanent blemish and even 
 resulting in death of the affected animal. The climatic condi- 
 tions in some localities favor these occurrences but they may 
 also be ascribed to improper food constituents and to possible 
 infective agencies. 
 
 Rarefying degenerative changes manifested by exostosis involv- 
 ing the phalanges of the young, causing ringbone, are fairly com- 
 mon in occurrence throughout this country. This is due, sup- 
 posedly, to a lack of mineral substance in the bony structure of 
 the affected animals, and is known as rachitis — commonly called 
 rickets. Since the affected subjects suffer involvement of several 
 of the extremities at the same time, the theory of rachitic origin 
 seems well supported. 
 
 Fractures. 
 
 Fractures of bones constitute serious conditions and are always 
 manifested by lameness. A sub-classification is essential here 
 
ETIOLOGY AND OCCURRENCE 1? 
 
 for the student of veterinary medicine who would comprehend 
 the technic of reduction and subsequent treatment in such 
 cases. 
 
 Fractures are classified by many authorities as being simple, 
 compound, and comminuted. This method is practical because 
 it separates dissimilar conditions. There are also grouped frac- 
 tures, the pathologic anatomy of which is similar. Classification 
 on an etiological basis would attempt to associate conditions, 
 the morbid anatomy and gravity of which would justly preclude 
 their being combined. 
 
 Simple Fracture is a condition where the continuity of the 
 bone has been broken without serious destruction of the soft 
 structures adjacent, and where no opening has been made to the 
 surface of the flesh. Such fractures do not reduce the bone to 
 fragments. Long bones are frequently subjected to simple frac- 
 ture, while short thick bones, such as the second phalanx, may 
 suffer multiple or comminuted fractures. 
 
 Compound Fracture designates a break of bone with the 
 destruction of the soft tissues covering it, making an open wound 
 to the surface of the skin. This form of fracture is serious 
 because of the attendant danger of infection, and in treatment, 
 necessitates special precaution being taken in the application of 
 splints that the wound may be cared for without infection of the 
 tissues. These fractures generally occur as a result of some 
 forceful impact through the flesh to the bone, or where the bones 
 are driven outward by the blow. Common examples are in frac- 
 tures of the metacarpus and metatarsus of the first phalanx. 
 This kind of injury in mature horses usually produces an ir- 
 reparable condition, and viewed economically, is generally con- 
 sidered fatal. 
 
 Comminuted Fractures, as the term implies, are those cases 
 wherein the bone is reduced to a number of small pieces. This 
 kind of break may be classified as simple-comminuted fracture 
 when the skin is unbroken, and when the bone is exposed as a 
 result of the injury, it is known as a compound-comminuted 
 fracture. Such fractures are caused by violent contusion or 
 where the member is caught between two objects and crushed. 
 
18 LAMENESS OP THE HORSE 
 
 Multiple Fractures. 
 
 Fractures are called multiple when the bone is reduced to a 
 number of pieces of large size. This condition differs from a 
 comminuted fracture in that the multiple fracture may break 
 the bone into several pieces without the pieces being ground or 
 crushed, and the affected bone may still retain its normal shape. 
 
 Further classification is of value in describing fractures of 
 bone with respect to the manner in which the bone is broken — 
 the direction of the fissure or fissures in relation to its long 
 axis. 
 
 A fracture is transverse when the bone is broken at a right 
 angle from its long axis. Such breaks when simple, are the least 
 trouble to care for because there is little likelihood that the 
 broken ends of bone will become so displaced that they will not 
 remain in apposition. Simple transverse fracture of the meta- 
 carpus, for instance, constitutes a favorable case for treatment 
 if other conditions are favorable. 
 
 Otlique fractures, as may be surmised, are solutions of con- 
 tinuity of bone in such manner that the fissure crosses the long 
 axis of a bone at an acute or obtuse angle. These fractures are 
 prone to injure the soft structures adjacent, and are frequently 
 compound, as well. IMoreover, because of the fact that the ap- 
 posing pieces of bone are beveled, the broken ends of bone are 
 likely to pass one another in such a way as to shorten the dis- 
 tance between the extremities of the injured member. Con- 
 traction of muscles also tends to exert traction upon a bone so 
 fractured, resulting in a lateral approximation of the diaphysis 
 and thus preventing union because the broken surfaces are not 
 in proper contact. 
 
 Fractures are longiiudinal when the fissure is parallel with 
 the long axis of the bone. This variety of break is not infre- 
 quent in the first phalanx ; and a vertical fracture of the second 
 phalanx is also said to be longitudinal, however, there is little 
 difference (if any, in some subjects) between the vertical and 
 transverse diameters of this particular bone. 
 
 Green stick fractures are essentially those resulting from falls 
 to young animals. Thej^ are usuallj^ sub-periosteal and when 
 
ETIOLOGY AND OCCURRENCE 19 
 
 the periosteum is left intact or nearly so, no crepitation is dis- 
 cernible. If this fracture is simple, prompt recovery may be ex- 
 pected. Bones of young animals, because they do not contain 
 proportionately as much mineral substance as do bones of adults, 
 are more resilient and less apt to become completely fractured. 
 They are, however, subject to what is known as green stick 
 fracture. 
 
 Impacted fractures are usually occasioned by falls. When the 
 weight of the body is suddenly caught by a member in such man- 
 ner as to forcefully drive the epiphyseal portions of bone into 
 and against the diaphysis, niultiple longitudinal fractures occur 
 at the point of least resistance. Parts so affected undergo a 
 fibrillary separation, increasing the transverse diameter of the 
 bone; or if the impact has been sufficiently violent, the portion 
 becomes an amorphous mass. 
 
 In a treatise on the subject of lameness, the bones chiefly con- 
 cerned and most often affected must be especially considered. 
 The shape and size of a bone when injured, determines in a 
 measure, the course and probable outcome in most cases, but of 
 first and greater importance is the function of the bone. A frac- 
 ture of the fibula in the horse need not incapacitate the subject, 
 but a tibial fracture is serious and generally proves cause for 
 fatal termination. The body of the scapula may be completely 
 fractured and recovery will probably result in most cases without 
 much attention being given to the sul)ject, yet a fracture of the 
 neck of this same bone constitutes an injury of serious conse- 
 quence. The difference in the function of different parts of this 
 same bone, as well as its shape and mode of attachment, deter- 
 mine the gravity of the case ; so it is in fractures of other bones 
 with respect to the course and prognosis of the case — function 
 is the important factor to be considered. 
 
 Next in importance is the age of the animal suffering fracture 
 of the bone. Capacity for regeneration is naturally greater in 
 a vigorous, young animal than in aged or even middle-aged sub- 
 jects. A healthy condition of the bone and the body favor the 
 process of repair in case of fracture, and prognosis may be favor- 
 able or unfavorable, depending upon these factors mentioned for 
 consideration. Individuals of the same species, differing in tem- 
 
20 LAMENESS OF THE HORSE 
 
 perament, may comport themselves in a manner that is conductive 
 to prompt recovery, or to early destruction. This feature cannot 
 be overestimated in importance, as it is sometimes a decisive 
 element, regardless of other conditions. A horse suffering from 
 an otherwise remediable pelvic fracture may be so worried and 
 tortured by being confined in a sling that the case calls for spe- 
 cial attention and care because of the animal's temperament. 
 Sometimes, the constant presence of a kind attendant will so 
 reassure the subject that it will become resigned to unnatural 
 confinement, in a day or two. This precaution may, in itself, 
 determine the outcome, and the wise veterinarian will not over- 
 look this feature or fail to deviate from the usual rote in the 
 handling of average cases. Recovery may be brought about in 
 irritable subjects by this concession to the individual idiosyn- 
 crasies of such animals. 
 
 AFFECTIONS OF LIGAMENTS. 
 
 Ligaments which have to do with the locomotory apparatus 
 are, for the most part, inelastic structures which are composed 
 of white fibrous tissue and serve to join together the articular 
 ends of bones ; to bind down, tendons ; and to act as sheathes or 
 grooves through which tendons pass, and as capsular membranes 
 for retention of synovia in contact with articular surfaces oP 
 bones. 
 
 Ligaments are injured less frequently than are bones. Because 
 of their flexibility they escape fracture in the manner that bones 
 suffer. They are, however, completely severed by being cut or 
 ruptured, though fibrillary fracture the result of constant or 
 intermittent tensile strain is of more frequent occurrence. 
 
 Simple inflammation of ligaments is of occasional occurrence 
 but, unless considerable injury is done this tissue, no perceptible 
 manifestation of injury results. No doul^t many cases wherein 
 fibrillary fracture of ligaments (sprain) takes place some lame- 
 ness is caused, but because of the dense, comparatively non- 
 vascular nature of these structures, little if any manifestation, 
 except lameness, is evident. And such eases, if recognized are 
 usually diagnosed by excluding the existence of other possible 
 causes and conditions wliidi miti'lit also cause lameness. 
 
ETIOLOGY AND OCCURRENCE 21 
 
 Certain ligaments are subjected to strain more than are others 
 and therefore, when so involved, frequently cause lameness. Ex- 
 amples of this kind are affections of the collateral (lateral) liga- 
 ments of the phalanges. Because of the leverage afforded by the 
 transverse diameter of the foot, when an animal is made to travel 
 over uneven road surfaces, considerable strain is brought to bear 
 on the collateral ligaments of the phalanges. A sequel to this 
 form of injury is a circumscribed periostitis at the site of at- 
 tachment of the ligaments and frequently the formation of an 
 exostosis — ringbone — results. 
 
 Where sudden and violent strain is placed upon a ligament 
 and rupture occurs, the division is usually effected by the liga- 
 ment being torn from its attachment to the bone. In such cases, 
 a portion of periosteum and bone is usually detached and the 
 condition may then properly be called one of fracture. In some 
 cases of this kind recovery is tardy, because of the difficulty 
 in maintaining perfect apposition of the divided structures, and 
 reactionary inflammation is not of sufficient extent to enhance 
 prompt repair. In fact, some cases of this kind seem to progress 
 more favorably, when no attempt at immobilization of the af- 
 fected member is attempted. 
 
 If some freedom of movement is allowed, acute inflammation 
 resulting in nature's provisional swelling soon develops and 
 repair is hastened because of increased vascularity. But where 
 luxation of phalanges accompanies sprain, reposition and immo- 
 bilization are necessary — that is if cases are thought likely to 
 benefit by any treatment. 
 
 Luxations — Dislocations. 
 
 Luxation or dislocation is a condition where the normal rela- 
 tion between articular ends of bones has been deranged to the 
 extent that partial or complete loss of function results. When a 
 bone is luxated (out of joint), there has occurred a partial or 
 complete rupture of certain ligaments or tendons; or a bone 
 may be luxated when an abnormal or unusual elasticity of inhib 
 itory ligaments or tendons obtains. 
 
 Luxations may be practically classified as temporarij and fixed. 
 In temporary luxations, disarticulation is but momentary and 
 
22 LAMENESS OP THE HORSE 
 
 spontaneous reposition always results ; while a fixed luxation does 
 not reduce spontaneously but remains luxated until reposition 
 is effected by proper manipulation and treatment. Fixed luxa- 
 tion may be of such character as to be practically irreducible 
 because of extensive damage done to ligaments or cartilage. 
 Where a complete luxation of the metacarpophalangeal joint 
 exists, it is probal)le that in most cases sufficient injury to col- 
 lateral and capsular ligaments has been done to render com- 
 plete recovery improbable, if not impossible. 
 
 Temporary luxation of the patella is a common affection of 
 tbe horse and fixed luxation of this bone also occurs. As a mat- 
 ter of fact, in the horse, patellar luxation is tbe one frequent 
 affection of this kind. 
 
 As a rule, complete disarticulation immobilizes the affected 
 joint and in most instances there is noticeable an abnormal prom- 
 inence in the immediate vicinity — in patellar luxation, the whole 
 bone. In other instances the articular portion only, of the af- 
 fected bone is malpositioned. Usually, luxation and fracture 
 may be differentiated in that there is no crepitation in luxation 
 and more or less crepitation exists in fracture. 
 
 It is evident, when one considers the symptomatology and 
 nature of the affection, that fixed luxation is usually caused by 
 undue strain or violent and abnormal movement of a part. 
 Joints having the greater freedom of movement are apt to suffer 
 luxation more frequently. 
 
 Arthritis. 
 
 The study of arthritis in the horse is limited to a considera- 
 tion of joint inflammations which, for the most part, are of 
 traumatic origin. Unlike the human, the horse is not subject 
 to many forms of specific arthritis — tubercular, gonorrheal, syph- 
 ilitic, etc. 
 
 A practical manner of classification of arthritis is traumatic 
 and metastatic. 
 
 Traumatic arthritis may result from all sorts of accidents 
 wherein joints are contused. Such cases may be considered as 
 being caused by direct injuries. Instances of this kind, depend- 
 ing on the degree of insult, manifest evidence of injury which 
 
ETIOLOGY AND OCCURRENCE 23 
 
 ranges from a simple synovitis to the most active inflammatory 
 involvement of the entire structure and adjacent tissues. 
 
 The reactionary inflammation wiiich attends a case of tarsitis 
 caused b}^ a horse being kieked is a good example of the i-esult 
 of direct injury. Such cases, if the contusion is of sufficient 
 violence, result in arthritis and periarthritis. In inactive farm 
 horses, during cold weather, this condition l)ecomes chronic, swell- 
 ing remains for weeks after all lameness and pain have sub- 
 sided and occasionally hyperthrophy is permanent. 
 
 Arthritis occasioned by indirect injury, such as characterizes 
 joint inflammation from continuous concussion, is seen in horses 
 that are worked at a rapid pace on city streets or other hard 
 road surfaces. Such affections may be acute, as in some cases 
 of spavin, but are usually inflammatory conditions that do not 
 occasion serious disturbance when these affections become chronic. 
 If the involvement persists with sufficient active inflammation, 
 there may follow erosion of cartilage and incurable lameness. 
 If extensive necrosis of cartilage takes place, the attendant pain 
 will be sufficient to cause the animal to favor the diseased part 
 and such immobilization enhances early ankylosis — nature's sub- 
 stitute for resolution in this disease. 
 
 Wounds invading the tissues adjacent to joints, when these 
 wounds are of considerable extent, cause inflammation of such 
 articulations by contiguous extension of inflannnation. As long 
 as an injury remains practically aseptic, or if infected and the 
 septic process does not involve the joint proper by direct ex- 
 tension, no more serious disturbance than a simple synovitis will 
 result. If, instead, a periarthritic inflammation is serious or 
 destructive in character, the type of arthritis will be grave — 
 even though due to an indirect cause. 
 
 Where a vulnerant body penetrates all structures and invades 
 the interior of the joint capsule the result is that a more or less 
 active disturbance is incited. The introduction of a sterile in- 
 strument into a joint cavity, under strict asepsis, where a per- 
 fect technic is executed, does not cause perceptible numifesta- 
 tion of the injury, if the opening so made is small — such as a 
 suitable exploratory trocar makes. But a puncture made in a 
 similar manner and with the same instruinciit witliout due regard 
 
24 LAMENESS OF THE HORSE 
 
 te asepsis is likely to cause an infectious synovitis and arthritis 
 usually follows. 
 
 A larger opening than is produced by means of an exploratory 
 trochar may be made into a joint cavity, causing escape of syn- 
 ovia as it is secreted for days and even for weeks and no serious 
 or permanent trouble is experienced in some cases. If the syn- 
 ovitis or arthritis remains non-infected and the wound, trau- 
 matic or surgical, is not too large, healing by granulation 
 occurs, and the discharge of synovia ceases. However, if synovial 
 discharge persists too long because of tardy closure of an open 
 joint, there is great danger of infection gaining entrance into 
 the synovial cavity, or in some instances, desiccation of endo- 
 thelial cells of the articulation occurs, in areas, and the reaction- 
 ary inflammation eventually results in ankylosis. 
 
 A small puncture which introduces into the synovial cavity 
 infectious material of active virulence will cause an arthritis 
 that is more serious, much more painful and more difficult to 
 handle than is occasioned by a wound of moderate size, that 
 affords ready escape of synovia even through the virulence of 
 the infection be the same. 
 
 Synovia is a good culture medium and the environment is 
 ideal for nuiltiplieation of bacteria; consequently, the grave 
 disturbances which may attend the introduction of pathogenic 
 organisms into a synovial cavity as the result of a puncture 
 Avound are not to be forgotten. The veterinarian is m no position 
 to estimate the virulency of organisms so introduced; neither 
 can he determine the exact degree of resistance possessed by the 
 subject in any given case. Therefore, he is uncertain as to the 
 best method of handling such cases where an injury has been 
 recently inflicted and positive evidence of the existence of an 
 infectious synovitis is not present. If one could determine in 
 advance the degree of infection and injury that is to follow small 
 penetrant M^ounds of joint capsules, it would then be possible 
 to select certain cases and immediately drain away all synovia 
 and fill the cavity by injection with suitable antiseptic solutions. 
 
 This offers a broad field for experimentation which will in 
 time be productive of a radical change in the manner of treating 
 such cases. 
 
ETIOLOGY AND OCCURRENCE 25 
 
 Metastatic arthritis is seen more frequently in colts or young 
 animals than in mature horses and we here take the liberty of 
 classifying with the arthritis of omphalophleliitis and strangles 
 the so-called rheumatic variety. 
 
 A specific polyarthritis or synovitis which attends navel in- 
 fection of foals is perhaps the most frequent form of arthritis 
 that is to be considered metastatic. This condition is truly a 
 disease of young animals and, while it is a specific arthritis, 
 the cause is yet to be attributed to any definite pathogenic organ- 
 ism with certainty. This condition is well defined by Bollinger 
 as quoted by Iloare,^ when he calls it a purulent omphalophle- 
 bitis due to local infection of the umbilicus and umbilical ves- 
 sels, by pyogenic organisms, causing a metastatic pyemia. 
 
 This affection is grave; its course is comparatively brief; the 
 prognosis is usually unfavorable ; and omphalophlebitis occa- 
 sions a form of lameness which at once impresses the practi- 
 tioner that serious constitutional disturbance exists. Its con- 
 sideration properly belongs to discussions on practice or obstet- 
 rics and diseases of the new born, and it has received careful 
 attention and is discussed at length in these works. 
 
 A second form of metastatic arthritis is met with in strangles. 
 Strangles occurs in the young principally and is not a frequent 
 cause of synovitis or arthritis in the adult animal. 
 
 Strangles or distemper is, according to most pathologists, due 
 to the Streptococcus equi, Hoare^ states that in this type of 
 specific arthritis the contagium is probably carried by the blood. 
 He gives it as his opinion that even laminitis has occurred as 
 a result of the streptococcus-equi. This, indeed, would point 
 toward probable extension by the blood as well as by way of 
 lymph vessels. 
 
 Septic synovitis and infectious arthritis are always serious af- 
 fections even in young animals and much depends upon indi- 
 vidual resistance and early rational treatment in such cases, if 
 recovery is to follow. 
 
 The same general plan of treatment is indicated in this kind 
 of septic synovitis as is employed in all cases of infective syn- 
 
 lA System of Veterinary Medicine by E. Wallis Hoare, F. R. C. V. S., Vol. 1, 
 page 510. 
 =Ibid, page 807. 
 
26 LAMENESS OF THE HORSE 
 
 ovitis and septie infection in open joints. There is to be consid- 
 ered, however, the fact that the young animal is more agile, a 
 better self-nurse, and in a general way more apt to recover than 
 is the adnlt, under similar conditions. 
 
 Rheumatic artJiritis, if one is justified in classifying rheumatic 
 inflammation of joints as a metastatic form of arthritis, is not 
 a common condition, though seen in mature and aged animals. 
 Cases that may be diagnosed with certainty are usually advanced 
 affections wherein dependable history is obtainable and the symp- 
 toms are well marked. 
 
 Rheumatism may be thought of, with respect to arthritic in- 
 flammation caused thereby, as a sort of pyemia. Undoubtedly, 
 exposure to wet and cold weather is an active factor, l;)ut prob- 
 ably a predisposing one only. Likewise a member that suffers 
 from chronic inflammation due to recurrent injury or to con- 
 stant or repeated strain is less able to resist the vicissitudes of 
 climate and work. 
 
 Consec[uentiy, rheumatic arthritis is to be seen affecting horses 
 that are in service, more often at heavy draft work Avhere they 
 are exposed to severe straining of joints; where stabling is in- 
 sanitary; and where they are obliged to lie down (if they do 
 not remain standing) upon cold and wet ground or upon hard 
 unbedded floors or paving. 
 
 Where such inhumane and cruel treatment is given animals 
 those responsible ought to be impressed with the unfairness to 
 the animal as well as the economic loss occasioned by inflicting 
 such unnecessary and merciless treatment upon their helpless 
 and uncomplaining subjects. The very nature of the veteri- 
 narian's work affords liim constant and frequent opportunity to 
 convince those who are responsil^le for keeping animals in this 
 manner, that it is inhumane and un]irofita])]e. 
 
 Cases of this kind are not uncommon about some grading and 
 lumbering camps and in contract work where, often, shelter for 
 animals is given little thought ; the result is a cruel waste of 
 horseflesh. 
 
 Chronic articular rheumatism is occasionally observed in 
 young animals that have never been in service. In these cases 
 it seems tliat there exists an individual susceptibility and in 
 
ETIOLOGY AND OCCURRENCE 27 
 
 some instances the condition is recurrent. Each attack is of 
 long-er duration, and eventually death results from continued 
 suffering, emaciation and intoxication. 
 
 AFFECTIONS OF BURSAE AND THECAE. 
 
 Acute bursitis and thecitis is of fre(|uent occurrence in horses 
 ])ecause of direct injury from contusion, punctures and other 
 forms of traumatism. These synovial membranes, with few ex- 
 ceptions, when inflamed occasion a synovitis that may be very 
 acute, yet there is less manifestation of pain than in arthritis. 
 
 It is only in structures such as the bursa intertubercularis or 
 in the sheath of the deep digital flexor that an inflammation 
 causes much pain and is apt to result in permanent lameness. 
 This is due to the i^eculiar character of the function of such 
 structures. 
 
 An acute inflammation of a small bursa may even result in the 
 destruction of such synovial apparatus without serious incon- 
 venience to the subject, either at the time of destruction or there- 
 after. Obliteration of the superficial bursa over the summit of 
 the OS calcis is not likely to cause serious inconvenience or distress 
 to the subject unless it be due to an infected wound. Even then, 
 with reasonably good care given the animal, recovery is almost 
 certain. Complete return of function of the member and cessa- 
 tion of lameness takes place within a few weeks in the average 
 case. 
 
 "Where an infectious synovitis involves a structure such as the 
 sheath of the tendon of the deep digital flexor (perforans) the 
 condition is grave and because of the location of this theca the 
 prognosis is not much more favorable than in an articular syn- 
 ovitis. 
 
 Inflammation of bursae and thecae may be classified on a 
 chronological basis with propriety 1)ecause the duration of such 
 affections, in many cases, materially modifies the result. A 
 chronic inflammatory involvement of a theca through which an 
 important tendon plays may cause adhesions to form. Or there 
 may occur erosions of the parts with eventual hypoi-fi-ophy and 
 loss of function, partial or complete. 
 
 However, in general practice a classiflcation on an etiological 
 
28 LAMENESS OF THE HORSE 
 
 basis is probably more practical and we shall consider inflamma- 
 tion of bursae and thecae as infectious and noninfectious. 
 
 Infectious bursitis and thecitis is usually the result of direct 
 introduction of septic material into the synovial structure by 
 means of injuries. Infection by contiguous extension occurs and 
 also metastatic involvement is met with occasionally. 
 
 The noninfectious inflammation of bursae and thecae usually 
 result from contusions or strains and generally run their course 
 without becoming infective in character, where vitality and re- 
 sistance of the subject are normal. 
 
 In a general way, inflammation and other affections of l)ursae 
 and thecae are considered very similar to like affections of joints. 
 
 AFFECTIONS OF MUSCLES AND TENDONS, 
 
 Muscles and tendons having to do with locomotion are more 
 frequently injured than are any of the other structures whose 
 function is to propel the body or sustain weight. This is due 
 in part to the exposed position of muscles and tendons. They 
 serve as a protection to the underlying structures and in this 
 manner receive many blows the force and violence of which are 
 spent before injury extends beyond these tissues. 
 
 Muscles of the breast, shoulder and rump are most frequently 
 the recipient of injuries of various kinds. The abductors of the 
 thigh are subjected to bruising when horses are thrown astride 
 of wagon poles or similar objects. Thus in one way or another 
 muscle injuries are occasioned and cause lameness. 
 
 Traumatic affection of muscles of locomotion may be surface 
 or sul)surface — subsurface with little injury done the skin and 
 fascia, but with subsurface extravasation of blood and maseera- 
 tion of tissue. Puncture wounds wherein the vulnerant body is 
 of small diameter, are observed, and they occasion deep seated 
 infectious inflammation of the parts affected, with surface 
 wounds that are often unnotieeable. Such injuries — puncture 
 wounds — are always serious, and because of the fact that there 
 exists little evidence of injury at the time of their infliction, 
 treatment is usually deferred several days and often infection 
 has become quite extensive when the practitioner is consulted. 
 
 "Where infective wounds of muscles of locomotion occur, the 
 
ETIOLOGY AND OCCURRENCE 29 
 
 course and gravity of the affection are directly influenced by the 
 proximity of the injury to lymph plexuses. For instance, in- 
 juries causing an infectious inflammatory involvement of the ad- 
 ductors of the thigh may result in a generalization of the infec- 
 tion by way of the inguinal lymph glands. 
 
 Large open wounds that extend deep into muscles, render 
 inactive such structures, and even where division is not com- 
 plete, the pain occasioned causes the subject to favor the part 
 in every way possible. Contraction of muscular fibers of such 
 parts increases pain and because of this fact groups of muscles 
 are at times disabled because of injury done to one muscle. In- 
 stances of this kind are frequently seen where shoulder injuries, 
 which affect but one muscle, exist; yet because of such injury a 
 marked swinging-leg lameness is present. 
 
 Tendons, because of their inelasticity, are subjected to injuries 
 peculiar to themselves. In addition to being affected as are mus- 
 cles, wounds of many kinds are found to affect tendons — con- 
 tusions, interference wounds, penetrant wounds, incised wounds 
 and lacerations. 
 
 However, the commoner form of injury done tendons, is strain 
 or sprain. Because of the sudden tensile strain brought to bear 
 upon tendons in the shocks of concussion, as well as in propulsion 
 of the body, there frequently occure a rupture of fibers and this 
 we know as sprain. 
 
 Sprains may be considered as fibrillary fractures of soft struc- 
 tures and since this form of injury is sul)surface, and limited to 
 fractional portions of tendons, the inflammation occasioned usu- 
 ally remains an aseptic one. Reaction to this form of injury 
 is characterized by inflammation, the course of which is erratic 
 and variable. In chronic inflammation of tendons, where ani- 
 mals are continued in service, the usual sequel is contraction, or 
 shortening of these structures. 
 
 The degree of contraction as well as its import varies in dif- 
 ferent subjects and in the various tendons which may be affected. 
 Contraction is a slow-going process that is progressive, gradually 
 causing a decrease in the length of the affected structure and 
 eventually rendering the animal useless. 
 
 The practice of applying shoes with extended toe-calks for 
 
30 LAMENESS OF THE HORSE 
 
 the purpose of "'stretching" contracted deep digital flexor 
 tendons (tiexor pedis perforans) cannot be too strongly con- 
 demned. While the addition of an extension such as is ordinarily 
 employed to the toe of a shoe of this kind, prevents for a time, 
 frequent stumbling in such cases, the increased tensile strain 
 which is thus occasioned hastens further contraction and sub- 
 jects animals so shod to much unnecessary pain. 
 
 AFFECTIONS OF NERVES. 
 
 Because of their being protected by other structures, nerve 
 trunks, which supply muscles of locomotion, are not su])jeeted to 
 frequent injuries such as contusions. However, they do become 
 injured at times and the result is lameness, more or less severe. 
 
 Lameness originating from nerve affection, may involve central 
 structures as, for example, the spinal cord, medulla oblongata 
 or parts of the brain. In making an examination of some lame 
 animals it is necessary to distinguish between cases of lameness 
 that are of central origin and marked by incoordination of move- 
 ment, and disturbances caused by other affections. Tetanus in 
 its incipiency should not be confused with laminitis involving 
 all four feet, or with certain forms of pleuritis, when careful ex- 
 amination is made, yet, in a way, to one not trained, the clinical 
 symptoms are similar. 
 
 Disturbances of nerve function are caused in a variety of ways. 
 It is not within the scope of this work to discuss central nervous 
 disturbances caused hy ingestion of mouldy provender, or dis- 
 turbances of the brain or cord occasioned by infectious diseases, 
 but mention of the existence of such conditions is appropriate. 
 
 By direct injury the result of lilows, certain nerves are in- 
 jured and muscles supplied by such nerves are rendered inactive. 
 Depending upon the nature and extent of an injury thus in- 
 flicted, so the manner in which the affection is manifested varies. 
 The suprascapular nerve is rather frequently injured causing 
 partial or complete loss of function of the structures supplied 
 by this nerve, and abduction of the scapulohumeral joint nat- 
 urally results. 
 
 In some cases of dystocia tbe obturator ner\'e, (or nerves, if 
 the involvement is bilateral), becomes injured by being caught 
 
ETIOLOGY AND OCCURRENCE 31 
 
 between tlie maternal pelvis and some dense part of the fetus. 
 This results in paralysis of the adductors of the thigh if suffi- 
 cient injury is done. 
 
 It is said that nerves become over-stretched and held tense, in 
 certain positions in which animals are obliged to remain while 
 cast in confinement such as in some instances where unusual 
 methods of restraint are employed. When the fore feet are 
 drawn backward in such numner that great strain is put upon 
 the radial nerve, it suffers more or less injury, and this is fol- 
 lowed by partial or complete paralysis which may be temporary 
 or permanent. 
 
 Degenerative changes affecting nerves, as in other tissues, oc- 
 cur and more or less locomotory impediment will follow — this 
 depending upon the nerve or nerves affected and the nature of 
 such involvement. Tumors may surround nerves and eventually 
 the nerve so exposed becomes implicated in the destructive 
 process. Before degenerative changes take place in the nerve 
 substance, in such cases, pressure may completely paralyze a 
 nerve when it is so situated. Melanotic tumors in the para- 
 proctal tissue in some cases, because of the large size of the new- 
 growths, cause paralysis of the sciatic nerve. The author has seen 
 one case of brachial paralysis occasioned by an enormous de- 
 veloiunent of fibrous tissue involving the structures about the 
 
 ulna. 
 
 AFFECTIONS OF BLOOD VESSELS. 
 
 Lameness caused by disturbances of circulation may be due to 
 structural affection of vessels, or functional disorders of the 
 heart, and in some instances, a combination of these causes may 
 be active. 
 
 Direct involvement of vessels is the commoner form of circu- 
 latory disturbance which occasions lameness, and the most fre- 
 quent cause is of parasitic origin. Sclerostomiasis with attendant 
 arteritis, thrombus formation and su])sequent lodgement of em- 
 boli in the iliac, femoral, or other arteries, causes sufficient ob- 
 struction to prevent free circulation of blood, and the character- 
 istic lameness of thrombosis results. 
 
 Indirect injury to vessels may occur because of contused 
 wounds and subsequent inflammation of tissues supplied by such 
 
32 LAMENESS OF THE HORSE 
 
 vessels. If the injury be of sufficient extent, considerable ex- 
 travasation of blood will take place and the painfully swollen 
 parts necessarily impair locomotion. In such instances lymph 
 vessels participate in the disturbance, and the condition then be- 
 comes one wherein lymphangitis is the predominant disturbing 
 element. 
 
 Angiomatous tumors are occasionally found affecting horses' 
 legs — usually the result of some injury ; and because of their size 
 or position, they mechanically interfere with function. Further- 
 more, when such tumors are located on the inner or flexor side 
 of joints, enough pain is occasioned that affected animals show 
 evidence of distress, usually by intermittent lameness. 
 
 Horses do not suffer from distension of veins as does man, 
 that is, there is rarely to be seen a case wherein much disturbance 
 from this source exists. 
 
 AFFECTIONS OF LYMPH VESSELS AND GLANDS. 
 
 Inflamed lymph vessels and glands, the result of various causes, 
 is a rather common source of lameness of horses. When one con- 
 siders the proportion of tissue that is composed of lymph vessels 
 and glands, it is then obvious that inflammation of these struc- 
 tures should cause a painful affection of members, when so af 
 fected, and that marked lameness and, in some instances, general 
 constitutional disturbance such as anorexia, hyperthermia and 
 general circulatory disorder are to follow. 
 
 Lymphangitis is most frequently occasioned by the introduc- 
 tion of septic material into the tissues; consequently, infectious 
 lymphangitis is more frequently observed than the non-infectious 
 type. 
 
 Specific infectious forms of lymphangitis are seen in glanders 
 and in strangles ; infectious types of this disturbance are found 
 in many instances where, initially, a localized or circumscribed 
 infection has occurred — the contagium having been introduced 
 by way of an injury. An example of this kind is to be seen in a 
 wound perforating the tibial fascia, where the injury is inflicted 
 by means of a horse being kicked by another animal shod with 
 sharp shoe-calks. Cases of this kind invariably result in a septic 
 lymphangitis, and frequently lymphadenitis also occurs, for the 
 
ETIOLOGY AND OCCURRENCE 33 
 
 inguinal lymph glands are so situated tliat their becoming con- 
 taminated is almost certain. 
 
 The trite phrase that ' ' the tissues are bathed in lymph ' ' should 
 make clear the reason for the frequent occurrence of infectious 
 lymphangitis and lymphadenitis. Foreign substances, bacteria 
 and their products, inorganic material and in fact, anything that 
 is inti-oduced into the tissues, if soluble or miscible, will be taken 
 up and conveyed by the afferent lymph vessels and disseminated 
 throughout the system — hence the constitutional disturbances so 
 frequently thus caused. 
 
 A non-infectious type of lymphangitis is frequently seen in 
 the heavy draft breeds of horses and in such cases one or both 
 hind legs are involved — it is very seldom that the thoracic limbs 
 become so affected. Law^ refers to this ailment as "Acute 
 Lymphangitis of Plethora in Horse." When one takes into 
 consideration that these cases so frequently occur in heavy draft 
 animals that are not worked regularly, that the pelvic limbs are 
 the ones involved, and that the disorder often runs a short 
 course (recover}' often taking place within two or three days, 
 with no treatment given other than a purge, circulatory stim- 
 ulants and walking exercise) it is plausible to ascribe the con- 
 dition to idiopathic factors. 
 
 Admitting the frequency of non-infectious lymphangitis, the 
 practitioner must not confuse this type with similar lymphatic 
 inflammation occasioned by nail punctures of the foot. It is 
 very embarrassing indeed to make a diagnosis of lymphangitis — 
 expecting that the disturbance will terminate favorably and un- 
 eventually — and later to discover a sub-solar abscess caused by 
 a nail prick in the region of the heel. 
 
 Recurrent attacks of this disturbance cause hypertrophy of 
 the lymph vessels and in some cases lymphangiectasis. In old 
 subjects used for dissection or surgical purposes, it is very evi- 
 dent that in the ones which have suffered from chronic lymphan- 
 gitis there exists an excessive amount of sub-facial connective 
 tissue, making subcutaneous neurectomies quite difficult in some 
 instances. 
 
 A sequel of chronic lymphangitis is a condition known as ele- 
 
 'A'ol. I, page 534, Veterinary Medicine, by James Law, F. R. C. V. S. 
 
34 LAMENESS OF THE HORSE 
 
 pliantiasis. In such cases there occurs a hyperplasia of the skin 
 and subcutaneous tissues, resulting in some instances, in the af- 
 fected member attaining an enormous size. Sporadic cases of 
 this kind are to be seen occasionally, and are apparently caused 
 by repeated attacks of lymphangitis. The affection is not bene- 
 fited by treatment, and while a horse's leg may become so heavy 
 and cuniliersome as to mechanically impede its gait, as well as 
 to fatigue the subject when made to do service even at a slow 
 pace, elephantiasis causes no constitutional derangement. The 
 hind legs, in elephantiasis, are affected and a unilateral involve- 
 ment is more often seen than a bilateral one. The legs may be 
 enlarged from the extremity to the body, but ordinarily the af- 
 fection does not extend higher than the hock or the mid-tibial 
 region. 
 
 A chronic, progressive, hyperplastic-degeneration exists in 
 some cases and the sul)jects are in time rendered unserviceable 
 because of the l)urden of getting about encumbered by the affected 
 extremity. In other animals hyperplasia progresses for a time 
 — until the parts become greatly enlarged and conditions appar- 
 ently attain an immutable state. Nevertheless animals so af- 
 fected may continue in service for years without lieing distressed. 
 
 AFFECTIONS OF THE FEET. 
 
 Lameness is very often due to affections of the feet, and in all 
 foot diseases probably the most constant cause is injury inflicted 
 in some manner. Resultant from injury, there frequently de- 
 velops complications and the one most often seen is infection. 
 
 Because of the fact that the feet are constantly exposed to 
 germ-laden soil and filth, if not actually bathed in such infectious 
 materials, it naturally follows that septic infection of some part 
 of the feet must be of frequent occurrence. 
 
 Subsequent to being obliged to stand in mud and other damp 
 or wet media, exposure to desiccating influences such as stabling 
 U])()n dry floors, or at service on hot and dry road surfaces causes 
 the insensitive pai'ts of tlie feet to become dry, hard and brittle. 
 This favors ''checking" of the protecting structures and it fre- 
 (picntly i-esults in the roi'iiiatioii of large fissures which expose 
 
ETIOLOGY AND OCCURRENCE 35 
 
 the underlying sensitive parts of the feet and lameness is the in- 
 evita])le outcome. 
 
 The function of the feet — bearing the weight of the animal at 
 all times when the subject is not recumbent, and in addition to 
 this, the increased strain put upon them at heavy draft work, 
 together ^^ ith the concussion and l)uffeting occasioned by locomo- 
 tion, make the feet susceptible to frequent affections of various 
 kinds. 
 
 Being almost completely encased by a somewhat inexpansible 
 and insensitive wall and sole, renders the foot subject to path- 
 ologic changes peculiar to itself. The very nature of the struc- 
 ture of the foot together with the function of the sensitive lamina 
 is sufficient cause for an affection unlike that seen involving other 
 tissues — laminitis. 
 
 An exhaustive consideration of foot affections is a study in 
 itself and one that comes within the realm of pathologic shoeing; 
 nevertheless, a practical knowledge of diseases of the foot is 
 indispensable in the diagnosis of lameness wherein the foot may 
 be at fault. 
 
 The peculiar nature of foot affections renders them difficult 
 of classification on any sort of basis that is helpful in the con- 
 sideration of this subject. Injuries are the most constant cause 
 of foot lameness, yet one must admit that there results compli- 
 cations because of infection in most instances ; and that in some 
 cases the injury is slight — just enough to permit the introduction 
 of vulnerant organisms into the tissues. Therefore, one might 
 well classify affections of the feet as infectious and non- 
 infectious. There can be grouped in the class of infectious af- 
 fections such conditions as nail pricks, calk wounds and canker. 
 In the class of non-infectious affections one may consider condi- 
 tions such as laminitis. strain and fractures. 
 
SECTION II. 
 DIAGNOSTIC PRINCIPLES. 
 
 To observe attentively is to remember distinctly. — Poe. 
 
 Before treatment is administered in constitutional disturb- 
 ances resulting in disease, cause is logically sought; so, in 
 order to handle effectively any case of lameness, it is necessary 
 first to discover the source of the trouble and contributing con- 
 ditions affecting the structures. Hence, diagnostic ability is 
 the prime requisite; and a thorough knowledge of pathologic 
 anatomy or of surgical technic is of little value if this knowledge 
 is not applied with the insight of the trained diagnostician. 
 
 The cruel and unnecessary methods employed by those un- 
 trained for diagnostics, cannot be too vigorously condemned. For 
 instance, the application of an active and depilating vesicant 
 upon a large area on the gluteal or crural region, in a case 
 where the practitioner "guesses" the condition to be one of 
 "hip lameness," constitutes an exposition of gross ignorance, 
 and at once stamps the perpetrator as a crude bungler without 
 scientific insight whose works are no credit to his profession. 
 How much better it would be, if the practitioner does not see 
 fit to call in a competent consultant, to prescribe a suitable agent 
 to be given internally, and to recommend complete rest for the 
 subject. 
 
 In establishing a diagnosis in such cases, the student or prac- 
 titioner seldom has recourse to laboratory assistance, and his 
 work is done by means of physical examination ; therefore, a 
 thorough knowledge and a clear conception of the physiology 
 of locomotion are essential. Memorizing nosological facts with- 
 out an understanding of underlying principles is of no more 
 practical benefit for qualification as a diagnostician in cases of 
 lameness, than is the employment of similar methods in the 
 study of theory and practice. A knowledge of the dosage of 
 drugs does not in itself qualify one as being competent to ad- 
 minister such therapeutic agents to a proper effect. How 
 
 S7 
 
38 LAMENESS OF THE HORSE 
 
 much is a practitioner benefited by the knowledge that a high 
 temperature is usually present in septic intoxication, if he is 
 not possessed of a scientific understanding of anatomy, physi- 
 olog}', bacteriology and pathology, as well as the principles of 
 clinical diagnosis? 
 
 In order to determine the reasons for certain symptoms mani- 
 fested by the suliject, an analysis of these symptoms is the proper 
 method of procedure, insofar as this is poasi])le. If one may 
 reason that an animal assumes a certain position while at rest 
 to allow relaxation of an inflamed tendon or ligament, such a 
 fact enables the diagnostician to recall that this is indicative 
 of some specific ailment. In acute tendinitis, the subject while 
 at rest, maintains the afi'ected member in volar flexion because 
 this position permits relaxation of the inhibitory apparatus, 
 including the inflamed tendon. Likewise, the various a])normal 
 positions assumed, — adduction, abduction, undue flexion or 
 pointing — have their own significance and are taken into ac- 
 count by the trained diagnostician in the course of an examina- 
 tion. 
 
 In the examination of lame subjects, where the cause is noi 
 obvious, a systematic method of diagnosis is pursued even by 
 the most expert practitioners. In all obscure cases of lameness 
 a methodical and thoroughly practical examination of the ani- 
 mal according to an established procedure is necessary to de- 
 termine the nature and source of the affliction. 
 
 Anamnesis. 
 
 The first thing to be given consideration in diagnosis is the 
 fact that related history of the case is not always dependable, 
 because of lack of accurate observation (u^ wilful deceit on the 
 ])art of the owner or attendant. The successful veterinarian 
 soon acquires the faculty of ol)taining information in a manner 
 best adapted to his client,— either by direct interrogation or by 
 subtle means of suggestion, and in this way he draws out evaded 
 facts essential to his diagnosis. In time he learns to make al- 
 lowance for misstatements made to shield the owner or driver 
 and to hide the facts of apparent neglect or abuse that the sub- 
 ject may have experienced. A suppurating cartilaginous quitter, 
 
DIAGNOSTIC PRINCIPLES 39 
 
 complicated by the presence of a large amount of hyperplastic 
 tissue, cannot be successfully represented to be an acute and 
 recently developed atfection, where a trained practitioner is left 
 to judge the validity of the statement. 
 
 In complicated conditions, where there is evident a chronic 
 disturbance which could not be conceived as sufficient cause for 
 a nuirked manifestation of lameness, accurate history of the case 
 may he of great aid in arriving at a diagnosis. An aged animal, 
 having recently become very lame, showing a small exostosis on 
 the first phalanx, and with the history given that the osseous 
 deposit was of long standing, should at once lead the veterinarian 
 to seek the source of trouble elsewhere. 
 
 Visual Examination. 
 
 As in all diagnostic work, a careful visual examination of the 
 subject should ])e made before it is approached. The novice is 
 given to hasty examination by palpation, not realizing how 
 nnieh may be revealed by a careful scrutiny of the subject. In 
 this way he is led to erroneous conclusions which the skilled 
 diagnostician has learned from experience to avoid. Too much 
 (iitphasis cannot he 2)laccd on the importance of making a 
 thoughtful visual examination in every instance before the sub- 
 ject is approached. In this examination, type, conformation 
 and temperament are taken into account at once, for each of 
 these qualities is in itself, a determining factor in predisposing 
 a subject to certain ailments or inherent attributes, which may 
 exert a favorable or unfavorable intiuenee upon existing condi- 
 tions and thus make recovery probable or otherwise. 
 
 Draft animals are less likely to be permanently incapacitated 
 as a result of tendinitis, than are thoroughbreds. Likewise, 
 one would not expect to find this affection present in heavy 
 harness horses as frequently as in light harness animals. 
 
 ]\ral-formation of a part, or an asymmetrical development of 
 the body as a whole, may render an animal susceptible to cer- 
 tain affections which cause lameness. A "tied in" hock predis- 
 poses the subject to curb, and an animal having powerful and 
 well-developed hips and imperfectly formed hocks, will, if sub- 
 jected to heavy work, be a favorable subject for bone spavin. 
 
40 LAMENESS OF THE HORSE 
 
 The matter of temperament cannot be disregarded in diag- 
 nosis, for in some instances, it is the chief determining factor 
 which materially influences the outcome of the case. A nervous, 
 excitable animal, that is kept at hard work, may, under some 
 conditions, be expected to experience disturbances which more 
 lethargic subjects escape. Nervous subjects, it is known, are 
 more prone to azoturia than are those of lymphatic temperament. 
 Furthermore, the lymphatic subject often recovers from cer- 
 tain bone fractures which are successfully treated only when 
 the animal is sufficiently resigned by nature to remain confined 
 in a sling for weeks without resistance. 
 
 The physiognomy of a subject is often indicative of the gravity 
 of its condition. The facial expression of an animal suffering 
 the throes of tetanus, azoturia, or acute synovitis, is readily 
 recognized by the experienced eye, and upon physiognomy alone, 
 in many instances, may the opinions regarding prognosis be 
 based. Particularly is this true where death is a matter of min- 
 utes, or at most is only a few hours distant. 
 
 Due allowance should be made for restiveness nmnifested by 
 some more nervous animals when the surroundings are strange 
 and unusual. In such instances, even pathognomic symptoms 
 may be masked to the extent that little, if any, sign of pain 
 or malaise is evinced. In these cases the subject should be 
 given sufficient time to adjust itself to the new environment, or 
 it should be removed to a more suitable place for examination. 
 Animals quickly detect the note of friendly reassurance in the 
 human voice and can very often be calmed by being spoken to. 
 
 By visual examination one may detect the presence of various 
 swellings or enlargements, such as characterize bruises and 
 strains of tendons where inflammation is acute. Inflammation 
 of the plantar (calcaneocuboid) ligament in curb is readily de- 
 tected when the affected member is viewed in profile. Spavin, 
 ringbone, splints, quittor and many other anomalous conditions 
 may all be observed from certain proper angles. 
 
 The fact that the skins of most animals are pigmented and 
 covered with hair, precludes the easy detection of erythema by 
 visual examination, consequently this indicator of possible in- 
 
DIAGNOSTIC PRINCIPLES 41 
 
 fiammation is not often made use of in the examination of 
 equine subjects. 
 
 Attitude of the Subject. 
 
 The position assumed while the subject is in repose, is often 
 characteristic of certain affections and this, of course, is noted 
 at once. The manner in which the weight is borne by the animal 
 at rest, should attract the attention of the diagnostician and if 
 the attitude of the subject is abnormal or peculiar, the ex- 
 aminer tries to determine the reason for it. If weight-bearing 
 causes symptoms of pain, the affected member will invariably be 
 favored and held in some one of a number of positions. The 
 foot may contact the ground squarely and yet the leg may re- 
 main relaxed and free from pressure; volar flexion, in such 
 cases, is indicative of inflammation of a part of the flexor ap- 
 paratus. If the condition be very painful, position of the af- 
 flicted member is frequently shifted, but in all cases where the 
 pain is not so keenly felt, the inflamed member is held in a 
 state of relaxation. There is need then, for a knowledge of 
 anatomy and certain principles in physics to enalile tlie ol)server 
 to determine just which structures are purposely eased in this 
 manner. Where palpation of parts is possible, one does not 
 need to depend on visual examination alone, and it is always 
 wise to take into consideration every factor that may influence 
 conditions. Manipulation or palpation of the stnictures thought 
 to be involved, should not he resorted to until a careful and 
 thorough observation of the subject has revealed all that it can 
 reveal to the diagnostician. 
 
 In all conditions where extreme pain is manifested by the 
 constant desire of the animal to keep its foot in motion off 
 the ground, examination should be made for local cause. This 
 is seen in certain septic inflammations of the feet such as those 
 caused by nail punctures invading the navicular joint, or in 
 newly made wounds where nerves have been divided and the 
 proximal end of such a nerve is exposed to pressure or irritation. 
 
 "Pointing" affords a comfortable position in some cases of 
 navicular disease, and in a unilateral affection, one may observe 
 the subject bearing weight with one sound member, while the 
 affected foot is planted well ahead of the sound one. In a bi- 
 
42 LAMENESS OF THE HORSE 
 
 lateral involvement of this kind, weight may be frequently 
 shifted from one foot to the other, or in chronic cases, where 
 no marked pain is experienced, the subject stands squarely upon 
 both front feet and no peculiar shifting of weiglit or pointing is 
 evident. 
 
 In some cases of hip or shoulder involvement, complete re- 
 laxation of all parts of the affected member may be noticed. 
 In brachial paralysis, the pectoral member is held limply; if the 
 patient is made to move, it is evident there is lack of innerva- 
 tion to the afflicted part. In some cases where contusion has 
 caused acute inflammation of the member, the subject instinct- 
 ively tries to keep it inactive to relieve the pain which move- 
 ment occasions. 
 
 Where there is an active and painful inflammation of the 
 prescapular lymph glands and contiguous structures, in some 
 cases of ''levator-humeri abscess," the scapulohumeral joint is 
 extended. This is brought about by flexion of the elbow and 
 carpal joints. 
 
 There are some eases of bi-lateral affections which occasion 
 such pain during weight-bearing that the subject shifts its 
 weight from one affected leg to the other; an example of this 
 condition may be observed in any acute case of gonitis which 
 affects both patellar regions, making it ecjually painful to bear 
 the weight on either member. 
 
 A peculiar characteristic position is assumed in acute laminitis 
 of the fore feet. In such instances, the hind feet are brought 
 forward under the body sufficiently to relieve the front feet of 
 the weight, insofar as is possible by the abnormal position taken 
 in cases of acute laminitis. 
 
 So in each position that is abnormal to any degree, assumed 
 by a suffering animal, there may l^e deduced, the fact that the 
 subject is attempting to relieve the affected structures, and in 
 each clinical picture of this kind, the trained diagnostician sees 
 some index to the nature and source of the trouble. Further 
 examination is rendered more effective because of this prelim- 
 inary visual examination which has precluded the unnecessary 
 annoyance of the animal by manii)nlating unaffected structures. 
 
 It has been presupposed in the foregoing, that the one raak- 
 
DIAGNOSTIC PRINCIPLES 4'd 
 
 iiig visual examination of a lame animal for diagnostic purposes, 
 will remcml)er that vritli the normal animal the -weight is borne 
 equally well with both fore legs; and that this is done without 
 shifting from one to the other; and that the pelvic limbs do not 
 support the body in this manner. Normal su])jects shift their 
 weight from one hind leg to the other and the one relaxed, rests 
 in a state of tiexion with the toe on the ground and the heel 
 raised. 
 
 Examination by Palpation. 
 
 In nearly every case where lameness exists an examination of 
 the affected parts, by palpation or by digital manipulation, 
 is necessary before an accurate conclusion may be drawn ; but 
 in making this kind of an examination one needs to exercise good 
 judgment lest he fail to acquire a correct impression of the 
 actual existent conditions. There is need for the diagnostician, 
 here, as well as in other conditions where physical examination 
 is made, to api)roach the subject in a manner that will not ex- 
 cite or disturb to the extent that the animal will, in one way 
 or another, resist or object to the approach of the diagnostician, 
 thereby masking the symptoms sought. The practitioner would 
 best acquire skill as a horseman — if he is not possessed of such 
 — and handle each individual subject in the manner calculated 
 to best suit the temperament of the animal examined. The 
 unbroken subject is not handled as satisfactorily as is the in- 
 telligent family horse ; in the former, in some cases, little de- 
 pendence is placed upon digital examination. 
 
 By palpation one is enabled to recognize hyperthermia and 
 this, in lieu of dependable history, is at times sufficient evidence 
 upon which to determine the duration of any given inflammatory 
 affection. 
 
 By comparison of different parts of the same member or with 
 an analogous portion of another member any marked increase in 
 the apparently normal temperature of a part at once signalizes 
 inflammation. In this manner, in examining a case where 
 laminitis or other inflammation of the feet is suspected, one may 
 arrive at a fairly accurate conclusion without the employment 
 of other means. Throbbing vessels are not always easily rec- 
 ognized if the subject is a victim of chronic lymphangitis. 
 
44 LAMENESS OF THE HORSE 
 
 In some instances, where a moderate degree of lameness exists 
 and cause is apparently obscure, the recognition of hyperthermia 
 may be the deciding factor in establishing a diagnosis. In cases 
 of sprained ligaments in the phalangeal region, because of the 
 dense character of the structures involved, little if any evidence 
 of the cause of lameness, other than local heat, may be found 
 twenty-four hours after the injury has been inflicted. 
 
 In order to determine the amount or extent of hyperthermia 
 with a fair degree of accuracy in any given case, one must make 
 due allowance for external conditions affecting temperature ; 
 also the effect of a considerable amount of hair covering an area, 
 as well as any possible dirt contacting the surface of the skin 
 must be taken into account. All dirt should be removed if prac- 
 ticable, so that the diagnostician's palms may come as nearly 
 in contact with the inflamed structures as possible. Then, too, 
 the sense of touch if the operator's hands are chilled, is not de- 
 pendable. In such instances the novice wnll need to be de- 
 liberate as to his findings — whether or not hyperthermia really 
 exists. Such an examination is of little value where the sub- 
 ject's feet are wet and an examination is hurriedly made, as in 
 eases of suspected laminitis. 
 
 Often, before being able to di.stinguish the presence of a 
 hyperthermic condition, one is impressed with the fact that an 
 animal manifests evidence of being supersensitive. In fact, 
 some animals in the anticipation of pain at the touch of an in- 
 jured part, will instinctively withdraw — in self-protection — such 
 an ailing member or resist the approach of the practitioner. This 
 sensitiveness is more apparent in animals that have been sub- 
 jected to previous manipulation or treatment which has oc- 
 casioned pain, and consequently, allowance must be made for 
 this exhibition of fear. No better example of this condition can 
 be imagined than is present in cases of "shoe boil." where 
 there exists an extensive area of acute inflammation of the el- 
 bow. There is always more or less surface disturbance wherever 
 vesication has ])een produced, and in cases where irritants of 
 any kind have been employed for several days or a week previous 
 to an examination, more or less supersensitiveness is to be ex- 
 pected. 
 
DIAGNOSTIC PRINCIPLES 45 
 
 One must not lose sight of the fact that unscrupulous dealers, 
 — "traders" — make use of their knowk^dge of this principle in 
 various way usually for the purpose of attracting attention to 
 a part, which, presumably might have been blistei'ed in order to 
 intentionally produce inflammation of tissu'^s. iti this way; 
 causing lameness which is not manifested until an animal has 
 been kept by its new owner for twenty-f( U)- Ik urs or more. 
 This, to be sure, usually makes a dissatisfied purchaser who is 
 willing to dispose of his newly acquired animal at a sacrifice. 
 thus enabling the original owner or his agent to regain posses- 
 sion of the victimized animal at less than its real value. 
 
 Some nervous animals, because of the manner of approach of 
 the practitioner, are wont to flinch, and there is manifested a 
 pseudo-supersensitiveness. Young animals not accustomed to be- 
 ing handled are likely to be timorous, and one must not hastily 
 conclude that a part is painful to the touch because the subject 
 resents even gentle digital manipulation of such parts. In 
 instances of this kind, one needs to compare sensibility by manip- 
 ulation of different parts of the subject's liody in a careful and 
 gentle manner ; and by exercising patience and good judgment 
 in such work, it is possible to actually distinguish between nor- 
 mal sensibility and abnormal sensitiveness, in most cases. Here, 
 again, the diagnostician needs to jiossess skill as a horseman and 
 good judgment as to individual temperament of different animals, 
 under any condition which may exist af the time he makes his 
 examination. 
 
 By palpation alone, one can recognize the presence of fluctu- 
 ating enlargements ; one may not oidy recognize such conditions, 
 but distinguish between a fluctuating ma-s such as exists in non- 
 strangulated hernia and a large fibrous tumor. By palpation, 
 for the recognition of density and for determining the presence 
 or absence of hyperthermia, one may decide that there exists 
 an abscess and not a tumor. Edematous swellings are recog- 
 nized by palpation, — the characteristic indentations which may 
 be made in dropsical swellings are pathognomonic indicafoi-s. 
 In this manner it is easy to differentiate post-operative or i)cst- 
 traumatic edemas which may or may not cause lameness. At 
 any rate, it is essential to take into account all determinate con- 
 
46 LAMENESS OF THE HORSE 
 
 ditions that may assist iu the prognosis of any given case, 
 for the purpose of being able to outline rational remedial 
 measures. To be able to distinguish between the generalization 
 of a septic infection in its incipiency, and a more or less benign 
 edema, is largely possible by digital manipulation alone. An 
 extremity may be greatly swollen because of the existence of 
 chronic lymphangitis, influenza, or an acute septic infection oc- 
 casioned by the introduction of pathogenic and aerogenic or- 
 ganisms. Since the effect produced by these dissimilar ailments 
 are productive of conditions that may terminate favorably or 
 unfavorably, it becomes necessary for the diagnostician to de- 
 velop a trained, discriminating, tactile-digital sense, in order to 
 correctly interpret existing conditions, and handle cases in 
 a rational and skillful manner. 
 
 In order to ascertain the extent and exact location of a tumor, 
 an exostosis, or other enlargements, the diagnostician, here also, 
 needs to be in possession of a trained tactile sense and in addi- 
 tion if he be fortified with an accurate knowledge of normal anat- 
 omy and pathology, he is able to arrive at proper conclusions, 
 when digital manipulations have been employed. Fibrous tu- 
 mors are sometimes located in the inferior part of the medial 
 side of the tarsus — exactly over the seat of bone-spavin. Such 
 tumors, when the affected member is supporting weight, are not 
 to be distinguished from exostoses; but as soon as the affected 
 leg ceases to bear weight, it may be passively flexed and the 
 nature of the enlargement recognized because it may be slightly 
 displaced by digital manipulation. Displacement, of course, is 
 not possible with an exostosis. 
 
 A necessary qualification, which the diagnostician must pos- 
 sess, is that of being able to judge carefully the nearness of any 
 given exostosis to articular structures. Also, the extent or area 
 of the base of an exostosis as well as its exact position, needs 
 be determined before one may estimate the probal)le outcome 
 in any case, — whether treatment should be encouraged or dis- 
 couraged by the practitioner. Periarticular ringbone may, be- 
 cause of the size and location of the exostosis, constitute a con- 
 dition Avhich cannot be relieved in any way in one case, and in 
 another, because of the manner of distribution of such osseous 
 
DIAGNOSTIC PRINCIPLES 47 
 
 deposits, the eoiulitiou may be such that prompt recovery will 
 follow proper treatment. In the examination of an exostosis of 
 the tarsus, it is particularly important to determine the exact 
 location of the exostosis — whether or not the spavin involves 
 the ti])ial tarsal (astragulus) ])one very near its tibial articular 
 portions. Obviously, if articular surfaces of joints are involved, 
 comjilete recovery cannot result despite the most skillful atten- 
 tion given the subject. 
 
 Passive Movements. 
 
 Wherever it is possible to gain the confidence of a tractable 
 animal to the extent that it will relax the structures sufficiently 
 to nuike possible passive movement of affected parts, much is 
 to be learned as a result of such manipulation. By this method 
 one may differeiitiate true crepitation, false crepitation, luxation 
 and inflammation of ligaments that have been injured, as in 
 sprains of such structures in the phalangeal region. 
 
 True crepitation is recognizable by the characteristic vibra- 
 tion which is interjireted by tactile sense. It is possible to rec- 
 ognize fracture by the use of other methods — auscultation, tun- 
 ing fork tests, etc., but in ordinary veterinary practice one must 
 rely upon the sense of touch for recognition of crepitation. 
 
 Where pain is not so great tliat relaxation of parts does not 
 occur, one can, by gently moving an extremity in various di- 
 rections — as in flexion, extension and lateral motion as well as by 
 rotation — cause to be manifested this peculiar grating, — the 
 friction of newly broken bone. This is known as true crepitation. 
 Where the subject, suffering phalangeal fracture, manifests 
 evidence of pain due to tensing the structures abinit a fractured 
 part, one may anesthetize the parts by using a1)0ut two cubic' 
 centimeters of a two per cent, solution of cocain upon the plantar 
 nerves, proximal to the fracture. It is perhaps l)est to deposit 
 the cocain solution by means of two hypodermic punctures at 
 different points along the course of each nerve, though closely 
 situated to one another, thereby making more sure of the so- 
 lution actually contacting the nerve. In some multiple frac- 
 tures of the first or second phalanx this is quite necessary; 
 otherwise, pain produced by passive manipulation causes the 
 
48 LAMENESS OF THE HORSE 
 
 subject to keep the tendons so tense that crepitation may not 
 be detected. The unnecessary infliction of pain is always to be 
 avoided. 
 
 We know as false crepitation a vibrating impulse occasioned 
 by normal contact of articular portions of bones such as in the 
 metacarpophalangeal joint when this structure is passively 
 moved, where the subject permits the parts to remain in a state 
 of complete relaxation. 
 
 Attempts to recognize supersensitiveness or inflammation by 
 means of passive movement of the shoulder or hip, whether 
 gently or forcefulty, is not productive of good, in any case, in 
 large animals. Because of the bulk and weight of parts so 
 manipulated, a.s well as the resistance the subject offers even 
 in normal cases, no accurate conclusion is to be arrived at in 
 this manner in the average instance. Animals nearly always 
 resist the placing of members in any position that is so unusual 
 and uncomfortable as that which is required to materially dis- 
 place the component tissues of the shoulder or hip ; therefore, 
 such ])raetiee is useless because one can not distinguish between 
 normal resistance and flinching caused by painful sensations in 
 injured parts. Such manipulations are practical in small ani- 
 mals. 
 
 Observing the Character of the Gait. 
 
 In order to determine the degree of lameness as well as its 
 character, it is necessary to cause the s'ubject which is being 
 examined, to move in some manner. The degree of inconvenience 
 or distress experienced by a lame animal that is being so ex- 
 amined is manifested l)y the character of the claudication ; and 
 where much pain is occasioned in locomotion there is disturbance 
 of respiration ; perspiration may be noticeable and in some in- 
 stances manifestation of nervous shock are very evident — this in 
 timid, nervous animals that anticipate being punished when 
 approached and, consequently, make every effort possible to 
 move when urged to do so. An animal, then, should be moved 
 only sufficiently to cause it to exhibit the degree of lameness 
 present in any given case, and if a marked impediment is mani- 
 fested it is not necessary to cause the subject to be exerted to 
 
DIAGNOSTIC PRINCIPLES 49 
 
 the extent of inflicting, in such manner, unnece^sai-y punishment. 
 Further or conclusive examination is made by palpation. To 
 cause the subject to move, an assistant may simply lead the ani- 
 mal with a halter and compel it to walk a few steps. In this 
 way, lameness, whether manifested during the weight-bearing 
 period of an alfected member, or when such a meud)er is being 
 advanced, or whether a com])ination of the two conditions exists, 
 is made apparent. In the words of Dollar, one is thus enabled 
 to recognize the existence of "supporting-leg-lameness," "swing- 
 ing-leg-lameness" or "mixed lameness." 
 
 ^Yhen the cause of lameness is not strikingly apparent it be- 
 comes necessary to have the subject moved farther than a few 
 steps and at different paces. Depending then, upon the charac- 
 ter of lameness manifested, as well as upon its degree of iu- 
 tensity, one needs to exercise the subject in various ways, but 
 this should not be overdone. 
 
 The first thing apparent in the lame subject in action, is the 
 lame leg. If this is not readily determinable, as in some compli- 
 cated cases, the leg or legs which are at fault are to be dis- 
 covered by further examination, and to do this, — word-pictures 
 convey little that is helpful in dif^cult cases, — long practice is 
 the one route by which one may become efficient; that is, by ex- 
 perience gained after fundamental principles in the diagnosis 
 of lameness have been mastered. 
 
 For a careful study of supporting-leg-lameness involving a 
 fore limb, the subject is driven or led toward the one making 
 such examination. If a hind leg is to be observed, the animal 
 is made to travel (nraij from the examiner. Where there exists 
 swinging-leg-lameness, the subject should be caused to movt 
 past the diagnostician, so that he may get a side view of the 
 subject while it is in motion. 
 
 In every case sucli examinations are made to the best ad- 
 vantage if the practitioner can view his patient from a little 
 distance. Here, again, a visual examination is made but this 
 cannot be successfully executed, in difficult cases, if the prac- 
 titioner is stationed at too close range. 
 
 The average subject is liest observed by being led, rather than 
 being ridden, and in so doing the animal should be given moder- 
 
50 LAMENESS OP THE HORSE 
 
 ately free rein. A close grasp on the lead may interfere some- 
 what with head movements. Nodding of the head with the catch- 
 ing up of weight hy a sound member in supporting-leg-lameness 
 of a fore leg, constitutes the chief symptom considered in de- 
 tecting the lame leg. 
 
 Where supporting-leg-lameness affects a hind limb the head 
 is raised at the time weight is caught by the sound member — 
 here the long axis of the subject's body may be likened unto 
 a lever of the first class. The posterior part of the body, at iho 
 time weight is taken upon the sound leg, is as the long arm : the 
 fore limbs the fulcrum, and the subject's head the weight, which 
 is lifted. The head movements of a horse at a trot, in support- 
 ing-leg-lameness of a front leg, synchronize with the discharge of 
 weight from a lame leg to the opposite one if sound ; but in 
 pelvic limb affections, the head is thrown or jerked upward as 
 weight is caught by the sound member, — this peculiar nodding 
 movement is opposite in the two instances. 
 
 In pacing horses, since front and liind legs of the same side 
 are advanced at the same time, there occurs in supporting-leg- 
 lameness, a nodding of the head with discharge of weight from 
 the lame leg, and a dropping of the hip as weight is caught by 
 the sound pelvic member. In observing animals that are limp- 
 ing, (as in supporting-leg-lameness) one notices particularly the 
 sacro-iliac region in hind leg affections and the occipital region 
 in lameness of the front legs. 
 
 Where there exists a bilateral affection, (such as characterizes 
 some cases of navicular disease or other affections causing sup- 
 porting-leg-lameness) there occurs no nodding of the head; 
 weight is supported for an equal length of time upon each one 
 of the two legs, but the stride^ is shortened. The gait, in such 
 cases, is peculiar, animals appearing stiff' and they are said, by 
 horsemen, to have a "choppy" gait. 
 
 It i? desirable, in some cases, to cause an animal to move from 
 side to side; in other instances the subject is best made to walk 
 or trot in a circle, and if the circle be very small the animal 
 then particularly employs the inner fore leg as a pivotal sup- 
 
 ^By .stiide i.s mefuit the distance l)etween two successive imi>rints of tlie 
 same foot. The term is not used in this work as being synonymous with 
 step. 
 
DIAGNOSTIC PRINCIPLES 51 
 
 porting member. To augment the manifestation of certain af- 
 fections, it is necessary to cause the patient to walk backward, 
 and each one of these tests of locomotion serves to point out 
 in a more or less characteristic manner, the site of the affection 
 which is causing lameness in different cases. 
 
 Sprains or injuries of lateral ligaments of the extremities, 
 ringbone and certain foot aft'ections, are made manifest by a 
 side to side movement or a pivotal movement. In fact, wherever 
 it is possiI)le to cause undue or unusual tension to be exerted 
 upon an inflamed structure, manifestation of pain is the re- 
 sponse. In an inflamed condition of the lateral side of the pha- 
 langes, unequal weight-bearing such as a rough road surface will, 
 by virtue of the leverage which the solar surface of the foot af- 
 fords, cause undue strain upon such inflamed parts, and in- 
 creased lameness is evident. 
 
 When an animal is made to travel in a circle, when a mem- 
 ber affected with supporting-leg-lameness is on the inner side 
 of the circle, lameness is accentuated because weight is borne by 
 the lame leg for a greater length of time, the result of such cir- 
 cuitous manner of locomotion. In swinging-leg-lameness, on 
 the other hand, because pain is increased at the time an affected 
 member is being advanced, lameness is increased when the sub- 
 ject is made to travel in a circle, with the lame leg on the out- 
 side of a circle thus described. 
 
 In supporting-leg-lameness, the transientness of the w^eight- 
 bearing period upon the affected member is the determining 
 factor in the production of lameness. This unequal period of 
 weight-bearing upon the front legs, for instance, causes an ac- 
 celeration in the advancement of the sound member, in order to 
 relieve the diseased one which is bearing weight. In other words, 
 when an animal that is affected with supporting-leg-lameness 
 travels in a straight line, since weight is borne by the diseased 
 leg for an abnormally short period of time, the sound member 
 needs be in the act of advancement a correspondingly short pe- 
 riod. The result is then, an une(iual division of stride; a nod- 
 ding of the head with the catching up of weight by the sound 
 leg, — in front leg affections — and this is termed limping. 
 
 With continuous exertion as in travel for a considerable dis- 
 
52 LAMENESS OF THE HORSE 
 
 tauce, ill some cases, lanieuess becomes less evident — as in sjiavin. 
 This "warming out" process is due in a measure to the parts 
 becoming less sensitive upon exertion, and is to be seen, to a 
 limited extent, in all inflammatory affections that are not too 
 severe; consequently, in some cases, examination of a lame ani- 
 mal should begin in the stall, for in instances where the impedi- 
 ment is not marked, there may be no evidence of lameness after 
 the subject ha.s walked a few steps. In other cases, lameness in- 
 creases as the subject continues to travel, and often to the ex- 
 tent that tile impediment becomes too severe to allow the animal 
 being serviceable. Therefore, one can not, in every case of lame- 
 ness observed, positively determine the gravity of the situation, 
 without having seen the affected animal in action for a sufficient 
 length of time to understand the nature of the condition ex- 
 isting. This necessitates driving the animal for several miles in 
 certain cases. 
 
 Sometimes it is impossible to arrive at any definite conclusion, 
 as the result of a single examination, and it then becomes neces- 
 sary to see the subject again at a later date, or under more 
 favorable circumstances. This is to be expected in some con- 
 ditions where there exists rheumatic affections, and also in some 
 foot diseases. 
 
 In the examination of young animals, unused to harness and 
 to other strange incumbrances, one is obliged to make allow^ance 
 for impediments of gait, which are not occasioned by diseased 
 conditions. Such affections have been termed "false lameness." 
 Young mules that are not well broken to harness, are difficult sub- 
 jects for examination ami in some eases it is necessary to have 
 them led or driven for a considerable distance before one can 
 definitely interpret the nature of the impediment in the gait when 
 lameness is not pronounced. Jt is especially difficult to satis- 
 factorily examine such subjects, for the reason that their normal 
 rebellious temperaments cause resistance whenever a strange 
 person approaches them, as it is necessary to do for an examina- 
 tion by palpation. In such cases — if an examination does not 
 reveal the cause of trouble, rest must be recommended and fur- 
 ther examination made at a later date, whereupon any new 
 developments iiuiy be noted, if such changes exist. 
 
DIAGNOSTIC PRINCIPLES 53 
 
 Special Methods of Examination. 
 
 After having coiupk'ted a general examination of a lame ani- 
 mal—obtaining tlie history of the case, noting its temperament, 
 type, size, conformation, position assumed while at repose, swell- 
 ings or enlargements if present, causing the subject to move to 
 note the degree and character of lameness manifested ; palpating 
 and manipulating the parts affected to acquire a fairly definite 
 notion of the nature of an intlannnation or to recognize crepita- 
 tion it becomes necessary in some cases to employ peculiar means 
 of examination in singular instances. This may be done by mak- 
 ing use of cocain in solution for the production of local anes- 
 thesia as in lameness of the phalanges. Such means are not, in 
 themselves, dependable but are valuable when used in conjunc- 
 tion with all other available and practical methods. 
 
 Trial use of various shoes in order to shift the weight from 
 one part of the foot to another or to cause an animal to "breali 
 over" in a different uumner so that the gait may be changed, 
 constitutes a special test procedure. The use of hoof testers 
 or of a hammer to note the degree or presence of supersensi- 
 tiveness is another means that is of practical service. No exam- 
 
 Pig. i_Hoof testers with special jaws of sufficient size to grasp the 
 largest foot. 
 
 ination, in any case of lameness, is complete without having re- 
 moved the shoe and scrutinized the solar surface of the foot. 
 
 Diagnosis by exclusion, finally, is resorted to, and, as in any 
 other case where the recognition of cause is difficult, exclusion 
 of the existence of conditions, — one at a time, by an analysis 
 of symptoms — generally enables the practictioner to eliminate all 
 but the disturbing element. 
 
SECTION IT I. 
 LAMENESS IN THE FORE LEG. 
 
 Anatomo-Physiological Review of parts of the Fore Leg. 
 
 For supporting weight, whether tlie suhjeet is at rest or in 
 motion, the bony eolunin of the leg, together with attached liga- 
 ments, tendons and muscles, is wonderfully well adapted by na- 
 ture for the function which they perform. The several bones 
 which go to make up the supportive portion of the leg, are so 
 joined at their points of articulation, that a minimum degree 
 of strain is put upon each attachment. 
 
 The upper third of the scapula, with its cartilage of prolonga- 
 tion, is sufficiently broad and flattened that it fits snugly against 
 the tliorax without necessity for a complicated method of attach- 
 ment — the clavicle l)eing absent, attachment is muscular. 
 
 Smith^ has very aptly stated that : 
 
 "It seems quite legitimate to regard the muscular union between 
 the thorax and forelimb as a joint. There are no bones resting 
 on each other, no synovia ; l)ut where the scapula has its largest 
 range of movement there is a remarkable amount of areolar 
 tissue, which renders movement easy. The whole central area 
 beneath the scapula and humerus not occupied by muscular at- 
 tachment, is filled with this easy-moving, apparently gaseously 
 distended, crepitant, areolar tissue over which the fore legs glide 
 on the chest wall as freely as if the parts were a large, well 
 lubricated joint. ' ' 
 
 The scapulohumeral articulation (shoulder joint) is an 
 enarthrodial (ball and socket) joint but because of its being 
 held more or less firmly against the thoracic wall by muscular 
 and tendinous attachment, and because a part of this attachment 
 affords a means of support for the body itself, there is no need 
 for binding ligaments and movement is possible in all directions 
 even though restricted as to extent. 
 
 iManual of Veterinary I'hysiology, by Major-General F. Smith, page .590. 
 
 55 
 
56 
 
 LAMENESS OP THE HORSE 
 
 Extensor cnrpi obliqum, 
 
 Metacarpal tuberosity — ^ [\ 
 Tendon from common to lateral extensor 
 
 Lateral small metacarpal bone 
 
 Branch of suspensory ligament to 
 extensor tendon 
 
 Olecranon 
 
 Ulnar head of deep flexor 
 
 Lateral extensor 
 Deep flexor (humeral head) 
 
 Tendon of ulnaris lateralis 
 Accessory carpal bone 
 
 Check ligament 
 
 Suspensory ligament 
 Flexor tendons 
 
 Flexor tendons 
 (Uirtilnge of third phalanx 
 
 Fig. 2 — Muscles of Left Thoracic Limb from Elbow Downward; Lateral 
 (External) View. 
 
 a, Extensor carpi radialis; g, brachialis: g', anterior superficial pectoral; 
 c, common digital extensor; e, ulnaris lateralis (After Ellenberger-Baum, 
 Anat. fiir Ktinstler.) (From Sisson's "Anatomy of the Domestic Animals"). 
 
LAMENESS IN THE FORE LEG 
 
 57 
 
 Long head of triceps 
 Medial head of triceps 
 
 Olecranon 
 Ulnar head of deep flexor - 
 
 Flexor carpi ulnaris 
 Flexor carpi radiaUa - 
 
 / Biceps brachii 
 
 1- 
 
 Extensor carpi radinlis 
 ■ Long tendon of biceps 
 Brachialis 
 Long medial ligawcnl 
 
 Radius 
 
 Accessory carpal hone 
 Medial ligament of carpjis 
 
 Superfwial flf.xnr tendon 
 
 Deep flexor lendon 
 Suspensory ligament 
 
 Distal end of Mc. II 
 Annnl/iT ligament 
 
 Superficial flexor tendon 
 Deep flexor tendon . 
 
 Tendon of extensor carpi 
 obbquus 
 
 Metacarpal tuberosity 
 
 Mc. Ill 
 
 Fetlock joint 
 
 Extensor branch of suspcnsorii 
 ligam.enl 
 
 Common extensor tendon 
 ■ Pastirn joint 
 Cartilage of third phalanx 
 
 Fig. 3 — Muscles of Left Thoracic Limb from Ell)o\v Dov.-pward; Medial 
 (Internal) View. 
 
 The fascia and the ulnar head of the flexor carpi ulnaris liave been re- 
 moved. 1, Distal end of humerus; 2, median vessels and nerve. (From 
 Sisson's "Anatomy of the Domestic Animals"). 
 
58 LAMENESS OF THE HORSE 
 
 Undue extension, (by extension is meant such movement as 
 will cause the long axis of two articulating bones to assume a 
 position which approaches or forms a straight line — opposite to 
 flexion), of the scapulohumeral joint is impossible while weight 
 is borne, because of the normally flexed position of the humerus 
 on the scapula ; whereas flexion, beyond desirable limits, is in- 
 hibited by the biceps braehii (flexor l)rachii or coracoradialis) 
 muscle. 
 
 The distal end of the humerus, however, articulating with the 
 radius and ulna in a fashion that no support is lent liy any sort 
 of contact with the liody, is a ginglymus (hinge) joint and later- 
 al motion, because of the long transverse diameter of its articular 
 ]")ortions, is easily prevented by the medial and lateral ligaments 
 (internal and external ligaments). Flexion of this, the humero- 
 radioulnar joint (elbow), is restrained by the triceps braehii 
 and extension is checked by the biceps braehii (flexor braehii). 
 
 The carpal joint (erroneously called the knee joint), is com- 
 posed of the several carpal bones which interarticulate and, 
 when taken as a group, serve as a means of attachment and ar- 
 ticulation for the radius and metacarpal bones. 
 
 The transverse diameter of this joint is long, thus giving it 
 contacting surfaces that are sufiiciently extensive to minimize 
 the strain upon the mesial and lateral ligaments (internal and 
 external lateral common ligaments). ]\Iotion is that of flexion 
 and extension ; slight rotation is possible when the position is 
 that of flexion. While supporting weight the carpus is fixed in 
 position by a slight dorsal flexion, but undue dorsal flexion is 
 prevented by the flexor muscles and tendons and volar-carpal or 
 annular ligament, together with the superior cheek ligament. 
 
 The metacarpophalangeal articulation (fetlock joint), is a 
 hinge joint and its articular surfaces contact one another, with 
 respect to their having a long bearing surface from side to side, 
 as do all ginglymus (hinge) joints. Two common lateral liga- 
 ments bind the bones together. AVhile bearing weight, there is 
 assumed a position of slight dorsal flexion, undue flexion being 
 checked by the inhibitory ap])aratus of the joint — cheek liga- 
 ments, and their tendons and the suspensory ligament. The in- 
 hibitory apparatus of the fetlock joint is materially reinforced 
 
LAMENESS IN THE FORE LEG 
 
 59 
 
 })y the proximal sesamoid bones. Situated as they are, between 
 tlie bifurcatino' portions of the suspensory ligament and the pos- 
 terior part of the distal end of the metacarpus — with which they 
 ai'ticulate — the sesamoid bones serve to change the course of the 
 
 Stin 
 
 Tendon of common exlensoi 
 
 Bursa 
 
 Capsule of fetlock joint 
 Cavity of fetlock joint 
 
 Cavity of /laslcrti jmnl 
 
 Cavity of coffin joint . ^^ 
 Coriinn of pcriople ^^ ^^ / 
 
 I'criopk^S^. / 
 rutin Jg' -- : 
 
 Middle scsamoidcan ligamcjil 
 
 -f^ir/ Digital synovial sheath 
 
 lfJJ~~ Cavity of pastern joint 
 
 Superficial sesamoidean ligament 
 
 Deep flexor tendon 
 
 Distal end of digital sheath 
 
 — r2 
 11 
 
 Digital cushion 
 
 Corium of sole 
 
 Fig. 4— Sagital Section of Digit and Distal Part of Metacarpus. 
 
 A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third phalanx; 
 E, distal sesamoid bone; 1, volar pouch of capsule of fetlock joint; 2, inter- 
 sesamoidean ligament; 3, 4, proximal end of digital synovial sheath; 5. 
 ring formed by superficial flexor tendon; 6, fibrous tissue underlying ergot; 
 7, ergot; 8, 9, 9', branches of digital vessels; 10, distal ligament of distal 
 sesamoid bone; 11, suspensory ligament of distal sesamoid bone; 12, 
 12', proximal and distal ends of bursa podotrochlearis. (From Sisson's 
 "Anatomy of the Domestic Animals"'). 
 
 branches of the suspensory ligament in a manner that they give 
 firm support to this joint. Volar Hexion is limited by the ex- 
 tensors of the phalanges. 
 
 The first phalanx (os suffraginis) normally sets at an angle 
 
60 LAMENESS OF THE HORSE 
 
 of about 50 to 55 degrees from a horizontal plane while weight 
 is being supported. Its distal end articulates with the second or 
 median phalanx (os corona) and forms the proximal inter- 
 phalangeal (pastern or sutfraginocoronary) joint. This also, 
 is a gingiymus joint, having but slight lateral motion, and that 
 only when it is in a state of flexion. A rather broad articular 
 surface — from side to side — exists here, lessening the strain 
 on the collateral ligaments somewhat. Dorsal flexion is checked 
 by the flexor tendons and dorsal ligaments. Volar flexion is re- 
 strained by the extensor tendons. 
 
 The distal end of the second phalanx (os corona) has but slight 
 lateral motion and this is manifested principally when it is in 
 a state of volar flexion. Undue dorsal flexion is prevented by 
 the deep flexor tendon (perforans) and volar flexion is inhibited 
 by the extensor of the digit (extensor pedis). Thus it is seen, 
 that when the leg is a weight-bearing member, weight is sup- 
 ported by the hony framework whose constituent parts are joined 
 together by ligaments and tendons and each one of the several 
 bones articulates in such manner that the joint is locked. The 
 articular parts of bones rest upon or against an inhibitory ap- 
 paratus, and are slightly flexed, as in the carpus, or considerably 
 flexed such as in the fetlock joint when weight is being sup- 
 ported. In the first instance, for example, the flexors of the 
 carpus and the superior check ligament assisted by the flexors 
 of the phalanges constitute the inhibitory apparatus. 
 
 It will be noted that provision for weight bearing is so ar- 
 ranged that muscular energy is not required except in the matter 
 of suspension of the body between the scapulae and here tonic 
 impulses only are necessary to maintain an equilibrium^, yet 
 in every instance where weight is not supported by bones, in- 
 elastic ligaments or tendinous structures relieve the musculature 
 of this constant strain. This explains the fact that some horses 
 do not lie in the stall, yet in spite of their constant standing 
 position, they are able to rest and sleep. 
 
 The student of lameness is interested in the function of the 
 legs in the role of supporting weight and as propelling parts, 
 and net ]i;)rtii'ulai'ly in tlic capacity of these members for in- 
 
 ^Manual of Veterinary l>hysiolo,a;v liy Major-Oeneral F. Smith, page 580 
 
LAMENESS IN THE FORE LEG 61 
 
 flicting offense or as weapons of defense. Yet, in the exercise of 
 their functions other than that of locomotive appliances, injury 
 often results, but usually it is the recipient of a blow that suffers 
 the injury, such as an animal may receive upon being kicked. 
 Therefore, we do not often concern ourselves with strains or other 
 injuries that the subject experiences as the result of efforts put 
 forth in kicking or striking. Where such injuries occur, how- 
 ever, a diagnosis is established l)y making use of the principles 
 heretofore discussed. 
 
 As propelling members the front legs bear weight and are 
 advanced alternately when the horse is walking or trotting — in 
 cantering this is not so. When the normal subject travels in a 
 straight line, at a walk or a trot, the length of the stride is the 
 same with the right and left nu^nbers. The stride of the right 
 foot then, for example, is equally divided by the imprint of the 
 left foot, in the normal horse, when traveling at a walk and in 
 a straight line. 
 
 Shoulder Lameness. 
 
 This enigmatical term is frequently employed by the diag- 
 mostician when he is baffled in the matter of definitely locating 
 the cause of lameness; when he has by exclusion and otherwise 
 arrived at a decision that lameness is "high up." Shoulder 
 lameness may lie caused l)y any one or several of a number of 
 conditions, e. g., fractures of the scapula or humerus; arthritis 
 of the shoulder or elbow joint; luxation of the shoulder or ell)OW 
 joint (rarely) ; injuries of muscles and tendons of the region due 
 to strains, contusions or penetrant wounds; paralysis of the 
 brachial plexus or of the prescapular nerve; involvement of 
 lymph glands; arterial thrombosis; metastatic infections; rheu- 
 matic disturbances ; and as the result of inflammation, infectious 
 or non-infectious occasioned by collar bruises. In some instances 
 such inflammation is due to the manner of treatment of collar 
 injuries. Therefore, when one considers the numerous and dis- 
 similar possible causes of shoulder lameness, it behooves the prac- 
 titioner to become proficient in diagnostic principles. 
 
 A principle which is elemental in the diagnosis of locomotory 
 impediment, is that lameness of the shoulder or hip is usually 
 
62 
 
 LAMENESS OF THE HORSE 
 
 manifested by more or less difficulty in swinging the affected 
 member. Swinging-leg-lameness, then, is usually present in 
 shouAder affections. In some instances lameness is mixed as in 
 joint ailments, involvement of the bicipital bursa (bursa inter- 
 tubercularis), etc. In affections of the extremity there exists 
 supporting leg lameness. Consequently, we employ this ele- 
 mental principle, and, by a visual examination of the subject, 
 which is being made to travel suital)ly, one may decide that 
 lameness is either "high up" — shoulder lameness or, "low 
 down" — of the extremitv. 
 
 Fig. 5 — Ordinary type of heav>- sling. 
 
 To make practical use of this principle, the examiner must 
 be thoroughly familiar with the anatomy of the various struC' 
 tures concerned in advancing the leg — those which support weight 
 as well as those concerned l)oth in weight bearing and swinging 
 the member. 
 
 Fracture of the Scapula. 
 
 Etiology and Occurrence. — Fractures of the body of the 
 scapula are of infrequent occurrence in horses for the reason 
 
LAMENESS IN THE FORE LEG 
 
 63 
 
 that protection is afforded this bone because of its position. Its 
 function, too, is such that very unusual conditions are necessary 
 to subject it to fracture. The spine is occasionally broken due 
 to blows such as kicks, etc., and here frequently a compound 
 fracture exists. 
 
 "Where fractures of the body of the scapula occur, heavy con- 
 tusions have been the cause as a rule, and serious injury is done 
 the subject ; consequently, treatment of fracture of the body of 
 
 Fig. 6 — A sling made in two parts so that horses may be supported with- 
 out use of central part or bodice. This sling is more comfortable than 
 is the ordinary style and is particularly useful in cases that require a 
 long period of this manner of confinement. 
 
 the scapula is seldom successfully practised. Fractures of the 
 body of this bone resulting from accidents not involving internal 
 injury or other disturbances and which would not seriously inter- 
 fere with the vitality of the suliject, are not necessarily serious 
 unless compound. 
 
 Fractures of the neck of the scapula are serious because of 
 the fact that there occurs displacement of the broken parts and 
 
64 LAMENESS OF THE HORSE 
 
 perfect apposition of the fractured ends is difficult, if not ini 
 possible. 
 
 Fractures that extend to the articular surface are very seri- 
 ous, and complete recovery in such instances is practically impos- 
 sible. The cartilage of prolongation of the scapula is sometimes 
 seriously involved in certain cases of fistulous withers, and in 
 some instances it has been separated from its attachment to the 
 rhomboidea muscles, and lameness has resulted. In such in- 
 stances, the upper portion of the scapula is disjoined from all 
 attachment, and with every movement the animal makes, the 
 scapula is moved l)ack and forth. Complete recovery in such 
 cases does not occur. 
 
 Symptomatology. — Fractures of the scapular spine are ordi- 
 narily readily recognized because there is usually visible dis- 
 placement of the broken part. Crepitation is also detected with- 
 out difficulty. 
 
 In fractures of the body of the scapula where an examination 
 may be made before much swelling has taken place, and in sub- 
 jects that are not heavily muscled, one should have no difficulty 
 in recognizing the crepitation. 
 
 Fractures of the neck of the scapula are recognized by crepi- 
 tation, by passively moving the leg, but it is necessary to exclude 
 fractures of the humerus when one depends upon the finding of 
 crepitation by this means. However, unless undue swelling ex- 
 ists, the exact location of the crepitation is recognized without 
 serious difficulty. 
 
 Treatment. — The treatment of compound fractures of the 
 scapular spine consists in the removal of the broken piece of 
 bone by ^^ay of a cutaneous incision so situated that good drain- 
 age of the wound will follow. 
 
 Simple fractures of the body of the scapula are best treated 
 by placing the subject in a sling, if the animal is halter broken, 
 and enforcing absolute quiet for a period of from tliree to six 
 weeks. Splints or similai' appliances are not of ])ractical value 
 in scapular fractures. 
 
 Compound fractures of tlic scapula usually result from vio- 
 lence, which at the same time does serious injury to adjacent 
 
LAMENESS IN THE FORE LEG 65 
 
 structures, and it then becomes necessary to administer an ex- 
 pectant treatment, observing general surgical principles and pro- 
 viding in so far as possible for the comfort of the patient. 
 
 Scapulohumeral Arthritis. 
 
 Anatomy.— The scapulohumeral joint is an enarthrodial (ball 
 and socket) joint wherein the ball or humeral articulating head 
 greatly exceeds in size the socket or glenoid cavity of the scapula. 
 The capsular ligament surrounding this joint is very large and 
 admits of free and extensive movement of the articulation. There 
 exist no lateral or common ligaments jointing the scapula and 
 humerus as in other joints, but instead the tendinous portions 
 of muscles perform this function. The principal ones which are 
 attached to the scapula and humerus that act as ligaments are 
 the supraspinatus (antea-spinatus), infraspinatus (postea- 
 spinatus) biceps-brachii (flexor brachii) and subseapularis mus- 
 cles. 
 
 Etiology and Occurrence. — Inflammation of the scapulohum- 
 eral articulation results from injuries of various kinds, including 
 punctures which perforate the joint capsule, bruises from col- 
 lars, metastatic infections and involvement as a result of direct 
 extension of infectious conditions situated near the joint. 
 
 Classification.— Acute arthritis may be septic or aseptic, and 
 there seems to be a remarkalile tendency for recovery in cases 
 of septic arthritis involving this joint in the horse. 
 
 Chronic arthritis with destruction of articular surfaces and 
 ankylosis, is seldom observed. It is only in cases of severe in- 
 jury, where the articular portions of the bones are damaged at 
 the time of infliction of the injury, and where the articulation 
 remains exposed for weeks at a time, together with immobility 
 of the parts because of attending pain, that permanent ankylosis 
 results. 
 
 Scapulohumeral arthritis may result then from infections, local 
 or metastatic; from injuries, such as contusions of various kinds; 
 from wounds, which break the surface structure or perforate 
 the joint capsule; or from luxations. 
 
66 ' LAMENESS OF THE HORSE 
 
 Infectious Arthritis. 
 
 Infectious arthritis of the scapulohumeral joint the result of 
 local causes other than produced by septic wounds, seldom causes 
 serious inconvenience to the subject. "Where such occurs, how- 
 ever, there is manifested mixed lameness and complete extension 
 of the extremity is impossible. Local swelling is present and 
 manifestations of pain are evident upon palpation of the affected 
 area. 
 
 Treatment. — During the first stage of the infection, local ap- 
 plications, hot or cold, are indicated. A hot poultice of bran 
 or other suitable material contained within a muslin sack, may 
 be supported by means of cords or taj^es which are passed over 
 the withers and tied around the opposite fore leg. Such an 
 appliance may be held in position more securely by attaching 
 it to the affected member. Following the acute stage of such an 
 infection, any local counter-irritating application or even a 
 vesicant is in order. 
 
 Where abatement of the infectious process does not take place, 
 and suppuration of the structures in the vicinity of the joint 
 occurs, it is necessary to provide drainage for pus. In some 
 cases of strangles, for instance, large pus cavities are formed 
 and drainage is imperative. However, metastatic inflammation 
 of this joint is seldom observed except in cases of strangles. 
 The animal should be kept perfectly quiet until recovery has 
 taken place. 
 
 Injuries. 
 
 Injuries to the scapulohumeral joint may be the result of 
 kicks, runaway accidents or bruises from the collar, and there 
 may result, because of such injuries, reactionary inflammation 
 which will vary in intensity from the mildest synovitis to the 
 most severe arthritis, causing more or less lameness. 
 
 Treatment. — The general plan of treatment in this form of 
 arthritis is the same as has been outlined under the head of in- 
 fectious arthritis, with the exception that there is seldom occa- 
 sion to provide for drainage of pus. 
 
LAMENESS IN THE FORE LEG 67 
 
 Wounds. 
 
 Wounds which cause a break of the skin and fascia overlying 
 the scapulohumeral joint are usually of little consequence, unless 
 the blow is of sufficient force to directly injure the articulation, 
 and in such cases, the treatment of the injury along general sur- 
 gical principles, such as cleansing the area, providing drainage 
 for wound secretion, and the administration of suitable dress- 
 ing materials such as antiseptic dusting powder, is all that is 
 required for the wound. The symptoms manifested by the sub- 
 ject in such cases are the same as have been discussed hereto- 
 fore and merit no special consideration. 
 
 Prognosis. — Unless very serious injury be done the articular 
 portions of the scapula or the humerus, resulting in the destruc- 
 tion of the capsular ligament, prognosis is entirely favorable. 
 
 Open Joint. — AVliere the capsular ligament is perforated and 
 the condition becomes one of open joint, then a special wound 
 treatment becomes necessary. The surface of the skin is first 
 freed from all hair and filth in the vicinity of the wound. The 
 wound proper is cleared of all foreign material either by clipping 
 with the scissors, curetting or mopping with cotton or gauze 
 pledgets. The whole exposed wound surface as well as the in- 
 terior of the joint cavity, if much exposed, is moistened with 
 tincture of iodin. Subsequent treatment consists in a local appli- 
 cation of a desiccant dusting poAvder, which should be applied 
 five or six times daily. The composition of the powder should 
 be such as to permit of its liberal use, thereby affording mechan- 
 ical protection to the wound as well as exerting a desiccative 
 effect. Equal parts of boric acid and exsiccated alum serve 
 very well in such cases. 
 
 Animals suffering from open joints of this kind should be 
 confined in a standing position, preferably in slings, and kept 
 so confined for three or four weeks. Since they usually bear 
 weight upon the affected member, there is no danger of lamin- 
 itis resulting. 
 
 Luxation of the Scapulohumeral Joint. 
 
 Because of the large humeral head articulating as it does with 
 
68 LAMENESS OF THE HORSE 
 
 a glenoid cavity, scapulohumeral luxations are very rare in the 
 horse. According to Moller^, luxation is generally due to exces- 
 sive flexion of the scapulohumeral joint. In such cases the head 
 of the humerus is displaced anterior to the articular portion of 
 the scapula and remains so fixed. 
 
 Symptoms. — Complete luxation of the scapula is recognized 
 because of innnobility of the scapulohumeral joint and of the 
 abnormal position of the head of the humerus, which can be rec- 
 ognized by palpation, unless the swelling be excessive. Immo- 
 bility of the scapulohumeral joint is noticeable when one attempts 
 to passively move the parts. 
 
 Treatment. — Reduction of the luxation is effected by mak- 
 ing use of the same general principles that are employed in the 
 reduction of all luxations, and they are — the control of the ani- 
 mal so that the manipulations of the operator are not antagon- 
 ized by muscular contraction, which is best accomplished by 
 anesthesia; placing the luxated bones in the position which they 
 have taken to become unjointed ; and then making use of force 
 which is directed in a manner opposite to that which has effected 
 the luxation. 
 
 In a forward luxation of this kind, the operator should further 
 flex the humerus, and while it is in this flexed position, force is 
 exerted upon the articular head of this bone, and it is pushed 
 downward and backward into its normal position. 
 
 After-care consists in restriction of exercise and, if necessary, 
 confining the subject in a sling and the application of a vesicant 
 over the scapulohumeral region. 
 
 Inflsunmation of the Bicipital Bursa. 
 ( Bursitis Intertuberculeuis. ) 
 
 Anatomy. — There is interposed between the tendon of the 
 biceps brachii (flexor brachii) and the intertubercular or bicipi- 
 tal groove a heavy cartilaginous pad, which is a part of the bursa 
 of the biceps brachii. This synovial bursa forms a smooth groove 
 through wliicli tlie l)ieeps braelni glides in the anterior scapulo- 
 
 'Regional Veterinary Surgery and Operative Technique, .Tno. A. W. Dollar, 
 M. R. C. V. S., F. R. S. E., M. R. I., page 765. 
 
LAMENESS IN THE FORE LEG 69 
 
 humeral region. Great strain is put upon these parts because 
 the biceps brachii is the chief inhibiting structure of the scapu- 
 lohumeral articulation— the one which prevents further flexion 
 of the luimerus during weight bearing. Passing, as it does, over 
 two articulations, the biceps brachii has a somewhat compli- 
 cated function, being a flexor of the radius and an extensor of 
 the humerus. Thus it is seen, the biceps brachii is a weight bear- 
 ing structure, as well as one that has to do with swinging the leg. 
 Etiology and Occurrence. — Because of the exposed position 
 of the bicipital bursa (bursa-intertubercularis) it is occasionally 
 injured. Blows and injuries received in runaway accidents do 
 serious injury to the bursa and because of the peculiar and im- 
 portant part it plays during locomotion, serious injuries are 
 not likely to resolve, and too often chronic lameness results. It 
 is to be noted that the tendon of the biceps brachii (flexor bra- 
 chii) is always involved in cases of inflammation of the bicipital 
 bursa, and according to the late Dr. BelP strain of the biceps 
 brachii is a frequent cause of lameness in city horses, more fre- 
 quent than is generally supposed. 
 
 Pathological Anatomy. — ]\Iore or less destruction of the car- 
 tilaginous portion of the bursa, sometimes involving the tendin- 
 ous portion of the biceps, takes place and, according to MoUer, 
 in some instances there occurs ossification of the tendon. Autop- 
 sies in some old horses reveal the presence of erosions of carti- 
 lage and hyperthrophy of the inflamed parts. 
 
 Symptoms. — In acute inflammations, there is always marked 
 lameness. This is manifested to a greater degree when the sub- 
 ject advances the affected leg. There is incomplete advancement 
 of the member; the toe is dragged when the horse is made to 
 walk and the foot kept in a position posterior to the opposite or 
 weight bearing foot while the suliject is at rest. Lameness is 
 disproportionate to the amount of local manifestation in the way 
 of heat, swelling and pain that is to be recognized on palpation. 
 In fact, in some cases so much pain attends the condition that 
 no weight is borne liy the affected member, and when compelled 
 to walk, the subject hops on the sound leg. 
 
 iDr. Roscoe R. Bell in the Proceedings, N. Y. State Veterinary Medical 
 Society, 1899. 
 
70 LAMENESS OF THE HORSE 
 
 Chronic inflammation of the bicipital bursa is occasionally met 
 with wherein both members are afiPected. Because of the nature 
 of the structures involved, when inflamed, chronic inflammation 
 is a more frequent termination than is complete recovery. Bi- 
 lateral affections are seen in horses that are driven for years, 
 regularly at a fast pace on paved streets. In such cases, the 
 gait is stilted, that is, there is incomplete advancement of both 
 members and, of course, the period of weight bearing is cor- 
 respondingly shortened; hence the short strides. 
 
 In chronic cases, little if any evidence of inflammation is to 
 be detected by digital manipulation of the parts. If flinching 
 occurs, one is often unable to interpret the manifestation as to 
 whether it is due to inflammation or not. 
 
 There is no marked "warming out" in this condition, and ani- 
 mals are nearly as lame after having been driven a considerable 
 distance as when started, although the lameness is not as a rule 
 very great. 
 
 Treatment. — In very painful cases acute inflammation is 
 treated by employing cold applications during the initial stage. 
 Cracked ice when contained in a suitable sack may be held in 
 contact with the affected part and the pack is supported by 
 means of cords or tapes as suggested in the discussion on treat- 
 ment of scapulohumeral arthritis on page 66. Later, hot appli- 
 cations may be employed to good advantage. 
 
 In the course of ten days or two weeks, if the acute painful 
 condition has entirely subsided, vesication is indicated. The 
 ordinary mercury and cantharides combination does very well. 
 Depending upon the course taken in any given case, one is guided 
 in the treatment employed. If prompt resolution comes to 
 pass, the subject may be given free run at pasture after three 
 or four weeks confinement in a box stall. If, however, the case 
 does not progress in a prompt and satisfactory manner, abso- 
 lute quiet must be enforced for six weeks or more. Kepeated 
 blistering is beneficial, although it is doubtful if firing is of 
 sufficient benefit in the average chronic case of intertubercular 
 bursitis to justify the punishment which this form of treatment 
 inflicts, unless infliction of pain is the thing sought, to en- 
 
LA.MENESS IN THE FORE LEG 71 
 
 force repose in restless subjects. Patients are best given a long 
 rest at pasture and returned to work for two or three months 
 after an acute attack of inflammation of the bursa, lest the con- 
 dition become chronic. When due consideration is given the 
 pathology of such cases, the frequent unsatisfactory termination 
 under the most careful treatment, is readily understood. 
 
 Contusions of the Triceps Brachii. 
 ( Triceps Extensor Brachii : Caput Muscles. ) 
 
 Anatomy. — The triceps brachii is the principal structure 
 which fills the space between the posterior border of the scapula 
 and the humerus. The several heads originate for the most part 
 on the border of the scapula, the deltoid tuberosity of the hu- 
 merus and the shaft of the humerus. Insertion of this large 
 muscular mass is effected by means of several tendons to the 
 olecranon. A synovial bursa is situated underneath the ten- 
 dinous attachment of the posterior portion of the triceps brachii 
 — the long head or caput magnum. 
 
 The function of the triceps as a whole is to flex the shoulder 
 joint and extend the forearm. The triceps brachii is the chief 
 antagonist of the biceps brachii. 
 
 Etiology and Occurrence. — Owing to the exposed position of 
 this structure, it is not infrequently contused, the result of falls, 
 kicks and other injuries. The function of the triceps is such 
 that it becomes strained upon rare occasions Avhen a horse resists 
 confinement of restraint in such manner that the parts are un- 
 duly tensed in contraction. This sort of resistance may stretch 
 the radial nerve or its branches in a way that paralysis results. 
 A condition known as "dropped elbow" is described by Henry 
 Taylor, F. R. C. V, S., in the Veterinary Record^ wherein a 
 two-year-old colt while resisting confinement was so injured. 
 
 The triceps group because of its convenient location, consti- 
 tutes the site for hypodermic injection of drugs and biologic 
 agents, with some practitioners; and as a result, more or less 
 inflammation may occur. The author has observed and treated 
 some twenty cases where an intensely painful infectious inflam- 
 
 lAmerican Veterinary Review, Vol. 35, P. 456. 
 
72 LAMENESS OF THE HORSE 
 
 mation of the triceps brachii was caused by the intramuscular 
 injection of a caustic solution by a cruel and unscrupulous em 
 piric, whose object was to increase his practice. 
 
 Symptomatology. — As the triceps brachii is not particularly 
 taxed during weight bearing in the su])ject at rest, there may 
 be no unnatural position assumed during inflammation of the 
 triceps. More or less swelling and supersensitiveness is always 
 present, however, and great care and discrimination must be ex- 
 ercised in digital manipulation of the triceps region because 
 many animals are normally sensitive to palpation of these parts. 
 It is sometimes difficult to correctly interpret the true state of 
 conditions because of this peculiarity. 
 
 There is always swinging-leg-lameness, which is accentuated 
 when the subject is urged to trot. AVhere symptoms are pro- 
 nounced, it is unnecessary to cause the subject to move at a 
 faster pace than at a walk to recognize the condition. The for- 
 ward stride is shortened and in extremley painful conditions, no 
 attempt is made to extend the leg. It is simply carried en une 
 pipce — flexion of the shoulder and elbow joints is carefully 
 avoided. 
 
 Treatraient. — During the early stage of inflammation, hot or 
 cold applications are beneficial. Long continued use of moist 
 heat — fomentations — allays pain and stimulates resolution. Keep- 
 ing in contact with the painfully swollen parts a suitable bag 
 filled with bran, which can be moistened at intervals with warm 
 water, constitutes a practical and easy means of treatment. By 
 employing this method, one is more likely to succeed in having 
 his patient properly cared for, in that less work is entailed than 
 if hot fomentations are prescribed. 
 
 After the acute and painful stage has subsided, a stimulating 
 liniment is of benefit. The subject should be kept within a com- 
 fortable and roomy box stall for a sufficient length of time to 
 favor prompt resolution. Wild and nervous subjects, if not so 
 confined, will i)i-()1)ably overexert the affected parts if allowed 
 the freedom of a paddock or pasture. 
 
 Where the inflammation liecomos infective, surgical interfer- 
 ence is necessary. The prompt evacuation of pus, with adequate 
 
LAMENESS IN THE FORE LEG 73 
 
 provision for wound discharge, should be attended to before 
 extensive destruction of tissue takes place. Resolution is prompt 
 as a rule in such cases because of the vascularity of the struc- 
 tures and the ease with which proper drainage may be effected. 
 No special after-care is necessary if drainage is perfect, ex- 
 cept that one should avoid injecting the wound cavity with 
 aqueous solutions unless it be absolutely necessary to cleanse 
 such cavity, and then it is best to swab the wound rather than 
 to irrigate it freely. 
 
 Shoulder Atrophy. 
 (Sweeny or Swinney) 
 
 No satisfactory consideration of the pathogeny of this condi- 
 tion is recorded, but practitioners have long distinguished be- 
 tween muscular atrophies which are apparently caused without 
 doing serious injury to nerves and muscular atrophy which 
 seems to be due to nerve affection. In the first instance, recov- 
 ery Avhen proper attention is given, is prompt; whereas, in the 
 latter, regeneration of the wasted tissues requires months in 
 spite of the best sort of treatment. 
 
 The parts more frequently affected are the supra- and infra- 
 scapularis (antea- and posteaspinatus) muscles. But in some 
 cases the triceps group is involved; however, this occurs in un- 
 usual and chronic affections. No doubt, these chronic cases are 
 due to suspended innervation and are not to be classed with 
 the ordinary case of atrophy of the aliductor muscles of the 
 liumerus (supra- and infraspinatus) as in the usual case of 
 "sweeny." 
 
 Occurrence. — Shoulder atrophy such as the general practi- 
 tioner commonly meets with, is an affection, more often seen in 
 young animals and it seems to be due to injuries of various kinds 
 which contuse the muscles of the shoulder. Ill-fitting collars 
 and pulling in a manner that there occurs side draft with un- 
 usual strain on the muscles of one side of the neck and shoulder, 
 seem to be the more frequent causes of this trouble. Blows such 
 as are occasioned by kicks and falls frequently result in atrophy 
 of shoulder muscles. 
 
74 LAMENESS OF THE HORSE 
 
 Course. — In some eases a rapidly progressive atrophy char- 
 acterizes the case and lameness and atrophy appear at about 
 the same time. The affection in such instances does not re- 
 cover spontaneously but constitutes a condition which requires 
 prompt and rational treatment so that function may be fully 
 restored to the parts involved. 
 
 Occasionally one may observe cases where there is but slight 
 atrophy; where the disease progresses slowly and atrophy is 
 not extensive or marked. In vigorous young animals that are 
 left to run at pasture when so mildly affected, spontaneous re- 
 covery occurs. 
 
 Symptomatology. — Lameness is the first manifestation of 
 shoulder atroi3hy, and in many cases where lameness is slight, 
 the veterinarian may fail to discover the exact nature of the 
 trouble if he is not very proficient as a diagnostician of lame- 
 ness or if he is careless in taking into consideration obtainable 
 history, age of the subject, etc. Because of the fact that the 
 average layman believes that practically every case of fore-leg 
 lameness wherein it is not obvious that the cause is elsewhere, 
 is due to a shoulder affection of some kind, we may be too hasty 
 in giving the client assurance that no "sweeny" exists. In some 
 of these cases where a diagnosis of "shoulder lameness" has 
 been made and the client has been assured that no sweeny exists, 
 the patient is returned in about a week and there is then marked 
 atrophy of one or both of the spinatus muscles. 
 
 A mixed type of lameness characterizes this affection, and in 
 the average case there exists little evidence of local pain. The 
 salient points in recognizing the condition are a consideration 
 of history if obtainable ; age of the subject ; finding slight local 
 soreness, by carefully manipulating the muscles which are usu- 
 ally involved; noting the character of the lameness if any is 
 present ; and where atrophy is evident, of course, the true con- 
 dition is obvious. 
 
 Treatment. — Sulx-iitanooiis injections of (M|ual parts of re- 
 fined oil of turpentine and alcoliol, with a suitable hypo- 
 dermic syringe, is a practical and ordinarily effective treatment. 
 From five to fifteen cubic centimeter.s (the quantity varies with 
 
LAMENESS IN THE FORE LEG 75 
 
 the size of the animal), of this mixture is injected into the atro- 
 phied parts at different points, taking care to introduce only 
 about one to two cubic centimeters at each point of injection. 
 The syringe should be sterile and, needless to say, the site of 
 injections must be surgically clean. 
 
 Other agents, such as tincture of iodin, solutions of silver 
 nitrate, saline solutions and various more or less irritating prep- 
 arations have been employed ; but in the use of these preparations 
 one may either fail to stimulate sufficient inflammation to cause 
 regeneration to take place, or infection is apt to occur. Where 
 suppuration results, surgical evacuation of pus must be promptly 
 effected else large suppurating cavities form. 
 
 The employment of setons constitutes a dependable method of 
 treatment of shoulder atrophy, but because of the attendant sup- 
 purative process which inevitably results, this method is not 
 popular with modern surgeons and is a last resort procedure. 
 
 After-care. — Regular exercise such as the horse usually takes 
 when at pasture, is very helpful in treating atrophy, and in some 
 cases it has been found that no reasonable amount of irritation 
 would stimulate muscular regeneration; but by later allowing 
 patients to exercise at will, recovery took place in a satisfactory 
 manner. No special attention is ordinarily necessary. 
 
 Paralysis of the Suprascapular Nerve. 
 
 Anatomy. — The suprascapular (anterior scapular) nerve, a 
 small branch of the brachial plexus, is given off from the an- 
 terior portion of this plexus. The nerve rounds the anterior 
 border of the neck of the scapula, passing upward and backward 
 under the supraspinatus (antea-spinatus) muscle and terminat- 
 ing in the infraspinatus (postea-spinatus) muscle. 
 
 Etiology and Occurrence. — As the result of direct injury to 
 this nerve by contusion such as may be received in runaway 
 accidents, collar bruises, especially collar bruises in young horses 
 that are not accustomed to pulling and that walk in a manner 
 to cause side draft, injury to the nerve occurs, and partial or 
 complete paralysis supervenes. Some writers state that it may 
 be produced by confining an animal in recumbency, with the 
 
76 
 
 LAMENESS OF THE HORSE 
 
 casting harness. The common cause of paralysis or paresis of 
 this nerve in cases such as one observes in country practice, is 
 bruises from the collar in colts that are put to heavy farm work 
 or whore ill fitting collars are used. 
 
 Symptomatology. — With partial or complete suspension of 
 function of the suprascapular nerve there results enervation 
 of the supraspinatus and infraspinatus muscles. Since these 
 muscles act as external lateral ligaments 
 of the scapulohumeral joint, when they 
 are incapacitated, there naturally fol- 
 lows more or less abduction of the 
 shoulder Avhen weight is borne. 
 
 In extreme cases, as soon a.!, the ailing 
 animal is caused to support w^eight with 
 the affected member, the joint is sud- 
 denly thrown outw^ard in a manner that 
 the average layman at once concludes 
 that there must be scapulohumeral luxa- 
 tion, and the veterinarian receives a call 
 to see a case wherein the "shoulder is 
 out of place." There exists, however, no 
 luxation in such cases. 
 
 If serious injury is done the nerve so 
 that it undergoes degenerative changes, 
 there will result atrophy of the muscles 
 that derive their nerve supply from the 
 suprascapular nerve. 
 
 Treatment. — During the hrst few days 
 following injuries wiiich result in this 
 form of paralysis, it is Avell to keep the subject inactive, and 
 if much inflammation of the injured structures contiguous to 
 the nerve exists, the application of cold packs is beneficial. 
 Later, as soon as acute inflammation has subsided, vesication 
 of a liberal area around the anteroexternal part of the scapu- 
 lohumeral joint and over the course of the suprascapular nerve, 
 W'ill stimulate recovery in favorable cases. As a rule, in mild 
 cases, the subject is in a condition to return to Avork in two or 
 three weeks. 
 
 Fig. 7 — Paralysis of the 
 .suprascapular nerve of 
 the left shoulder. 
 
LAMENESS IN THE FORE LEG 77 
 
 Radial Paralysis. 
 
 Described under the titles of "Radial Paralysis" and "Bra- 
 chial Paralysis," there is to be found in veterinary literature 
 a discussion of conditions which vary in character from the 
 almost insignificant form of paresis to the incurably affected con- 
 ditions wherein the whole shoulder is completely paralyzed. 
 
 When one considers the anatomy of the brachial nerve plexus 
 and the distribution of its various branches, the location of this 
 plexus and its proximity to the first rib, and the inevitable in- 
 jury it must suffer in fracture of this bone, together with the 
 inaccessibility of the plexus, it is not strange that a correct 
 diagnosis of the various affections of the brachial plexus and 
 the radial nerve is often impossible until several days or weeks 
 have passed. And, in some instances, diagnosis is not established 
 until an autopsy has been performed. Here, too, we fail to find 
 cause for paralysis in some rare instances. 
 
 Anatomy. — The radial nerve is a large branch of the brachial 
 plexus and is chiefly derived from the first thoracic root of the 
 plexus and is here situated posterior to the deep brachial artery. 
 It is directed downward and backward ander the subscapularis 
 and teres major muscles, rounding the posterior part of the 
 humerus, and passing to the anterior and distal end of the 
 humerus, it finally terminates in the anterior carpal region. The 
 radial nerve supplies branches to the three heads of the triceps 
 brachii, to the common and lateral extensors of the digit and also 
 to the skin covering the forearm. 
 
 Etiology and Occurrence.— Nothing definite is known about 
 the cause of some forms of radial paralysis. However, radial 
 paralysis is encountered following injury to the nerve occasioned 
 by its being stretched, as in cases where the triceps brachii is 
 unduly extended in restraining subjects by means of a casting 
 harness. Berns^ states that in confining horses on an old oper- 
 ating table where it was necessary to draw the affected foot for- 
 ward twenty-four to thirty-six inches in advance of its fellow. 
 
 i"Radial Paralysis and Its Treatment by Mechanical Fixation of Knee and 
 Anltle," Geo. H. Berns, D. V. S. Proceedings of the American Veterinary 
 Medical Association, 1912, i). 219. 
 
78 
 
 LAMENESS OF THE HORSE 
 
 which was secured in a natural vertical position, radial paralysis 
 of a mild form was of frequent occurrence. Country practi- 
 tioners, in restraining colts by casting with harness or ropes, 
 occasionally observe a form of paresis wherein the radial nerve 
 suffers sufficient injury that there is caused a temporary loss of 
 function of the triceps brachii. Such cases recover within three 
 
 Fig. 8 — Radial paralysis. 
 
 or four days and are not a true paralysis, but nevertheless con- 
 stitute conditions wherein normal nerve function is temporarily 
 suspended. 
 
 Symptoms. — Immediately subsequent to injuries which in- 
 volve the radial nerve, there is manifested more or less impair- 
 ment of function. Remembering the structures supplied by the 
 radial nerve and its branches, one can readily understand that 
 there should occur as Cadiot^ has stated : 
 
 ^As quoted bv Bcrns, in Radial Paralysis, etc., Proceedings of the A. V. 
 ivr. A., 1912. 
 
LAMENESS IN THE FORE LEG 
 
 79 
 
 In complete paralysis, the joints of the affected limb with the 
 exception of the shoulder are usually flexed when the horse is 
 resting. In consequence of loss of power in the triceps and an- 
 terior ])rachial muscles, the arm is extended and straightened on 
 the shoulder, the scapulohumeral angle is open, and the elbow 
 depressed. The forearm is flexed on the arm by the contraction 
 of the coracoradialis (biceps brachii), while the metacarpus and 
 phalanges are bent by the action of the posterior antibrachial 
 iiuiscles. The knee is carried in advance, level with, or in front 
 of, a vertical line dropped from the point of the shoulder. The 
 hoof is usually rested on the toe, but when advanced beyond the 
 above mentioned vertical line, it may be placed flat on the 
 
 Fig. 9 — Merillat'.s method of fixing carpus in radial paralysis. Courtesy, 
 Alex. Eger. 
 
 ground, the joints then being less markedly bent. When the 
 limb as a whole is flexed, it may be brought into normal position 
 by thrusting back the knee with sufficient force to counteract the 
 action of the flexor muscles. 
 
 When made to walk, the animal l)eing unable to exert muscular 
 action with the paralyzed structures, limply carries the member 
 as a whole, and there is shortening of the anterior portion of 
 the stride. There ])eing loss of function of the triceps brachii, 
 it is impossible for the subject to straighten the leg in the normal 
 position for supporting weight ; therefore, any attempt to bear 
 
80 LAMENESS OF THE HORSE 
 
 weight results in further flexion of the affected member and the 
 animal will fall if the body is not suddenly caught up with the 
 sound leg. 
 
 Differential Diagnosis. — In making examination of these 
 cases, one can exclude fracture by absence of crepitation and 
 usually, also, swelling is absent in radial paralysis. In a typical 
 case of radial paralysis, the affected leg can sustain its normal 
 share of weight if placed in position, that is, if the carpal joint 
 is extended in such manner that the leg is positioned as in its 
 normal weight-bearing attitude. In brachial paralysis, whether 
 due to fracture of the first rib or to other serious injury, it is 
 impossible for the subject to support weight with the affected 
 member even when it is passively placed in position. 
 
 No difficulty is ordinarily experienced in differentiating radial 
 paralysis from muscular injuries to the triceps; yet, in some 
 cases of ' ' dropped elbow, " it is necessary to observe the progress 
 of the case for ten days or two weeks before one can positively 
 establish a diagnosis. 
 
 Quoting Merillat^: "When, after four weeks, there is no 
 amelioration of the paralysis, the muscles have atrophied, and 
 the patient has become emaciated from pain and discomfort, the 
 diagnosis of brachial paralysis with fracture of the first rib may 
 tlicn be announced." 
 
 Prognosis. — AVhen no complete paralysis of the l)rachial 
 plexus or no fracture of the first rib exists, the majority of cases 
 recover completely in from ten days to six weeks. Some writers 
 claim that recoveries occur in ninety per cent of cases when 
 conditions are favorable. 
 
 Treatment. — A\nien incomplete radial paralysis exists, little 
 needs be done except to allow the subject moderate exercise and 
 to provide for its comfort. Local applications, stimulative in 
 character, are beneficial, and the internal administration of 
 strychnin is indicated. 
 
 In the cases where weight is not supported without the affected 
 leg being passively placed in position, it is necessary to provide 
 for the subject's comfort in several ways. 
 
 Mechanical appliances such as braces of some kind in order 
 
 ^Veterinary Surgical Operations, by L. A. Merillat, V. S., p. 507. 
 
LAMENESS IN THE FORE LEG 81 
 
 to keep the affected leg in a position of carpal extension, consti- 
 tute the essential part of treatment. The leg is supported in 
 such a manner that flexion of the carpus is impossible. Due re- 
 gard is given to prevent chafing or pressure necrosis by contact 
 of the skin with the braces — this may be done by bandaging with 
 cotton. The supportive appliance is kept in position for ten 
 days or two weeks. At the end of this time the brace may be 
 removed and the subject given a chance to walk, and improve- 
 ment, if any exists, will be evident. When there is manifested 
 an amelioration of the condition, moderate daily exercise and 
 massage of the affected parts are helpful. 
 
 Should the subject be seriously inconveuienced by the applica- 
 tion of a brace or other supportive appliances, it is necessary 
 to employ slings. Further, if weight is supported entirely by 
 the unaffected member, laminitis may supervene if a sling is not 
 used. 
 
 Thrombosis of the Brachial Artery. 
 
 Thrombosis of the brachial artery or of its i^rincipal branches 
 is of very rare occurrence in horses. 
 
 Etiology. — Partial or complete obstruction of arteries 
 (brachial or others) occurs as the result of direct injury to the 
 vessel wall from compression and tension of muscles and re- 
 sultant arteritis ; lodging of emboli ; and parasitic invasion of 
 vessel walls causing internal arteritis. 
 
 Symptomatology. — If sufficient collateral circulation exists to 
 supply the parts with blood, no inconvenience is manifested while 
 the subject is at rest. Where the lumen of the affected vessel 
 is not completely occluded, there may be no manifestation of 
 lameness when the ailing animal is moderately exercised. Con- 
 sequently, the degree of lameness depends upon the extent of 
 the obstruction to circulation ; and, likewise, the course and 
 prognosis depend upon the character and extent of such obstruc- 
 tion. 
 
 In severe eases, lameness is markedly increased by causing 
 the animal to travel at a fast pace for only a short distance. There 
 are evinced symptoms of pain, muscular tremors and sudation, 
 but the affected member remains drv and there is a marked dif- 
 
82 LAMENESS OP THE HORSE 
 
 ference of temperature between the normal areas and the cool 
 anemic parts. When the subject is allowed to rest, circulation 
 is not taxed, and there is a return to the original and apparently 
 normal condition, only to recur again with exertion. This con- 
 dition characterizes thrombosis. 
 
 Treatment. — In these cases, little if any good directly results 
 from any sort of treatment in the way of medication. Abso- 
 lute rest is thought to be helpful. Potassium iodid, alkaline 
 agents such as ammonium carbonate and potassium carbonate, 
 have been administered. Circulatory stimulants also have been 
 given, but it is doubtful if any good has come from medication. 
 
 Fracture of Humerus. 
 
 The shaft of the humerus, protected as it is by heavy muscles, 
 is not frequently fractured; and fractures of its less protected 
 parts, as for example, the head, are complicated in such manner 
 that resultant arthritis soon constitutes the more serious condi- 
 tion. 
 
 As a result of falls on frozen ground, kicks or any other form 
 of heavy contusion, the humerus is occasionally broken. It is 
 rarely fractured otherwise. Because of the force of contusions 
 usually required to effect humeral fracture, the manner in which 
 the bone is broken, with respect to direction, is variable. Often 
 oblique fractures exist and occasionally there occurs multiple 
 fracture. In addition to the ordinarily serious nature of the 
 fracture itself, there is always much injury done the adjoining 
 structures. 
 
 Sjrmptomatology. — Mixed lameness and manifestation of 
 severe pain characterize this affection. Considerable swelling 
 which increases, in some cases for a week or more, is to be ob- 
 served. Crepitation is readily detected, if pain and swelling is 
 not too great to prevent passive movement of the member. 
 Where intense pain is not manifested, because of manipulation, 
 one may abduct the extremity and thereby occasion distinct 
 crepitation; but when it is po-ssible to recognize crepitation by 
 liolding the hand in contact with the olecranon while tlie animal 
 is made to walk, this method is to be preferred, if the su])ject 
 
LAMENESS IN THE FORE LEG 83 
 
 can move without serious difficulty. The pathognomonic symp- 
 tcmi here is recognition of crepitation, but this may be very diffi- 
 cult to recognize in fracture of condyles, and in such instances, 
 a careful examination is necessary. Gentle manipulation in a 
 manner that pain is not aggravated will tend to inspire confi- 
 denee on the part of the subject and relaxation of muscles will 
 enable the operator to detect crepitation. 
 
 Course and Prognosis. — Because of the direction of the long 
 axis of the humerus, with relation to the bony column of the 
 extremity, it is obvious that any lateral movement of the leg 
 tends to rotate the shaft of this bone. In fractures of the shaft 
 of the humerus, then, it is apparent that immobilization is very 
 difficult if at all possible. 
 
 The proximity to the axillary lymph glands makes for easy 
 dissemination of infection when the contused musculature be- 
 comes infected. The adjacent brachial nerve plexus is so very 
 apt to become involved, if not actually injured at the time frac- 
 ture occurs, that paralysis is a probable complication. Conse- 
 quently, it is logical to reason that because of the many possilile 
 serious complications, such as shock, occasioned by the injury 
 and the distress and pain which this accident produces, recov- 
 ery must be the exception in fracture of the humerus. How- 
 ever, recoveries do take place and in addition to the reported 
 recoveries by Liautard, ]Moller, Stockfleth, Lafosse, Frohner and 
 others, we have instances cited by American practitioners where 
 cases resulted in recovery. Thomp.son^ reports a good recovery 
 in a 1600-pound mare where there existed an oblique fracture 
 of the humerus. This mare was kept in slings for eight weeks. 
 Walters- reports complete recovery in humeral fracture in a foal 
 three days old. The only treatment given was the application 
 of a pitch plaster from the top of the scapula to the radius. 
 The colt was kept in a comfortable box stall and in about four 
 weeks regained use of the leg. Complete recovery eventually 
 resulted. In the experience of the author, recovery has not oc- 
 curred in humeral fractures. 
 
 ^A paper presented before the Illinois Veterinary Medical Assn. by Dr. H. 
 Thompson of Paxton, Ul., American Veterinary Review, Vol. 15, p. 134. 
 
 -"Fractures in Foals," by Dr. Wilfred Walters, M. R. C. V. S., American 
 Journal of Veterinary Medicine, Vol. S, p. 669. 
 
84 LAMENESS OF THE HORSE 
 
 Treatment. — "When animals are not aged and of sufficient 
 value to justify treatment, they are best supported in a sling, if 
 halter broken. If subjects are nervous, wild and unbroken, it 
 is possible to employ the sling, if care is given to train the ani- 
 mal to this manner of restraint. The presence of an attendant 
 for a day or two will reassure such subjects so that even in 
 these cases it may be j^racticable to employ the sling. 
 
 Braces and other mechanical appliances intended to immobi- 
 lize the parts are not of practical benefit in the horse. Unlike 
 the dog, the horse as yet has not been successfully subjected to 
 tolerating rigid braces for the shoulder and hip. 
 
 Everything possible must be done that will make for the pa- 
 tient's comfort. If the subject turns out to be a good self nurse, 
 and the nature of the fracture is such that practical apposition 
 of the broken ends of bone may be maintained, recovery will 
 occur in some cases. 
 
 Inflammation of the Elbow. 
 (Arthritis.) 
 
 Affections of this articulation other than those which are pro- 
 duced by traumatism are rare. This joint has wide articular 
 surfaces, and securely joined as they are by the heavy medial 
 and lateral ligaments (internal and external lateral ligaments), 
 luxation is practically impossible. When luxation does occur, 
 irreparable injury is usually done. Castagne as quoted by 
 Liautard^ reports a case of true luxation of the elbow joint in a 
 horse where reduction was effected and complete recovery took 
 place at the end of twenty-five days. This is an unusual case. 
 The average practitioner does not meet with such instances. 
 
 Anatomy. — The condyles of the humerus articulate with the 
 glenoid cavities of the radius and a portion of the ulna. Two 
 strong collateral ligaments pass from the distal end of the hu- 
 merus to the head of the radius. The capsular ligament is a 
 large, loose membrane which encloses the articular portion of the 
 humerus with the radius and ulna and also the radioulnar articu- 
 lation. It is attached anteriorly to the tendon of the biceps 
 
 ^American Veterinary Review, Vol. 26, p. 1068. 
 
LAMENESS IN THE FORE LEG 85 
 
 bracliii (flexor braehii). The capsule extends downward be- 
 neath the origin of these digital flexors. This fact should be 
 remembered in dealing with puncture woimds in the region, lest 
 an error be made in estimating their extent and an open joint 
 be overlooked at the initial examination. 
 
 Etiology and Occurrence. — Exclusive of specific or metastatic 
 arthritis, which is seldom observed except in young animals, in- 
 flammation of the elbow joint is usually caused by injury. This 
 articulation is not subject to pathologic changes due to concus- 
 sion or sprains as occasioned by ordinary service, but is fre- 
 quently injured by contusion from falls, blows from the wagon- 
 pole and kicks. Wounds which affect the elbow joint, then, may 
 be thought of in most cases, as resultant from external violence. 
 They may be contused wounds or penetrant wounds. Sharp 
 shoe-calks afford a means of infliction of penetrant wounds which 
 may occasion open joint and infectious arthritis. 
 
 Classification.— A practical manner of classifying inflamma- 
 tion of the elbow is on an etiological basis. Eliminating the 
 forms of elbow inflammation, such as are caused by metastatic 
 infection and other conditions which properly belong to the do- 
 main of theory of practice, we may consider this affection under 
 the classification of contusive wounds and penetrative tvounds. 
 
 Symptomatology. — Any injury which is of sufficient violence 
 to occasion inflannnation of the elbow causes marked lameness 
 and manifestation of pain. The degree of lameness and distress 
 manifested by the subject, depends upon the nature and extent 
 of the involvement. A contusion suffered as the result of a fall, 
 which occasions a circumscribed inflammation of the structures 
 covering this joint and where little inflammation of the articu- 
 lating parts exists, marked evidence of pain and lameness might 
 be absent. On the other hand, if a true arthritis is incited, there 
 will be evident distress manifested, .such as hurried respiration, 
 accelerated pulse, inappetence, mixed lameness, local evidence 
 of inflammation and particularly marked supersensitiveness of 
 the affected parts. Considering these two extremes of manifested 
 distrcvss and injury, one may readily conclude that in the fre- 
 quently seen case, wherein contusion has occasioned a moderate 
 
8G LAMENESS OF THE HORSE 
 
 degree of injury, prognosis is favorable and recovery ordinarily 
 follows in the course of a few weeks' treatment. 
 
 In cases of arthritis due to penetrative wounds (because of 
 the important function of this joint and its large capsule, which 
 when intlamed discharges synovia in a manner that closure of 
 such an open joint is seldom possible) a very grave condition 
 results. 
 
 Treatment. — Inflammation of the elbow, such as is frequently 
 seen in general practice where horses are turned out together 
 and exposed to kicks and other injuries, yields to treatment 
 readily, if an open joint does not exist. 
 
 Hot packs supported in contact with the elbow and kept around 
 the inflamed articulation for a few days, materially decrease pain 
 and tend to reduce inflammation. The subject must be kept 
 quiet in a comfortable stall and, if necessary, a sling used. 
 Where it is impossible for the animal to support much weight 
 with the injured member the sling should be employed. 
 
 As inflammation abates, which it does in the course of from 
 one to three weeks in uncomplicated cases, the subject may be 
 allowed the freedom of a comfortable box stall. Vesication of 
 the parts is in order, and this may be repeated in the course of 
 two weeks, if it is deemed necessary. 
 
 Penetrative wounds resulting in open joint are not treated 
 with success as a rule, and because of the handicap under which 
 veterinarians labor, methods of handling such cases, where large, 
 important articulations are affected, are not being rapidly im- 
 proved. Prognosis is usually unfavorable, and for humane and 
 economic reasons, animals so affected should be destroyed. 
 
 Ordinary wounds of the region of the elbow are treated along 
 general lines usually employed. They merit no special consid- 
 eration, except that it may be mentioned that with such injuries 
 concomitant contusion of the parts occasions injury that does 
 not recover quickly. 
 
 Fracture of the Ulna. 
 
 Etiology and Occurrence. — Fractures of the ulna in the horse 
 are not connuon in s|)ite of the exposed position of the olecranon. 
 This bone when broken, is usually fractured by heavy blows 
 
LAMENESS IN THE PORE LEG «7 
 
 and any form of nlnar fracture is serious because of its function 
 and position in relation to the joint capsule. Transverse frac- 
 tures do not readily unite because of the tension of the triceps 
 muscles, which prevent close approximation of the broken ends 
 of the bone. 
 
 Thompson^, however, reports a case of transverse simple frac- 
 ture of the ulna in a mare, the result of a kick, in which com- 
 plete recovery took place. He kept the subject in a sling for 
 six weeks and then allowed six months rest. 
 
 Symptomatology. — The position assumed by a horse sutfer- 
 ing from a transverse fracture of the ulna, is similar to that in 
 radial paralysis. Crepitation may be detected by manipulating 
 the parts, and in some instances of fracture of the olecranon, 
 there occurs marked displacement of the broken portions of the 
 bone. Lameness is intense and the parts are swollen and super- 
 sensitive. The capsular ligament of the elbow joint is usually 
 involved in the injury because fracture of the ulna may directly 
 extend within the capsular ligament. In such cases, there is 
 synovitis, and later arthritis causes a fatal termination. 
 
 Treatment. — The impossibility of applying a bandage in any 
 way to practically immobilize these parts in fracture of the ulna, 
 prevents our employing bandages and splints. Therefore, one 
 can do little else than to put the patient in a sling and try to 
 keep it quiet and as nearly comfortable as circumstances allow. 
 
 Fracture of the Radius. 
 
 Etiology and Occurrence. — From heavy lilows received such 
 as kicks, collision with trees or in falls in runaway accidents, the 
 radius is occasionally fractured. In very young foals, fracture 
 of the radius, as well as of the tibia and other bones, results 
 from their being trampled upon by the mother. 
 
 Symptomatology. — Excepting in some cases of radial frac- 
 ture of foals where considerable swelling has taken place, there 
 is no difficulty in readily recognizing this condition. The heavy 
 brachial fascia materially contri])utes to the support of the ra- 
 
 iPractures, bv H. Thomp.son, Paxton, III., American Veterinary Review, 
 Vol. 15, p. 134. 
 
88 LAMENESS OF THE HORSE 
 
 dius, and in cases where swelling is marked, crepitation may not 
 be readily detected. In fact, a sub-periosteal fracture may exist 
 for several days or a week or more and then, with subsequent 
 fracture of the periosteum, crepitation and abnormal mobility 
 of the member are to be recognized. In such cases, the subject 
 will bear some weight upon the affected member, but this causes 
 much distress. In one instance the author observed a trans- 
 verse fracture of the lower third of the radius which was not 
 positively diagnosed until about ten days after injury was in- 
 flicted. In this case, without doubt, the subject originally suf- 
 fered a sub-periosteal fracture of the bone and because the animal 
 was a good self nurse, the brachial fascia supported the radius 
 until the periosteum gave way and the leg dangled. In this 
 instance infection took place and suppuration resulted. It was 
 deemed advisable to destroy this animal. 
 
 "" Prognosis. — In adult animals, radial fracture constitutes a 
 grave condition; generally speaking, prognosis, in such cases, is 
 unfavorable. Because of the leverage afforded by the extremity, 
 immobilization of the radius is difficult. Any sort of mechanical 
 appliance, which will immobilize these parts, is likely to produce 
 pressure-necrosis of the soft structures so contacted. There is 
 occasioned thereby much pain and the subject becomes restive, 
 unmanageable and sometimes the splints are completely deranged 
 because of the animal's struggles, and much additional injury 
 to the leg is done. Occasionally, an otherwise favorable case is 
 thus rendered hopelessly impossible to handle, and the subject 
 must be destroyed several days after treatment has been insti- 
 tuted. 
 
 Consequently, unless all conditions are good, and the affected 
 animal a favorable subject, young, of good disposition, and the 
 fracture a simple transverse one, complete recovery is not likely 
 to result from any practical means of handling. 
 
 Treatment. — Mature subjects ought to be put in slings and 
 kept so restrained throughout the entire time of treatment. 
 Immobilization of the broken parts of the bone is the object 
 sought. This is attempted by practitioners who employ various 
 methods, and each method has its advocates. 
 
LAMENESS IN THE FORE LEG 89 
 
 Casts are used by some and serve very well in many cases ; but 
 because of their bulk and unyielding and rigid nature, they are 
 not well adapted to use on fractures of bones proximal to the 
 carpus and tarsus. This is in reference to plaster-of-paris casts 
 or those of any similar material. 
 
 Appliances which depend on glue or other adhesive substances 
 combined with leather, wood or fiber for their support, are effi- 
 cacious but not comfortable. 
 
 The use of heavy leather when the member has been suitably 
 padded with cotton and bandages, constitutes a very good man- 
 ner of reducing fracture of the radius or of the tibia. Leather 
 when cut to fit both the medial and lateral sides of a leg, and 
 firmly held with bandages, will form a firm support that yields 
 slightly to changes of position, thus making for comfort of the 
 subject. 
 
 Such a splint or support should extend from the fetlock region 
 to the elbow, but the cotton and bandages are to reach to the 
 foot. When one considers that, with the supportive appliance 
 placed on each side of the affected member, rigidity is accom- 
 plished as much from tensile strain put upon the leather as from 
 its own stiffness, it is seen that the leather need not be of the 
 heaviest — sole leather is unnecessary. Because of the more com- 
 fortable immobilizing appliance, the subject is less restive, and 
 chances for a successful outcome are materially increased 
 thereby. 
 
 In the mature subject, six or eight weeks' time is required 
 for union of the parts to occur suf^ciently so that splints may 
 be dispensed with. Rearrangement of the supportive apparatus, 
 however, is possible and usually necessary during the first few 
 weeks of treatment. By employing care in handling the parts, 
 the subject will be unlikely to do itself injury at the time read- 
 justment of splints is being effected. 
 
 In foals, it is best to give them the run of a box stall with 
 the mother. Being agile, they get up and lie at will without 
 doing injury to the fractured member. The splints (leather is 
 preferable in these cases also) are looked after and readjusted 
 as necessity demands. 
 
 Three or four weeks time is all that is required for the average 
 
90 LAMENESS OF THE HORSE 
 
 young colt to be kept in splints when suffering from simple 
 transverse fracture of the radius. 
 
 Compound fractures are necessarily more difficult to treat 
 than are the simple variety, but even in such cases recovery re- 
 sults sometimes, and the practitioner is justified in attempting 
 treatment after having explained the situation to his client. 
 
 Oblique fractures, even when simple, do not completely recover, 
 ^luscular and tendinous contraction, together with the natural 
 tendency for the beveled contacting parts of the broken bone to 
 pass one another in oblique fracture, results in shortening of the 
 leg and, if union results, a large callus usually forms. Where 
 shortening of bones occur, necessarily, permanent lameness 
 follows. 
 
 Wounds of the Anterior Brachial Region. 
 
 Etiology and Occurrence. — Contusions and lacerations of the 
 forearm are of fre(|uent occurrence in horses and are troublesome 
 cases to handle; particularly is this noticeable where extensive 
 laceration of the parts occurs. These injuries are caused by 
 animals being kicked; by striking the forearm against bars in 
 jumping; and in sections of the country where barbed wire is 
 used to enclose pastures, extensive lacerated wounds are met 
 with when horses jump into such fences. 
 
 Symptomatology. — Any wound which causes inflammation 
 of the structures of the anterior half of the forearm, is charac- 
 terized by swinging-leg-lameness. Depending upon the nature 
 and extent of the injury, manifestation varies. In cases where 
 laceration has practically divided all of the substance of the 
 extensor tendons, it is, of course, impossible for the subject to 
 advance the leg ; but where lacerated wounds involve only a part 
 of the extensor apparatus of the foreleg, not so much inconveni- 
 ence is evident, unless the wound is seriously infected and inflam- 
 mation involves contiguous structures. Therefore, in many in- 
 stances, lameness is more pronounced in contusions of the an- 
 terior brachial region than where tissues have been divided more 
 or less keenly. 
 
 In every instance diagnosis is easily established. The injury 
 is quite evident, and the nu^nner of locomotion is not in itself 
 
LAMENESS IN THE FORE LEG 91 
 
 an essential feature to he considered in a discussion of symptoms. 
 Where a contusion of the anterior brachial structures occurs, 
 there is, in addition to lameness, swelling which is painful be- 
 cause of the pressure occasioned by the heavy non-yielding ])ra- 
 chial fascia. And where suppuration occurs, there is then an 
 intensely painful condition which is not relieved until pus has 
 been evacuated. Rather frequently, drainage for wound secre- 
 tions is a difficult problem, and approximation of the divided 
 ends of muscles is always difficult to maintain. 
 
 Treatment. — Contused wounds of the anterior brachial region 
 are treated along usual lines ; that is, attempt is made to stimu- 
 late prompt resolution. Hot or cold applications are employed 
 throughout the acute stage of the affection. Complete rest is 
 provided for until all pain has subsided. Later, stimulating lini- 
 ments are beneficial. 
 
 Where no injury is done the periosteum or bone, complete 
 resorption of all products of inflammation usually occurs, though 
 in many instances, this is tardy — six weeks or more are some- 
 times required for recovery to take plac'?. 
 
 If suppuration occurs, it is necessary to provide for drainage 
 as soon as it is possil)le to distinguish the presence of pus. Due 
 regard is given the manner of establishing drainage because of 
 the usual existence of su])-fascial fistulae. In these cases, one 
 avoids injecting solutions of aqueous antiseptics. By gently com- 
 pressing the parts, pus is caused to drain out and in enforeinsr 
 a moderate amount of exercise at a walk, when lameness is not 
 intense, drainage is maintained. Cotton packs, moistened with 
 hot antiseptic solutions, and kept around the forearm for sev- 
 eral hours daily, are helpful because drainage is facilitated, 
 and resolution is stimulated by the increase of blood thus at- 
 tracted to the parts, and pain materially diminishes. 
 
 In lacerated wounds of the anterior brachial region, after 
 having controlled hemorrhage, an area around the wound margin 
 is freed of hair by clipping or shaving. The wound is carefully 
 examined, and the best site for drainage is selected and a suit- 
 able opening for wound discharge is provided for. Where the 
 extensor carpiradialis (metacarpi magnus) with other struc- 
 tures, is divided and the distal portion is torn downward, as 
 
92 LAMENESS OF THE HORSE 
 
 frequently is the case in barbed wire cuts, it is necessary to 
 make careful provision for drainage. The wound is thoroughly 
 cleansed by means of ablutions if necess;iry; but preferably l)y 
 swabbing with pledgets of cotton or gauze which are moistened 
 in antiseptic solutions. All shreds of macerated tissue are 
 clipped with scissors and finally the whole wound surface is 
 painted with tincture of iodin. 
 
 If drainage is made by cutting through the tissues in the 
 median portion of the structures that have been displaced, the 
 opening should be packed with gauze so that it may remain 
 patent after swelling has occurred. Such packing is left in 
 situ for twenty-four hours. 
 
 The pendant muscular portions of tissues are sutured up by 
 means of tapes and, while perfect apposition is not ordinarily 
 possible, it is very essential to train the pendant tissues in their 
 normal position even if they require resuturiug within a week. 
 This minimizes granulation of tissue, and there results less scar 
 if the detached portions are kept near, even if not in contact with 
 the proximal wound margins. The skin together with sub- 
 cutaneous fascia is sutured on either side unless drainage is to 
 be provided for on one side, and the lowermost part of that side 
 is left unsutured. 
 
 After-care. — Where extensive suturing of tissues has been 
 necessary, subjects must be kept quiet. They are best confined 
 in box stalls and not taken out for several weeks. Particularly 
 is this true where transverse division of extensors has taken place. 
 Sutures are removed at the end of from ten days to three weeks 
 as cases permit. Drainage of wound secretions, which usually 
 become infected, is necessary, because M'ith obstructed drainage 
 in an infected wound of this kind, there will result an early 
 destruction of tissue at some point sutured. Daily irrigation 
 done in a manner that practical asepsis is carried out, is neces- 
 sary for about a week. All irrigation is done by way of the 
 drainage opening, and this with warm aqueous solutions of suit- 
 able antiseptics. After a week or ten days' time, the wound 
 should not be dressed more frequently than twice weekly. 
 
 If it is necessary to leave a portion of the wound uncovered. 
 
LAMENESS IN THE FORE LEG 93 
 
 as in cases where skin is destroyed, the frequent (three or four 
 daily) application of a suitable antiseptic powder is necessary 
 to check exuberant granulation. This may be directly effected 
 by the use of an astringent or desiccant preparation, and such 
 dressing serves as a mechanical protection as well. 
 
 When such wounds are kept clean, where drainage is properly 
 maintained, and the subject kept quiet, no particular attention 
 other than the local application of an astringent lotion (such 
 as the zinc and lead lotion) is necessary after the first three or 
 four weeks. Usually, if the animal gnaws at the parts or other- 
 wise manifests evidence of discomfort, it is an indication that 
 new areas of infection are being established because of obstructed 
 drainage or retained eschars. A thorough cleansing of the 
 wound with a two per cent solution of Liquor Cresolis Com- 
 positus and this followed by moistening every part of the wound 
 with tincture of iodin, will check all such disturbance if done 
 promptly. 
 
 Where practically all of the anterior surface of the radius 
 has been denuded, recovery is tardy and there is in some cases 
 imperfect extension of the leg for months after the wound has 
 healed. But in such instances, animals gradually regain com- 
 plete use of the affected member and in the course of a year 
 function is fully restored. 
 
 Inflammation and Contraction of the Carpal Flexors. 
 
 Anatomy. — The structures w^hich are usually considered as 
 true flexors of the carpus are a group of three muscles, which 
 have separate heads of origin and different points of tendinous 
 insertion. 
 
 The flexor carpiradialis (flexor metacarpi internus) originates 
 from the medial epicondyle of the humerus. It is inserted to 
 the proximal end of the medial metacarpal (inner metacarpal or 
 splint) bone. This muscle is the smaller of the three and is not 
 usually divided in doing carpal tenotomy. 
 
 The flexor carpiulnaris (flexor metacarpi medius) has two 
 heads of origin ; one, the larger, originates from the epicondyle 
 of the humerus and the other from the posterior surface of the 
 
94 LAMENESS OF THE HORSE 
 
 oleenmon. The two heads unite at the upper third of the radius 
 and the muscle, becoming tendinous, as is the case with the other 
 carpal flexors, is attached by one point of insertion to the acces- 
 sory carpal bone (trapezum). The other blends with the 
 posterior annular ligament of the carpus. 
 
 The ulnaris lateralis (flexor metacarpi externus) has its origin 
 from the lateral epicondyle of the humerus and inserts to the 
 proximal extremity of the fourth metacarpal (outer splint) 
 bone and by another attachment to the accessory carpal bone 
 (trapezium) with the tendon of the flexor carpiulnaris (flexor 
 metacarpi medius). 
 
 Acting together, these muscles flex the carpus or extend the 
 elbow and this action is antagonized by the biceps brachii (flexor 
 brachii) and extensors of the carpus and phalanges. 
 
 Etiology and Occurrence. — Inflammation of the muscular or 
 tendinous parts of tlie carpal flexors, does not occur as fre- 
 quently as does inflammation of the flexors of the extremity. 
 They are subject to injury such as is occasioned by hard work 
 and concussion and contract as a result ; but, more frecjuently 
 a congenital malformation of the leg is responsible for undue 
 strain upon these parts. Horses that are "knee sprung" or that 
 have a congenital condition where in the anterior line, as formed 
 by the radius, carpal and metacarpal bones, is bent forward at 
 the carpus, are subject to inflammation and contraction of the 
 carpal flexors. When these flexors are contracted, the condition 
 is commonly known among horsemen as "buck knee." In itself, 
 intlaiiimation of the carpal flexors is not a condition which is 
 likely to prove troulilesome, l)ut because of carpal involvement 
 (which is often present) the cause of the troul)le remains, and 
 inHaiinnation of the carpal flexors recurs or becomes chronic 
 and contraction of tendons results. 
 
 Symptomatolog-y. — Inflammation of the carpal flexors, when 
 acute and uiici»iii|)licated, is characterized ]\v a painfully swollen 
 condition of the afl'cctcd tendons. No weight is ])orne upon 
 the affected leg and tlic carpal joint is flexed. .Mixed huneness 
 is present. There is no difficidty encountered in arriving at a 
 diagnosis because of Ihe very noticeably inHamed parts. 
 
LAMENESS IN THE FORE LEG 
 
 05 
 
 IMaiiy fully developed cases of eoiitraction of the tendons of 
 the carpal flexors are observed where the condition has become 
 established gradually and no lameness has resulted from tendin- 
 itis or carpitis. In some of these cases, subjects are stumblers 
 and when they are carelessly handled or kept at fast work over 
 irregular or hard roads, chronic carpitis with hyperplasia of the 
 structures of the anterior carpal region results, owing to frequent 
 bruising from falls. 
 
 Fig. 10 — Contraction of carpal flexors, "knee sprung." 
 
 Where inflammation is caused by a puncture wound and sub- 
 fascial infection occurs, there is evident manifestation of pain. 
 No weight is supported liy the affected member and because of 
 the pressure, occasioned by the swollen muscles confined within 
 the non-yielding brachial fascia, there exists marked supersensi- 
 tiveness of the affected parts. Flexion of the elliow is avoided 
 because contraction of the biceps l)rachii (flexor l)rachii) or the 
 extensors, which are antagonists of the flexors of the carpus, 
 tenses the carpal flexors and pain is thereby increased. 
 
 However, in most instances, the practitioner's attention is not 
 directed to typical and uncomplicated cases, but to subacute or 
 chronic inHainmations which are often attended with contraction 
 of the tendinous pai'ts of the carpal fiexors, and in such cases 
 
96 LAMENESS OF THE HORSE 
 
 carpitis is present. Animals so affected have lost the rigidity 
 Avhich characterizes the normal carpal joint when the leg is a 
 weight bearing member, and because of its sprung condition, 
 the leg trembles when supporting weight. 
 
 Treatment. — Acute inflammation is treated by means of local 
 application of cold or hot packs until the pain and acute stage 
 of inflammation has subsided and later stimulating liniments 
 are indicated. Absolute quiet must be enforced. Especially 
 where the carpus is involved must the subject be kept quiet until 
 all evidence of inflammation has subsided. 
 
 The application of vesicants or line-firing is beneficial in sub- 
 acute inflammation of the tendons of the carpal flexors. Where 
 contraction of tendons exists and no osseous or ligamentous 
 change prevents correction of the condition, tenotomy is neces- 
 sary. The reader is referred to Merillat's "Veterinary Surgery"^ 
 for a good description of the technic of this operation. 
 
 In all serious cases of inflammation of the carpal flexors, 
 whether tenotomy has been performed or not, the subject needs 
 a long period of rest subsequent to treatment. In fact, three 
 or four months at pasture is necessary to permit of recovery 
 and this where no congenital deformity has predisposed the sub- 
 ject to such affection of the flexors. Return to work must be 
 gradual and the character of the work such as to enable the 
 animal to become inured to service without a recurrence of the 
 trouble if possible. 
 
 It follows then, that tenotomy, here as in other cases, is not 
 practical from an economic viewpoint, unless the animal be of 
 sufficient value to justify the long period of rest for recovery. 
 Tenotomy is not of practical benefit unless ample time is allowed 
 for regeneration of divided tendinous tissue. 
 
 Fracture and Luxation of the CarpaJ Bones. 
 
 Etiolog-y and Occurrence. — Fracture of the carpal bones is of 
 infrequent occurrence in horses and, wlien it does occur, it is 
 usually due to injuries, and because of their nature (resulting 
 as they generally do from heavy falls or in being run over by 
 
 ""^Veterinary Surgical Operations, by L. A. Merillat, Vol. 3, p. 19S. 
 
LAMENESS IN THE FORE LEG 97 
 
 street ears or wagons), a comminuted fracture of one or more 
 bones exists. The accessory carpal bone (trapezium) is said to 
 be fractured at times without being subjected to blows or like 
 injuries, but this is exceptional. 
 
 Luxations of the carpal joint are of rare occurrence, and very 
 few cases of this kind are on record. Walters^ reports a case 
 of carpometacarpal luxation in a pony wherein reduction was 
 spontaneous and an uneventful recovery followed. His reason 
 for reporting the case, as he states, is its rarity. 
 
 Symptomatology. — Fractures of the carpal bones as they 
 usually take place are diagnosed without difficulty. Because 
 of their usually being comminuted, abnormal movement of the 
 joint is possible. Such movement is not restricted and flexion 
 of the leg at the carpus in any direction is possible. Crepitation 
 is readily detected and frequently these fractures are of the 
 compound-comminuted variety. 
 
 In fracture of the accessory carpal bone (trapezium) or in 
 fracture of any other single bone when such exists, there is no 
 increase in the movement of the joint. The accessory carpal 
 bone may be readily manipulated and when fractured, its parts 
 are more or less displaced. Recognition of fracture of any other 
 single carpal bone must be done by detecting crepitation unless 
 it be a compound fracture, whereupon probing is of aid in es- 
 tablishing a diagnosis. 
 
 Carpal luxation when present is to be recognized by finding 
 the apposing carpal bones joined in an abnormal manner — that 
 is, out of position. There is restricted or suspended function 
 of the joint, and in the cases recorded, no difficulty has been 
 experienced in making a diagnosis. The carpometacarpal por- 
 tion of the articulation is the part which is usually affected. 
 
 Prognosis and Treatment. — There is no chance for complete 
 recovery in the usual case of carpal fracture because of the fact 
 that there results sufficient arthritis to destroy articular cartilage 
 beyond repair. In the average instance, because of arthritis 
 which persists for a considerable length of time, more or less 
 ankylosis results. At best, one can only hope for partial re- 
 
 iWilfred Walters, American Journal of Veterinary Medicine, Vol. 8, p. 606. 
 
98 LAMENESS OF THE HORSE 
 
 eovery, that is to say, the member may regain its usefulness as 
 a weight-supporting- part, but because of restricted or abolished 
 joint function, locomotion is more or less difficult. Exostoses, 
 articular and periarticular, occur and the carpus usually be- 
 comes a large immobile articulation. There is danger of infec- 
 tion resulting in simple carpal fractures and, needless to say, 
 in a compound- comminuted fracture of the carpus, infection 
 usually occurs and a fatal outcome is probable. 
 
 When treatment is instituted, antiseptic precautions are taken 
 in handling the compound fractures, and in any case immobiliza- 
 tion of the parts is sought. Here, as has been previously pointed 
 out, it is best to employ leather splints, so that a maximum de- 
 gree of rigidity with a minimum of distress and inconvenience 
 to the patient will result. The leg must be bandaged from the 
 hoof upward, making use of a sufficient amount of cotton to 
 ensure against pressure-necrosis. The leather splints are placed 
 mesially and laterally and, of course, need to extend as high 
 as the proximal end of the radius. SuL-jects must be kept in 
 slings until union of bones has become established, and as a 
 rule there will then exist marked ankylosis. 
 
 There is no particular difference in the handling of carpal 
 luxation and dislocation of other bones. Where ligaments have 
 not been destroyed to the extent that reduction is of no prac- 
 tical use, the parts are kept immobilized, if thought necessary. 
 Later, vesication of the whole pericarpal region is done and the 
 subject allowed exercise at will. 
 
 Carpitis. 
 
 Etiology and Occurrence. — Inflammation of the carpus is 
 caused by contusions, such as are occasioned in falling, by kicks 
 by striking the carpus against objects in jumping and some- 
 times by striking it against the manger in pawing. The con- 
 dition is of rather frequent occurrence. 
 
 Symptomatology. — Evident symptoms of inflammation in 
 carpitis are always present — hyperthermia, supersensitiveness 
 and swelling. Also, there exists lameness which is characterized 
 by an a])parent inability to flex the leg, and there is eircum- 
 
LAMENESS IN THE FORE LEG 
 
 99 
 
 duction of the leg as it is advanced l)eeaase in this way littk' if 
 any flexion of the carpus (which increases pain) is necessary. 
 
 Depending upon the nature of the cause, there occurs a 
 marked difference in the character and amount of swelling. 
 
 Fig. 11 Pericarpal inflammation and enlargement due to injurj'. 
 
 Naturally, when nuich extravasation of serum and 1)lo()d takes 
 place, there is occasioned a fluctuating swelling which is usually 
 less painful to the subject upon manipulation than is a dense 
 inflammatory change without marked extravasation. 
 
 In acute carpitis, there is present, then, a very painful con- 
 dition which involves the articulation, causing marked lameness, 
 disturbance of appetite and some elevation of temperature. 
 
 Chronic cases do not occasion serious pain or constitutional 
 disturbances, but do interfere with locomotion in direct propor- 
 tion to the existing articular inflammation and periarticular 
 hypertrophy of ligamentous and tendinoi^.s structures. 
 
 Treatment.— If possible, keep the subject absolutely quiet, 
 employing the sling if necessary. During the first stages of in- 
 flammation, the ai)plication of ice packs to the affected parts, is 
 
100 LAMENESS OF THE HORSE 
 
 of marked benefit. At the end of forty-eight hours, hot applica- 
 tions may be used and this treatment continued throughout sev- 
 eral days. Anodyne liniments are of service and should be em- 
 ployed throughout the acute stage of infiammation during in- 
 tervals between the hydrotherapeutic treatments. 
 
 As inflammation subsides, a counterirritating application such 
 
 Fig-. 12 — ^HygTomatous condition of the right carpus, also distension of 
 sheaths of extensor tendons of botli fore legs. 
 
 as a suitable liniment and later blistering or line-firing is help- 
 ful in stimulating resolution. 
 
 Open Carpsd Joint. 
 
 Anatomy. — The carpal bones as they articulate with one an- 
 other and with the radius and metacarpal bones, as classed by 
 anatomists, form three distinct articular parts of the joint as a 
 whole and are known as radiocarpal, intercarpal and carpometa- 
 carpal. These three pairs of articulating surfaces are all en- 
 closed within one capsular ligament. On the anterior face of the 
 bones, the capsular ligament is attached to the carpal bones in 
 
LAMENESS IN THE FORE LEG 101 
 
 such manner that an imperfect partitioning of the three joint 
 compartments is formed. Posteriorly, the capsule is very heavy 
 and forms a sort of padding over the irregular surfaces of the 
 bones, and also its reflexions constitute the sheaths of the flexor 
 tendons. The anterior portion of the capsular ligament forms 
 sheaths for the extensor tendons, and both portions of the joint 
 have an attachment around the distal end of the radius and 
 another at the proximal end of the metacarpal bones. 
 
 Etiology and Opcurrence. — Puncture wounds of any kind 
 
 Fig. 13 — Carpal exostosis in aged horse. 
 
 may serve to perforate the joint capsule and such traumatisms 
 are occasioned by falls, kicks and iu various ways in runaway 
 accidents, and open carpal joint may follow. 
 
 Symptomatology. — The pathognomonic symptoms of the ex- 
 istence of an open joint is the exposure to view of articular 
 surfaces of bones or noting the escape of synovia from the joint 
 capsule. As has been previously referred to, there always exists 
 a peculiar suspension of carpal flexion in all cases of carpitis. 
 
 Non-infective wounds which may cause open joint are not 
 necessarily productive of an active carpitis — a synovitis may 
 be the extent of the disturbance. Ualike synovitis, which may 
 
102 
 
 LAMENESS OF THE HORSE 
 
 characterize a non-infectious penetrative wound of the capsular 
 ligament, septic arthritis which may supervene is a very painful 
 inflammatory disturbance. It is characterized by all of the 
 symptoms which attend the case of open joint and synovitis plu.s 
 the obvious manifestation of great pain. There is an elevation 
 of temperature of from two to five degrees above normal; cir- 
 culation is accelerated; the pulse is bounding; respiration is 
 hurried ; there is an expression of pain as indicated by the 
 physiognomy; and because of rapid erosive changes of cartilages 
 which take place, there is soon so much of the articulation de- 
 stroyed that death is inevitable. Death is usually due to gen- 
 eralization of the arthritic infection. 
 
 In the meanwhile, if the character of the infectious material 
 is not so virulent, the disease will take on a slower course 
 
 and the subject may experience 
 laminitis from supporting weight 
 upon the sound member, or be- 
 cause of continued recumbency, 
 decubital gangrene and emacia- 
 
 Fig. 14 — Exostosis of 
 resultant from carpitis. 
 
 carpu.s 
 
 -pig. 15 — Distal end of radius. U- 
 lustrating the effects of chronic car- 
 pitis. 
 
LAMENESS IN THE FORE LEG 103 
 
 tion sometimes cause death. If the subject does not soon suc- 
 cumb, it is compelled to undergo days or even weeks of unneces- 
 sary suffering, and too often in such cases, it is later deemed 
 advisable to destroy the animal because of the cost of continuing 
 treatment until the horse is serviceable. Therefore, it is evident 
 that when such joints as the carpus or tarsus are open and infec- 
 tion exists, if they are not promptly treated and the infectious 
 process checked, it is neither humane nor practical to prolong 
 treatment. 
 
 Distinction must be made between the different joints wher, 
 infected as the condition is much more serious in some cases 
 than in others. All things considered, perhaps open joints rank, 
 with respect to being serious cases as follows: elbow, navicular, 
 stifle, tarsus, carpus, fetlock and pa.stern. This, of course, is 
 restricted to articulations of the locomotory apparatus. 
 
 Treatment. — Preliminary care in the treatment of an open 
 carpal joint, is the same as has been described in this condition 
 as it affects the scapulohumeral articulation described on page 
 65. Likewise the further treatment of such cases is along the 
 same lines except that where it is possible, the parts are kept cov- 
 ered with cotton and bandages. However, in some cases, animals 
 have been successfully treated without bandaging and by keep- 
 ing the patient in a standing position and on pillar reins until 
 recovery resulted. Such cases were of the non-infectious type 
 and recovery was possible within three or four weeks. Further, 
 the condition is not sufficiently painful in such instances as to 
 prevent the subjects bearing weight with the affected member ; 
 hence, no danger of resulting laminitis is incurred. And finally, 
 where bandages are not employed, the frequent use of antiseptic 
 dusting powders is substituted for cotton as a protector. 
 
 When l)andaged, such wounds need dressing more or less fre- 
 quently, as individual instances demand. The purulent infective 
 inflammation of a carpal joint will recpiire daily dressing; where- 
 as, in other cases (non-infective), semi-weekly change of band- 
 ages is sufficient. E(|ual parts of l)oric acid and exsiccated alum 
 constitute a suitalile combination for the treatment of these 
 cases, and this powder should be liberally employed. Tincture 
 of iodin may be injected into the joint capsule where there is 
 
104 LAMENESS OF THE HORSE 
 
 provision for its ready evacuation, as conditions seem to require. 
 Daily injections for three, four or five days, are not harmful 
 and will control infection in many instances. 
 
 Thecltis and Bursitis. 
 
 Etiology and Occurrence. — The thecae and bursae of the leg 
 are several in number. In the carpal region, the flexors of the 
 phalanges are contained together in the carpal sheath, and this 
 is the principal theca in the carpal region. Each of the tendons 
 is provided with synovial sheaths which are subject to inflam- 
 mation and occasionally synovitis and distension of these synovial 
 sheaths occur. 
 
 Because of faulty conformation, some animals are subject to 
 inflammation of these sheaths, and all forms of strenuous work 
 which taxes the tendons greatly is apt to result in synovitis. 
 Direct injury such as blows may be the cause of synovial disten- 
 sion of thecae and the affection is to be seen in all horses that 
 have done much fast work on hard road surfaces or pavements. 
 
 The usual case as it occurs in practice is a non-infective syn- 
 ovitis, but where puncture wounds cause the trouble, an in- 
 fectious inflammation obtains. 
 
 Symptomatology. — No trouble is experienced in diagnosing 
 distension of tendon sheaths, for the affection is very palpable. 
 During acute inflammatory stages of this affection, some lame- 
 ness is present — in infectious inflammation lameness is intense. 
 Local heat and pain upon manipulation are readily discernible 
 in all acute cases. And finally, where there is reason for doubt, 
 an aseptic exploratory puncture of the wall of the fluctuating 
 enlargement may be made with a suitable trocar, and the dis- 
 charging synovia will be proof of the existence of synovial dis- 
 tension. 
 
 After the affection becomes subacute or chronic, no lameness 
 or inconvenience is manifested, and the condition is undesirable 
 only because of its being a blemish. 
 
 Treatment. — Acute non-infectious synovial distension of ten- 
 don sheaths is treated by aspirating as much synovia as pos- 
 sible from the affected theca (this is, of course, done under 
 
LAMENESS IN THE FORE LEG 105 
 
 strict asepsis) and by means of bandages, a uniform degree of 
 pressure is kept over the parts for ten days or two weeks. The 
 patient is kept quiet and in the course of two weeks an active 
 blistering agent is employed over the region affected. Usually, 
 at the end of a month's time, complete recovery has taken place 
 and the subject may be gradually returned to work. 
 
 When synovial distensions are of long standing, it is necessary 
 to take special precautions to cheek excessive secretion of synovial 
 fluid, and, also because of the atonic condition of the tissues 
 affected, resolution is tardy. In addition to aspirating synovia, 
 the introduction of equal parts of alcohol and tincture of iodin 
 into the theca is necessary. The quantity of this combination 
 injected, depends upon the size of the sheath affected and the 
 amount of synovia retained at the time injection is made. Ex- 
 perience is necessary to judge as to this part of the work, but 
 one may consider that a quantity between three and ten cubic 
 centimeters of equal parts of tincture of iodin and alcohol con- 
 stitutes the proper amount to employ. Where much synovia is 
 contained within the sheath at the time of injection, there occurs 
 great dilution of the agent injected and consequently less irri- 
 tation results. 
 
 The object of such injections is to check synovial secretion, 
 and this is sought by the local effect of iodin in contact with the 
 secreting cells together with the reactionary swelling which oc- 
 casions pressure. An increase in the local blood supply also 
 follows. In all cases where it is possible to employ suitable 
 bandages, this should be done. The ordinary derby bandages 
 serve well and if their use is continued for a sufficient length of 
 time, good results follow. 
 
 There are other methods of treating these affections, and each 
 has its advantages and disadvantages. Line-firing, instead of 
 the vesicant is made use of by some, but the object desired is 
 the same and results obtained are similar. 
 
 Sheaths may be opened surgically by means of a knife, and 
 the removal of a portion of the wall of distended and atonic 
 tendon sheaths is possible. These operations belong to the realm 
 of surgery and are not properly a part of this treatise. However, 
 in passing, it may be said that if a perfect technic is possible in 
 
106 LAMENESS OF THE HORSE 
 
 doing the last iiained operation, a permanent recovery is the 
 ontcome. 
 
 Fracture of the Metacarpus. 
 
 Etiology and Occurrence. — As the resnit of all sorts of vio- 
 lence, such as falls and injuries in accidents of various kinds 
 wherein the metacarpals are subjected to contusions, fractures 
 may result. In the horse it is unusual for fracture of one of the 
 small metacarpal bones to take place without there being at the 
 same time a fracture of the third (large) metacarpal lione. 
 
 Classification. — Fractures of the metacarpal bones as they 
 occur, are as likely to be compound as simple, and the nudtiple 
 and comminuted varieties are -occasionally observed. The man- 
 ner in which the third (large) metacarpus is fractured, largely 
 determines the outcome in any given case. 
 
 Symptomatology. — Abnormal mobility of the l)roken parts 
 of bone and crepitation mark fracture cf the metacarpus, and 
 the condition is easily diagnosed. In many instances, when 
 compound fracture exists, broken ends of bone are protruding 
 through the skin. No weight is borne upon the fractured mem- 
 ber ordinarily, altliough during the excitement occasioned by 
 runaways, horses are sometimes seen to support weight with a 
 broken leg even when the protruding bone is sunk into the 
 ground in so doing. 
 
 Prognosis. — Generally speaking, fractures other than the 
 simple-transverse in young animals, are considered unfavorable 
 eases. With the metacarpus, however, there are instances where 
 compound fracture occurs in colts that justify treatment. But 
 in all cases of compound fracture, the element of infection in 
 addition to the increased difficulty in maintaining immoliility 
 of the broken bone, creates almost insuperable difficulties in the 
 average instance. And unless the practitioner distinctly ex- 
 plains to his client the various reasons wliich make treatment an 
 economic imin'acticability, dissatisfaction is likely to follow if 
 treatment is instituted without such an underetanding. 
 
 Treatment. — Perfect ai)i)()sition of tiie broken ends of bone 
 is easily effected and less difficulty is encountered in maintain- 
 
LAMENESS IN THE FORE LEG 107 
 
 ing such relations in metacarpal fractures than in fractures of 
 the radius. However, reduction and immobilization of this as 
 in all fractures, must be done without delay. In simple fracture, 
 the metacarinis is covered with enough cotton to pad the parts, 
 and this is retained in position by liandages. Splints of heavy 
 leather or of thin pieces of tough flexible wood are placed on 
 each side of the leg and firmly held in position with bandages. 
 Bandages may be put on in layers and a coating of glue ap- 
 plied over each layer if this is thought necessary. The ad- 
 vantage gained in using glue or other adhesive materials is that 
 the cast thus formed is more rigid than where such material is 
 not employed. On the other hand, all elasticity is lost as soon 
 as the cast adapts itself to the contour of the extremity, and 
 because of this rigidity, it is doubtful if anything is gained by 
 the incorporation of glue, except in the way of added strength of 
 the cast. Since the animal does not walk upon the broken leg, 
 it is possible to employ splints of suitable materials which are 
 retained in position without glue and frequent readjustment of 
 a part of the immobilizing apparatus is possible. This is im- 
 possible with casts. 
 
 In compound fractures, provision ought to be nuide for dress- 
 ing the wound of the soft structures. This entails adjusting 
 the splints in such manner that one splint may be retained and 
 others removed for dressing the wound and readjusted as often 
 as wound dressing is necessary. 
 
 Splints. 
 
 By this term is meant a condition where there exists an 
 exostosis which involves usually the second (inner small) and 
 third (large) metacarpal bones. While an exostosis involving 
 any one of the splint bones, even when directly caused by an 
 injury, is called a "splint," the term is employed here, in refer- 
 ence to exostoses not due to direct injury such as in contusions. 
 
 Etiology and Occurrence. — Tliis condition is one wherein 
 there is osseous formation following a periostitis and the region 
 of the upper portion of the second (inner small) metacarpal bone 
 is the usual site of the exo.stosis. There is incited an intlamma- 
 
108 LAMENESS OF THE HORSE 
 
 tion of the periosteum at the site of the interosseous ligament 
 which attaches the small to the large metacarpal bone. This liga- 
 ment is involved in the inflammatory process, and according to 
 Havemann, whose view is supported by Moller, this inflamma- 
 tion is the origin of the trouble. 
 
 Various theories attempting an explanation of the frequent 
 affection of this one certain part so regularly involved have been 
 offered, but no proof of the correctness of any exists. It fol- 
 lows, however, that splints occur in young animals; that the 
 affection seldom starts in subjects that are ten years of age or 
 
 ""-■'-isliC J- 
 
 Fig'. 16 — Posterior view of radius (rigiit) illustrative of effects of splint. 
 Note the extent of exostosis. 
 
 older, and that when the exostosis has formed, lameness usually 
 subsides. Anything which will cause undue strain or irritation 
 of the metacarpal bones in young animals, is quite apt to result 
 in a splint being formed. Concussion such as is caused by fast 
 work on hard roads, or work on rough or irregular road surfaces 
 which cause unequal distribution of weight, will cause splint 
 lameness and exostosis follows. 
 
 Course. — Because of the peculiar manner in which the second 
 and third metacarpal bones articulate in j^oung animals, until 
 the bones become ossified and permanently joined, the inflam- 
 mation which attends the acute stage of this affection, causes 
 lameness. Later, unless an unusually large exostosis is formed, 
 whicli may cause a constant irritation due to its size and juxta- 
 position to the carpus, lameness is disconlinued. 
 
LAMENESS IN THE FORE LEG 109 
 
 Symptomatolog'y. — Lameness is usually the first manifesta- 
 tion of this disorder, and the thing which characterizes splint 
 lameness is its peculiar intermittence. There is a mixed form of 
 lameness which may not be in evidence when an affected animal 
 is started on a drive, but which is marked after the subject has 
 gone some distance. The animal may, however, go lame through- 
 out the whole of a drive and continue to be lame for several 
 days or weeks in some cases. It is noticeable that lameness is 
 augmented or produced when the sul)ject travels on rough road 
 surfaces and that little or no difficulty is encountered when roads 
 are smooth. 
 
 The heavy brachial fascia is inserted in part to the head of 
 the second metacarpal (inner small) bone together with the 
 oblique digital extensor (extensor metacarpi obliquus) and this 
 explains the reason for pain being manifested during extension 
 of the member. 
 
 Before there is a visible exostosis, supersensitiveness is readily 
 recognized upon palpation of the parts, if careful comparison is 
 made between the sound and unsound members. However, fre- 
 quently splints occur on both forelegs at the same time and in 
 some instances exostoses are several in n amber upon each mem- 
 ber affected. In some instances, the affection involves the outer 
 splint bone and no evident involvement of the inner one exists. 
 
 Treatment. — At the onset complete rest should be provided 
 and the local application of some good cataplasm is in order. A 
 stimulating liniment is beneficial when employed several times 
 daily and massage is also quite helpful. Later, the application 
 of a blistering ointment is good treatment. The use of the actual 
 cautery stimulates prompt resolution, but there is seldom any 
 resorption of products of inflammation following firing. Where- 
 as, in cases where other treatment is begun early, there usually 
 follows considerable diminution in the size of the exostosis. A 
 rest of four or five weeks is necessary and very young animals 
 should not be put to work too soon, if the character of the work 
 is such as to induce a recurrence of the trouble. 
 
 Many cases are treated successfully in draft types of animals 
 (where the subjects are not kept at work that occasions seri- 
 
110 LAMENESS OP THE HORSE 
 
 ous irritation to the aifected parts) by blistering the exostosis 
 repeatedly and allowing the animals to continue in service. In 
 such cases, it is unreasonal)le to expect to check the size of the 
 exostosis and, of course, such methods are not employed where 
 lameness causes distress to the subject. 
 
 Firing usually causes prompt recovery from lameness and is 
 a dependable manner of treating such eases but there remains 
 more blemish following cauterization than where vesication is 
 done. 
 
 OPEN FETLOCK JOINT. 
 
 This condition, because of the frequency with which it occurs 
 may be taken as typal, from the standpoint of treatment and 
 results obtained therefrom. AVhile it serves to constitute a basis 
 from which other joints, when open, are to be considered, due 
 allowance must be made for the fact that, as has been previously 
 mentioned, some articulations when open constitute cause for 
 grave consequences; while with others an open capsule, even 
 when infected, does not cause disturbance enough to be classed 
 as difficult to handle. IMoreover, the fetlock joint is admirably 
 suited, anatomically, to bandaging ; and wdien wounded, is easily 
 kept protected by means of surgical dressings. This fact is of 
 great importance in influencing the course and termination in 
 any given case of open fetlock joint and should not be forgotten. 
 
 There is no logical reason for comparing the pedal joint with 
 the pastern on the basis that it may also be completely and se- 
 curely bandaged. Open navicular joint does not occur, as a 
 rule, except by way of the solar surface of the foot, and the in- 
 troduction of active and virulent contagium is certain to happen; 
 consequently, an acute synovitis quickly rosidting in an intensely 
 septic and progressively destructive arthritis soon follows in 
 perforation of the capsule of the distal inlerphalangeal articula- 
 tion. 
 
 Etiology and Occurrence. — Wounds of the fetlock region re- 
 sulting in perforation or destruction of a part of the capsular 
 ligament are caused by all sorts of accidents, such as wire cuts, 
 incised wounds occasioned l)y plowshares, disc harrows, stalk 
 cutters and other farming implements. In runaways the joint 
 
LAMENESS IN THE FORE LEG 111 
 
 capsule is sometimes punctured l)y sliarp pieces of wood or other 
 objects. In horses driven on un paved country roads the fetlock 
 is occasionally wounded by being struck against the sharp end 
 of some object, the other end of which is firmly embedded in the 
 ground. In one instance the author treated a case wherein the 
 fetlock joint was perforated by the sickle-guard of a self-binder. 
 In this case there occurred complete perforation causing two 
 openings through the cul-de-sac of the joint. Such wounds are 
 produced l)y implements which are, to say the least, non-sterile, 
 and this perforation of the uncleansed skin conveys infectious 
 nuiterial into the joint capsule. Yet in many instances, espe- 
 cially in country practice, no infectious arthritis results where 
 cases are promptly cared for. 
 
 Symptomatology. — A difiPerence in the character of symp- 
 toms is evidenced when dissimilar causes exist. Small penetrant 
 wounds which infect the synovial membranes cause infectious 
 arthritis in some cases, whereas a wound of sufficient size to 
 produce evacuation of all synovia will, in many instances, cause 
 no serious distress to the subject, even wlien not treated for sev- 
 eral days. If it is not evident that an open joint exists and the 
 articular cavity is not exposed to view a positive diagnosis may 
 be early established by carefully probing the wound. In some 
 cases where a small wound has perforated the joint capsule, 
 swelling and slight change of relation of the overlying tissues 
 may preclude all successful exploratory probing. In such in- 
 stances it is necessary to await development of symptoms. 
 Twenty-four hours after injury has been inflicted, there is notice- 
 al)le discharge of synovia which coagulates about the margin of 
 the orifice, where synovial discharge is possible. Particularly 
 evident is this accumulation of coagulated synovia where wounds 
 have been bandaged — there is no mistaking the characteristic 
 straw-colored coagulum vdiich, in such cases, is somewhat ten- 
 acious. 
 
 No diflPerence exists between otlicr symi)t()ins in infectious 
 arthritis caused l)y punctures, and non-infectious arthritis, ex- 
 cepting the intensity of the pain occasioned, the rise in tempera- 
 ture, circulatory disturbances, etc.; all of which have been pre- 
 viously mentioned, 
 
112 LAMENESS OF THE HORSE 
 
 Treatment. — Just as has been stated in discussions on the 
 subject of open joint, probing or other instrumentation is to be 
 avoided until the exterior of the wound and a liberal area sur- 
 rounding has been thoroughly cleansed — too much importance 
 can not be placed on this preliminary measure. In cases of open 
 joint where ragged wound margins exist and the interior of the 
 joint capsule is contaminated, much time is required to 
 thoroughly cleanse all soiled parts. In some instances an hour's 
 time is required for this cleansing process after the subject has 
 lieen restrained and prepared. In order to thoroughly cleanse 
 these delicate structures without doing them serious injury, one 
 ought to be skillful and careful in all manipulations of the ex- 
 posed parts of the joint capsule. 
 
 The general plan of treatment, after preliminary cleansing 
 has been accomplished, has been outlined on page 66 in the 
 consideration of scapulohumeral joint affections. The injection 
 of undiluted tincture of iodin in ounce quantities, it must be 
 remembered, is not to be done unless there is provision for its 
 free exit. Where good drainage from the joint cavity exists 
 all infected wounds should be thus treated, and this treatment 
 may be repeated as conditions seem to require — until infection 
 is checked. 
 
 If daily injections are necessary, dilution of the tincture of 
 iodin with an equal amount of alcohol is advisable in order to 
 avoid doing irreparable damage to the articular cartilages and 
 synovial membranes. 
 
 An antiseptic powder composed of equal parts of boric acid 
 and exsiccated alum is employed to protect the wound surfaces 
 and the margins, and the parts are then bandaged. In bandag- 
 ing wounds of this kind a liberal amount of cotton should be 
 employed, and after a large surface surrounding the wound has 
 been thoroughly cleansed, it must be so kept thereafter. This 
 is impossible, if one uses a small amount of cotton, particularly 
 if such meager quantity of dressing material is carelessly 
 wrapped in position with an insufficient amount of bandage ma- 
 terial. Mention, without description of the elemental problem 
 of applying cotton and bandages to a wound, would be suffi- 
 cient, were it not that this is a very important part of the hand- 
 
LAMENESS IN THE FORE LEG 113 
 
 ling of such cases, and many practitioners are not only thought- 
 less in this part of their work, but also apparently careless. 
 What does it profit to prepare a part and cleanse a wound with 
 painstaking care and then neglect to take every possible precau- 
 tion to prevent its subsequent contamination? 
 
 In the handling of open joint capsules where the perforation 
 of the capsular ligament is small and discharge of synovia does 
 not immediately follow, there is presented a problem which is 
 difficult to decide upon and that is the manner in which such 
 wounds are to be handled. One hesitates to enlarge such open- 
 ings to drain or irrigate the capsule when there is no proof that 
 serious trouble will follow because of infectious material which 
 has probably been introduced at the time the wound was in- 
 flicted. It is especially difficult to decide upon the manner of 
 handling such cases where the tarsal joint is wounded, although 
 one hesitates to invade any joint to the extent of incising its 
 capsule, unless there is urgent need of so doing. 
 
 Frost ^ offers the following suggestion in such instances : 
 The treatment recommended by us for open joints, in which 
 we wish to prevent ankylosis, is, first, to shave all hair from the 
 area surrounding the wound, following v>'ith a thorough cleans- 
 ing of the skin and disinfection of the v/ouud, and then to in- 
 ject a twenty per cent Lugol's solution in glycerin into the 
 wound. This should be repeated two or three times a day, each 
 time enough of the solution being injected to fill the joint cap- 
 sule, thereby securing the flushing effect. As this solution does 
 not cause irritation to the tissue and yet is a strong antiseptic, 
 it serves to shorten the period of congestion and inflammation 
 and to overcome the infection without causing a destruction of 
 the secreting membrane until the external wound has had time 
 to heal. The injection of this solution seems to retard the ex- 
 cessive secretion of synovia. The larger the joint capsule and 
 the smaller the external wound, the longer our antiseptic will 
 remain in contact with the inflamed tissues as the glycerin, 
 being thick, does not flow through a small opening. 
 
 After-care. — Following the initial cleansing and treatment of 
 open joint, subsequent dressing is necessary as frequently as 
 conditions demand. If the parts are badly infected and profuse 
 discharge of pus exists a daily change of dressings is necessary. 
 
 ij. N. Frost, assistant professor of Surgery, Veterinary Dept., Cornell 
 University, in "Wound Treatment," page 159. 
 
il4 LAMENESS OF THE HORSE 
 
 In the average instance, however, semi-weekly treatments are 
 sufficient. And in many instances where one is obliged to travel 
 a considerable distance to handle the affected animal one weekly 
 dressing of the wound will suffice after the second treatment. 
 
 The same general plan of treatment concerning the subject's 
 comfort that has lieen previously mentioned in arthritis, is car- 
 ried out liere. A further and detailed consideration of the 
 subject of handling of open joints follows.^ 
 
 *•• * * Such wounds may be elassifi(Hl in two general groups 
 as follows: First, wounds in which the trauma has exposed 
 the articulation to view, and second, those the result of punc- 
 tures, in which the external wound is snmll and free drainage 
 is lacking. 
 
 Wounds in which the articulation is exposed to view have 
 drainage either all ready provided for, or it is established with- 
 out hesitancy surgically. AVith free drainage thus established 
 there is little or no chance for the adjacent tissues to become 
 infiltrated with infected wound discharge. This prevents an 
 extension of the injury and the establishment of a good field 
 for the growth of anaerobic bacteria. 
 
 Open joints caused by punctures, unless the puncture is 
 aseptic, produce a swelling which is more painful than is the 
 open wound which exposes the joint to view. Especially is this 
 true if the puncture is of small diameter, allowing the tissues 
 to partially close the opening immediately after the wound has 
 been made. Where drainage is lacking there follows an exuda- 
 tion which congests the tissues surrounding the injury and all 
 factors favoring germ, growth are present. It is perhaps advis- 
 able to establish good drainage in such cases as soon as a diag- 
 nosis is made. 
 
 It is not always an easy matter to recognize an open-joint, 
 when first made, but twelve to twenty-four hours later there is 
 no cause for doubt. The condition is then a very painful one ; 
 lameness is excessive; there is rise in temperature; acceleration 
 of the pulse and manipulation or palpation of the region affected, 
 occasions great pain. 
 
 The treatment of open joints must be varied to suit the dis- 
 position of the animal, the nature and location of the injury, 
 the length of time intervening 1)etween the infliction of the 
 wound and the first attention given, and flie surroundings in 
 which the patient is kept. 
 
 In each and every case in which there exists an open wound 
 
 'Open Joints and Their Treatment in my practice, by J. V. Lacroix, Amer- 
 ican Journal of Veterinary Medicine, Vol. 5, page 203. 
 
LAMENESS IN THE FORE LEG 115 
 
 the surface surrountlinti' tlie wound is cleansed thoroughly, the 
 hair is shaved if possible, and the margin of the wound is cur- 
 retted and cleansed thoroughly with antiseptic solutions. 
 
 If there is evidence that the articulation contains infective 
 material, it is washed out with copious quantities of peroxide 
 of hydrogen — usually as nnicli as six or eight ounces. This is 
 followed by injection of an ounce or two of tincture of iodin. 
 Even though the joint appears to be clean some tincture of iodin 
 is used, as it checks the secretion of synovia and is, in every 
 way, beneficial. Care is taken to apply the iodin also to the sur- 
 face immediately surrounding the wound. The entire wound is 
 then covered with a dusting powder composed of zinc oxide, boric 
 acid, exsiccated alum, phenol and camphor. 
 
 This powder is used in abundance and the wound is then 
 covered with a heavy layer of absorbenc cotton and well ban- 
 daged. This bandage is not disturl)ed for at least three days 
 and may be left in place for a week. In cases in which it is 
 necessary to keep the dressing on for a Vv'cek, or in cases where 
 the patient is, through necessity, kept in quarters that are wet 
 or unclean, the first bandage is covered with a layer of oakum 
 which has been saturated in oil of tar and this in turn is held 
 in place by means of several layers of bandages. The Ijandages 
 are also saturated with oil of tar. 
 
 In from one to two months wounds so treated, unless they are 
 foot-wounds, will be ready to dress without being bandaged. 
 It is ordinarily unnecessary to dress foot-wounds oftener than 
 every second week after the discharge of synovia has ceased. 
 When the wound has filled with granulation, a protective dress- 
 ing is applied which is rendered water proof by the use of 
 bandages covered with oil of tar. The patient can now be turned 
 out for a month or six weeks without disturbing the dressing. 
 After the removal of the bandages, the only treatment necessary 
 is an occasional application of some mildly antiseptic ointment. 
 
 Except in nail pricks of the foot, occasioned by punctures, a 
 five per cent tincture of iodin is injected into open joints, if the 
 wound renuiins sufficiently open, and this treatment is continued 
 so long as there is a discharge of synovia. Surgical drainage is 
 established if it is considered practicable and the remainder of 
 the treatment is about the same as for wounds which are open. 
 
 Open joints occur in horses at pasture and are sometimes not 
 discovered until several days or a week after the injury, and in 
 some instances the wounds are filled with maggots. The only 
 difference in the treatment of these cases is that more time and 
 care is taken in cleansing the wound, more curetting is neces- 
 sary, and after cleansing the Avound with peroxide of hydrogen, 
 
116 LAMENESS OF THE HORSE 
 
 the joint is thoroughly washed out with equal parts of tincture 
 of iodiu and chloroform. This is follo\\ed by the injection of a 
 quantity of seventy-five percent alcohol and the wound is dressed 
 and bandaged as already described. At each subsequent dressing 
 of infected wounds so treated less suppuration is noticed and 
 the synovial discharge usually ceases in from one to two months. 
 About ninciij percent of all cases of open joint make complete 
 recoveries, about four per cent partially recover and six per cent 
 are fatal. Among the fatal cases are the open joints with com- 
 plications as severed tendons, those occasioned by calk wounds 
 in horses that are stabled, and nail punctures of the feet. The 
 foUoAving report of twelve favorable cases is taken from a record 
 of sixty-two cases. The favorable ones are reported, chiefly 
 because there are now enough reports on record of such cases 
 which have terminated fatally. 
 
 Case 1. — A gray gelding used as a saddle pony received a 
 horizontal wire cut laying completely bare the scapulohumeral 
 articulation. The margins of the wound were cleansed as here- 
 tofore described, a drainage was provided surgically, tincture of 
 iodin was injected and the wound was covered with equal parts 
 of boric acid and exsiccated alum. The iiorse was kept tied and 
 a diluted tincture of iodin was injected into the wound once 
 daily and the powder applied often enough to keep the wound 
 covered. The case made a complete recovery and the pony was 
 again in service within sixty days. 
 
 Case 2. — A twelve-hundred-pound bay mare with an open car- 
 pal joint. The wound was an open one al)Out two and one-half 
 inches in length, and made transversely and when the member 
 was flexed the articular surface of the carpal bones were pre- 
 sented to view. An ounce of tincture of iodin was injected into 
 this joint after having cleansed the margin of the wound and 
 the mare was cross-tied in a single stall to keep her from lying 
 down. The owner was instructed to keep the outside of the 
 wound powdered with air slaked lime and a very unfavorable 
 prognosis was given. 
 
 I heard nothing further from this case until fifty-nine days 
 from the date of the injury, when I met the owner driving this 
 mare to a buggy. The wound had healed by first intention and 
 at that time so little cicatrix remained that it was difficult to 
 find it. 
 
 Case 3. — A brown mare with an open fetlock joint due to a 
 spike-nail puncture. Lameness was excessive, and joint greatly 
 swollen. Tincture of iodin was injected into the wound and 
 towels dipped in hot antiseptic solutions were applied for several 
 
LAMENESS IN THE FORE LEG 117 
 
 hours daily until the acute stage had passed. Later the mare 
 was turned out to pasture and a vesicant was applied once or 
 twice a month until recovery was complete which was in about 
 six months. 
 
 Case 4. — A four-year-old bay mare having a wire-cut which 
 opened the tarsus joint was treated as heretofore described. The 
 wound was kept bandaged for about two weeks and later it was 
 dressed without being bandaged. In ninety days she had com- 
 pletely recovered. 
 
 Case 5. — A twelve-year-old mare with an open fetlock joint 
 due to a puncture wound. The margins of the wound were 
 cleansed and the external wound enlarged to facilitate drainage. 
 Tincture of iodin was injected; the wound was bandaged and 
 dressed for a month in the manner heretofore described, when 
 all discharge had stopped. A vesicant was applied; the mare 
 was put to pasture and within sixty days from the date of the 
 injury she was being driven on short trips. 
 
 Case 6. — A two-year-old brown gelding with a wire-cut on 
 the left front foot. The wound extended down through the sole 
 and opened the navicular joint. This colt was very wild and it 
 was necessary to tie it down each time the wound was dressed 
 The wound was dressed weekly for a month and less frequently 
 thereafter. It was handled eight times; the last dressing was 
 left in place until worn out. Six months later the colt was prac- 
 tically well, a very little lameness being shown when walking 
 on frozen ground. 
 
 Case 7. — A seven-year-old saddle-horse weighing eleven hun- 
 dred and fifty pounds received a wound of the tarsus, laying 
 bare the articular surfaces of a part of the joint. It was im- 
 possible to keep this wound bandaged because of the restless 
 disposition of the subject. Injections of a dilute tincture of 
 iodin were emploj^ed every second or third day for a month 
 and the wound was kept covered with the antiseptic dusting 
 powder referred to heretofore. In five months complete recovery 
 had taken place, with the exception of a stubborn skin disturb- 
 ance which was successfully treated six months after the wound 
 was inflicted. The horse is still in use and is absolutely free 
 from lameness. 
 
 Case 8. — A two-year-old brown gelding with a wire-wound 
 opening the scapulohumeral joint. This wound was large enough 
 to expose to view the articular portion of the humerus. The same 
 treatment as that given case No. one was instituted and in ninety 
 days the colt was practically well. 
 
118 LAMENESS OF THE HORSE 
 
 Case 9. — A three-year-old bay filly was found at pasture with 
 one fore foot badly injured. The owner intended to destroy her, 
 hut a neighbor prevailed upon him to have her treated. Ap- 
 parently the wound was of about a week's standing and in a 
 very bad condition, filled with maggots and dirt. Both the 
 navicular and coronary articulations were open. This wound 
 was cleansed in the usual manner and the owner cared for the 
 case the balance of the time because the distance from my office 
 was too great to give her personal attention. She made an al- 
 most complete recovery in five months. 
 
 Case 10. — At two-year-old mule with an open navicular joint 
 due to a barbed wire wound. Usual care was given this case and 
 in five months recovery was complete and little scar is to be 
 seen. This case received seven treatments. 
 
 Case 11. — An eighteen-months-old colt at pasture was found 
 down and unable to rise without help. In addition to several 
 wounds of lesser importance there was a large wound on the 
 inner side of the elbow, the joint was open and the entire leg 
 was greatly swollen and in a state of acute infectious inflamma- 
 tion. The colt could not walk, its temperature was 105°, pulse 
 was rapid and respiration was a little hurried. After advising 
 the owner to put the poor animal out of its misery I left the 
 place. Four clays later the owner came to my office and asked 
 if he could borrow some old shears to "trim off some loose hide 
 from that colt." He left the colt in the pasture and all the 
 care it received was the regular application of a proprietary 
 dusting powder. It made a complete recovery. 
 
 Case 12. — A family mare, heavy in foal, received a vertical 
 wound of the fetlock joint inflicted by a disc-harrow. The cid- 
 de-sac of the ligament of this joint was opened freely. The 
 wound was dressed in the usual manner and again three days 
 later when no suppuration had ta _m place. Four days later 
 the patient gave birth to a colt and suckled it right along through 
 her convalescence. This wound healed by first intention and 
 seventy-nine days from the date of the injury the mare was 
 driven to town, two and one-half miles distant, and showed but 
 little lameness. 
 
 Phalangeal Exostosis (Ringbone) 
 
 This tci'iii is applied to exostoses involving the first and second 
 phalanges (suffraginis and corona), regardless of their size, ex- 
 tent or location. It is a misnomer, in a sense, and the veter- 
 inarian is frequently obliged to spend considerable time with his 
 
LAMENESS IN THE FORE LEG 119 
 
 clients in order to convince tlicni that a spherodial exostosis of 
 the proximal phalanx, in certain cases, is in reality ' ' ringbone, ' ' 
 even though there exists no exostosis which completely encircles 
 the affected bone. 
 
 Etiolog'y and Occurrence. — Exostosis of the first and second 
 phalanges is usually due to some form of injury, whether it be a 
 contusion, a lacerated wound which damages the periosteum, or 
 periostititis and osteitis incited by concussions of locomotion, 
 or ligamentous strain. Practically the only exception is in the 
 rachitic form of ringbone which affects young animals. 
 
 There are predisposing causes that merit consideration, chief 
 among which is the normal conformation of the coronet joint. 
 This proclivity is constant ; the normal interphalangeal articula- 
 tion is an incomplete ginglymoid joint and while its dorso-volar 
 diameter is great, this in no wise compensates for its dispropor- 
 tionately narrow transverse diameter. The pivotal strain which 
 is sometimes thro^Ml upon this articulation when an animal turns 
 on one foot, as well as the tension which is put on the collateral 
 ligaments when the inner or the outer quarter of the foot rests 
 in a depression of the road surface, tends to detach the insertion 
 of these ligaments or to cause fibrillary fractures of their sub- 
 stance. 
 
 Short, upright, pasterns receive greater concussion during fast 
 travel on hard roads than do the longer more sloping and well 
 formed extremities. Those who are advocates of the theory that 
 this type of osteitis with its complications has its origin in the 
 articular portion of the joint, claim that the upright pastern con- 
 stitutes an important tendency toward ringbone. Howbeit, ring- 
 bone is an active, serious and frequent cause of lameness and it 
 affects animals of all ages and occurs under various conditions. 
 Horses having good conformation and kept at work wherein no 
 great amount of strain is put upon these parts, are occasionally 
 victims of this affection. 
 
 Classification. — The arrangement employed by Moller^ is in- 
 tensely practical and logical. He considers ringbone as articu- 
 lar, periarticular, rachitic and traumatic. A mode of classifica- 
 
 iRegional Veterinary Sui-gery MiiUer — Dollar, page G05. 
 
120 LAMENESS OF THE HORSE 
 
 tion that is common and in a practical way, good, is, high and 
 low ringbone. When prognosis is considered, for instance, it is 
 very convenient to state that the chances for recovery are much 
 better in high ringbone than in low ringbone. The classification 
 of ]\Ioller will be followed here. 
 
 Symptomatology. — In all forms of incipient ringbone except 
 rachitic, the first manifestation of its existence, or of injury to 
 the ligaments in the region of the pastern joint which causes 
 
 Fig. 17 — Phalangeal exostoses. 
 
 periostitis, or affections of the articular portions of the proximal 
 inter-phalangeal joint, is lameness. Lameness which typifies 
 ringbone is of the supporting-leg variety and by compelling the 
 subject to step from side to side, marked flinching is observed, 
 especially in periarticular ringbone; causing the affected animal 
 to turn abruptly on the diseased member, using it as a pivot, 
 likewise accentuates the manifestation. In fact, many subjects 
 that exhibit no evidence of locomotory impediment while walking 
 or trotting in a straight line on a smooth road surface, will mani- 
 fest the characteristic form of lameness from ringbone when the 
 aforementioned side to side movement is performed. 
 
LAMENESS IN THE FORE LEG 
 
 121 
 
 When the manner in which pain is occasioned is considered, it 
 will be understood why lameness is intermittent in the early 
 stages of this affection and may even be unnoticed by the driver. 
 An animal may travel on a smooth road without giving evidence 
 of any inconvenience, but as soon as a rough and irregular pave- 
 ment or road surface is reached, will limp. As the subject is 
 driven farther on level streets the lameness may disappear. This 
 intermittent type of lameness may continue until there is de- 
 veloped a large exostosis, or until articular involvement causes 
 
 Fig. 18 — Rarefying osteitis in chionic ringbone and ossification of lateral 
 cartilages. 
 
 SO much distress during locomotion that lameness is constant. 
 On the other hand, resolution may occur during the stage of 
 periosteal inflammation, oi', an exostosis forms which causes no 
 interference with function. 
 
 Before there is evidence of an exostosis, diagnosis of ringbone 
 is not easy, for it is then a problem of detecting the presence of 
 a ligamentous sprain, periostitis, or osteitis. The diagnostician 
 should take note of local manifestations of hypersensitiveness, or 
 heat if such exist, and, in addition, other conditions must be ex- 
 cluded before definite conclusions are possible. 
 
 In articular ringbone as soon as there is developed an exostosis, 
 
122 LAMENESS OF THE HORSE 
 
 it occupies a position on the dorsal (anterior) part of the articu- 
 lation and extends around the sides of the joint. 
 
 Periarticular ringbone is characterized hy exostoses which 
 are situated on the sides of the phalanges and not extending 
 around to the anterior part of the joint. This type of ringbone 
 as well as the articular may occur "high" or "low." 
 
 Fig-. 19 — Phalangeal exostoses in chronic ringbone. Museum specimen of 
 the Kansas City Veterinary College. 
 
 With the trau malic form of ringbone, all consequences, as to 
 the size and form the exostosis is to assume, depend upon the 
 nature and extent of the injury. 
 
 Rachitic ringbone is frequently observed in some sections of 
 tlie country and docs not oi-diiiarily cause much if any lameness. 
 It is a disease of colts and may affect one or all of the phalanges 
 at the same time. As the sul)jcct advances in age there is more 
 or less diminution in the size of the enlargements. 
 
LAMENESS IN THE FORE LEG 123 
 
 Treatment. — Rest is essential in the treatment of ringbone. 
 If diagnosed during its ineipieney, remedial measures such as 
 are usually employed to treat sprains, are indicated and hiter 
 the parts should be blistered. When an exostosis has developed 
 puncture firing is the remedy par excellence. Not that this 
 method of treatment is infallible, for to any thinking one who 
 takes into consideration the pathological anatomy of this condi- 
 tion, it is evident that no manner of treatment is beneficial in 
 some eases. If the exostosis is so situated that it does not me- 
 chanically interfere with function, and is not so large that it 
 may inhiliit flexion and extension, and where the articular por- 
 tions of the joint are not eroded, good results attend the use of 
 the actual cautery. 
 
 In firing, after having anesthetized the extremity, and pre- 
 pared the surgical area, the cautery is deeply inserted in numer- 
 ous places, taking care, however, not to open the joint. The parts 
 are immediately covered with aseptic absorbent cotton and this 
 dressing is left in position for forty-eight hours and if perchance 
 there is evidence of synovial discharge, the parts are again 
 aseptically dressed in order to prevent infection of the articula- 
 tion. If, as is the case usually, no perforation of the joint cap- 
 sule exists, the openings made by the cautery have been closed 
 by the coagulation of serum and there is then little chance of 
 infection causing troul)le, even though the member is left un- 
 bandaged. 
 
 In several instances, the author has treated ringl)one by this 
 method where the periarticular type existed and lameness was 
 marked, and in three weeks the subjects were in service and not 
 lame — this, in one instance in a valual)le polo pony where the 
 subject continued in service for more than a year without any 
 evidence of recurrence of the lameness. The production of a 
 deep-seated and acute inflammation with the actual cautery is 
 preferable to any sort of counter-irritation which may be pro- 
 duced by vesicants. 
 
 There is no occasion for any ditfereuce in the treatment of 
 either of the first three classes of ringbone, l)ut in the rachitic; 
 type where treatment is given, the application of a vesicant is 
 
124 LAMENESS OF THE HORSE 
 
 all that is required. In most instances treatment is not neces- 
 sary. 
 
 The affected animals require a month to three months' time 
 for recovery to take place in the average favorable cases of ring- 
 bone. 
 
 Median neurectomy is of service in many instances where 
 lameness is not completely relieved by the use of the actual 
 cauteiy and no bad results attend the performance of this opera- 
 tion even though no benefit is derived thereby. Plantar neu- 
 rectomy is contraindicated in all cases where there exists much 
 lameness. If lameness is due to acute inflammation bad results 
 such as sloughing and loss of the hoof may follow ; and if large 
 exostoses mechanically interfere with function of the joint, or 
 where articular erosions exist, no possible good can come from 
 neurectomy. Careful discrimination should be employed in se- 
 lecting cases for neurectomy for this operation; otherwise, it is 
 very likely to prove disappointing. 
 
 Open Sheath of the Flexors of the Phalanges. 
 
 This condition does not differ from a like affection involving 
 other tendons except that the function of these tendons is such 
 that large synovial sheaths are necessary, and when synovitis 
 exists, the condition then becomes more serious. 
 
 Infectious synovitis involving these tendons in the fetlock 
 region is of more frequent occurrence than a like affection of 
 carpal or tarsal sheaths. With the exception of the extent of 
 the involvement and distress occasioned thereby, synovitis the 
 result of open tendon sheaths, is similar wherever it occurs. 
 
 Etiology. — The same conditions which are responsible for 
 open fetlock joint and other wounds of the pastern region, cause 
 open tendon sheaths of the flexor tendons. 
 
 Symptomatology. — Because of the size and extent of this 
 slicalli and the different manner in whidi it is opened, there is 
 manifested dissimilar symptoms in different cases. A nail 
 puncture which perforates the sheath in the pastern region and 
 at the same time produces an infectious synovitis, will cause 
 a markedly different manifestation than will a wound which 
 
LAMENESS IN THE FORE LEG 125 
 
 freely opens the sheath above the fetlock. In the first instance, 
 the condition is much more painful; swelling is intense in some 
 cases; and if the subject does not possess sufficient resistance so 
 that spontaneous resolution promptly occurs, surgical evacua- 
 tion of pus is usually necessary. When these tendon sheaths 
 are opened, there follows a reaction which is quite analogous to 
 that which exists in arthritic synovitis, but instead of ankylosis, 
 adhesions with thecal obliteration occur. Rarely there result 
 cartilaginous and osseous formations. 
 
 The constitutional disturbances Avhich characterize this con- 
 dition vary with the degree of distress occasioned. As the in- 
 fection is virulent and causes serious destruction of the affected 
 parts, so does evidence of malaise and finally distress appear. 
 Detailed discussions of symptomatology in similar conditions 
 have heretofore been given, and further repetition is unneces- 
 sary. 
 
 Treatment. — The same general plan of treatment which is 
 employed for handling open joint is put in practice in these 
 cases. Following the preoperative cleansing of the exteriuil 
 wound and adjacent surfaces, where lilieral drainage exists, 
 tincture of iodin is injected into the sheath, the parts covered 
 with a suita])le dressing powder, and th^ entire meml)er is care- 
 fully dressed with cotton and bandages. 
 
 Subsequent treatment is the same as has been outlined \n the 
 discussion of open fetlock joint on page 112. The same general 
 plan of after-care is necessary. Recovery, however, does not 
 require so much time ordinarily, yet punctures of the sheath 
 occasioned by nails or other siiuiU implcmeiiis make for long 
 draAvn out cases of infective synovitis. 
 
 Luxation of the Fetlock Joint. 
 
 Etiology and Occurrence. — The numner of construction of 
 the fetlock joint is such that disarticulntion without irreparable 
 injury resulting, is practically impossil)l\ Logically, this joint 
 in the fore legs (not so in the pelvic limbs) should disarticulate 
 in such nu^mer that eitlier all of the inhibitory apparatus (flexor 
 tendons and suspensory ligament) nnist rupture or a lateral 
 luxation is necessary. Lateral disarticulation must necessarily 
 
126 LAMENESS OF THE HORSE 
 
 sever the attachment of one of the common collateral ligaments. 
 Because of the width (transverse diameter) of the articulating 
 surfaces of this joint, lateral luxation requires a great strain; 
 and a force that is sufficient to occasion this trauma usually 
 causes serious additional injury. Therefore, the condition is 
 considered one wherein prognosis is always unfavoral)le in so 
 far as practical methods of treatment are concerned. 
 
 Mr. A. Barbier^ reports a case of bilateral luxation of the fet- 
 lock joints of the hind legs in a horse. This was done in jump- 
 ing, and the extensor tendon of each leg was ruptured and the 
 anterior portion of the metatarsus was protruding tli rough the 
 skin. Profuse hemorrhage had taken place due to tearing of 
 the blood vessels. 
 
 Symptomatology. — Entire luxation of this joint when present 
 is so evident that one cannot fail to recognize the condition. 
 Complete disarrangement of normal relation occurs and there is 
 either a breaking down of the inhil)itory njiparatus, or if a lateral 
 disarticulation exists, the normally straight line formed by the 
 bones of the front leg, as viewed from the front or rear, is broken 
 at the fetlock. 
 
 Often fracture of bones are concomitant and then, of course, 
 mobility is increased and not decreased as is the case in un- 
 complicated luxation. 
 
 Such violence occurs at times, when this joint is disarticulated, 
 that the joint capsule is also completely ruptured and the articu- 
 lar portion of the bones is exposed to view. 
 
 Treatment.— The condition being practically a hopeless one, 
 destruction of the subject is the thing which should be promptly 
 done. Tn valuable breeding animals, owners may prefer that 
 treatment be attempted when a lateral luxation and detachment 
 of but one common ligament have permitted luxation without 
 complete disarticulation and rupture of the joint capsule. In 
 such eases, by immobilizing the affected parts as in fracture, 
 and confining the subject in a sling for about sixty days, partial 
 recovery may occur in some instances. 
 
 Experience has shown that where luxation with detachment of 
 
 ^Extract from Receuil de M^decine V^t^rinaire in Ameircan Veterinary 
 Review, Vol. 23, p. 893. 
 
LAMENESS IN THE FORE LEG 127 
 
 a collateral ligament occurs, recovery is slow and incomplete — • 
 there always results considerable exostosis at the site of injury. 
 
 Sesamoiditis. 
 
 Etiology and Occurrence. — Inflammation of the proximal 
 sesamoid Ijones is caused by any kind of irritation which may 
 involve this part of the inhibitory apparatus. Positioned as 
 they are, between the bifurcations of the suspensory ligament 
 and the pastern joint, they serve as fulcra and effectively assist 
 in minimizing concussion which is received by the suspensory 
 ligament. The flexor tendons also, in contracting, exert strain 
 upon the inter-sesamoidean ligament, which has a similar effect 
 upon the sesamoid bones as that which is produced by the sus- 
 pensory ligament. 
 
 The condition occurs quite frequently, and because of the 
 important function performed by these bones, active inflamma- 
 tion of the sesamoids constitutes a serious affection. Because 
 of the fact that these bones have proportionately large articular 
 surfaces, when they are inflamed to the extent that degenerative 
 changes affect the articular cartilage, complete recovery seldom 
 results. 
 
 The same pathological changes occur here that are to be seen 
 in any case of arthritis. No special pathological condition char- 
 acterizes sesamoiditis but this condition causes incurable lame- 
 ness when the sesamoid bones are much inflamed. 
 
 Symptomatology. — In acute inflammation, there exist all tlie 
 symptoms which portray any arthritic inflammation of like char- 
 acter. The parts are readily palpable and are found to be hot, 
 supersensitive, and more or less infiltration of the tissues con- 
 tiguous to the joint causes swelling. There is volar flexion of the 
 phalanges when the subject is at rest. Lameness is intense ; in 
 some acute inflammatory disturbances the subject is unable to 
 bear weight on the affected member. 
 
 In chronic sesamoiditis, constant lameness is the one salient 
 feature which marks the condition. While it is possible for one 
 sesamoid bone to become involved without its fellow being af- 
 fected, this is not usual. Considerable organization of tissue 
 surrounding the joint is present and no particular evidence of 
 
128 LAMENESS OF THE HORSE 
 
 siipersensitiveness exists. However, supporting weight brings 
 sufficient pressure to bear upon the intlamed and more or less 
 eroded Imnes so that pain is occasioned and lameness results. 
 
 Treatment. — During acute inflammation, absolute quiet is. 
 of course, of first consideration. Cold packs are to be kept in 
 contact with the parts until acute inflammatory symptoms sub- 
 side. The fetlock region is then enveloped with a poultice or an 
 iodin and glycerin combination (iodin one part to seven parts 
 of glycerin) is applied and a dressing of cotton is kept in con- 
 tact with the inflamed region. Following this, a vesicant is em- 
 ployed and the subject is allowed a month's rest. 
 
 Tn sub-acute cases, the entire region .surrounding the pastern 
 is blistered or the actual cautery is used. Line-firing is pref- 
 erable. The subject is given a month or six weeks rest and one 
 may be guided by the presence or absence of lameness as to 
 whether improvement or recovery i.s taking place. 
 
 Old chronic cases, and particularly those where there are con- 
 siderable induration and fibrous organization of tissue surround- 
 ing the joint, are not to be benefited by treatment. 
 
 The chief consideration in handling sesamoiditis is checking 
 inflammation as early as possible and preventing, if this can be 
 done, the erosion of articular surfaces. If destruction of any 
 part of the articular surfaces can be prevented and the patient 
 allowed ample time for complete resolution of the affected parts 
 to occur, permanent relief is possible. 
 
 Fracture of the Proximal Sesamoids. 
 
 Etiology and Occurrence. — Fracture of the proxinud sesa- 
 moid bones is caused l)y violent strain when there exists fragilitas 
 ossenm, or by contusions. The author treated a case where 
 fracture of one sesamoid was occasioned by a horse receiving a 
 puncture wound wherein the sharp end of a steel bar was pro- 
 truding from the ground where it was firmly embedded. The 
 subject in this case was injured while being driven along a 
 country road. Frost^ reports simultaneous fracture of all of the 
 proximal sesamoids occurring in a sixteen-year-old pony. The 
 
 'Fracture of All the Sesamoid Bones, by R. F. Frost, M. R. C. V. S., 
 A. V. D., Rangoon, Burmah, in American Veterinary Review, Vol, 5, p. 362. 
 
LAMENESS IN THE FORE LEG 129 
 
 condition is of rather common occurrence in some countries be- 
 cause of tlie fragile condition of horses' bones. 
 
 Symptomatology. — If the parts can be examined before ex- 
 travasation of l)lo()d and swelling mask the condition, crepita- 
 tion may be detected. In other instances, it is possible to note a 
 displacement of parts of the sesamoid bones — this in horizontal 
 fracture. There occurs more or less descent of the fetlock which 
 must not be attributed to rupture of the superficial tlexor tendon 
 (perforatus). By outlining the course of this tendon with the 
 fingers, when it is passively tensed sufficiently to follow its course, 
 one may exclude rupture of the superficial flexor. Finding the 
 suspensory ligament intact from its origin to the sesamoid at- 
 tachments, one may also eliminate rupture of this structure as 
 a cause of the trouble. Needless to say, marked lameness and 
 swelling of the fetlock soon take place. The condition is painful, 
 and ordinarily, recovery is impossil)le. 
 
 Treatment. — Where treatment is attempted, immobilization 
 as in luxation is in order. The patient's comfort is sought, and 
 if the fractured parts can be kept in close proximity, their union 
 may occur in time. However, chances for partial recovery 
 (which is the best to be hoped for) are so remote that early de- 
 struction of the subject is the humane and economical thing to 
 do. 
 
 Where treatment is instituted, it is found that there is required 
 a long time for union of the fractured bones to occur (where 
 union does take place) and the cost of treatment together with 
 the uncertainty of even partial recovery, makes for an unfavor- 
 able outcome. When the best possi])le results succeed treatment, 
 a large callosity is formed and movement of the pastern joint 
 is restricted. Lameness, though not intense, in the case referred 
 to, where one bone was broken, was i)ermanent and the subject 
 was out of service for nearly a year. 
 
 Inflammation of the Posterior Ligaments of the Pastern (Prox- 
 imal Interphalangeal) Joint. 
 
 Anatomy. — The ligaments here involved are the four vohir 
 ligaments described by Sisson^ as follows: "The volar ligaments 
 
 >The Anatomy of the Domestic Animal, by Septimus Sisson, S. B., V. S. 
 
130 LAMENESS OF THE HORSE 
 
 (Ligg Volaria)i consist of a central pair and a lateral and me- 
 dial bands which are attached below to the posterior margin of 
 the proximal end of the. second phalanx and its complementary 
 fibro-cartilage. The lateral and medial ligaments are attached 
 above to the middle of the borders of the first phalanx, tlie cen- 
 tral pair lower down and on the margin of the triangular rough 
 area." 
 
 This portion of the inhibitory apparatus is described by 
 Strangewaj^s' Anatomy as two posterior ligaments which run 
 each from three points on the sides of the os suffraginis to a 
 piece of fibro cartilage, described as the glenoid cartilage, and 
 attached to the postero-superior edge of the os corouae ; between 
 them is the insertion of the inferior sesamoidean ligament. 
 
 Etiolog-y and Occurrence. — Everything tending to increase 
 
 strain upon these ligaments is contributory to possible fibrillary 
 fracture of these structures. Excessive leverage as furnished 
 by long toes, long toe-calks and low heels increases the normal 
 tension on the posterior ligaments of the pastern joint. Faulty 
 conformation, which throws an abnormal strain on these liga- 
 ments, is a predisposing cause of inflammation of these struc- 
 tures. Hard pulling upon slippery and rough or frozen roads 
 is a common exciting cause of this injury. The condition is of 
 comparatively frequent occurrence and is seen affecting draft 
 horses frequently, in the hind legs. 
 
 Symptomatolog-y.— Lameness is the first manifestation of this 
 affection and weight bearing is painful in direct proportion to 
 the extent of injury present. Volar flexion of the phalanges 
 relieves tension on the parts ; therefore, this position is assumed 
 while the subject is at rest. When considerable tissue has been 
 ruptured, and the condition is very painful, the foot is held off 
 the ground as in ail painful affections of the extremity. 
 
 By palpation evidence of pain is discernible, though very little 
 swelling occurs. Pain is increased by manual tension of the 
 parts which is done by grasping the toe of the foot and exerting 
 traction on the flexor apparatus. Care must be taken in execut- 
 ing such manipulations, and it is only by comparison of the 
 affected member with the sound one and noting the difference 
 
LAMENESS IN THE PORE LEG 131 
 
 in the manifestations of discomfort that we may arrive at the 
 proper conclusion. 
 
 Some hyperthermia is to be recognized in acute inflammation, 
 by comparing the extremities. In the fore legs, navicular disease 
 is differentiated by noting absence of contraction at the heel. 
 By use of the hoof testers one may recognize evidence of inflam- 
 mation of the navicular apparatus. In inflannnation of the pos- 
 terior ligaments of the pastern joint, there is also absence of the 
 characteristic stuml)ling which is seen in navicular disease. 
 
 Treatment. — Rest is the first requisite, and in addition every 
 mechanical means possilile to change the center of gravity in 
 the phalangeal region, is to be employed. This is best accom- 
 plished by shortening the toe and paring the sole at the toe as 
 much as conditions will permit. The heel is raised by means 
 of a shoe with moderately high heel calks. 
 
 The iodin-glycerin combination heretofore mentioned may be 
 ai)plied and the parts covered with cotton and bandage. Sub- 
 jects require froin three weeks to several months' rest and must 
 be returned to work carefully, lest the incompletely regenerated 
 tissues suffer injury. 
 
 Regeneration of tissue in such cases, as has been pointed out, 
 is slow and sufficient time for complete recovery must be al- 
 lowed or relapses will occur. 
 
 Fracture of the First 2uid Second Phalanges. 
 
 Etiology and Occurrence. — Fractures of the first phalanx 
 (suffraginis) occur with respect to frequency, second to pelvic 
 fractures. Often, almost insignificant injuries cause phalangeal 
 fractures. On city streets, horses shod with shoes having long 
 calks get caught in frogs of street railways or by slipping on 
 rails, and phalangeal bones are often broken. The author ob- 
 served a case of comminuted fracture of both the first and sec- 
 ond phalanges (suffraginis and corona) in a polo pony caused 
 by making a sudden turn while in action in a contest on the turf. 
 
 Symptomatology. — Fracture of the phalanges is nearly al- 
 ways signalized l)y lameness, and this is marked during the pe- 
 riod of weight bearing. Lameness is usually intense and where 
 
132 LAMENESS OF THE HORSE 
 
 the pathognomonic symptom (crepitation) is not recognized, the 
 intensity of the chuidication, when other causes are absent, is 
 indicative of fracture. The subject does not bear weight upon 
 the affected member and where pain is intense, the foot is held 
 in an elevated position and swung back and forth. In hind legs 
 the member is often flexed in abduction and held in this position 
 for several minutes, being rested on the ground only during 
 short intervals. When compelled to walk, if pain is excruciating, 
 the animal hops with the sound leg, no weight being supported 
 liy the fractured member. 
 
 When an examination of the subject is possible before the 
 extremity is swollen, crepitation is usually found without great 
 difficulty, except in a subperiosteal break or in some eases of 
 vertical or oblique fracture. Great care is necessary in handling 
 the injured extremity in these cases, and particularly in nerv- 
 ous subjects or in excited animals that have lieen recently in- 
 jured in runaways, is it necessary to be gentle in manipulating 
 the extremity, if definite deductions are to be made. As has 
 l)een mentioned in the chapter on diagnostic principles, if the 
 condition is so painful that the subject does not relax the parts 
 and crepitation is masked, local anesthesia is necessary. An 
 anesthetic solution of cocain or novocain may be applied to the 
 metacarpal or metatarsal nerves and an entirely satisfactory 
 examination is then possible. 
 
 Passive movement of the phalanges in all directions is prac- 
 tised in order to produce crepitation. When rotation of the 
 parts does not occasion crepitation, gentle flexion and extension 
 may do so. And in many instances, consideral)le manipulation 
 of the i)halanges is necessary before the pathognomonic symptom 
 is to be recognized. 
 
 In eases where crepitation is not found and lameness is pro- 
 nounced, out of proportion with other possible existing causes, 
 one may by exclusion of other causes establish a diagnosis of 
 fracture in the course of forty-eight hours. In the meanwhile, 
 support is given the affected member by applying an effective 
 leather splint, so that pain may ])e diminished. To combat in- 
 flammation, a suitable cataplasm may l)e applied directly to the 
 skin, the extremity l)andaged, and the temporary immobilizing 
 
LAMENESS IN THE PORE LEG 133 
 
 appliance may be secured over all. In this manner one niay 
 make repeated examinations of the subject, and if slings are 
 used and every other necessary precaution taken to promote 
 comfort for the subject, no harm will result in delaying for 
 several days the application of permanent immobilization — ban- 
 dages and splints or casts. In fact, where much swelling exists 
 at the time one is called to treat such cases, it is advisable to delay 
 the application of a permanent dressing or east until inflamma- 
 tion has somewhat subsided. 
 
 Course and Prognosis. — AVhere conditions are favorable, the 
 nature of the fracture one that will yield to treatment, the sub- 
 ject not aged, and facilities for giving good attention to the 
 affected animal are ample, fractures of the first and second 
 phalanges recover completely in from six weeks to four months. 
 Only simple fractures are considered curable from a practical 
 and economical point of view, excepting in foals, where com- 
 pound, and even comminuted, fractures may be so handled that 
 animals may eventually become serviceable though blemished. 
 
 Age retards the process of osseous regeneration, but in one 
 instance at the Kansas City Veterinary College, a very aged 
 mare suffering from a multiple fracture of the first phalanx was 
 treated and at the end of sixty days was able to walk into an 
 aml)ulance. Large exostoses had developed and the subject re- 
 mained lame, but union of the broken bone took place in a sur- 
 privsingly prompt and effective manner, when age of the subject 
 and nature of the fracture are considered. 
 
 As a nde, one is loath to reconnnend treatment, even in a sim- 
 ple transverse fracture of the first phalanx, in animals ten years 
 of age or older. The conditions which exist in any given locality 
 that regulate the expense of caring for an animal during the 
 period of treatment, especially influence the course to be pur- 
 sued in treating fractures. 
 
 Treatment. — For permanent immobilization of the phalanges 
 in fracture, materials which might adapt themselves to the irreg- 
 ular contour of the member and at the same time contribute suf- 
 ficient rigidity to the parts without doing injury to the soft 
 
134 LAMENESS OF THE HORSE 
 
 structures, ^yould coustitute ideal means of treatment; but no 
 such materials have yet been devised, and opinions are various 
 as to the most efficient and practical method to employ. 
 
 After the fetlock has been shorn of hair and the ergot trimmed, 
 the skin is thoroughly cleansed and allowed to dry. Several 
 thin layers of long fiber cotton are then wrapped around the 
 extremity — enough to pad well the member — and this is retained 
 in position with a wide bandage. Gauze bandages are prefer- 
 able to heavier bandages of cotton fabric because they are some- 
 wliat more elastic and yield to the irregular contour of the parts 
 to a better advantage. Layers of three inch gauze bandages, 
 which are soaked with a cold starch paste are wound about the 
 extremity. Strips of leather that are flexible and not more than 
 an inch in width are placed in a vertical position around the 
 leg and these are also covered with the starch and securely held 
 in position with the bandages. In this way, one is able to pro- 
 vide a sufficient degree of rigidity and at the same time, where 
 the cast is carefully applied, little if any injury is done the skin. 
 Such a cast is not difficult to remove and is so inexpensive that 
 it may be removed and reapplied at any time it should be 
 thought preferable to do so. Of course, this does not constitute 
 an effective means of support if the parts are to be frequently 
 and thoroughly soaked with water, but animals undergoing this 
 sort of treatment are usually kept sheltered. 
 
 The same after-care is necessary in such eases as is given in 
 fractures of other bones. Two months after the injury has 
 been done, the application of a blistering ointment to the entire 
 region is of benefit. 
 
 Results. — Much depends on the nature of fractures as to the 
 success one may attain in approximating the parts of a broken 
 bone, and in some cases of oblique fracture for instance, com- 
 plete recovery is impossible, despite the most skillful and pains- 
 taking attention given. On the other hand, cases of simple 
 transverse fractures make perfect recoveries in some instances. 
 All fractures are serious, and in every instance the practitioner 
 M'ould best be careful to impress his client with the many diffi- 
 culties which usually attend the treatment of fracture in horses. 
 
LAMENESS IN THE FORE LEG 135 
 
 Tendinitis. 
 Inflammation of the Flexor Tendons. 
 
 One of the most eominon causes of lameness in light harness 
 and saddle horses is tendinitis, and because of the character of 
 the structure of tendons and because of their function, an active 
 inflammation of these parts is always serious. 
 
 Being almost inelastic and not well supplied with blood, ten- 
 dinous tissue is slowly regenerated, and .so much time is required 
 for complete recovery to take place in tendinitis, that affected 
 animals seldom fully recover before they are in service or vig- 
 orously exercising at will. As a result, complete recovery is de- 
 layed or prevented. 
 
 The extensor tendons, because of the nature of their function, 
 are very seldom strained ; they are often bruised and occasionally 
 divided, but unlike this condition in the flexors, tendinitis of 
 the extensors is of rare occurrence. 
 
 For a concise discussion of this subject the most practical 
 classification is one made on a chronological basis and we may 
 then consider tendinitis as acute and chronic. 
 
 ACUTE TENDINITIS. 
 
 Etiology and Occurrence. — Causes of tendinitis, as in almost 
 all diseases, may be considered under the heads of predisposing 
 and exciting. Among the predisposing causes of tendinitis may 
 be mentioned, faulty conformation. Everything which has to 
 do with increasing the strain upon tendons adds to the proba- 
 bility of their being over-taxed. Long, sloping, pastern bones; 
 disproportionate development of parts, such as a heavy body 
 and small, weak tendons and long hoofs, are the principal fac- 
 tors which usually predispose to tendinous sprains. Degenera- 
 tive changes which take place in tendons following constitu- 
 tional diseases such as influenza may also be classed as a predis- 
 posing cause. 
 
 Excessive strain when put upon tendons in any possible man- 
 ner, such as is occasioned in running and jumping; making mis- 
 steps and catching up the weight of the body with one foot, when 
 the force thus thrown upon the supporting structure is great 
 
136 LAMENESS OF THE HORSE 
 
 because of monientiiin gained at a rai)id j)aee, are exciting- 
 causes of tendinitis. 
 
 Symptomatolog-y. — In all cases of acute tendinitis there is 
 presented a characteristic attitude by the subject. Volar flexion 
 in a sufficient degree to relax the inflamed structures is always 
 evident. The foot may be rested on the toe or placed slightly 
 in advance of the one supporting weight, l)ut the fetlock is al- 
 ways thrown forward. More or less swelling of the inflamed 
 tendons is present. Where the deep flexor (perforans) is in- 
 volved swelling is marked and with swelling there is present 
 the other symptoms of inflammation — heat and supersensitive- 
 ness. 
 
 In manipulating tendons for the purpose of detecting super- 
 sensitiveness, care must be taken so that no false conclusion 
 be drawn, because of the aversion many horses have to sul^nit- 
 ting to palpation of the tendons even when they are in a normal 
 condition. 
 
 Supporting-leg-lameness is present and varies in degree with 
 the intensity of the pain caused by weight bearing. In many 
 instances, as soon as the subject has traveled a consideralile dis- 
 tance, lameness diminishes or discontinues. As soon as the af- 
 fected animal is permitted to stand long enough to "cool out" 
 there is a return of the lameness, which is then marked. 
 
 No ditflculty is encountered in making a practical diagnosis 
 in tendinitis ; that is, one may fail to readily recognize the ex- 
 tent of the involvement as it affects the superficial flexor tendon, 
 for instance, but this has no {practical liearing on the prognosis 
 and treatment, when existing inflannnation of the deep flexor is 
 recognized. 
 
 The course of each tendon is readily outlined by palpation ; 
 all ])arts are easily manipulated ; and with experience one may 
 readily i-ecognize the extent and degree of the inflammation. 
 
 Treatment. — In some cases of acute tendinitis, pain is intense 
 and Ihc application of cold i)acks during this stage is very 
 t)eneficial in that ])ain is controlled and inflannnation subsides. 
 The extremity may be bandaged with a liberal quantity of ab- 
 sor])ent cotton or with woolen material. Ice water is then poured 
 
LAMENESS IN THE FORE LEG 137 
 
 around the bandaged member every fifteen minutes and this 
 should be continued for al)Out forty-eight hours. In some cases 
 this treatment is not necessary for more than twelve hours; at 
 the end of this length of time, pain has subsided and the acute 
 stage of iiirtammation has passed or its intensity has been dimin- 
 ished. 
 
 Following the a]^plication of cold packs, the use of a poultice 
 such as some of the sterile, medicated muds, is of marked ben- 
 efit. The author has made use of tincture of iodin and glycerin 
 in the proportion of one part of iodin to seven parts glycerin, 
 with very satisfactory results. This combination is hygroscopic, 
 anodyne and antiseptic and is easily applied. A liberal quan- 
 tity is directly applied all around the affected tendons and tlie 
 leg covered with a heavy layer of cotton, and this is snugly 
 held in position with liandages. The application may be used 
 once or twice daily, or if it is thought necessary, an attendant 
 may pour a quantity of the iodized-glycerin around the leg and 
 under the bandage once daily without removing the cotton and 
 bandage. Needless to say, absolute rest is imperative. 
 
 When all evidence of acute inflammation has .subsided vesica- 
 tion is indicated. At this stasre walking exercise is beneficial 
 and tlie subject may be allowed the freedom of a paddock. 
 
 Some practitioners are ]')artial to the use of the actual cautery 
 in these cases, but it is doubtful if it is necessary to produce 
 such a great degree of counter-irritation in cases where the sub- 
 ject is suffering the first attack of tendinitis. 
 
 As has been indicated, ample time should be allowed for re- 
 covery and depending upon conditions, it takes from three weeks 
 to six months for cnniplete recovery to become established. 
 
 Chronic Tendinitis and Contraction of the Flexor Tendons. 
 
 Etiolog'y and Occurrence. — Acute inflammation of tlie flexor 
 tendons may result in chronic tendinitis. Recurrent attacks in 
 cases where insufficient time is allowed for complete recovery 
 to result, is followed by chronic inflammation and hypertrophy 
 of the tendons. Again, in subjects where conformation is faulty, 
 no amount of care will be sufficient to prevent a recurrence of 
 the inflammation and the condition must become chronic. 
 
13S 
 
 LAMENESS OF THE HORSE 
 
 Symptomatology. — On visual examination of the subject at 
 rest, one may note the hypertrophied condition of the affected 
 tendons. Their transverse diameter is usually perceptibly in- 
 creased and in many cases, there is an increase in the antero- 
 posterior diameter. The latter condition causes a bulging of 
 the tendon that is so noticeable, because of the convexity thus 
 formed, it is commonly known as "bowed tendon." 
 
 In chronic tendinitis there occurs repeated attacks of inflam- 
 mation wherein lameness is pronounced and there exists in real- 
 
 Fig. 20 — Contraction of tlie superficial digital flexor tendon (perforatus) of 
 the right hind leg, due to tendinitis. 
 
 ity, at such times, acute inflammation of a hypertrophic struc- 
 ture, where at no time does inflammation completely subside. 
 Therefore, in chronic tendinitis there is to be found at times the 
 same conditions which characterize acute inflammation, except 
 that there is usually a variance of symptoms because of the dif- 
 ference in the degree of inflammation and pain. 
 
 The diagnosis of contraction of tendons is an easy matter be- 
 cause of the fact that relations between the phalanges are con- 
 stantly changed with tendinous contraction. If one bears in 
 mind the attachments and function of the digital flexors, no 
 difficulty is encountered in recognizing contraction of either ten- 
 don. 
 
LAMENESS IN THE FORE LEG 
 
 139 
 
 Contraction of the superficial digital flexor (perforatus), when 
 nncomplieated, is characterized by volar flexion of the pastern 
 joint. The foot is flat on the ground and the heel is not raised 
 because tlie superficial flexor tendon does not have its insertion 
 to the distal phalanx (os pedis) and therefore can not affect the 
 position of the foot. 
 
 By causing the subject to stand on the affected member, one 
 
 Fig. 21 — Contraction of the deep flexor tendon (perforans) of the riglit hind 
 leg, due to tendinitis. 
 
 may outline the course of the flexor tendons by palpation, and 
 in this way recognize any lack of tenseness or contraction of 
 tendons or of the suspensory ligament. 
 
 Contraction of the suspensory ligament would cause the pas- 
 tern joint to assume the same position as is occasioned by con- 
 traction of the superficial digital flexor (perforatus) tendon, but 
 when the subject is bearing weight on the affected member, it is 
 easy to determine that no contraction of the suspensory liga- 
 
140 
 
 LAMENESS OP THE HORSE 
 
 inent exists, by noting an absence of abnormal tenseness of this 
 structure. And finall}^ contraction of the suspensory ligament 
 is of rare occurrence. 
 
 Contraction of the deep flexor tendon (perforans) causes an 
 elevation of the heel. The foot can not set flat because the in- 
 sertion of the deep flexor tendon to the solar surface of the distal 
 phalanx (os pedis) causes — when the tendon is contracted — a 
 rotation of the distal phalanx on its transverse axis — hence the 
 
 Fig-. 22 — A chronic case of contraction of both flexor tendons of the pha- 
 langes. In this case (presented at a clinic of the Kansas City Veterinary 
 College) because of long continued contraction of the flexors, which pre- 
 vented weight being supported with any degree of comfort, there resulted a 
 partial paralysis of the extensors, and consequently the extremity was 
 dragged on the ground. 
 
 raised heel. No other tendon has this same effect on the distal 
 phalanx and the condition is correctly diagnosed without diffi- 
 culty. 
 
 Course and Complications. — This condition may exist for 
 years without causing the subject any serious inconvenience, if 
 the affected animal is kept at suitable work. In other instances 
 recurrent attacks of lameness are of such frequent occurrence 
 that the subject is not fit for service. Many affected animals 
 that are kept in service in spite of lameness (and in some in- 
 
LAMENESS IN THE FORE LEG 
 
 141 
 
 stances where no lameness is present), soon become unservice- 
 able because of contraction of the inflamed tendon. This, in 
 fact, is the condition which eventually becomes established in 
 most instances. 
 
 Treatment. — Where conformation is not too faulty so that 
 recovery may be expected, good results are obtained by line- 
 firing the tendons and allowing the subject a few months' rest. 
 
 Fig. 23 — Contraction of the superficial and deep flexor tendons (perforatus 
 and perforans) of the left fore leg. 
 
 In some cases median neurectomy is advisable. This is recom- 
 mended by Breton^ as being productive of good results even 
 where contraction of tendons exists and tenotomy is done. 
 
 By shoeing with high heel-calks considerable strain is taken 
 from the inflamed tendons because of the changed position of 
 the foot which alters the distribution of weight on different parts 
 of the leg. Rubber pads materially diminish concussion and 
 
 ^Traits De Therapeutique Chirursicale Des Animaux Domestique. par 1'. J. 
 Cadiot et J. Almy, Tome Second, page 547. 
 
142 LAMENESS OF THE HORSE 
 
 should be made use of when the subject is returned to work, if 
 the character of the work is such as to occasion much concussion. 
 It is to be remembered, however, that in sprains there occurs 
 fibrillar}^ fracture of soft structures and time is required for 
 regeneration of tissue which has been injured or destroyed. Ab- 
 solute rest is necessary where inflammation is acute and in sub- 
 acute or chronic tendinitis avoidance of all work which causes 
 irritation to the affected tendons is imperative. 
 
 Fig. 24 — Contraction of superficial digital flexor and slight contraction of 
 deep flexor tendon. 
 
 Where contraction of tendons exists surgical treatment is nec- 
 essary. No good comes from appliances which are calculated to 
 stretch the affected tendons ; in fact, they aggravate the inflamed 
 condition and hasten complete loss of function of the affected 
 member. Where there exists no articular or ligamentous dis- 
 eases which would defeat the purpose, tenotomy is the only 
 remedy for contracted tendons. 
 
LAMENESS IN THE FORE LEG 143 
 
 Contracted Tendons of Foals. 
 
 Etiology and Occurrence. — This condition is occasionally ob- 
 served aiul no positive explanation of the reason for its exist- 
 ence can be given. That mal-position en utcro causes the meta- 
 carpal bones to develop in length so rapidly that the tendons 
 are too short, is an explanation that is offered. Be that as it 
 may, in breeding sections of the country the general practitioner 
 is obliged to handle these cases and successful methods of treat- 
 ment are essential even though cause is not removable. 
 
 Symptomatology. — The superficial flexor tendon (perforatus) 
 alone, is the one usually contracted, and while both flexors are 
 at times involved, this rarely occurs. The condition is usually 
 bilateral. 
 
 The degree of contraction varies greatly in different cases. 
 In some, contraction exists to such extent that it is impossi])le 
 for the colt to stand, and because of continual decubitus where 
 no relief is given, the subject is lost because of gangrenous in- 
 fection occasioned by bed sores. Otherwise the same symptoms 
 are to be observed in this condition, that exist in contraction of 
 tendons of the mature animal. 
 
 Treatment. — "Wherever contraction is not too marked and 
 weight is borne with the affected members, and where the feet 
 can be kept on the ground in a nearly normal position, it is pos- 
 sible to correct the condition without doing tenotomy. That is, 
 in cases where the subject is simply "coek-ankled", where volar 
 flexion of the pastern joint exists but the foot is kept flat on the 
 ground, correction is possible without tenotomy. 
 
 In such instances the foal must be treated early — before the 
 skin on the anterior pastern region has been badly damaged by 
 knuckling over. It is possible in many cases to stretch the flexor 
 tendons by grasping the colt's foot with one hand, and with the 
 other hand one may push the pastern in the direction of dorsal 
 flexion. This may be tried and when a reasonable amount of 
 force is employed, no harm is done, even though no material 
 benefit results. Some veterinarians claim good results from this 
 treatment alone and direct their clients to repeat the stretching 
 process several times daily. 
 
144 LAMENESS OF THE HORSE 
 
 Whether the tendons are manually stretched or not, splints 
 should be adjusted to the affected members. The legs are padded 
 with cotton and bandages and a suitable splint is applied on 
 either side of the members and securely fixed in position by 
 bandaging. 
 
 The splints are kept in position for four or five days and then 
 removed for inspection of the affected parts. If necessary, they 
 are reapplied and left in position for a week; however, this is 
 unnecessary in the average case that is treated in this manner. 
 
 "Where contraction exists to the extent that the subject can 
 not stand and where no weight is borne by the feet, it is neces- 
 sary to divide the affected tendons surgically. The same technic 
 is put into practice that is employed in the mature subject but 
 there is much greater chance for a favorable outcome in the foal. 
 Further, if necessary, one may divide with impunity, both ten- 
 dons ou each leg, at the same time. In all cases this operation 
 is done by observing strict aseptic precautions and the legs are, 
 of course, bandaged. If both tendons are divided, splints should 
 be employed and kept in position for ten days or two weeks. 
 Primary union of the small surgical wound of the skin and 
 fascia occurs in forty-eight hours. 
 
 The reader is referred to William's "Veterinary Surgical 
 and Obstetrical Operations," for a complete description of this 
 operation. 
 
 In veterinary literature there is occasionally described a con- 
 dition which affects young foals wherein symptoms similar to 
 those of contraction of the flexors are manifested, but upon 
 examination it is found that rupture of the extensor of the 
 digit (extensor pedis) exists. This affection is briefly described 
 by Cadiot but no complete treatise on this condition has been 
 published. 
 
 In parts of Canada foals of from one to three days of age 
 are found affected in such manner that more or less interference 
 with the gait is to be seen in those moderately affected. There 
 is, in some subjects, only a slight impediment in locomotion 
 which is occasioned by inability to properly extend the digit. 
 In other subjects, while able to stand and walk, great difficulty 
 is experienced because of volar flexion of the phalanges. The 
 more seriously affected animals are unable to stand and. in most 
 instances, perish because of the effects of prolonged decubitus. 
 
la:\ieness in the fore lec; 145 
 
 A local enlargement occurs at the anterior carpal region and 
 the mass is somewhat tiuctuating, extravasated fluids becoming 
 infected in many instances, and necrosis of the skin and fascia 
 provide means for spontaneous discharge of the contents of 
 the enlargement if it is not opened. The infection when it 
 becomes generalized causes a fatal termination in most cases that 
 are not treated. 
 
 Fig. 25 — "Fish knees." 
 
 ^Photo by Thos. Millar, SI. R. C. V. S. 
 
 Native stock owners of some parts of Canada know this con- 
 dition as "fish knees" because of the presence of the ruptured 
 end of the extensor tendon which is found coiled in the cavity of 
 the enlargements caused by the ruptured tendon. 
 
 Local practitioners have treated the condition by incising the 
 swollen mass and removing the part of tendon contained within 
 such cavities. Treatment has not proved entirely satisfactory 
 in the majority of instances, perhaps because of tardy inter- 
 ference. 
 
 In a colt's leg sent the author by .Mr. Thoma.s ]\Iillar, Isl. R. 
 C. V. S., of Asquith, Saskatchewan, a careful dissection of the 
 carpal region revealed the fact that in this case the ruptured 
 extensor tendon was due to injury. The colt may have been 
 trampled upon by its dam in such manner that the tendon was 
 divided. No noticeable evidence of injury to the skin was to be 
 seen on its outer surface, but on the fascial side a cyanotic con- 
 gested area, which was situated immediately over the site of the 
 ruptured tendon, was very evident. 
 
146 
 
 LAMENESS OF THE HORSE 
 
 With the execution of a good surgical technic, the ruptured 
 tendon might be sutured; the wound of the tendon sheath as 
 well as that of the skin carefully united by means of gut sutures, 
 the leg bandaged and immobilized with lea,ther splints and re- 
 covery follow in a reasonable percentage of cases so treated. 
 These cases afford an opportunity for the perfection of practical 
 means of treatment by those who frequently meet with this affec- 
 tion. 
 
 Rupture of the Flexor Tendons and Suspensory Ligament. 
 
 Etiology and Occurrence. — Rupture of the flexor tendons or 
 of the suspensory ligament is of rare occurrence. Frequently, 
 these structures are divided as the result of wounds; but rup- 
 ture, due to strain, is not frequent. 
 
 Fig. 26 — Extreme dorsal flexion said to have resulted from an attack of 
 distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No. 4. 
 
 In some cases in running horses, or in animals that are put 
 to strenuous performances, such as are jumpers, rupture of ten- 
 dons or of the suspensory ligament takes place. However, more 
 frequently this follows certain debilitating diseases such as in- 
 fluenza or local infectious inflammation of the parts which re- 
 sults in degenerative changes and rupture follows. 
 
 The non-elastic suspensory ligament receives some heavy strains 
 
LAMENESS IN THE PORE LEG 147 
 
 during certain attitudes which are taken by horses in hurdle 
 jumping as is explained in detail by Montane and Bourdelle^ 
 under the description of this ligament. But in spite of the fre- 
 quent and unusually heavy strains, which these structures re- 
 ceive, complete rupture is not frequently seen. 
 
 Symptomatology. — AYhen the anatomy and function of the 
 flexor tendons and suspensory ligament is thoroughly under- 
 stood, recognition of rupture of either of these structures is 
 easily recognized. When one considers that in rupture, a posi- 
 tion directly opposite to that which is seen in contraction in 
 either one of these structures, is assumed, a detailed description 
 of each separate condition is needless repetition. 
 
 However, it is pertinent to suggest that rupture of the deep 
 flexor tendon (perforans) allows a turning up of the toe. 
 Whether it be torn loose from its point of attachment or rup- 
 tured at some point proximal thereto, the position is the same 
 — heel flat on the ground, toe slightly raised and this raising 
 of the toe varies in degree as the subject moves al)out. 
 
 AVhen the superficial flexor (perforatus) is ruptured there is 
 no change in the position of the foot but the fetlock joint is 
 slightly lowered. The pathognomonic symptom is the lax ten- 
 don during weight bearing, Avhich may l)e felt by palpation of 
 the tendon along its course in the metacarpal region. 
 
 With complete rupture of the suspensory ligament there oc- 
 curs a marked dropping of the fetlock joint and an alinormal 
 amount of weight is then thrown upon the superficial flexor ten- 
 don (perforatus), causing it to be markedly tensed. This is 
 readily recognized by palpation. By palpating the suspensory 
 ligament from its proximal portion down to and beyond its 
 bifurcation, while the affected member is supporting weight, it 
 is possible to diagnose rupture of one of its branches. 
 
 Prognosis and Treatment. — In rupture of the superficial 
 flexor tendon (perforatus) because of its comparatively less im- 
 portant function, prognosis is favorable and recovery takes place 
 when proper treatment is put into practice. 
 
 lAnatomie Regionale Des Animaux Domestique, page 695. 
 
148 
 
 LAMENESS OF THE HORSE 
 
 With rupture of the deep tiexor tendou (perforans), especially 
 wlien it occurs at or near its point of insertion and sometimes 
 foUowiug disease, prognosis is unfavorable. 
 
 Rupture of the suspensory ligament constitutes a condition 
 which is, as a rule, hopeless, because of the impracticability of 
 treating such cases. 
 
 The salient feature which characterizes any practical attempt 
 at treatment of ruptured tendons or other portions of the inhibi- 
 tory apparatus of the fetlock region, is to retain the phalanges 
 in their normal position for a sufficient length of time that the 
 approximated ends of ruptured tendons or ligaments may unite. 
 The length of time required for this to occur, together with the 
 
 Fig. 27 — A good style of shoe for bracing the fetlock where tenotomy has 
 been performed, or in case of traumatic division of the flexor tendons. An 
 invention of Dr. G. H. Roberts. 
 
 difficulties encountered in confining the affected extremities in 
 suitable braces or supportive appliances, precludes all possibil- 
 ity of this condition's being practically amenable to treatment 
 when the deep flexor tendon (perforans) and suspensory liga- 
 ment are simultaneously ruptured. It does not follow, even so, 
 that recovery does not succeed treatment in some of these un- 
 favorable eases. 
 
J.AMEXESS IN THE FORE LEG 149 
 
 Affected subjects are kept in slings as long as it seems neces- 
 sary — until they learn to get up without deranging the braces 
 worn. 
 
 Several styles of braces are in use and each has its objections ; 
 nevertheless some sort of support to the affected member is neces- 
 sary and steel braces which are connected with shoes are usually 
 employed. 
 
 The principal difficulty which attends the use of braces is 
 pressure-necrosis of the skin which is caused by the constant 
 and tirm contact of the metal support. The practitioner's in- 
 genuity is taxed in every case to contrive practical means of 
 padding the exposed parts in order to prevent or minimize ne- 
 crosis from pressure. This is attempted — with more or less suc- 
 cess — by frequent changing of bandages and the local application 
 
 Fig. 2H — Showing the Uolierts brace in operation. 
 
 of such agents as alcohol or witch hazel. Needless to say, the 
 skin must be kept perfectly clean and the dressings free from 
 all irritating substances. 
 
 The fact that tendons or ligaments which are ruptured, do 
 not regenerate as readily as in cases where traumatic or surgical 
 division occurs, must not be lost sight of, and prognosis is given 
 in accordance. 
 
150 LAMENESS OF THE HORSE 
 
 Thecitis and Bursitis in the Fetlock Region. 
 
 Etiology and Occurrence. — Synovial distension of tendon 
 sheaths and bursae in the region of the fetlock are caused by 
 the same active agencies which produce this condition in other 
 parts. The fetlock region is exposed to more frequent injury 
 than is the carpus and as a consequence is more often affected. 
 The same proportionate amount of irritation affects this part 
 of the leg, owing to strains, as affect the carpus from a similar 
 cause; and synovitis from this cause, is as frequent in one case 
 as in the other. Therefore, it is a natural sequence that the 
 tendon sheaths of the metacarpophalangeal region are frequently 
 distended because of chronic synovitis and thecitis. These in- 
 flammations are usually non-infective in character. 
 
 The cul-de-sac of the capsular ligament of the fetlock joint 
 which extends upward between the bifurcation of the suspensory 
 ligament is the most frequently affected structure in this region. 
 When distended, tM-'o spheroidal masses bulge laterally and an- 
 terior to the flexor tendons in a characteristic manner. This 
 condition is known among horsemen as "wind-gall" or "fet- 
 lock-gall." 
 
 The sheath of the flexor tendons, whieli begins about the mid- 
 dle portion of the lower third of the metacarpus, and continues 
 downward below the pastern joint is often distended. 
 
 Excepting in cases of acute inflammation attending synovitis 
 of these parts, no lameness marks its existence and in chronic 
 cases of synovial distension the service of affected animals is not 
 interfered with. These distensions constitute unsightly blemishes 
 and they are treated chiefly for this reason. 
 
 No difficulty is encountered in recognizing these conditions 
 even where considerable organization of tissue overlying dis- 
 tended thecae occurs. In such cases there may be only slight 
 fluctuation of the enlargement, but if necessary, an aseptic ex- 
 l)l()ratory puncture may lie nmde with a suitable needle or tro- 
 car. 
 
LAMENESS IN THE FORE LEG 151 
 
 Treatment. — Complete rest and the local application of cold 
 packs are in order in acute synovitis when there is distension of 
 tendon sheaths. In the fetlock region, because of the ease with 
 which pressure may be employed, the parts should be kept 
 snugly wrapped with cotton, and derby bandages are used to 
 exert the desired amount of pressure over the affected region. 
 The pressure-bandages should be employed as soon as all acute 
 and painful inflammation has subsided ; and then they should be 
 continued, day and night, for ten days or two weeks. The ban- 
 
 Fig. 29 — Distension of tlieca ni tlic rxlt-iisor oi llu- iW-aW U'xtensor pedis). 
 
 dages should be removed morning and night. After the skin 
 of the leg has thoroughly dried off, an infriction of alcohol or 
 distilled extract of hamamelis is given the parts and the cotton 
 and bandages are readjusted. A good, even and firm pressure 
 in such cases is productive of satisfactory results. 
 
 In chronic distensions of tendon sheaths synovia may be as- 
 pirated and about five cubic centimeters of equal parts of tinc- 
 ture of iodin and alcohol is injected into the cavity. This is not 
 done, however, without usual aseptic precautions. If no marked 
 
152 LAMENESS OF THE HORSE 
 
 swelling- results within forty-eight hours the entire fetlock re- 
 gion is thoroughly vesicated and, as soon as the skin has recov- 
 ered from the effects of the vesicant, pressure bandages may be 
 employed. In these cases, subjects may be put into service after 
 all swelling which the injection or the vesicant has produced 
 has subsided. The pressure liandages are used at night or during 
 the time that the horse is in its stall and they are not worn by 
 the subject while at work. 
 
 Where no marked swelling occurs within ten days, as the re- 
 sult of the injection of iodin, the injection may be repeated and. 
 if thought necessary, the quantity may be materially increased. 
 If sw^elling does not occur it is indicative that no particular irri- 
 tation has been caused. 
 
 Some swelling is desirable and much swelling sometimes re- 
 sults and persists for weeks. This is not in any way likely to 
 cause permanent trouble ; and if the technic of injection is skil- 
 fully ('xecuted no infection will follow. 
 
 By persistent and careful use of suitai)]e elastic bandages, the 
 support thus given the parts, together with the absorption of 
 products of inflammation whicli constant pressure occasions, 
 some chronic cases of synovial distension of tendon sheaths re- 
 cover in two or three months and this without other treatment. 
 Such good results are not to be expected in aged subjects, nor 
 in horses having at the same time, chronic lymphangitis. 
 
 Where bandages of pure rubber are employed great care is 
 necessary, if one is not experienced in their use, lest necrosis 
 result. W^here bandages are unecmfoitabiy tight the subject will 
 manifest discomfort, and an attendant should observe the animal 
 at intervals for a few hours (where there may be some doubt as 
 to the degree of pressure which is exerted by elastic bandages) 
 and readjustment made before any harm is done. 
 
 Arthritis of the Fetlock Joint. 
 
 Anatomy. — The anatomy of the metacarpophalangeal arti- 
 culation is briefly reviewed on page 58 under the heading of 
 " Anntoino-Physiological Review of Parts of the Foreleg." 
 
 Etiology and Occurrence. — The chief causes of non-infective 
 
LAMENESS IN THE FORE LEG 
 
 153 
 
 arthritis of the fetlock joint are irritations from concussion and 
 contusions due to interfering. The condition occurs in young 
 animals tliat are over-driven in livery service or other similar 
 exhausting work, where they become so weary that serious injury 
 is done these parts by striking the pasterns with the feet — inter- 
 fering. In these "leg-weary" animals, that are always kept 
 shod with fairly heavy shoes, much direct injury is done at times 
 
 
 Fig. 20— Rarefying osteitis whereir articular cartilage was destroyed in a 
 case of arthritis of fetlock joint. 
 
 by concussion due to self-inflicted blov/.s. In older animals, 
 where there exists similar conditions, with respect to their being 
 worn from fatigue and, in addition, periarticular inflammatory 
 organizations, arthritis is not of uncommon occurrence. 
 
 Symptomatology. — In true arthritis there exists a very pain- 
 ful affection which is characterized by manifestations of distress. 
 The subject may keep the extremity moving about — where pain 
 is great — suspended and swinging. There is sAvelling which is 
 more or less hot to the touch and compression of the parts with 
 the fingers increases pain. Lameness is always pronounced and 
 no weight is supported witli the affected member in very acute 
 and generalized arthritic inflammations. There occurs the usual 
 
154 LAMENESS OF THE HORSE 
 
 facial manifestations of pain — the tense condition of the facial 
 muscles and the fixed eye and nostril are in evidence 
 
 In cases Avhere there exists a synovitis or where a very limited 
 portion of the articulation is involved, a somewhat different clin- 
 ical picture is presented. Then, the disturbance causes less dis- 
 tress; local SM'elling and evidence of supersensitiveness are not 
 so pronounced and lameness is not intense, though weight-bearing 
 is painful. 
 
 Prognosis. — There is a constant difference in the degree of 
 pain manifested, as well as the other symptoms of inflammation, 
 between true arthritis, which involves much of the joint, and 
 synovitis; or synovitis plus a small circumscribed area of joint 
 involvement. This difference is present in all joint affections 
 of the extremities and, in passing, it is well to say that infection 
 usually increases every manifestation of pain. Infection occasions 
 more pronounced local symptoms of inflammation and, l)ecause 
 of the rapid progress of necrotic destruction of cartilage, the 
 course of the affection is usually rapid; ankylosis is a frequent 
 result and loss of the subject is often inevitable. However, in 
 non-infective arthritis of the fetlock joint, prognosis is favor- 
 able. 
 
 Treatment. — The same general principles which are employed 
 in arthritis of other joints are used here. Eest and comfort for 
 the patient is sought in every available manner. If the subject 
 remains standing too long, the sling should be used and a well- 
 bedded box-stall will contribute much to the comfort of the 
 patient. 
 
 Pain and acute inflammation is diminished or controlled, if 
 possible, by using ice-cold packs. In nervous, well-bred animals 
 analgesic agents may be employed; or small doses of morphin 
 sulphate — one to two grains — given at intervals of three hours 
 during the first stages of the affection is very beneficial. This 
 is especially indicated in infectious arthritis. 
 
 As inflammation subsides, hot applications are used and finally 
 counter irritants are employed. Their selection is a matter of 
 choice with the practitioner. The object sought is the same 
 with every practitioner and while methods employed vary, re- 
 
LAMENESS IN THE FORE LEG 155 
 
 suits are not markedly different except in so far as the degree 
 of counter irritation which is produced varies in given cases. 
 Where a great degree of counter irritation is thought necessary, 
 line-firing with the actual cautery is the remedy par excellence. 
 
 After-care.— In the course of three or four weeks subjects 
 may be allowed the run of a paddock and, after a complete rest 
 of six weeks at pasture, they may be returned to w^ork with care, 
 if the work is not of a nature to occasion concussion or other 
 manner of irritation to the articulation. 
 
 Neurectomy is not indicated even though there is a recurrence 
 of lameness, unless the lameness is not pronounced and inflamma- 
 tion is periarticular and no osseous enlargements mechanically 
 interfere with function of the joint. There are few cases then, 
 where neurectomy is materially helpful. 
 
 Ossification of the Cartilages of the Third Phalanx. 
 (Ossification of the Lateral Cartilages.) 
 
 Anatomy and Function of the Cartilages. — Surmounting each 
 wing of the distal phalanx (os pedis) is the irregularly-quad- 
 rangular cartilage. The superior border of this cartilage is thin, 
 generally convex, and perforated for vessels to pass to the frog ; 
 the inferior border is attached to the wing of the third phalanx 
 and posteriorly, it is reflected inward and is continuous with 
 the inferior surface of the sensitive frog. The anterior border 
 which is directed obliquely downward and ])ackward becomes 
 blended with the anterior lateral ligament of the coffin joint. 
 The fibrous expansion of the anterior digital extensor (extensor 
 pedis) is united to the anterior borders of the lateral cartilages. 
 
 According to Smith^ : These structures form an elastic wall 
 to the sensitive foot, and attachment to the vascular laminae; 
 they also admit of increase in width occurring at the posterior 
 part of the foot without destroying the union of the two set of 
 leaves. Further, by their connection with the vascular system 
 of the foot, their elastic movements materially assist the circu- 
 lation. The primary use of the lateral cartilages is to render 
 the internal foot elastic, and admit of its change in shape which 
 occurs under the influence of the weight of the body. The 
 
 ^Manual of Veterinary Physiology, by Major-General F. Smith, C. B., 
 C. M. G., page 678. 
 
156 
 
 LAMENESS OF THE HORSE 
 
 alteration in the shape of the foot is brought about by pressure 
 on the pad, which widens and in consequence presses on the bars. 
 The pressure received by the pad is also transmitted to the plan- 
 tar cushion, which likewise flattens and spreads under pressure. 
 Both of these factors force the cartilages slightly outwards. 
 When the posterior Avail recoils the cartilages are carried back 
 to their original position. Should the elastic cartilage under 
 pathological conditions become converted into bone, its functions 
 are destroyed, and lameness may occur. 
 
 Etiolog-y and Occurrence.— The causes of ossification of these 
 cartilages are several. No doubt there exists a predisposition 
 to this condition for it is of such frequent occurrence in heavy 
 
 \^ 
 
 /^*- 
 
 Fig. 31 — Ring!)one and .sidebone. 
 
 draft types of horses. Concussion plays an important role and, 
 according to Holler's^ theory, which is sound, high heel calks 
 prevent the frog from contacting the ground, and as weight is 
 placed upon the foot "the lateral cartilages are subjected to a 
 continuous inward and downward dragging strain." 
 
 The condition affects the cartilages of the fore feet more fre- 
 quently than those of the hind and the outer cartilage is more 
 often ossified than is the inner. This fact may be accounted for 
 by its more exposed position ; it is also frequently injured by 
 
 'Moller's Regional Veterinary Surgery, by Dollar, page 630. 
 
LAMENESS IN THE FORE LEG 157 
 
 being trampled upon and otherwise contused or cut, as in lacer- 
 ated wounds of the quarter. 
 
 Symptomatology. — Ossification of tlie cartilages is known by 
 grasping the free borders with the fingers and attempting their 
 flexion ; the rigid inflexible ossified cartilage is thus easily recog- 
 nized. 
 
 Lameness during weight-bearing occurs in the majority of 
 cases at some time. Much depends on the conformation of the 
 foot and whether the involvement affects one or both cartilages 
 as to the degree and duration of lameness which marks this 
 affection. In narrow and contracted heels it is reasonable to 
 expect more lameness than in well formed feet. "Where only 
 one cartilage is ossified, the other being flexible, there is less in- 
 convenience experienced by the subject during weight-bearing, 
 because of the expansion of the heel which the one normal carti- 
 lage allows. 
 
 Treatment. — There is little if anything to be done in case the 
 cartilage ha.s become ossified except to shoe without high calks 
 but preferably with rubber pads. The hoof should be kept 
 moist; the wall at the quarter may be rasped thin and kept 
 anointed. Firing is of no practical benefit in these cases, and 
 it is doubtful if vesication is helpful excepting where only a part 
 of the cartilage is ossified. 
 
 Subjects which continue somewhat lame, because of complete 
 ossification of both cartilages, are best put to slow work on soft 
 ground and not driven on pavements. 
 
 Navicular Disease. 
 
 This more or less ambiguous term has been applied to various 
 diseases affecting the structures which make up the coffin joint. 
 "We consider this name to be applicable to inflammatory involve- 
 ment of the third sesamoid (navicular bone), the deep flexor 
 tendon (perforans) and the bursa podotroehlearis or navicular 
 bursa. 
 
 Etiology and Occurrence. — In 1804 Thomas Greaves^ wrote 
 on the subject of navicular disease as follows: "The opinion I 
 
 ^Edinburgh Veterinary Review, Vol. VI, page 616 
 
158 LAMENESS OF THE HORSE 
 
 entertain upon the suhjeet of navicular disease is. that in by 
 far the greater majority (if not all) of these cases there exists 
 in the animal affected a congenital tendency or predisposition, 
 that, generally speaking, it is the high stepper, the good goer, 
 that becomes the victim to this disease ; and it is a fact well at- 
 tested, that it as frequently develops itself in the feet with wide 
 frogs, bulbous heels, shallow heels, spread flattisli feet, as in the 
 narrow upright feet. . . . T have known foals, born from de- 
 fective parents, in wliicli this condition was so strongly devel- 
 oped, that all men would at once pronounce them affected with 
 navicular disease, a^'-d such lameness was permanent." 
 
 Often both fore feet are affected and this would point toward 
 its being a disease wherein either conformation or congenital 
 tendencies exists. It is rare that hind feet are involved. 
 
 There are many theories regarding the possible exciting causes 
 of navicular disease and, when one has carefully considered the 
 explanations as offered by Peters, INIoller, Branell, Schrader and 
 others, he may conclude that navicular disease is a non-infectu- 
 ous intlammatory affection of the third sesamoid (navicular) 
 bone, deep flexor tendon (perforans) and adjoining structures. 
 "Whether it originates in the flexor tendon or whether the bone 
 is the original part affected, the disease is freciuently met, and 
 of all possible causes, jars and irritation incident to concussion 
 of travel, are pro])ably the princij^al causative agents. 
 
 Symptomatology. — Lameness is the primary indicator and a 
 constant sym])t()m which attends navicular disease wherever 
 much structui-al change aff(M'ts the infirm ])arfs. As the degree 
 of intensity or extent varies, so is there a dissimilarity in the 
 character of the impediment. Incipient cases of bilateral in- 
 volvement are more difficult to diagnose than are unilateral af- 
 fections, particulai'ly when lameness is not marked. There is 
 manifested a sui)i)orting-leg-lameness which varies as to degree 
 in tlie same subject at different times. This may be noticed dur- 
 ing the same ti-ip in an animal tluit is lieing driven. There is 
 a tendency for the subject to stumble and, of course, where the 
 affection is bilateral, there is a stilted gait owing to shortened 
 strides. 
 
LAMENESS IN THE FORE LEG 159 
 
 At rest the lame animal usually points with the afifected mem- 
 ber. Because of the fact that the distance is lessened between 
 the origin and insertion of the deep flexor tendon (perforans) 
 by this attitude, one may readily understand the reason for the 
 position assumed by the subject. Pressure on the navicular bone 
 is diminished and tension on the flexor tendon is relieved by 
 even slight volar fiexion. 
 
 In acute inflammatory affections abnormal heat may be de- 
 tected ill the region of the heel. By exerting tension on the 
 flexor tendon, by means of passive dorsal flexion of the member, 
 evidence of hyperesthesia may be detected. With the hoof test- 
 
 Fig-. 32 — "Pointing"' — the position as.sumed by horse havirg unilateral navic- 
 ular disease. 
 
 ers one may determine supersensitivenss in most instances. There 
 occurs more or less contraction of the hoof in navicular disease, 
 but this is not to be taken as a cause of the affection, but rather 
 a sequence. 
 
 In some cases of unilateral navicular disease there is a marked 
 contrast in size between the sound and unsound foot. HowcAcr, 
 one must not be misguided in this particular, for in some pairs 
 of sound feet there exists considerable difference in size. Finally, 
 by a change from the normal position of the foot to one in which 
 the heel .is somewhat elevated (as may be obtained by shoeing 
 witli big 1 heel calks), relief is evident, and in the opposite 
 
160 LAMENESS OF THE HORSE 
 
 position, the condition is aggravated. This experiment may be 
 used for diagnostic purposes. 
 
 Treatment. — When the anatomy of the diseased parts is 
 taken into consideration, and an analysis of the lesions which 
 occur in cases where considerable structural change is occasioned 
 by this affection, it is obvious that recovery is impossible. Only 
 in eases where the inflammation is promptly cheeked before 
 damage has been done the navicular bone or the flexor tendon, 
 is permanent recovery possible. The disease is not frequently 
 treated during this stage, however, and in the majority of in- 
 stances the condition becomes chronic. 
 
 As soon as a diagnosis is made the shoes must be removed, the 
 toe shortened with the hoof pincers and rasp and the subject is 
 put in a well bedded box-stall. If the animal is very lame and 
 the inflammation is acute, ice-cold packs should be applied to 
 the feet. As soon as acute inflammation has subsided the foot 
 may be so pared that all excess of sole and frog is removed with- 
 out lowering the heels, and the animal may be blistered about 
 the coronet region. The subject may be shod later, with heel 
 calks that raise the heel moderately and a protracted period of 
 rest should be enforced. 
 
 Tn cases where no acute inflammatory condition exists, neurec- 
 tomy is beneficial. One must discriminate, however, between 
 favorable and unfavorable subjects. This is not a last resort 
 expedient to be employed in cnses where extensive lesions of the 
 navicular structures exists. With proper shoeing, and by put- 
 ting the subject at suitable work, where concussion of fast travel 
 on hard roads is not necessary, the best results are obtainable. 
 
 Laminitis. 
 
 This disease is primarily a non-infective inflammation of the 
 sensitive laminae which very frequently affects the front feet. 
 Often all four feet are affected, less frequently one foot (when 
 its fellow is unable to sustain weight) and rarely the hind feet 
 alone. 
 
 Occurrence.— Probably a greater number of cases of laminitis 
 occur in localities where horses that are worked on heavy trans- 
 
LAMENESS IN THE FORE LEG 161 
 
 fer wagons are, when in a state of perspiration, allowed to stand 
 exposed to sudden lowering of temperature and to stand in a 
 cool or cold shower of rain such as occurs near the coast of the 
 Great Lakes or the ocean in some parts of this country. 
 
 This disease occurs in connection with digestive disorders of 
 various kinds and, because of the frequent association of the 
 two conditions, the common term "founder" has long been em- 
 ployed to designate laminitis. In cases of "over-loading," par- 
 ticularly when a large quantity of wheat has been eaten by 
 animals that are unaccustomed to this diet, laminitis almost con- 
 stantly results. 
 
 Large draughts of cold water, when drunk by animals that 
 are overheated is often followed by laminitis. Concussion, such 
 as attends hard driving, especially in unshod horses or on rough 
 and hard roads, is often succeeded by this affection. Likewise, as 
 has been stated, injury such as is occasioned by long continued 
 standing on the same foot is followed by laminitis. Some horses 
 that are frequently shod, suffer from this affection a few hours 
 after shoes have been reset. Dr. Chas. R. Treadway of Kansas 
 City reports the rather frequent occurrence of such conditions 
 in horses that are in the fire department service in his city. 
 
 Age in no way influences the occurrence of laminitis and the 
 general condition of an animal with regard to its vigor or state 
 of flesh has no apparent influence toward predisposiag horses to 
 this ailment. 
 
 Etiology and Classification. — As it is with some other dis- 
 eases, one may unprofitably theorize on cause and readily enu- 
 merate many conditions which are apparently contributory 
 toward producing the affection. Causes may well be grouped, 
 however, and a more definite understanding of laminitis is pos- 
 sible as a result. Such collocation would include conditions 
 which directly or indirectly affect the digestion, such as puer- 
 peral laminitis, drinking of large quantities of cold water and 
 exposure to cold and rain when the body is warm. All of these 
 various conditions might be said to affect the vaso-constrictor 
 nerves in such manner that the natural tendency (because of the 
 peculiar structure of the sensitive laminae and their mode of 
 
162 LAMExNESS OF THE HORSE 
 
 attachment to the non-sensitive wall) which solipeds have for 
 this affection is indirectly due to this one cause — vaso-constric- 
 tion. According to Dr. D. ]\I. Campbell, the eft'ect of toxic ma- 
 terials, which may be absorbed from the digestive tract or the 
 uterus in parturient females, upon the vaso-constrictor nerves, 
 is such that a passive congestion of the sensitive laminae occurs 
 and laminitis is the result. He believes that even the chilling 
 of the surface of the body when very warm, by a cold rain, con- 
 stitutes a condition wherein the effect upon the vaso-constrictors 
 is the same. 
 
 This grouping does not include the effect of direct injuries of 
 any and all kinds to which the feet are subjected such as : 
 Concussion in fast road work, injuries occasioned by tight or 
 ill fitting shoes, contusions of any kind resulting in non-infec- 
 tious inflammation of the sensitive laminae, as well as the causes 
 which produce laminitis where weight is borne by one foot when 
 its fellow is out of function. 
 
 A classification which is practical is that of aciiie and chronic 
 laminitis. To the practicing veterinarian it is this manner 
 of consideration that i.s essential in the handling of these cases. 
 
 Symptomatology. — In the acute attack the condition is so 
 well described by Dr. R. C. Moore^ that we quote him in part as 
 follows : 
 
 The acute form is generally ushered in very suddenly. Often 
 a horse that is perfectly free from symptoms of the disease is 
 found a few hours later so stiff and sore that he will scarcely 
 move. They stand like they were riveted to the ground. If 
 forced to move the evidence of pain subsides to some extent after 
 they have gone a short distance, to return more severe than ever 
 after they have been allowed to stand for a short time. If the 
 disease is confined to the two front feet, the hind feet are placed 
 well under the center of the body to support the weight and 
 the front ones are advanced in front of a perpendicular line so 
 as to lessen the weight they must bear. If they are made to 
 move, the same position of the feet is maintained. If made to 
 turn in a small circle, they do so by using the hind feet as a 
 pivot, bringing the front parts around l)y i:>lacing as little weight 
 on them as possible. 
 
 Placing the hind feet so far under the body, arches the back 
 
 ■< !« 
 
 ^Kquine Laminitis or Pododermatitis, by R. C. Moore, D. V. S., American 
 Journal of Veterinary Medicine, Vol. XT, page 284. 
 
LAMENESS IN THE FORE LEG 163 
 
 and often leads to errors in diagnosis, the condition sometimes 
 being taken for diseases of the loins or kidneys. 
 
 If all four feet are involved, the animal stands in the usual 
 position assumed in health, but if urged to move, the least effort 
 to do so usually brings on chronic spasms of the entire body. In 
 very severe cases, a slight touch of the hand will develop the 
 spasms. At times they are so severe, and have such short inter- 
 missions, that the disease has been mistaken for tetanus. How- 
 ever, the clonic nature of the spasm should prevent such an 
 error. If tli-y are lying down, it is difficult to get them to arise, 
 and if they do so, they show marked symptoms of pain for some 
 time after rising. 
 
 If the disease is confined to the hind feet, they are placed 
 well forward to relieve the strain on the toe caused by the down- 
 ward pull of the perforans (deep flexor) tendon, but in place of 
 the front feet ])eing kept in front of a perpendicular line, as they 
 are when the disease is confined to the front ones, they are placed 
 far back under the body, so they will carry the maximum share 
 of the body weight of which they are capable. The position of 
 the feet is of great importance and offers symptoms that should 
 not be overlooked. 
 
 Wlien the subject is caused to walk, symptoms of excruciating 
 pain are manifested in all acute cases of laminitis. In some cases 
 where all four feet are affected, no reasonable amount of per- 
 suasion will cause the suffering animal to move from its tracks. 
 There is acceleration of the rate of heart action; the pulse 
 is full and in some cases, bounding. As the affection progresses 
 the pulse becomes rather weak and irregular. The character of 
 the pulse in the region of the extremity is a reliable indicator; 
 but one has to learn to make necessary discrimination because 
 of the condition of the parts, as in some cases of lymphangitis 
 or where the skin is abnormally thick. The characteristic throb- 
 bing pulse is, however, easily recognized in most cases. Tem- 
 perature is variable, though usually elevated from one to four 
 degrees above normal. This symptom varies with the type and 
 stage of the affection. In a subject tliat has been down, unable 
 to rise for several days, where there is a suppurative and slough- 
 ing condition of the laminae, the temperature is high. Whereas, 
 in some other and less destructive cases there may be little 
 thermic disturbance after the first few hours have lapsed. 
 
 A constant symptom in liilateral affections of acute laminitis 
 
164 LAMENESS OP THE HORSE 
 
 is the difficulty with which the subject supports weight with 
 one foot. It is this which causes the victim to stand as if 
 "rooted to the ground" when all four feet are involved. If one 
 attempts to take up one foot, thus causing the subject to stand 
 on the other, there is much resistance and in many eases the 
 animal refuses to give the foot. 
 
 When we consider that the sensitive parts of the foot are 
 encased by a horny, unyielding box and that, when the laminae 
 are congested, a great pressure is brought to bear upon the sensi- 
 tive structures, it is easy to understand why the condition is so 
 painful. 
 
 Chronic laminitis is a sequel of acute inflammation of the sensi- 
 tive laminae. It varies as to intensity and the exact manner 
 of its manifestation depends upon preexisting disturbances. 
 
 In some mild cases of laminitis there are recurrent attacks 
 wherein no particular structural change exists, and diagnosis 
 is established chiefly by noting the character of the pulse at the 
 bifurcation of the large metacarpal (or metatarsal) artery just 
 above the fetlock. The same manifestation of pain is present 
 when weight is supported by one foot, though in a lesser degree. 
 There is less local heat to be detected by palpation than in 
 the acute cases. 
 
 Chronic laminitis as it occurs following acute attacks which 
 have resulted in structural changes of the foot, present the same 
 symptoms just described and, in addition, the j^eculiar altera- 
 tions in structure exist. When, owing to acute inflammation of 
 the sensitive laminae, there has resulted necrosis of this sensitive 
 tissue together with infiltration between the anterior surface of 
 the distal phalanx (os pedis) and the contacting hoof, the lower 
 portion of the distal phalanx is turned downward and backward 
 (rotated upon its transverse axis). Because of the traction 
 which is exerted by the deep flexor tendon (perforans), as it 
 attaches to the solar surface of the distal phalanx, this rotation 
 is facilitated. With hyperplasia of lamina, at the anterior por- 
 tion of the distal phalanx, there results a thick "white line." 
 Rotation of the distal phalanx necessitates a descent of its apical 
 portion and there occurs a "dropped sole." 
 
LAMENESS IN THE FORE LEG 165 
 
 In time, partly because of excessive wear of hoof at the heel, 
 owing to an altered condition in the normal antagonistic rela- 
 tion between the flexor and extensor tendons, the toe makes an 
 excessive growth, and the concavity of the anterior line is ac- 
 centuated owing to this abnormal length of hoof. The hoof, 
 because of recurrent inflammator}^ attacks, is corrugated — eleva- 
 tions of horn in parallel rings are usually present. 
 
 Aniiuals that are so affected in traveling strike the heel first 
 
 Fig. 33— The hoof in chronic laminitis. Note the concavity. This animal 
 was serviceable for any worlv that could be performed at a walk. 
 
 and the toe is later contacted with the ground surface. Rotation 
 of the distal phalanx upon its transverse axis produces a con- 
 dition, with respect to this peculiar impediment, that is equiva- 
 lent to added and excessive length of the deep flexor tendon. 
 
 Where there occurs suppuration, by careful inspection of the 
 coronary region, one may early recognize detachment of hoof. 
 In such cases animals remain recumbent and, while the condi- 
 tion is not so painful at this stage, the practitioner must not 
 overlook the real state of affairs. History, if obtainable, will 
 be a helpful guide in such cases. Separation of hoof occurs as 
 
166 
 
 LAMENESS OF THE HORSE 
 
 a, rule in from four to ten days after the initial attack of acute 
 laminitis. Needless to say these cases are hojieless, when the 
 economic phase of handling subjects is considered. 
 
 Treatment. — Much depends upon the concomitant disturb- 
 ances (or causes if one is justified in referring to them as such) 
 as to the manner in which laminitis is to be treated. In all cases 
 where digestive disturbances exist, the prompt unloading of the 
 
 Fig. 34 — Showing the effects of laminitis. By permission, from Merillat's 
 "Veterinary Surgical Operations." 
 
 contents of the alimentary canal is certainly indicated. D. M. 
 Campbell^ in a discussion of laminitis has the following to say 
 regarding the treatment of such cases : 
 
 Because superpurgation may be followed by laminitis, the ad- 
 visa))ility of using the active hypodermic cathartics is questioned. 
 Neither arecolin nor eserin can cause superpurgation. The action 
 of the former does not continue longer than an hour after ad- 
 ministration and of the latter not more than eight hours. The 
 action of either is mild after the first few minutes. 
 
 I do not think that anyone has recommended either arecolin 
 or eserin where there is severe purgation. Where the intestinal 
 canal is fairly well emptied and its contents fluid, I should be 
 inclined to rely ujion intestinal antiseptics to hold in check harm- 
 ful bacterial growth. 
 
 ^American Journal of Veterinary Medicine, Vol. XI, page .318. 
 
LAMExNESS IN THE FORE LEG 167 
 
 Tlie use of aliiiii in the treatment of laminitis is held to be with 
 out reason other than the empirical one that it is beneticial. If 
 laminitis is due chiefly to an autointoxication, good and sufficient 
 reason for the administration of alum can be shown based upon 
 its known physiological action. It is the 2nost powerful in- 
 testinal astringent that I know of and has the fewest disad- 
 vantages. I have not noted constipation following its use nor 
 diarrhea, nor a stopping of peristalsis, nor indigestion, and in 
 any case its action lasts at most only a. few hours, and if it did 
 all these, it could not much matter. Quitman says, that it con- 
 stricts the capillaries. If this is true, a thing of which I am not 
 certain, is it not reasonable to suppose that as with other vaso- 
 constrictors, e. g., digitalis, there is a selective action on the part 
 of the capillaries Cnot of the drug) and those that need it most, 
 i. e., those of the affected feet in laminitis, are constricted most? 
 All body cells exert this selective action in the assimilation of 
 food, the tissue needing most any particular kind of food cir- 
 culating in the blood, gets it. 
 
 Our first consideration in laminitis should be to remove the 
 cause — to stop the absorption of the toxin in the intestinal tract 
 that is producing the condition. This we accomplish by partially 
 unloading it by the use of the active hypodermic cathartics and 
 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 sur- 
 mise, and it is unimportant. At any rate, when alum is ad- 
 ministered, the onslaught of the disease is promptly stopped. Ir- 
 reparable damage may already have been done if the ease 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 necessarj^ 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 exten- 
 sion 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 anv of these conditions a distui'bed <'irciilalioii. and aconitin 
 
168 LAMENESS OF THE HORSE 
 
 is the first and foremost of circulation "equalizers." Further- 
 more, 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 
 
 Fig. 35 — Inferior (convex) surface of Cochran shoe. 
 
 in cases of laminitis, which constitutes assuredly an important 
 part of its treatment. 
 
 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. 
 
LAMENESS IN THE FORE LEG 
 
 169 
 
 Dr. David W. Cocb.ran of New York City has attained unusual 
 success in cases of chronic laminitis with dropped sole by the use 
 of a specially designed shoe. 
 
 Cochran claims that, not only are horses with dropped soles 
 that would othei'wisio have to be put off the streets enabled to do 
 
 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. 
 
 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 ar- 
 ranged to facilitate breaking over. 
 
 From having been successfully used on some race horses of 
 
170 LAMENESS OF THE HORSE 
 
 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^ 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 grow^th 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 suffi- 
 ciently to prevent using an animal at any sort of work on hard 
 roads, median neurectomy will relieve all lameness in most in- 
 stances. 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 in- 
 flicted upon the coronary region but usually they are due to the 
 foot being trampled upon. When the foot that inflicts the in- 
 jury happens to be unshod, a contusion of the injured member 
 is occasioned, Init in the majority of instances, wounds that de- 
 mand attention are the result of shoe calks which have pene- 
 
 'The Shoeing- of a Dropped Sole Foot by Dr. David W. Cochran. New 
 York City, The Horse Shoers Journal, March, 1915. 
 
LAMENESS IN THE FORE LEG 171 
 
 trated 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 move- 
 ments which frequently result in deep calk wounds of the coro- 
 net. Some horses have a habit of i;esting 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 un- 
 derneath 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 inflannnation occurs in some 
 localities during the winter months, wherein the condition is 
 enzootic. 
 
 Symptomatology. — Depending upon the manner in which 
 the injury b.as 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 sul)sur- 
 face structures, there will not immediately occur pronounced 
 local evidence of the existence of injury ; but as soon as the lame 
 animal is nuide to move, the peculiar character of the impedi- 
 ment (supporting-leg lameness witli the affected foot kept well 
 in advance of its normal position) directs attention to the ex- 
 tremity and all of the symptoms of acute inflanunation are dis- 
 covered. 
 
 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 -i-xistence of the wound. 
 
 Because of the fact that there is every facility for the pro- 
 duction 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 injur3\ 
 
 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 
 com])ination of one part of iodin to four parts of glycerin is 
 
172 LAMENESS OF THE HORSE 
 
 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 usu- 
 ally suffers no suppurative disturbance when the surface struc- 
 tures 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 struc- 
 tures are freed of hair and the parts cleansed in the usual man- 
 ner, (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 
 enaliled to cleanse the average wound quickly and almost pain- 
 lessly. 
 
 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 fre- 
 quent. 
 
 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 requir- 
 ing a radical operation to establish drainage and to disinfect 
 if possible, the suppurating tissues. 
 
 Corns. 
 
 Etiolog'y and Occurrence. — In horses, because of a tendency 
 toward contraction of the heel in some subjects, together with 
 
LAMENESS IN THE FORE LEG 173 
 
 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 re- 
 mains 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. 
 
 Symptomatolog-y. — A supporting-leg-lameness characterizes 
 this condition; and this lameness in most instances varies in de- 
 gree with the amount of distress which is occasioned hj 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 tlie 
 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 re- 
 sults within about three weeks after such treatment has been 
 given. In other instances temporary relief is not to be gotten 
 
174 LAMENESS OP THE HORSE 
 
 in this manner for any great length of time or until a more 
 rational mode of treatment becomes necessary so that the sub- 
 ject may experience a cessation of the inconvenience or distress. 
 
 The general plan which meets with the approval of most prac- 
 titioners 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 obtainnble 
 in this manner. Thinning the wall of the quarter is advocated 
 by many jn-aetitioners 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 treat- 
 ment. 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 em{)loyed 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 enqdoyed to designate an infectious inflamnui- 
 tion of the lateral cartilage and adjoining structures. The 
 disease is characterized by a slowly progressive necrosis and by 
 a destruction of moi'e or less of the cartilage and by the presence 
 of fistulous tracts. 
 
 Etiology and Occurrence. — The disease is due to the intro- 
 duction of pus {)roducing organisms into the subcoronary region 
 
LAMENESS IN THE FORE LEG 175 
 
 of the foot under eomlitions whieh favor the retention of such 
 eontaii'iuni and extension of infection into contiguous tissues. 
 
 jMorbitie 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, I)ecause of lack of 
 proper care or because of virulency of the contagium or low 
 vitality of the subject, is finite apt to result in cartilaginous 
 affection and its perforation by necrosis follows. 
 
 Symptomatology. — Quittor is readily diagnosed on sight in 
 many instances. AVhere there is depentlable 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 nuiy distinguish between true cartilaginous 
 quittor and superficial abscess formation that is often accom- 
 panied 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 diff'M-ent cases. 
 
 Treatment. — Two general plans of handling this disease are 
 in vogue. One. the more popular method, consists in the in- 
 jection 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 j^ortions, or removal of the dis- 
 eased parts of curettage. 
 
 When quittor has not extensively damaged the foot and the 
 lateral cartilage is not i)artly 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 ^NFerillat'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 
 
176 LAMENESS OF THE HORSE 
 
 such that they are not desirable surgical eases and also because 
 some animals may be put in service before treatment is com- 
 pleted, 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 quit- 
 tor and we can do no better than quote Dr. J. T. Seeley^ on his 
 manner of using this particular treatment. 
 
 
 Fig. 37 — Hyperplasia of riglit fore foot, due to chronic quittor. 
 
 Preparation. — First remove the shoe, have the foot pared 
 very thin and balanced as nicely as possible. IMoreover, 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 scrubl^ed in like manner. 
 The foot is then placed in a bichlorid ])ath several hours daily, 
 
 'Quitter and Its Treatment by the Hughes Method, J. T. Seeley, M. D. C, 
 Seattle, Washington, Chicago Veterinary College Quarterly Bulletin, Vol. 9, 
 page 27. 
 
LAMENESS IN THE FORE LEG .177 
 
 for from two to five days, depending upon wliether or not sore- 
 ness 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 
 
 A» ^ 
 
 Fig. 38 — Chronic quittor, left hind foot. Showing position assumed because 
 of painfulness of the affection. 
 
 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. 
 
 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 : Ilydrarg. Chlor. Corros. oIV ; 
 Acid Hydrochlor. olss. ; Aqua Bulliens, Oij. This should be 
 
178 LAMENESS OF THE HORSE 
 
 tiiorouglily triturated, and then filtered into a clean liottle, when 
 it is ready for use. 
 
 Injection. — The patient should be laid on a table, if one is 
 available, or east, and the foot securely fixed. Then, with an 
 ordinary one-ounce hard rubber syringe. v,ith a good plunger 
 (tried first to note Avhether or not any fiuid works around be- 
 tween 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 -vith cotton- 
 while filling" the other so that if there is a connection the solu- 
 tion 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 pre- 
 scribed. 
 
 After-Treatment. — Put on a pack saturated with a solu- 
 tion of ])ichlorid of mercurj'^ 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 ap- 
 ply a dry dressing or healing oil composed of phenol, camphor 
 gum and olive oil. 
 
 When Dangerous to Inject. — Never inject a ciuittor in the 
 acute stage. Never inject a (|uittor if considerable lameness is 
 present. On injecting a solution of formalin, hold cotton tightly 
 around the nozzle of the syringe, when the plunger is down, 
 then withdraw the syringe gently and note particularly if the 
 fluid returns through the opening; if none returns cease opera- 
 tions at once, as it is dangerous to proceed farther, it indicates 
 that the sinus is not well defined and the fluid retained will 
 cause much trou1)le and often the death of the patient. 
 
 Experience has taught that, if extensive destructive changes 
 of the foot exist, the Bayer operation is not indicated. In the 
 country, where quittors are not so frequently met as in ur'-an 
 practice, the ]\Ierillat operation is preferable in all cases. How- 
 ever, the cost of the protracted period of idleness, which con- 
 valescent surgical patients require, renders the Hughes method 
 more satisfactory in the hands of the general practitioner, espe- 
 cially in the city. 
 
 Nail Punctures. 
 
 Nail punctures, as herein considered, embrace all penetrant 
 wounds of the solar surface of the horse's foot due to trampling 
 
LAMENESS IN THE FORE LEG 179 
 
 upou street nails. This does not include accidental nail pricks 
 occasioned in shoeing. In city practice, in some stables, these 
 cases are of frequent occurrence ; and, generally speaking, nail 
 punctures are observed more frequently in urban horses than 
 in animals that are kept in the country. 
 
 Occurrence and Method of Examination. — This condition, 
 then, is a rather conniion cause of lameness and in no case, 
 where cause of the claudication is not obvious, is the practitioner 
 
 Fig. 39 — Skiagraph of foot. The X-ray offers very limited possibilities in 
 the diagnosis of lameness. The location of a "gravel" or a nail that had 
 worked its way some distance from the surface, or of an abscess of some 
 proportion, deep in the tissues, might be facilitated under some circumstances 
 by the aid of the X-ray. Its use in the detention of fractures is very limited, 
 owing to the difficulty encountered in getting a view from the right position — 
 many trials being necessary in most cases. The case shown above was diag- 
 nosed clinically as incipient ringbone. The X-ray revealed no lesions. (Photo 
 by L. Griessmann.) 
 
 warranted in concluding his examination without careful search 
 for the possible existence of nail punct'ire of the solar surface 
 of the foot. 
 
 In occasional instances there co-exists an obvious cause for 
 supporting-leg-lameness and an occult cause — a nail puncture. 
 Where such complications ai'o met, the practitioner is not neces- 
 sarily guilty of neglect or carch^ssnoss when the nail puncture 
 
180 LAMENESS OF THE HORSE 
 
 is not discovered at once, nevertheless, an examination is not 
 complete until practically every possible cause of lameness has 
 been located or excluded in any given case. 
 
 In a search for nail puncture it is necessary to expose to view 
 every portion of the sole and frog in such manner that the 
 existence of the smallest possible wound will be revealed. This 
 necessitates removal of the shoe, if, after a preliminary ex- 
 amination, a puncture is not found, when there is good reason 
 to suspect its presence. However, where it is readily possible 
 to locate and care for a wound without removal of the shoe, 
 allowing the shoe to remain materially facilitates retaining 
 dressings in position and relieves the solar surface of contact 
 with the ground. If extensive injury or infection exists, it is 
 of course necessary to remove the shoe and leave it off. By re- 
 moving a superficial portion of all of the sole and frog, thus 
 carefully and completely exposing to view all parts of the solar 
 surface of the foot, and with the aid of hoof-testers one is enabled 
 to positively determine the existence of nail punctures. Because 
 of the tendency of puncture wounds of the foot to close, and 
 since the superficial portion of the solar structures are usually 
 soiled, it is absolutely necessary to conduct examinations of this 
 kind in a thorough manner. 
 
 Symtomatology. — Not all cases of nail puncture cause lame- 
 ness during the course of the disturbance and in many instances 
 no lameness is manifested for some time after the injury has 
 been inflicted — not until infection has been the means of caus- 
 ing consideral)le inflammation of sensitive structures. Never- 
 theless, this lack of manifestation occurs only in cases where 
 serious injury has not taken place and the degree of lameness 
 is a constant and reliable indicator of the character and extent 
 of nail punctures within twenty-four hours after injury has been 
 inflicted. 
 
 The position assumed by the affected animal inconstantly 
 varies with the location and nature of the injury and is not 
 of particular importance in establishing a diagnosis. The sub- 
 ject may support some Aveight with the affected member and 
 stand "base-wide" or "base-narrow," or no weight may be 
 ])orne with the foot or the animal may point or keep the ex- 
 
LAMENESS IN THE FORE LEG 181 
 
 tremity in a state of volar flexion. In cases where extensive 
 injury has been inflicted, and great pain exists, the foot is kept 
 off the ground niiieh of the time and it may be swung back and 
 forth as in all painful affections of the extremity. 
 
 Nail punctures cause typical supporting-leg-lameness and in 
 some cases certain peculiarities of locomotory impediment are 
 worthy of notice. Punctures of the region of the heel, which 
 directly affect or involve the deep tendon sheath, cause a type 
 of lameness wherein pain is augmented, when dorsal flexion of 
 the extremity occurs as well as when weight is borne. Wounds 
 in the region of the toe of the hind feet sometimes cause the 
 subject to carry the extremity considerably in advance of the 
 point where it is planted and, just before placing the foot on the 
 ground, it is carried backward a little way — ten or twelve inches. 
 
 However, diagnosis of nail puncture is l)ased on the finding of 
 the characteristic wound or resultant local changes. 
 
 Course and Prognosis. — The nature of the progress and the 
 manner of termination of these cases are variable. If the coffin 
 joint has been invaded, and a septic arthritis exists, the condi- 
 tion is at once grave. An open and infected tendon sheath, 
 while not so serious, constitutes a condition which is distressing, 
 and recovery is slow even under the most favorable conditions. 
 Where a heavy, rigid and sharp nail enters the foot, in such 
 manner that fracture of the third phalanx (os pedis) occurs, 
 this complication makes for a protraction of the condition. Ex- 
 perience teaches that tlie natural course and termination in 
 these cases are modified by the location and depth of the injury, 
 virulency of the contagium and resistance of the subject to such 
 infection. 
 
 Prevention. — In all horses w^liich are kept at such work that 
 exposure to nail punctures is frequent, a practical means of pre- 
 vention of such injuries consists in ^e employment of heavy 
 sole leather or suitable sheet metal to cover the sole of the foot 
 and, at the same time, confine oakum and tar in contact with 
 the solar surface to prevent the introduction of foreign material 
 between the foot and such protecting appliances. Further, if 
 drivers and owners could be impressed with the serious complica- 
 tions which so frequently attend wounds of this kind, undoubt- 
 
182 LAMENESS OF THE HORSE 
 
 edly many cases which are now lost, because of ignorance or 
 neglect on the part of the teamsters or proprietors of horses, 
 would lie saved by i)ronipt and rational treatment. 
 
 Treatment. — The treatment of this condition falls so largely 
 within the dominion of surgery that we can give little more 
 than an outline here. 
 
 In cases where there exists no evidence of open joint or open 
 tendon sheath as judged by the site of the puncture and degree 
 of lameness present (after having thoroughly cleansed the solar 
 surface of the foot and enlarged the opening in the nonsensitive 
 sole) a little phenol is introduced into the wound. In such 
 cases, where it is possible for the antiseptic to contact every part 
 of wound surface to the extreme depths of the puncture, in- 
 fection is prevented when such treatment is promptly admin- 
 istered. This may be considered as first aid, or emergency care, 
 and is indicated in all wounds of the foot whether the injury 
 be serious or almost insignificant. 
 
 Subsequently one of two general courses may be pursued in 
 the treatment of cases of nail puncture. One, by the employ- 
 ment of means to keep the wound patent and injection of suit- 
 able antiseptics, or agents that are more or less caustic in con- 
 junction with strict observance of asepsis and wound protection. 
 The other method consists in prompt estal)lishment of drainage 
 by surgical means and includes exploration and curettage. 
 
 The first method is better adapted to the use of the average 
 general practitioner and he would do well to keep the opening 
 in the nonsensitive structures patent. By introducing equal 
 parts of tincture of iodin and glycerin daily, good results will 
 follow in most instances. The wound is protected in unshod 
 horses, either by completely bandaging the foot and retaining, 
 in contact with the wound, cotton that is saturated with iodin 
 and glycerin, or, if a minor injury exists, the moderately en- 
 larged opening in the nonsensitive sole or frog, which has been 
 moistened with the antiseptic, is packed with a very small quan- 
 tity of cotton. A little practice in this mode of closing benign 
 puncture wounds will enable tlie practitioner to successfully 
 protect the sensitive parts in the treatment of such cases in un- 
 shod countrv horses. 
 
LAMENESS IN THE PORE LEG 183 
 
 When the condition progresses favorably the wound may be 
 dressed every second day or twice weekly, and in the course of 
 from two to six weeks recovery should be complete. 
 
 If the practitioner is somewhat proficient as a surgeon, and 
 has at his command facilities for doing surgery, the second 
 method is preferable in many cases. By using a local anesthetic 
 on the plantar nerves and confining the subject on an operating 
 table, restraint should be perfect. The solar surface of the foot 
 is first thoroughly cleansed, the puncture wound is enlarged in 
 the nonsensitive structures and the parts are then moistened 
 with phenol or other suitable antiseptics. By means of a small 
 probe the puncture is explored and, depending on the character 
 of the wound and the structures involved, surgical intervention 
 is varied to suit the case. If necessary, all of the insensitive 
 frog is removed, and in wounds aifecting the region of the heel 
 the tissues may be incised from the puncture outward dividing 
 all of the tissues outward and backward to the surface. A 
 suitable surgical dressing is then applied. 
 
 If, on the other hand, the puncture extends into the navicular 
 bursa, the radical operation is perhaps indicated, though not 
 until one is sure that infection of the bursa and seiious conse- 
 quences are to follow if this operation is not performed. De- 
 tailed description of the technic of this operation belongs to the 
 realm of surgery and a good discussion of it is to he found in 
 William's work on vetprinary surgical and obstetrical opera- 
 tions. 
 
 One may sunnnarize the discussion of treatment of nail punc- 
 ture by saying that emergency care as herein described is of first 
 consideration. In every ease an immunizing dose of anti-tetanic 
 serum should be given. Subsequently, the method emj-loyed 
 must suit the character of the wound, existing facilities for 
 handling the su])ject and the skill and ajititude of the prac- 
 titioner. 
 
SECTION IV. 
 LAMENESS IN THE HIND LEG. 
 
 Anatomo-Physiological Consideration of the Pelvic Limbs. 
 
 The pelvic bones as a whole constitute the analogue of the 
 scapulae with respect to their function as a part of the mechan- 
 ism of locomotive and supportive apparatus of the horse. The 
 manner of attachment or connection between the ilia and the 
 trunk is materially different from that of the scapulae, how- 
 ever, and the angles as formed by the long axes of the ilia in 
 relation to the spinal column are maintained by two functionally 
 antagonistic structures — the sacrosciatic ligaments, and the a1j- 
 dominal muscles by means of the prepubian tendon. The sacro- 
 iliac articulations are such that a very limited amount of move- 
 ment is possible; free movement, however, is unnecessary be- 
 cause of the enarthrodial (ball and socket) femeropelvic joint. 
 
 The various muscles which exert their effect upon the pelvis 
 in changing their relationship between the long axes of the ilia 
 and spinal column, are concerned but little more in propulsion 
 and weight bearing than are the pectoral muscles. A general 
 treatise on the subject of lameness does not properly include 
 such structures any more than it does the various affections of 
 the dorsal, lumbar and sacral vertebrae or inflammation of the 
 abdominal parietes. Involvement of such parts cause manifesta- 
 tions of lameness but the matter of establishing a diagnosis is 
 difficult in many instances and in some cases impossible. 
 
 The femeropelvic articulation is formed by the hemispherical 
 head of the femur and the acetabulum ; the latter constituting a 
 cotyloid cavity which is deepened by the cotyloid ligament. 
 
 The round ligament (ligamentum teres) is the principal bind- 
 ing structure of the hip joint and it arises in a notch in the 
 head of the femur and is attached in the subpubic groove close 
 to the acetabular notch. Another ligament, peculiar to Equidae 
 — the accessory (pubiofemoral) — is attached to the head of the 
 femur near the round ligament and passes through the cotyloid 
 
 185 
 
186 
 
 LAMENESS OF THE HORSE 
 
 Tendon of 
 gastrocnemius 
 
 Superficial 
 flexor tendon 
 
 — Tuber calcis 
 
 Subcutaneous 
 
 Tendon of per- 1- 
 
 oneus tertiuts I 
 
 Tibial tarsal bon 
 
 Medial ^endon of 
 tibialis anterior 
 
 thickening 
 
 Tarsal sheath 
 
 Superficial flexor 
 tendon 
 igament 
 
 11 i_^ -iuperjiciai jie. 
 
 t I / tendon 
 
 j I / _ Annular ligament 
 
 Joint canty 
 Dorsal ligament Vv Vi 
 
 Central tarsal bont 
 Third tarsal bone 
 
 Ml. Ill 
 
 Joint capsule (tarso- 
 metatarsal ligament) 
 
 Fourth tarsal 
 Perforating tarsal vein 
 Check ligament 
 Suspensory ligament 
 
 Fig. 40 — Sagital section of right hock. The section passes through the 
 middle of the groove of the trochlea of the tibial tarsal bone. 1 and 2. Prox- 
 imal ends of cavity of hock joint. 3. Thick part of joint capsule over which 
 deep flexor tendon pla.vs. 4. Fibular tarsal I)one (sustentaculum). A large 
 vein crosses the upjjer part of the joint capsule (in front of 1). (From Sis- 
 son's "Anatomy of the Domestic Animals.") 
 
LAMENESS IN THE HIND LEG 
 
 187 
 
 Lateral ridge of trochlea of femur 
 Lateral femoro-tihial ligament 
 
 Lateral meniscu 
 Lateral condyle of tib, 
 
 Long extensor (stump) 
 
 Peroneus terti.iis 
 Tibialis anterior 
 Lateral extensor 
 
 Extensor hrevi. 
 
 Teruion of lateral extensor 
 Tendon of long extensor 
 
 Tendinous looj j \ - #v J fW 
 
 Medial ridge of trochlea of femur 
 
 Medial meniscus 
 
 Medial femoro-tibial ligament 
 
 Tendon of long extensor 
 Annular ligament 
 Peroneus tertius 
 
 Medial tendon of tibialis anterior 
 
 Anterior tendon of tibialis anterior 
 A nterior tendon of peroneus tertius 
 
 Annular ligament 
 
 Ml. in 
 
 Fig. 41- :\Ius(les of right leg; fioiit view. The greater part of the long 
 extensor has been removed. 1, 2. 3. Stumps of patellar ligaments. 4 
 Tuberosity of tibia. (From Sis.son's "Anatomy of the Domestic AnimaLs.") 
 
188 LAMENESS OP THE HORSE 
 
 notch and along the under side of tlje pubis. It is inserted or 
 blends with the prepubic tendon. This ligament prevents ex- 
 treme abduction of the leg. The joint capsule encompasses the 
 articulation and is attached to the brim of the acetabulum and 
 the edge of the head of the femur. 
 
 The stifle joint is analagous to the knee joint of man and is 
 to be considered an atypical ginglymus (hinge) articulation 
 formed by the femur, tibia and patella. The ligaments are 
 femerotibial, femeropatellar and capsular. 
 
 In addition to the usual provision for articulation of bones 
 there are situated cartilaginous menisci between the condyles 
 of the femur and the head of the tibia. These discs surround 
 the tibial spine and are otherwise shaped to fit perfectly between 
 the articular portions of the femur and tibia. 
 
 Collateral ligaments (internal and external lateral) pass from 
 the distal end of the femur to the proximal portion of the tibia. 
 The mesial (internal) arises from the internal condyle of the 
 femur and is attached to a rough area below the margin of the 
 medial (internal) condyle of the tibia. The lateral (external), 
 shorter and thicker, arises from the depression on the lateral 
 epicondyle and inserts to the head of the fibula. 
 
 The crucial or interosseus, anterior and posterior, are situ- 
 ated between the femur and tibia, and according to Smith,^ 
 the crucial ligaments are necessary to properly join the two 
 bones, because of the character of the structure of the articular 
 ends of the femur and tibia. 
 
 The femeropatella ligaments are two thin bands which re- 
 inforce the capsular ligament. They arise from the lateral 
 aspects of the femur, just above the condyles and are inserted 
 to the corresponding surfaces of the patella 
 
 The patellar ligaments are three strong bands which arise 
 from the antero-inferior surface of the patella, and are inserted 
 to the anterior aspect of the tuberosity of the tibia. 
 
 Taken as a whole, the tarsal bones, interarticulating and articu- 
 lating with the tibia and metatarsal bones form the hock joint 
 and this articulation is analagous to the carpus. As with the 
 carpus, there is less movement in the inferior portion of the 
 
 ^Manual of Veterinary Physiology. Page 610. 
 
LAMENESS IN THE HIND LEG 
 
 189 
 
 PaUlla 
 
 Crest oj tibia 
 
 Long digital extensor 
 Lateral digital extensor 
 
 Gastrocnemius, lateral head 
 
 Sok'us 
 
 Tendori of gasiroaiemius 
 Tarsal icndnn of biceps femcris 
 Deep f.:xor 
 
 Superficial 
 flexor tendon 
 
 Proximal anmdar ligament 
 Lateral malleolus 
 
 Distal annular ligament - 
 
 Tendon of long extensor ■ |/ | j 
 
 Tendon of lateral extensor t-/ 
 
 Branch of suspensory lignm(nt to 
 extensor tendon 
 
 Superficial flexor 
 tendon 
 
 Deep flexor tendon 
 
 Suspensory 
 ligament 
 
 Fig. 42— Muscles of lower part of thigh, leg and foot; lateral view, o'. 
 Fascia lata; q, q', q", biceps femoris; r, semitendinosus; 21', lateral condyle 
 of tibia. The extensor brevis is visible in the angle between the long and 
 lateral extensor tendons. (After Ellenberger-Baum, Anat. fiir Ktinstler.) 
 (From Sisson's "Anatomy of the Domestic Animals.") 
 
190 
 
 LAMENESS OF THE HORSE 
 
 joint than in the superior part of the articulation. The chief 
 articulating parts are the tibia with the tibial tarsal bone (astra- 
 gulus). 
 
 The capsular ligament is attached around the margin of the 
 articular surfaces of the tibia, to the tarsal bones, the collateral 
 
 Pioximal Liid of 
 Jimoro-ixUelldr 
 ca/JbuU 
 
 Lateral head of gaslroctumius 
 
 Lateral feynoro-paleUar ligament 
 
 Attachment of joint capsule 
 
 Lateral condyle of femur 
 
 Lateral femoro-tibial ligament 
 
 Poplileus 
 
 Deep digital flexor 
 
 Base of patella 
 
 Distal end of capsule 
 Middle patellar ligameiU, 
 Medial patellar ligament 
 
 Lateral patellar ligament 
 {slump) 
 
 Tuberosity of tibia 
 Tibialis anterior 
 
 Long extensor 
 
 Laterid rxirnsor 
 
 Fig. 43 — Right stifle joint; lateral view. Tlie femoro-patellar capsule was 
 filled with plaster-of-Paris and then removed after the cast was set. The 
 femoro-tibial capsule and most of the lateral patellar ligament are removed. 
 M. Lateral meniscus. (From Sisson's "Anatomy of the Domestic Animals.") 
 
 ligaments (internal and external lateral) and to the metatarsus. 
 
 The common ligaments of the tarsal joint are the collateral, 
 the plantar (calcaneo-metatarsal and c. cuboid) and dorsal liga- 
 ments (oblique). 
 
 The medial (internal lateral) ligament serves to join the 
 medial (internal) tibial malleolus with tibial tarsal (astragulus) 
 and other tarsal bones. 
 
(LAMENESS IN THE HIND LEG 
 
 191 
 
 The lateral (external lateral) ligament is inserted to the lateral 
 (external) tibial malleolus and its distal portions are attached 
 to the tibial tarsal (astragalus), til)ular tarsal (calcaneum) bone, 
 fourth tarsal (cuboid) and metatarsus bones. 
 
 Base of pnklla 
 
 Acccusari/ r:irlili<ie 
 
 Medial condyle of 
 femur 
 Medial femorn-tibial 
 ligament 
 Medial meniscua 
 
 Medial condyle of 
 tibia 
 
 5' ' Mcdud ridge of Irovldea 
 
 I 
 
 Medial patellar ligor- 
 inenl 
 
 Middle patellar ligor 
 merU 
 
 T)d>erosily of tibia 
 
 Fig. 44— Left stifle joint; medial view. The capsules are removed. (From 
 Sisson's "Anatomy of the Domestic Animals.") 
 
 The plantar ligament (calcaneo-cuboid) is a strong fiat band 
 which is attached to the plantar surface of the fibular and fourth 
 tarsal bones (calcaneum and cuboid) and the head of the lateral 
 mctalarsal (external small) bone. 
 
 The dorsal (oblique) ligament is attached al)ove to the distal 
 tuberosity on the inner side of the tibia. It is inserted below to 
 the central (cuneiform magninii) and third (e. medium) tarsal 
 
lyz LAMENESS OF THE HORSE 
 
 hones, to the proximal ends of the large and outer small meta- 
 tarsal bones. 
 
 The tarsus is a true hinge joint and because of the great 
 stram which it sustains, is su])ject to frequent injury. About 
 seventy-fiye percent of cases of lameness affecting the hind leg 
 may be said to arise from disease of the hock. 
 
 As members of locomotion the legs receive strains of two kinds : 
 those of concussion and weight-bearing and strains of propul- 
 sion ; the latter are the greater. In the horse as a work animal, 
 the hind legs are probably subjected to greater strains than are 
 the front but the manner of construction of the various parts 
 of the pelvic limbs with the possible exception (according to 
 some authorities) of the tibial tarsal joint, offsets this condition. 
 
 The femur may be considered analagous to the humerus in 
 that it bears a similar relationship to the ilium, that exist be- 
 tween the humerus and scapula. Further flexion during repose 
 is prevented chiefly by the gluteus medius (maximus) muscle 
 and its tendons. The larger tendon inserts to the suuniiit of the 
 trochanter major of the fennir and corresponds to the biceps 
 brachii in the action of the latter on the seapulohuuieral joint, 
 except that the gluteus medius, in attnching to the femoral 
 trochanter, exerts its effect as a lever of the first class. Because 
 of the relationship between the long axes of the femur and iliac 
 shaft it is evident that the angle formed by these two bones 
 is maintained chiefly by the gluteus muscles during weight bear- 
 ing. Contraction of muscular fibers of the gluteus medius causes 
 extension of the femur and muscular strain is prevented to a 
 great degree by the inelastic portion of this muscle. The chief 
 physiological antagonistics of the glutei are the quadriceps 
 femoris and tensor fascia lata. 
 
 While the leg is supporting weight the stifle joint is fixed in 
 position mainly by the quadriceps femoris group of muscles 
 which are attached to the patella. Tendinous fibres intersect 
 this muscular mass and relieve muscular sti'ain during weight 
 bearing. Because of the manner in which the patella function- 
 ates with the trochlea of the femur, comparatively little energy 
 is required to prevent further flexion of the stifle joints The 
 
OLAMENESS IN THE HIND LEG 
 
 193 
 
 patella, according to Strangeways, may be considered a sesamoid 
 bone. 
 
 The quadriceps group of muscles is assisted by the anterior 
 digital extensor (extensor pedis) peroneus tertius and tibialis 
 
 Fema 
 
 Accessory cartilage of . 
 
 patella [ 
 
 Medial ridge of trochlea 
 
 Medial patellar ligament 
 
 Medial epicondyle 
 
 Medial femoro-lihial ■ i. 
 ligament |. 
 
 Medial mentbcw -'-^ 
 
 edial ment^cw —^ — \ 
 ondiile of tibia — ET" i 
 
 Medial condyle of 
 
 Tuberosity of 'Ma 
 
 ~ Patella 
 
 Biceps femoris 
 - Lateral patellar ligament 
 
 Lateral femoro-libial 
 ligament 
 
 Lateral meniscus 
 Lateral condyle of tibia 
 
 Interosseous sj)ace 
 
 Fibula 
 
 Interosseous ligament 
 
 Fig. 45— Left Stifle joint; front view. The capsules are removed. 1. Middle 
 patellar ligament. 2. Stump of fascia lata. 3. Stump of common tendon of 
 extensor longus and peroneus tertius. (From Sisson's "Anatomy of Domestic 
 Animals.") 
 
 anticus (flexor metatarsi) muscles. The latter pair (flexor 
 metatarsi, muscular and tendinous portions, because of their 
 attachment to the external condyle of the femur and to the 
 metatarsal bone) are enabled to automatically flex the tarsal 
 joint when the stifle is flexed. 
 
194 LAMENESS OF THE HORSE 
 
 The liock is kept fixed in position by the gastrocnemius and 
 the superficial digital flexor (perforatus). The latter structure, 
 which is chiefly tendinous, originates in tlie supracondyloid fossa 
 of the femur and has an insertion to the summit of the fibular 
 tarsal (calcis) bone. It relieves the gastrocnemius of muscular 
 strain during weight bearing. 
 
 Smith^ styles the function of the stifle and hock joints a re- 
 cijirocating action, and we quote from this authority the follow- 
 ing: 
 
 From Avhat has been said, it is evident that flexion and ex- 
 tension of stifle and hock are identical in their action. When 
 the stifle is extended, the hock is automatically extended, nor 
 can it nnder any circumstances flex without the previous flexion 
 of the stifle. There is no parallel to this in the body. The two 
 joints, though far apart, act as one, and they are locked by the 
 drawing up of the patella, and in no other way. The so-called 
 dislocation of the stifle in the horse is a misnomer. That the 
 patella is capable of being dislocated is beyond doubt, but the 
 ordinary condition described under that term, when the stifle 
 and hock are rigid while the foot is turned back with its wall 
 on the ground, is nothing more than spasm of the muscles which 
 keeps the patella drawn np. The moment they relax the pre- 
 viously immovable limb and useless foot have their function 
 restored as if by magic, but are immediately thrown out of gear 
 in the course of a few" minutes as a recurrence of the tetanus of 
 the petallar muscle takes place. The fascia of the thigh, like 
 that of the arm, is a most potent factor in giving assistance to 
 the constant strain imposed on the muscles of the limbs during 
 standing. 
 
 Below the hock the hind liml) is arranged like that of the fore, 
 the deei5 flexor (perforans) receiving its additional support from 
 the "check ligament," as in the fore leg. 
 
 The natural attitude of standing adopted by the horse is to 
 rest on three legs — one hind and two fore. If he is alert, he 
 stands on all four limbs; but if standing in the ordinary man- 
 ner, he always rests on one hind leg. He does not remain long 
 in this position witliout changing to the other. Hour by hour 
 he stands, shifting his weight at intervals from one to the other 
 hind leg, and resting its fellow by flexing the hock and standing 
 on the toe. He never spares his fore-limbs in this manner in a 
 state of health, ])ut always stands squarely on them. 
 
 1 Manual of Velerinai-y Physiology, page 601. 
 
[LAMENESS IN THE HIND LEG 195 
 
 Hip Lameness. 
 
 Fortunately, ])ecause of the heavy miiseuhiture which goes 
 to form a part of the loeoniotive apparatus of the rear extremity, 
 hip lameness is comparatively rare. While the term is in itself 
 ambiguous and signifies nothing more definite than does "shoul- 
 der lameness," yet diagnosis of almost any condition that may 
 be classed under the head of "hip lameness" is not easy except in 
 eases where the cause is obvious, as in wounds of the musculature 
 and certain fractures. To the complexity which the gait of the 
 quadruped contributes, because of its being four-legged, there 
 is added the complicated manner of articulation of the bones of 
 the hind leg. This involves the hip in the manner of diagnostic 
 problems and because of the inaccessibility of certain parts, 
 owing to the bulk of the musculature of these parts, diagnosis 
 of some hip ailments becomes an intricate problem. Conse- 
 quently, in some instances, before one may arrive at definite 
 and enlightening conclusions, repeated examinations are neces- 
 sary as Avell as a knowledge of reliable history and recorded 
 observations of the subject over a considerable period. 
 
 Rheumatic atfections, when present, usually cause recurrent 
 attacks of lameness ; myalgia, due to subsurface injury occasioned 
 l)y contusion, generally produces an ephemeral disturbance ; and 
 while these are examples of cases where occult causes are active, 
 tliey are hy no means unprecedented. In cases where the cause 
 of lameness is not definitely located, and when by the process 
 of exclusion one is enabled to decide that the seat of trouble is 
 in the hip, a tentative diagnosis of hip lameness is always ap- 
 propriate. 
 
 In one instance a Shetland pony evinced a peculiar form of 
 intermittent lameness which affected the left hip, and repeated 
 examinations did not disclose the cause of the trouble. After 
 about a jear there was established spontaneously an opening 
 through the integument overlying the region of the attachment 
 of the psoas major (magnus"), through which pus discharged. 
 With the occurrence of this fistula, lameness almost entirely 
 disappeared, but the emission of a small amount of pus persisted 
 for more than a year. The subject was not observed thereafter 
 
196 LAMENESS OF THE HORSE 
 
 and the outcome in this case is not a matter of record. Whether 
 there existed a psoic phlegmon due to metastatic infection or 
 necrosis of a part of a lumbar or dorsal vertebra is a matter for 
 speculation. Thus the presence of some anomalous conditions 
 which affect the pelvic region and cause lameness may be dis- 
 covered, yet both in hip and shoulder regions causes may not be 
 definitely located by means of practical methods of examination. 
 
 Injuries of all kinds are the more frequent causes of hip lame- 
 ness. In such cases, lameness may result directly and resolution 
 be prompt, or the claudication become aggravated in time, due 
 to muscular atrophy or degenerative changes affecting the hip 
 joint or nerves. Rheumatism or metastatic infection may be 
 the cause of hip lameness as well as affections of the pelvic ])ones, 
 lum])ar and sacral vertebrae. Hip lameness may also be pro- 
 voked by melanotic or other tumors. 
 
 In the diagnosis of hip lameness, one is guided in a general 
 way by the character of the impediment manifested. Swinging- 
 leg lameness is often present and the impediment is more ac- 
 centuated when the animal is caused to step backward. In many 
 cases lameness is ndxed, being about equally noticeable during 
 weight bearing and while the member is being swung. By ex- 
 clusion of causes which might affect other parts, one may defi- 
 nitely locate the cause of the trouble or determine that a certain 
 region is affected. 
 
 The sudden manifestation of lameness is indicative of injury ; 
 thermic disturbances may signalize metastatic infection ; history, 
 if dependable, is always helpful. Repeated observations, taking 
 into account the course which the affection assumes during a 
 period of a few days, often serve to afford a means of establish- 
 ing a diagnosis in liaffling cases. 
 
 Fractures of the Pelvic Bones. 
 
 The OS innominatum may be so fractured that the pelvic girdle 
 is broken, as in fracture of the iliac shaft, or in a manner that 
 the girdling continuity of the innominate bones is not inter- 
 rupted. It naturally follows that greater injury is done when 
 the pelvic girdle is 1)roken than when it is not, except in cases 
 
(LAMENESS IN THE HIND LEG 197 
 
 where the acetalnilmn is involved and its hrim not completely 
 divided. 
 
 Etiology and Occurrence. — Pelvic fractures are usually 
 caused by falls or other manner of contusion. Cases are re- 
 ported where it would seem that fracture of the iliac angle re- 
 sulted from muscular contraction, but it is certain that most 
 fractures of this kind are due to collisions with door jambs or 
 similar injuries. In old horses especially, fracture of pelvic 
 bones occurs frequently. This form of injury is of more frequent 
 occurrence in animals of all ages that work on paved streets. 
 The country horse is not subjected to the uncertain footing of 
 the slippery pavement, nor to injuries which compare with those 
 caused by contusions sustained in falling npon asphalt or cobble- 
 stones. 
 
 Symjptomatology. — While in many cases of pelvic fracture 
 lameness or al)nornial decumbency are the salient manifestations, 
 yet the pathognomic symptoms are crepitation or palpable evi- 
 dence which may be ol)tained by rectal or vaginal examination. 
 In fractures of the angle of the ilium and the ischial tulierosity, 
 perceptible evidence always exists. 
 
 In cases where fracture of some portion of the pelvic girdle 
 is suspected and the subject is able to walk, crepitation is sought 
 by placing one hand on an external angle of the ilium and the 
 other on the ischial tul)erosity and the animal is then made to 
 walk. Or, by placing the hands as just directed, an assistant 
 may grasp the horse's tail and by alternately exerting traction 
 on the tail and pushing against the hip in such manner that 
 weight is shifted from one leg to the other, crepitation may be 
 detected. 
 
 Fracture of the pubis near its symphysis constitutes a grave 
 injury, as there is danger of the bladder becoming caught in the 
 fissure and perforation of its wall may result. Such a case is 
 reported by Bauman'^ wherein a three-year-old gelding bore the 
 history of having l)een lame for ten days. Upon rectal examina- 
 tion the bladder was found to be hard and tumor-like and about 
 the size of a baseball. The body of the ischium in this case 
 
 ^Case report at meeting of the Iowa State Veterinary Medical Associatioii, 
 Jan., 1904, by Dr. S. H. Bauman, Birmingham, la. 
 
198 LAMENESS OF THE HORSE 
 
 was fractured and a rent in the bladder was caused by a sharp 
 projecting piece of bone. Autopsy revealed, in addition to the 
 fracture and rent of the l)ladder wall, a large quantity of urine 
 in the peritoneal cavity. 
 
 In other instances hemorrhage caused death and not infre- 
 quently infection was responsible for a fatal issue. Moller,- 
 quoting Nocard, describes a case where fracture occurred through 
 the region of the foramen ovale and paralysis of the obturator 
 nerve followed. 
 
 Fractures which include the acetabular bones cause great pain. 
 This is manifested by marked lameness, both during weight 
 bearing and when the member is swung. Such cases terminate 
 unfavorably — complete recover}^ is impossible. 
 
 Where small portions of the angle of the ilium are broken, and 
 the skin is left intact, there exists the least troublesome class 
 of pelvic fracture. If large portions of the ilium are fractured, 
 considerable disturbance results. There eventually occurs more 
 or less displacement in such cases, if such displacement does not 
 take place at the time of injury. The same may be said of frac- 
 ture of the tuber ischii, but when these bones are fractured a 
 more serious condition results. 
 
 Treatment. — AVhen a case is found to be uncomplicated, that 
 is, if the fracture is such that recovery seems possible and after 
 having determined that treatment may be practicable, the first 
 consideration is that of confining the subject in suitable slings. 
 In many cases of pelvic fracture, the atfected animal will need 
 to be kept in slings from six weeks to three months, and it l)e- 
 comes a difficult problem to minimize the distress during this 
 long period of confinement in the peculiar manner required for 
 favorable outcome. 
 
 The pattern of sling employed should be the best that is ob- 
 tainable aud the matter of its adjustment is quite important lest 
 unnecessary chafing or even necrosis of skin result. Frequent 
 readjustment may be necessary, and time is well spent in this 
 manner since this contributes materially toward a favorable 
 termination by encouraging the subject to remain q\iiet so that 
 
 ^Regional Veterinary Surgery and Operative Technique, by .Tohn A. W. 
 Dollar, M. R. C. V. S., F. R. S. E., M. R. I., page 733. 
 
LAMENESS IN THE HIND LEG 199 
 
 coaptation of the broken bones may be maintained. Aside from 
 slings, mechanical appliances that are helpful in the treatment 
 of these cases are not yet in use. 
 
 A regimen that is nutritive and at the same time laxative is 
 essential and in some cases cathartics and enemata are necessary. 
 Also, during the t:rst few days, if there is retention of urine, 
 catheterization is imperative. In a word, the handling of such 
 cases consists largely in keeping the subject inactive, as com- 
 fortable as possible, and giving attention to suitable diet. 
 
 Simple fracture of the external iliac angle needs no particular 
 attention, except that the subject is kept quiet until lameness 
 subsides. In all cases where much of the bone is broken, the ani- 
 mal is blemished, but interference with function does not follow. 
 If infection results because of a compound fracture, loose pieces 
 of bone must be removed surgically and drainage provided for. 
 
 In fracture of the ischial tuberosity, infection is more apt to 
 result than in like injury of the ilium, and greater displacement 
 of bone occurs. This displacement, due to contraction of the 
 attached muscles, is in some instances a contributing cause to 
 the infection which often follows in these cases. In females 
 where the body of the ischium is fractured, lacerations of the 
 vagina may be present, and this constitutes a serious complica- 
 tion which usually terminates fatally. 
 
 After-care in fracture of the pelvic girdle consists principally 
 in allowing a protracted period of rest before subjects are i)ut 
 to work. 
 
 Fractures of the Femur. 
 
 Etiology and Occurrence, — This is a comparatively rare in- 
 jury in the horse because of the protection afforded the femur 
 by the heavy musculature. Fragilitas of the bone probably 
 exists in many cases when fracture of its diaphysis occurs. It 
 is generally conceded that the neck of the femur is rarely broken 
 because of a lack of constriction in this part, but fracture of the 
 trochanters has been recorded rather frequently. However, 
 Lienaux and Zwanenpoete^ state that fracture of the neck of 
 the femur is of frequent occurrence in Belgian colts. Tapley- 
 
 lAs quoted bv A. Liautard, M. 15., V. M., American Veterinary Review, 
 Vol. 37, page 667. 
 
 ^Quoted by Prof. Liautard, American Veterinary Review, Vol. 33, page 190. 
 
200 LAMENESS OP THE HORSE 
 
 reports in the Veterinary Jonrnal (English) fracture of the head 
 and internal trochanter of the femur and patellar luxation oc- 
 curring simultaneously affecting a mule. In this case the mule 
 was found decumbent on a concrete floor. After three weeks, 
 the subject was destroyed and autopsy revealed rupture of the 
 left pubiofemoral ligament, tearing with it a portion of the 
 articular surface of the femur. The internal trochanter was 
 also fractured in four small pieces. In this case it is fair to 
 suppose that the mule in trying to regain footing on a slippery 
 floor violently abducted the legs and fracture resulted. It is 
 
 Fig. 46 — Oblique fracture of the femur of a 1,500 six-year-old draft hoi'se. 
 Showing- shortening of bone, owing to a lateral approximation of the diaphysis 
 because of muscular contraction. Photo by Dr. Edward Merillat. 
 
 possible also that a temporary luxation of the patella took place 
 first and caused the animal to struggle in such manner that frac- 
 ture followed. 
 
 Symptomatology. — According to Cadiot and Almy,' "regard- 
 less of the location of femoral fractures, the subject is usually 
 intensely lame, the animal frequently w;dking on three legs — 
 fractures of the diaphysis are characterized by an alinormal mo- 
 l)ility." 
 
 As a rule, crepitation is to be recognized in fractures of the 
 
 iTraite de Thgrapeutique Chirurgical des Animaux Domestique par V. J. 
 Cadiot et J. Almy, Tome second, page 460. 
 
LAMENESS IN THE HIND LEG 201 
 
 shaft of the bone, by passively moving the leg to and from the 
 medial plane (adduction and abduction). 
 
 Fracture of the trochanter major is signalized by local swelling 
 and evidence of pain; the forward stride is shortened because 
 this movement tenses the tendon of the gluteus major (maximus) 
 which is attaclicd principally to the trochanter. 
 
 Treatment.— Reduction of femoral fracture in the horse is 
 practically impossible, and retaining the broken bones in coapta- 
 tion is not possible by means of mechanical appliances. Conse- 
 ciuently, prognosis is unfavorable in fracture of the body of the 
 femur. When union of bone occurs, there results shortening of 
 
 Pig 47 — Same bone as in Fig. 46 after about six months' treatment. In this 
 case Dr. Merillat employed a weight to counteract muscular contraction. It 
 is noticeable that very little provisional callus has formed in this case, and 
 in spite of unusual ingenuity and good facilities for caring for the subject, 
 union of bone did not occur. 
 
 the leg and animals are rendered permanently lame. If the 
 immediate region of the head of the bone is involved as well as 
 in case of fracture of the condyles, an incurable arthritis ensues. 
 Where the trochanters are broken, chronic lameness and 
 muscular atrophy is the result. Therefore, it is evident that, 
 because of the manner of function of the femur, the leverage 
 afforded by its great trochanter and its heavy muscular attach- 
 ments, fractures of this bone in the horse do not terminate favor- 
 ably. 
 
 Luxation of the Femur. 
 
 Etiology and Occurrence. — Uncomplicated femoral luxation 
 is of less frequent occurrence in the jiorse than in the other 
 
202 LAMENESS OF THE HORSE 
 
 domestic animals. The deep cotyloid cavity renders disarticula- 
 tion ditBcult and luxation does not often take place. Complica- 
 tions that usually occur are rupture of the round (coxofemoral) 
 ligament or fracture of the neck of the femur. Falls or violent 
 strains are necessary to produce this luxation. Goubaux is 
 quoted by Cadiot and Almy^ as having observed the head of the 
 femur in an instance wherein luxation had long existed. In this 
 case autopsy revealed the fact that the inner portion (two-thirds) 
 of the head of the femur had completely disappeared. 
 
 Luxation of the femur is observed in old emaciated animals 
 that are worked on slippery pavements. Occasionally, evidence 
 of chronic luxation of the femur is observed in the anatomical 
 laboratory. The chronicity of the condition is o])vious when 
 one notes the well formed articulation which Nature provides 
 for the head of the femur, where fractuie or other serious com- 
 plications are not present. 
 
 Symptomatology. — In every case there must exist either 
 restriction of movement or an evident abnormal position of the 
 leg, or both conditions may exist at once. Also, the leg may be 
 markedly shortened. IManifestation of this affection varies, de- 
 pending upon the character of the luxation (position of the 
 head of the humerus with relation to the acetabulum). Lusk^ 
 cites a case of a mule which had suffered femoral luxation. The 
 animal was destroyed and on autopsy the head of the fenuir 
 found to be contained within a false articular cavity situated 
 about four inches above the acetabulum. In Dr. Lusk's case as 
 he states it, the following symptoms were presented: "Limb 
 shortened and fixed in a position of adduction. While standing 
 the affected limb hung directly across and in front of the oppo- 
 site one ; upper trochanter very prominent ; skin over hip joint 
 very tense. The mobility of the limb was very limited, especially 
 in the forward direction." 
 
 Being very prominent when there is an upward luxation and 
 less perceptible in downward displacement, the location of the 
 trochanter major is an indicator of the character of the luxation 
 with respect to the positicm of the head of the femur. This 
 
 iTraite de Therapeutique Chiruig-ical, Tome .second, pase ido. 
 =Luxation of the Femur, by AVm. V. Lusk, Veterinary Surgeon, U. S. 
 Cavalry, American Veterinary Review, Vol. 21, page 254. 
 
LAMENESS IN THE HIND LEG 203 
 
 variation of position causes abnormal tenseness or looseness of 
 the skin over the region of the trochanter major. Rectal ex- 
 amination IP of aid in locating the head of the humerus. 
 
 Treatment. — AVhen it is evident that a suhjeet should 1)e 
 given treatment and not destroj^d, the animal must be cast and 
 completely anesthetized. With complete relaxation thus secured 
 by rotation of the limb, using the hip joint region as a pivot, re- 
 duction may be effected. Traction is exerted in the same direction 
 from the acetabulum that the head of the femur is situated and 
 by pressing over the joint, the displaced bone may be returned 
 in position. If luxation is downward, traction on the extremity 
 will tend to dislodge the head of the femur from the inferior 
 acetabular margin making reduction possilile. 
 
 The same general plan Avhieh is ordinarily employed in cor- 
 recting luxation is indicated here, but because of the heavy 
 musculature of the hip, complete anesthesia is imperative in all 
 such manipulations. 
 
 Gluteal Tendo-S5movitis. 
 
 The gluteus medius (g. maxinuis) muscle is inserted chiefly by 
 means of two tendons ; one to the summit of the trochanter major 
 of the femur and the other passing over the anterior part of the 
 convexity of the trochanter, and being attached to the crest be- 
 low it. The trochanter is covered with cartilage, and a bursa 
 (the trochanteric) is interposed between the tendon and the 
 cartilage. 
 
 Etiology and Occurrence. — This affection is probably caused 
 in most instances 1)y direct injury to the parts, such as may be 
 occasioned by being kicked, falling on pavement, or being struck 
 by the body of a heavy wagon. Strains in pulling or in slipping 
 are undoubtedly causative factors and in draft horses such 
 strains may result in involvement of this synovial apparatus. 
 
 Symptomatology. — Tf pain l)e severe and inflammation 
 acute, weight may not be borne with the affected member. There 
 is some local manifestation of the condition in acute cases. 
 Swelling of the tissues contiguous to the bursa is present and 
 
204 LAMENESS OP THE HORSE 
 
 pain is evinced upon manipulation of the parts. A character- 
 istic gait marks inflammation of the trochanteric bursa, and as 
 G-unther has put it, the subject generally moves or trots as does 
 the dog — the sound member being carried in advance of the 
 affected one and the forward stride of the diseased leg is short- 
 ened. In some chronic cases crepitation is discernible by holding 
 the hand on the trochanter while the subject walks. 
 
 Treatment.— In the first stages of an acute affection abso- 
 lute quiet must be enforced; local antiphlogistic applications 
 are bencfioial. Later, vesication of a liberal area surrounding 
 the trochanter major is indicated. Where the condition has be- 
 come chronic in horses that are to be kept at heavy draft work 
 there is little chance for complete recovery. And, naturally, 
 one is not to expect resolution in cases where there exist erosion 
 and ossification of cartilage — where crepitation is discernible. 
 
 Paralysis of the Hind Leg. 
 
 Aside from paraplegic conditions due to disease of the cord or 
 the lumbosacral plexus, and monoplegic affections resultant from 
 disturbances of this plexus, paralysis of certain nerves are oc- 
 casionally encountered. 
 
 Anatomy. — The lumbosacral plexus results substantially 
 from the union of the ventral branches of the last three lumbar 
 and the first two sacral nerves, but it derives a small root from 
 the third lumbar nerve also. The anterior part of the plexus 
 lies in front of the internal iliac artery, between the lumbar 
 transverse processes and the psoas minor. It supplies branches 
 to the iliopsoas^ (designated by Girard, the iliacomuscular 
 nerves) . The posterior part lies partly upon and partly in the 
 texture of the sacrosciatic ligament. From the plexus are de- 
 rived the nerves of the pelvic limb (Sisson). 
 
 Paralysis of the Femoral (Crviral) Nerve. 
 
 Anatomy.— Til e femoral nerve (crural) is derived chiefly 
 from the fourth and fifth lumbar nerves. It runs ventrally 
 
 'Because of the intimacy of the psoas major (p. magnus) and the iliacus 
 they are sometimes called iliopsoas. 
 
[LAMENESS IN THE HIND LEG 205 
 
 and backward, at first between the psoas major and minor, then 
 crosses the deep face of the tendon of the latter and descends 
 under cover of the sartorious over the terminal part of the 
 ilioisoas. It innervates the psoas major (magnus), psoas minor 
 ^parvus), sartorious, rectus femoris, vastus lateralis (internus). 
 Branches supply the stifle and the adductor and pectineus mus- 
 cles. 
 
 Etiology and Occurrence. — While paralysis of the femoral 
 nerve, also known as "dropped stifle" occurs as a result of local 
 injuries and melanotic tumors in gray horses, most cases are due 
 to azoturia. So-called crural paralysis or "hip swinney" is oc- 
 casionally observed but this is not a condition wherein the nerve 
 is affected in the manner that characterizes the marked atrophy 
 of quadriceps femoris (crural) muscles in some cases of hema- 
 globinuria. This form of paralysis according to Hutyra and 
 ]Marek is due primarily to diffuse degeneration of the muscles. 
 
 Symptomatology. — AVhen muscular atrophy is not extensive 
 no particular evidence of this condition may be manifested while 
 the subject is at rest, but where muscular waste has occurred, 
 the nature of the ailment is at once recognized. Since the fem- 
 oral nerve supplies the quadriceps femoris muscles, it follows 
 that when the psoic portion of this nerve becomes diseased, the 
 stifle loses its support, and in a unilateral involvement when the 
 subject attempts to walk on the affected member, the stifle sinks 
 down for want of support and the leg collapses unless weight is 
 caught up with the other leg. Often, following azoturia, a 
 bilateral affection is to be observed. 
 
 Treatment, — Horses may be restrained in the standing posi- 
 tion, and in the average instance, a twitch and hood are all the 
 restraining appliances necessary. 
 
 In cases where the disease is unilateral and atrophy is not of 
 too long standing, recovery is possible in vigorous subjects. All 
 affections, however, wherein degenerative changes involve the 
 nerve trunk, whether due to diffuse myositis or pressure from 
 malignant tumors, will not yield to treatment. 
 
 The same general plan of treatment is indicated that is de- 
 scribed on page 7-4 in the consideration of atrophy of the 
 
206 LAMENESS OF THE HORSE 
 
 .scapular muscles. It is especially important to provide for the 
 subject to be exercised when there is atrophy of the quadriceps 
 muscles following azoturia. 
 
 In addition to the foregoing, good results have attended the 
 use of intramuscular injections of oxygon. The technie of the 
 operation consists in preparing the area of skin which covers 
 the atrophied muscles as for any operation. The hair is clipped 
 over five or six or more circular areas of about an inch in diame- 
 ter; the skin is cleansed and then painted with tincture of iodin. 
 
 A long heavy sterile needle, which is connected with an oxygen 
 tank by means of six feet of rubber tubing, is thrust into the 
 depths of the affected muscles and the gas is gently introduced 
 into the tissues. One needs exercise extreme care that the gas 
 enter slowly because great pain is produced by the sudden in- 
 jection of the oxygen. Likewise too nmch of the gas must not 
 be introduced at one place. When the oxygen is slowly intro- 
 duced it may be allowed to enter the tissues until the subject 
 gives evidence of experiencing considerable pain, or if the parts 
 are not particularly sensitive, a reasonable amount (enough to 
 cause a mild degree of diffuse inflammation) is introduced at 
 each one of five or six points. In large animals more points 
 of injection may be used. 
 
 No infection or other bad results will follow the execution of 
 a good technie and the treatment may be repeated every three 
 or four weeks until either marked regeneration of tissue is evi- 
 dent or the case is obviously proved hopeless. 
 
 Paralysis of the Obturator Nerve. 
 
 Anatomy. — The obturator nerve, situated at first under tlie 
 peritoneum, accompanies the ol)turator artery through the ob- 
 turator foramen and gaining tlie muscles on the internal face 
 of the thigh, terminates in the obturator externus, adductors, 
 peetineus and gracilis, also giving twigs to the obturator in- 
 ternus (Strange ways). 
 
 Etiology and Occurrence. — This condition occurs upon rare 
 occasions as tlie result of injury such as falls which cause ex- 
 treme abduction of the legs, or in pelvic fracture where the 
 
ILAMENESS IN THE HIND LEG 207 
 
 nerve is directly injured, or when melanotic tumors or other 
 new growths compress the nerve in such manner that its function 
 is suspended. Paralysis of the obturator nerve or nerves is met 
 with rather frequently, notwithstanding', in mares, following 
 dystocia. The nerves (one or both) may become bruised at the 
 lu'im of the oliturator foramen by being caught between the pel- 
 vis and the body of the fetus in some cases of protracted labor. 
 
 Symptomatology. — Tn a unilateral affection there may be 
 little evidence of the trouble while the subject is standing; or 
 there is to be seen some abduction; or the affected member may 
 present abduction of the stifle and stand "toe outward." If 
 the animal is walked there will be manifested more or less abduc- 
 tion and the character of the impediment varies according to 
 the nature of the involvement. 
 
 Following protracted cases of labor in some instances where 
 only a unilateral paralysis exists, walking is performed with 
 difficulty; the subject may be unal^le to support weight witli the 
 affected member and is obliged to hop on the one sound hind leg. 
 In bilateral affections, they are iinable to rise. If the condition 
 is severe the sling is required to keep the subject standing, and 
 with this care, recovery Avill follow. 
 
 Treatment. — If new growths or callosities or similar condi- 
 tions affect the nerve, little, if any, hope for recovery exists. In 
 young and vigorous subjects where cause is not definitely known, 
 a course of strychnin may be given. Good nursing, providing 
 for the subject's comfort and allowing moderate exercise, consti- 
 tute rational treatment. Stimulating embrocations on the ab- 
 ductor muscles resorted to in cases during the incipient stage 
 may prove helpful. 
 
 "When paralysis of the obturator nerve occurs as a post-partum 
 complication, and other conditions are favorable, the subject 
 should be raised to its feet without unnecessary delay. If the 
 mare is unable to assist in regaining her feet, a sling is recpiired. 
 Usually little else is necessary and after a few days in the sling 
 the subject can get about unassisted. In the meanwhile the 
 well-being of the affected animal is to be considered just as in 
 any other case where the patient is so confined. The foal in 
 
208 LAMENESS OF THE HORSE 
 
 siieh instances constitutes a source of some trouble, but the aver- 
 age mare offers no serious resistance to the confinement occa- 
 sioned by the sling. 
 
 Good hygienic care, a suitalile diet and full i^hysiological doses 
 of strychnin are indicated. Cadiot and Almy recommend vaginal 
 douches of cold water and counterirritation of the region of the 
 inner thigh in these cases. 
 
 Paralysis of the Sciatic Nerve. 
 
 Anatomy. — The great sciatic nerve leaves the pelvis in com- 
 pany with the gluteal nerves, through the great sciatic foramen 
 (notch), passing downward along the posterior face of the femur. 
 Near the stifle it passes between the two heads of the gastroc- 
 nemius muscle and continues as the tibial. Branches supply 
 the following muscles — ol)turat<)r, semimem])ranosus (adductor 
 magnus), biceps femoris (triceps abductor femoris), semitendi- 
 nosus (biceps rotator tibialis), lateral extensor (peroneus) and 
 the tibial nerve, its continuation, innervates the digital flexors. 
 
 Etiology and Occurrence. — Paralysis of the great sciatic 
 nerve may be caused by central disorders, injury in falling, frac- 
 tures and new growths. Because of its protected position, this 
 nerve does not often suffer injury, and paralysis of the sciatic 
 nerve is recorded in a few instances owing to its rarity. 
 
 Symptomatology. — When consideration is given the number 
 of muscles that are supplied by the sciatic nerve and the func- 
 tion of these muscular structures, it is obvious that the leg 
 cannot be used in sciatic paralysis. However, the limb is 
 capable of sustaining weight when it is fixed in position, but this 
 is done without exertion of muscular fibers which are supplied 
 by the great sciatic nerve. Trotting is impossilile and flexion 
 of the affected member is also likewise precluded. The foot is 
 dragged when the subject is caused to advance. 
 
 Under the heading "sciatica," Scott^ has described a case of 
 acute sciatic affection wherein a pacing horse manifested evidence 
 of great pain of a nervous character. There were muscular 
 
 iDr. John .Scott, Peoria, III., in The American Veterinary Review, Vol. 16, 
 page 16. 
 
LAMENESS IN THE HIND LEG 209 
 
 twitchings and the leg was held off the floor and moved about 
 convulsively. Breathing was very much accelerated, pulse 85 
 per minute, the temperature was 103° and manipuhition of the 
 hips augmented the pain. 
 
 This was not a paralytic condition and recovery resulted, yet 
 undoubtedly this was a ease which, if not properly cared for, 
 might have terminated unfavora])ly. 
 
 Treatment. — Prognosis is decidedly unfavorable in paraly- 
 sis of the great sciatic nerve. If treatment is attempted, it is 
 to be conducted along the same general lines as in femoral 
 paralysis. Particular attention should be given to conditions 
 which will make for the patient's comfort, and as soon as it 
 is evident that the affection is not progressing favorably, the 
 subject should be humanely destroyed. 
 
 Iliac Thrombosis. 
 
 This condition is undoubtedly of more frequent occurrence 
 than we are wont to grant when one considers the comparatively 
 small number of cases that are actually recognized in practice. 
 It does not follow, however, that iliac thrombosis rarely exists. 
 Probably in the majority of instances there is insufficient obstruc- 
 tion of the lumina of vessels to provoke noticeable inconvenience. 
 Or, if circulation is hampered to the extent that function is 
 impaired and manifestations are observed by the driver, the 
 subject may be permitted to rest a few days and p.-^rtial resolu- 
 tion occurs, so that further trouble is not noticeable. 
 
 As judged by lesions of the aorta and iliac "arteries in dissect- 
 ing subjects, the conclusion that arteritis and resultant disorders 
 are of rather frequent occurrence, is logical. 
 
 Etiology. — Inflammation of the vessel walls and resultant 
 prolifieration of tissue together with the accmnulation of clotted 
 blood becoming organized, serve to obstruct the lumen of the 
 affected artery. The cause of arteritis is unknown in many 
 instances, but parasitic invasion and contiguous involvement of 
 vessels in some inflammatory injuries are etiological factors. 
 
 Symptomatology. — A cluiracteristic type of lameness sig- 
 nalizes iliac thr()ml)osis and the following l)rief abstract from a 
 
210 LAMENESS OF THE HORSE 
 
 contribution on this subject by Drs. IMerillat^, clearly portrays 
 the chief symptoms : 
 
 The seizures are accompanied with profuse sudation, tremors, 
 
 Fig-. 4S — Exposure of aorta and its branches, showing location of thrombi in 
 numerous places. In this case (same as Fig. 49) Dr. L. A. and Dr. Edward 
 Merillat found the cause of the condition to be due to sclerastomiasis. 
 
 dilated nostrils, accelerated respirations and otlier symptoms of 
 pain and distress, all of which, together with the lameness, dis- 
 appear as rapidl}^ as they had developed, leaving the animal in 
 
 lAnnotation on Surgical Items, by Drs. L. A. and Edward Merillat, Ameri- 
 can Veterinary Review, Vol. 31, page S58. 
 
LAMENESS IN THE HIND LEG 
 
 211 
 
 an apparently perfect state of health, ready to fall with another 
 attack of precisely the same kind, a.s soon as enough exercise is 
 forced upon it. The rectal explorations may reveal a pulseless 
 state of one or more of the iliac arteries and a hardness and 
 enlargement of the aortic quadrifurcation, but sometimes this 
 palpation fails to disclose any perceptihle diminution of the blood 
 current of these vessels. The obturation being incomplete, it 
 may be impossible by palpation to decide that thrombosis really 
 
 Fig. I'.t— lllu.strativf 
 by Dr. L. A. Merillat. 
 
 ii' Ihi' aorta, iliacs and branches. Photo 
 
 exists. In this event and, in fact, in all eases, the clinical sjanj)- 
 toms are sufficiently characteristic to make a diagnosis without 
 reservation. It cannot be mistaken for any other disease, once 
 properly investigated. Any given seizure may easily be mis- 
 taken for azoturia, at first, but a better examination soon ex- 
 cludes that disease. 
 
 Prognosis and Treatment. — In the majority of instances, 
 when there is occasioned serious inconvenience, the outcome is 
 not likely to be favorable, according to Moller. Detachment of 
 a portion of the thrombus, according to Hoare, may result in 
 the lodgment of an embolus in the brain or kidneys. The latter 
 authority also states that muscular atrophy may occur owing to 
 lack of blood supply in some of these cases. Moller states that 
 
212 LAMENESS OF THE HORSE 
 
 moderate exercise or work stiini^lates the estahlishment of col- 
 lateral circulation, ^lassage per rectum is condemned as danger- 
 ous by Cadiot. 
 
 Fracture of the Patella. 
 
 Etiolog-y and Occurrence. — Patellar fractures are rarely met 
 with in the horse but may be caused. by falls and heavy con- 
 tusions. Violent muscular contraction, it is said, may also bring 
 al)Out the same condition. 
 
 Symptomatology. — Fracture may be transverse or vertical, 
 and depending on the manner in which the bone is broken, prog- 
 nosis is either at once rendered favorable or unfavorable. The 
 patella performs a function which is in a way similar to that 
 of the sesamoids and when fractured, complete recovery is im- 
 probable in the average instance. When complete, transverse 
 fractures permit of separation of the parts of bone. Tension on 
 the straight ligaments below and contraction of the quadriceps 
 above usually cause insuperable difficulty in the handling of this 
 type of fracture in the horse. 
 
 Compound fractures as well as multiple or comminuted frac- 
 tures occasionally occur and these constitute injuries which are 
 generally considered fatal, although Andrien, according to Cadiot 
 and Almy, succeeded in obtaining complete recovery in a case of 
 compound fracture of the patella and the horse was in service 
 and almo.st free from lameness two months after treatment was 
 'begun. 
 
 No difficulty is encountered in recognizing the fracture of the 
 patella because of the exposed position of the bone. Crepitation, 
 and in some cases fissures, may be easily detected. 
 
 Treatment. — In simple fracture, when treatment is thought 
 a(lvisal)le, the subject is put in a sling and kept as nearly com- 
 f()rta])le as possibk\ If little inflammation exists, the application 
 of a vesicant two or three weeks after the injury has been in- 
 flicted will be helpful and serve to. hasten repair. 
 
 Bandages or mechanical appliances are of no practical- use in 
 the handling of these cases. 
 
LAMENESS IN THE HIND LEG 213 
 
 Luxation of the Patella. 
 
 Etiology and Occurrence. — This, the iwost common luxation 
 met with in tlie eijuine sul)ject, has been described by writers 
 as existing in many forms. Patellar disarticulation may be more 
 practically considered as momentary and fixed, regardless of the 
 position taken by the patella. Described under the title of false 
 luxation are recorded cases wherein the quadriceps (crural) 
 muscles become contracted in such manner that a condition sinui- 
 lating- true disarticulation of the patella obtains. Also, some 
 practictioners report cases of patellar luxation and refer to 
 pseudo-luxations, without clearly defining the conditions which 
 constitute pseudo-luxation. This has contributed to the extant 
 cause of misconception as to actual differences between luxation 
 and conditions simulating dislocation. 
 
 Luxation of the patella is a condition wherein the articular 
 portions of the femur and patella assume abnormal relations 
 whether such displacement of the patella be momentary and 
 capable of spontaneous reduction, or fixed and requiring cor- 
 rective manipulation. Spasmodic contraction of the crural mus- 
 cles which sometimes retains the patella in such position that 
 the leg is rigidly extended, does not in itself constitute luxation 
 of the patella; and unless this bone becomes lodged on the upper 
 portion of a femoral condyle or laterally displaced out of its 
 femoral groove, luxation cannot be said to exist in the horse. 
 These are sub-luxations. 
 
 Occasionally one may observe in suckling colts outward luxa- 
 tion of the patella wherein there is history of navel infection 
 and no marked evidence of rachitis is present. Some of these 
 cases recover. In a unilateral involvement of this kind in a 
 three-month-old mule colt, the author observed a case wherein 
 an unfavorable prognosis was given and destruction of the sub- 
 ject advised, because of the extreme dislocation of the patella. 
 This colt, however, was not destroyed and in three weeks had 
 apparently recovered. No treatment was given in this instance ; 
 the colt was allowed the run of a small pasture with its dam and 
 in time it matured, becoming a sound and servicea])le animal. 
 
 Classification. — Two forms of true patellar luxation in the 
 
214 LAMENESS OF THE HORSE 
 
 horse may be considered; one wliicli is due to the patella becom- 
 ing fixed upon the internal trochlear rim of the femur and the 
 other when the patella slips over the outer rim of the trochlea. 
 
 The first form is known as upward luxation and is made pos- 
 sible by rupture of the mesial (internal) femeropatellar ligament. 
 According to Cadiot and Almy, it is only by the rupture of 
 this ligament — the femeropatellar — that upward luxation may 
 occur. This type of luxation is rarely observed and is usually 
 due to violent strain and abnormal extension of the stifle joint. 
 
 The second class, outward luxation, occurs in colts and is, 
 in many instances, congenital. This form of luxation is also 
 the one usually seen following debilitating diseases such as influ- 
 enza and pneumonia. 
 
 Vpivard luxation of the patella is characterized by the stiff- 
 extended position of the leg. "When the patella is situated 
 upon the inner trochlear rim, the tibia must be extended because 
 of the traction exerted by the straight ligaments. Since the 
 stifle and hock joints extend and flex in unison, there is presented 
 also an extension of the tarsus. Extension of the stifle joint 
 would increase the distance between the femoral origin of the 
 gastrocnemius and its insertion to the summit of fibular tarsal 
 bone (calcis) were it not for the gastrocnemius and superficial 
 flexor (perforatus). Extension of the hock in upward luxation 
 of the patella, permits of flexion of the phalanges. In upward 
 luxation, then, the leg is extended as if too long, but the pha- 
 langes may be in a state of moderate flexion. If the foot rests on 
 the ground when the extremity is not flexed, it is almost impossi- 
 ble for the subject to step backward. Because of immobilization 
 of the stifle and hock joints in upward luxation, the subject can 
 walk only by hopping on the sound leg and then the extremity 
 is flexed, allowing the anterior portion of the fetlock to drag on 
 the ground. 
 
 In some cases practitioners are called to attend young animals 
 that are reported to be "stifled" (often in young mules that 
 have made a rapid growth) and upon arrival the only noticeable 
 symptom of preexisting luxation is the soiled condition of the 
 anterior fetlock region — evidence of its having been dragged. 
 Such cases may be styled momentary luxation, whether they are 
 
LAMENESS IN THE HIND LEG 215 
 
 due to a weakened condition of the patellar ligaments or spas- 
 modic contraction of the crural muscles. 
 
 In upward luxation, reduction is effected by attempting fur- 
 ther extension of the stitie joint and at the same time the patella 
 is pulled outward, off the internal rim of the trochlea. This is 
 attempted by securing the subject in a standing position; the 
 sound side is kept against a wall if possible and a rope is tied 
 to the extremity of the affected leg. Traction is exerted upon 
 tile rope and at the same time force is directed against the stifle 
 joint to produce further extension if possible, so that the straight 
 patellar ligaments may relax sufficiently to allow the patella to 
 be dislodged from its position upon the inner trochlear lip. Fail- 
 ing in this manner of procedure, the affected animal is to be 
 cast and anesthetized with chloroform. The relaxation which 
 attends surgical anesthesia will permit of reduction of the dis- 
 located bone and uuuiipulations such as have just been outlined 
 may be employed. 
 
 Following reduction in the average case it is essential that the 
 subject be given vigorous exercise for a few minutes. Reduction 
 having been affected, the application of a vesicant over the 
 whole patellar region is customary. 
 
 In cases of habitual luxation, unless the ligaments are so lax 
 that the patella may be displaced laterally over the inner as 
 well as the outer trochler rims, division of the inner straight 
 patellar ligament will correct the condition. This desmotomy 
 has been advocated by Bassi, and good results in appropriate 
 cases have been reported by Cadiot, Merillat and Schumacher. 
 This operation has been found a corrective in cases of outward 
 luxation as well as those of upward dislocation of the patella 
 when resorted to before the trochleae are worn from frequent 
 luxation. 
 
 Outward luxation of the patella is occasioned by a lax condi- 
 tion of the internal femeropatellar ligament or a rupture of the 
 same so that the patella slips over the outer femoral trochlear 
 rim and permits of an abnormal flexion of the stifle joint. The 
 outer trochlear rim being the smaller of the two, inward luxation 
 does not occur in the horse. With the patella disarticulated in 
 
21& LAMENESS OF THE HORSE 
 
 this manner, the action of the quapriceps femoral group of 
 muscles has no effect on the stitie joint and, therefore, flexion of 
 this articulation occurs as soon as the subject attempts to sustain 
 weight and the leg collapses unless weight is at once taken up by 
 the other member if sound. 
 
 As a rule, the reduction of this form of luxation is not diffi- 
 cult. The patella may be pushed inward and into position with- 
 out manipulation of the leg. Retention of the patella in position 
 is a difficult problem. Bandaging is considered impractical and 
 is not ordinarily done in this country. Benard, according to 
 Cadiot and Almy, recommends bandaging with a heavy piece of 
 cloth in which an opening is made through which the patella 
 is allowed to protrude, and by turning such a bandage snugly 
 about the stifle several times, the patella is held in position. This 
 bandage should be kept in place for about ten days. 
 
 In young and rachitic animals outdoor exercise and a good 
 nutritive ration for the subject are indicated. Hypophosphites 
 in assimilal)le form may be beneficial, and vesication of the pa 
 tellar region contributes to recovery. 
 
 Where extreme luxation is present in l)oth stifles, the prog- 
 nosis is unfavorable. In such cases, degenerative changes may 
 exist and in some instances the ligaments are so diseased and 
 elongated that regeneration is impossible. Williams^ reports a 
 case where bilateral "floating" (outward) luxation was present 
 and extensive degeneration changes affected the articulation. 
 
 In subjects suffering frequent dislocation of the patella (ha- 
 bitual luxation) it is possible in some cases, to prevent its occur- 
 rence or at least to minimize the distress occasioned by momen- 
 tary luxation, l^y keeping the animals in wide stalls so that 
 "backing" is unnecessary. In some nervous subjects that seem 
 to be suffering from cramp of the crural muscles, the difficulty 
 and pain of their being backed out of narrow stalls, accentuates 
 the nervousness. Sudation and restlessness are manifested and 
 the subject presents a clinical picture of distress and fear of a 
 painful ordeal. In some cases of this kind, complete recovery 
 takes place by the time animals are five or six years of age. 
 One should avoid keeping such subjects in narrow stalls. Pref- 
 
 iW. I.. Williams in American Veterinary Review, Vol. 21, page 452. 
 
[LAMENESS IN THE HIND LEG 217 
 
 erably patellar desmotomy should l)e performed that relief may 
 be obtained at once. 
 
 ' Luxations attending some cases of influenza recover promptly 
 when subjects are kept comfortably confined in roomy box-stalls. 
 The administration of stimulative medicaments such as nux vom- 
 ica and the application of an active blistering agent to the 
 patella serve to hasten recovery. Dislocations in such cases are 
 often bilaterar and they are usually momentary. Reduction 
 occurs spontaneously, as a rule, and the subjects are not occa- 
 sioned much distress if they are kept quiet for a few days. 
 
 Chronic Gonitis. 
 
 Etiolog"y and Occurrence. — Chronic infiammation of tlie 
 stifle joint is met with following acute synovitis due to strains 
 and concussion. It is an ailment which affects heavy horses and 
 particularly animals that are kept at work on paved streets, but 
 this does not explain its existence in animals that are not sub- 
 jected to work likely to cause concussion. Berns^ considers rheu- 
 matism a probable cause of gonitis and, as he states, the dropsical 
 form of affection of this joint is not ordinarily attended with 
 manifestations of inconvenience to the subject. Gonitis is often 
 bilateral and its onset is insidious in many instances. 
 
 Symptomatology. — In unilateral gonitis weight is not borne 
 I)y the affected member. There is noticeable distension of the 
 joint capsule — a characteristic pendant pouching protrusion. 
 When both stifles are affected the subject frequently shifts the 
 weight from one limb to the other. Lameness comes on gradu- 
 ally and during the incipient stages may be intermittent but it 
 progressively increases so that in time affected animals become 
 useless. In bilateral affections animals drag the toes because 
 of the pain incident to flexing the stifles. This is particularly 
 evident when the subject is made to trot. iVs the disease pro- 
 gresses, atrophy of the quadriceps femoris muscles becomes pro- 
 nounced and as destructive changes involving the articular car- 
 tilages take place. The su])ject becomes more lame and eventu- 
 ally is rendered incapable of service. 
 
 iGeo. H. Berns, D. V. S., report, American Veterinary Medical Association, 
 1912, page 238. 
 
218 
 
 LAMENESS OF THE HORSE 
 
 Upon manipulation of the patellar I'egion, one is impressed 
 with the fact that hyperesthesia does not exist in proportion to 
 the pain manifested during locomotion. In some cases a gel- 
 atinous swelling is present and may be detected by palpating 
 
 Fig. 50 — Cliionic gonitis. The knuckling which results from long cuntimKil 
 inactivity of the crural muscles in chronic cases is marked in this instance. 
 Photo by Dr. L. A. Merillat. 
 
 between the straight ligaments of the patella. "Williams, Hughes, 
 Merillat, liadley and others have directed attention to the exist- 
 ence of floating masses {corpora orijzoidea) in the synovial cap- 
 sule of this joint in gonitis, and as with all cases of arthritis, 
 irreparable damage is often done the articular cartilages during 
 the course of the ailment. 
 
ILAMENESS IN THE HIND LEG 
 
 219 
 
 Treatment. — No effective method is as yet known which 
 will control this condition dnring its incipiency. The disease 
 progresses, and more or less damage is done the affected parts 
 in the course of months or even years in some cases before sub- 
 
 Fig. 51 — Gonitis. Showing position assumed in such cases because of pain 
 occasioned. Photo by Dr. C. A. McKilHp. 
 
 jects are rendered hopelessly crippled. When recognized early 
 (before chronic gonitis exists) aspiration of the synovia and the 
 injection of diluted tincture of iodin might prove beneficial in 
 cases of .synovial distension. Chronic gonitis is considered an 
 incurable affection and as soon as subjects manifest evidence of 
 distress from this condition they should by all means be taken 
 from work. Firing and vesication have not been productive of 
 beneficial results. 
 
220 LAMENESS OF THE HORSE 
 
 Open Stifle Joint. 
 
 Anatomy of the Joint Capsule. — This joint capsule is thin 
 and very capacious. On the patella it is attached around the 
 margin of the articular surface, but on the femur the line of 
 attachment is at a varying distance from the articular surface. 
 On the medial side it is an inch or more from the articular car- 
 tilage; on the lateral side and above, about half an inch. It 
 pouches upward under the quadriceps femoris for a distance of 
 two or three inches, a pad of fat separating the capsule from the 
 muscle. Below the patella it is separated from the patellar liga- 
 ments by a thick pad of fat, but interiorly it is in contact with 
 the femerotibial capsules. The joint cavity is the most extensive 
 in the body. It usually communicates v.-ith the medial sac of 
 the femerotibial joint cavity by a slit-like opening situated at 
 the lowest part of the medial ridge of the trochlea. A similar, 
 usually smaller, communication with the lateral sac of the fe- 
 merotibial capsule is often found at the lowest part of the lat- 
 eral ridge. (Sisson's Anatomy.) 
 
 Thus it is seen that because of its frequent communication 
 with the other parts of this large synovial membrane, a wound 
 which opens the external portion of the femerotibial capsule 
 may be the cause of contamination and resultant infectious ar- 
 thritis of the whole stifle joint. Because of the distance between 
 the most dependent part of the femerotibial articulatioii and 
 the summit of the patella, one may misjudge the exact location 
 of the lowermost part of this portion of the capsular ligament 
 of the stifle joint and thereby fail at once to appreciate the seri- 
 ousness of calk wounds in this region. 
 
 Etiology and Occurrence. — AVounds to the patellar region 
 are of rather frequent occurrence, and because of the compara- 
 tively unprotected position of these structures, the capsular liga- 
 ments of the stifle joint may be perforated as a result of violence 
 in some form. Calk wounds which penetrate the tissues in the 
 immediate region of the lower portion of the external part of 
 the femerotibial capsule sometimes result in open joint because 
 of tissue necrosis resulting from the introduction of infection. 
 Contused wounds sometimes destroy the skin and fascia over 
 
LAMENESS IN THE HIND LEG 221 
 
 large areas on the lateral patellar region and because of subse- 
 quent sloughing of tissue due to infection as well as to the man- 
 ner in which such wounds are inflicted, septic arthritis subse- 
 quently occurs. Penetrant wounds, such as may be caused by a 
 fork tine may not result in infection; if infectious material is 
 introduced an infectious arthritis does not necessarily follow, 
 though such cases should be considered as serious from the out- 
 set. ^ ^' 
 
 Symptomatology. — The pathognomonic symptom of open 
 stifle jouit is the profuse escape of synovia, indicating perfora- 
 tion of the synovial capsule; by means of a probe the wound 
 may be explored in a way that will clearly reveal the nature of 
 the injury. 
 
 After a few days have elapsed in cases where considerable 
 infection has taken place, there is manifestation of pain as in 
 all cases of infective arthritis. Hughes^ gives an excellent de- 
 scription of the clinical aspect of arthritis Avhich applies here: 
 
 Acute arthritis begins like an ordinary attack of synovitis. 
 In joints other than the pedal and pastern, there is sudden and 
 extensive swelling, which at first is intra-articular, succeeded by 
 extra-articular tumefaction, and accompanied by violent lame- 
 ness. The pain soon becomes intense and agonizing. There is 
 severe constitutional disturbance, the temperature ranging from 
 104 to 106 degrees and the pulse from 60 to 72. Painful con- 
 vulsions of the limb occur, shown by involuntary spasmodic ele- 
 vations due to reflex irritation of the muscles. There is loss 
 of appetite, rapid emaciation, the flank is tucked up and the 
 back arched. In from three to six days, the tumefaction around 
 the joint tends to soften at a particular place, and bursts, and 
 a discharge that is sometimes of a sanious character, mixed with 
 synovia, escapes. Great exhaustion at times supervenes, and 
 if the joint is an important one, the horse lies or falls and is 
 unable to rise. 
 
 Treatment. — In small puncture Avounds the immediate appli- 
 cation of a vesicating ointment has given good results, but Avhen 
 infection has taken place to such extent that the animal mani- 
 fests evidence of intense pain, and lameness is marked and local 
 swelling and hyperesthesia are great, vesication is contraindi- 
 
 ijoseph Hughes. M. R. C. V. S., in the Chicago Veterinary College Quar- 
 terly Bulletin, Vol. 10, page 15. 
 
222 LAMENESS OF THE HORSE 
 
 eated. In such instances the exterior of the wound and its mar- 
 gins should be prepared as in similar affections of other joints. A 
 quantity of synovia is then aspirated by means of a small tro- 
 car and care should be taken to observe all due aseptic precau- 
 tions. Subsequently the injection of from four to six ounces 
 of a mixture of tincture of iodin, one part to ten parts of gly- 
 cerin, and gentle massage of the joint immediately after the 
 injection has been made, serves to check the infective process 
 in some cases. 
 
 The subject should be cared for as has been previously sug- 
 gested in arthritis — proper provisions for comfort being made. 
 Good nursing is always essential to a successful issue. However, 
 the author cannot view cases of open stifle joint with the same 
 optimism concerning their course and outcome that is expressed 
 by a number of writers on this subject. It is a grave condition 
 wherein the prognosis should be given advisedly 
 
 Fracture of the Tibia. 
 
 Etiology and Occurrence. — Because of its exposed position 
 to kicks, and its lack of protection by heavy musculature (espe- 
 cially on its inner surface), there is afforded ample opportunity 
 for frequent injury to the tibia. Fractures are complete and 
 varying as to nature, or incomplete. The heavy tibial fascia 
 affords sufficient protection so that fissures without entire solu- 
 tion of continuity of the bone may occur from violence to which 
 this part is often subjected. Moller classes tibial fracture as 
 ranking second in frequency — pelvic fracture being more often 
 mot with in horses. This does not apply in our country as pha- 
 langeal and metacarpal and even metatarsal fractures are ob- 
 served in more instances than are such injuries to the tibia. The 
 tibia is occasionally broken at its middle and lower thirds, but 
 malleolar fractures are not common. 
 
 Symptomatology. — AVhen fracture is complete and all sun- 
 port is removed, the leg dangles, and the nature of the injury 
 is so obvious that there is no mistaking its identity. However, 
 in case of incomplete fracture one needs to base all conclusi(ms 
 upon the history of the case, evidence of injury, or other knowl- 
 
(LAMENESS IN THE HIND LEG 223 
 
 edge of the character of violence to which this bone has l)een 
 exposed. For without the presence of crepitation (even by ex- 
 cluding other possible causes for the pronounced lameness which 
 characterizes some of these cases) we can only resort to the 
 knowledge which experience has taught that fracture may be 
 deemed probable in many injuries to the til)ial region. Con- 
 sequently, we are to look upon all injuries that affect the tibia 
 as being fractures of some sort when there is either local evidence 
 of the infliction of violence or whenever marked lameness attends 
 such injuries, unless there is positive indication that no fractures 
 exist. 
 
 A careful examination of parts of the tibia, i. e., noting the 
 amount and painfulness of swellings, exploration with the probe, 
 and observations of the course taken in any given case, will 
 determine the exact nature of injuries. Such examination needs 
 to extend over a period of a week or in some instances two or 
 three weeks may pass before the true state of affairs is apparent. 
 In the meanwhile, cases are to be handled as though tibial frac- 
 ture certainly existed. 
 
 Prognosis. — Prediction of the outcome in tibial fracture is 
 somewhat presumptuous, but in the majority of cases in mature 
 subjects fatality results. Cadiot^ however, views this condition 
 with more optimism than have American practitioners. Wliile 
 he considers the condition grave, in citing case reports of suc- 
 cessful treatment by d'Arboval, D'uchemin, Leblanc, and others, 
 his conclusion is that many practitioners erroneously consider 
 fractures of the tibia as incurable. 
 
 The method of handling these cases by Leblanc is as follows : 
 The subject is placed in a sling; a pit is excavated below the 
 affected member so that a heavy weight may be attached to the 
 extremity; splints are applied to each, side of the leg, which is 
 padded with oakum, and this is kept in position by means of 
 bandages covered with pitch; The outer splint extends from 
 the hoof to the stifle and the inner one from the hoof to the 
 upper third of the leg. This method in the hands of Leblanc 
 has been successful in several instances, according to Cadiot. 
 
 ^Traite de Therap. Cliir, Cadiot et .41my, Tome second, page 480, 
 
224 LAMENESS OF THE HORSE 
 
 In a foal the author has in one instance succeeded in obtain- 
 ing complete recovery in a simple fracture of the lower third 
 of the tibia where the only support given the broken bone was 
 a four-inch plaster-of-paris bandage which was adjusted above 
 the hock. Below the tarsus a cotton and gauze bandage was ap- 
 plied to prevent swelling of the extremity. In this instance 
 (an emergency case in which materials that are not to be recom- 
 mended were necessarily employed) recovery took place within 
 thirty days. 
 
 As has been mentioned in the consideration of radial frac- 
 tures, heavj^ leather is better suited for immobilization of these 
 parts than a cast or other rigid splint materials. Mature ani- 
 mals may be expected to resist the immobilization of the hind 
 legs because of the normal manner of flexion of the tarsal and 
 stifle joints in unison. Therefore, the application of rigid splints 
 to the leg and including the hock is productive of disastrous 
 results in some eases. 
 
 The application of cotton and bandages to pad the member 
 and the adjustiug of heavy leather splints on either side of the 
 leg, and retaining them in position with four-inch gauze band- 
 ages will prove more nearly satisfactory than some other meth- 
 ods employed. Prognosis is unfavorable, however, in most cases 
 of compound fracture and recovery is improbable when the 
 upper portion of the tibia is broken. 
 
 Rupture and Wounds of the Tendo AchilHs. 
 
 Etiology and Occurrence. — Cases are recorded by Uhlridi 
 in which rupture has followed degenerative changes affecting 
 the tendo Achillis. Not infrequently, the result of a trauma, 
 division of the tendo Achillis occurs. IMoller states that rupture 
 of this tendon may be due to jumping, in riding horses and in 
 draught horses, in their efforts to avoid slipping. In runaways, 
 it sometimes occurs where sharp-edged implements are l)Ounced 
 against the legs in such fashion tliat division of tlie tendon re- 
 sults. 
 
 Symptomatology.— AVith division of the tendo Aeliillis or 
 of the musculature of the gastrocnemii and the superficial flexor 
 
LAMENESS IN THE HIND LEG 225 
 
 (perforatiis), there remains nothing to inhibit tarsal flexion 
 except the deep flexor tendon (perforans) and this does not sup- 
 port the leg. When attempt is made to sustain weight with the 
 affected member, abnormal flexion of the tarsus takes place and 
 the hock sinks almost to the ground. The symptoms are so char- 
 acteristic that recognition is always easy even in case no wound 
 of the skin exists. 
 
 Prognosis. — Spontaneous recoveries occur and such cases 
 are reported by Bouley who is quoted by Cadiot as having ob- 
 served division of the tendo Achillis due to a sword wound 
 wherein at the end of four mouths recovery was complete. Di- 
 vision of this tendon in brood mares has been practiced by the 
 early settlers of parts of the United States for the purpose of 
 preventing their straying too far from home. In such instances 
 one leg only was so mutilated and in most instances, it is re- 
 ported that spontaneous recovery took place. 
 
 In unilateral involvement without complications, the prog- 
 nosis is not unfavorable if provisions for giving necessary atten- 
 tion are available. 
 
 Treatment.— Tlie subject is to be confined in a sling and the 
 member bandaged and supported by means of leather splints. 
 Immobilization as for fracture is not necessary but, nevertheless, 
 movement is to be restricted as much as possible. In case of 
 open wounds, tiie exposed tissues are cared for along general 
 surgical lines. Where the divided parts of the tendon are main- 
 tained in fairly close and constant relation, granulation of tissue, 
 sufficient to sustain weight takes place in from six weeks to three 
 months. 
 
 Spring-Halt. ( String-Halt. ) 
 
 Occurrence. — This condition is a myoclonic affection of the 
 hind leg which is discussed in works on theory and practice 
 under the head of neuroses, but the cause or causes have not 
 been established. Theories that heredity is responsible have 
 their supporters and advocates of hypotheses attributing it to 
 disease of the sciatic nerve, patellar subluxation, fascial con- 
 traction of various muscles, "dry spavin" (tarsal arthritis), 
 iliac exostoses, disease of the foot and contraction of the hoof. 
 
226 
 
 LAMENESS OF THE HORSE 
 
 are on record in veterinary literature. This ailment affects old 
 horses more frequently than it does young and is seen in all 
 breeds of animals including mules. 
 
 Symptomatology. — This disease develops slowly, and pro- 
 gressively increases in severity as a rule, Init does not ordinarily 
 
 Fig. 52— Spring-halt. 
 
 constitute cause for rendering an animal unserviceable. While 
 the affection is sometimes l)ilateral (occasionally affections of 
 the forelegs are reported) and the extreme flexion of the legs 
 in the spasmodic manner which characterizes spring-halt, cause 
 great waste of energy during locomotion, yet such cases are 
 rare. Usually the ailment is markedly evinced when subjects 
 are first taken from the stable, but as they are exercised the 
 manifestation diminishes, and in many instances it completely 
 subsides. The condition is generally more noticeable when the 
 subject is made to step backward. In some animals there is 
 
L.AMENESS IN THE HIND LEG 227 
 
 marked abduction at the time flexion occurs and in singular 
 instances the spasmodic contraction is so violent that the subject 
 falls to the ground as a result of the peculiar flexion of the leg. 
 In severe cases of "scratches" or chemical irritation of the 
 extremity, the legs are abnormally flexed in a manner which 
 simulates spring-halt, but because of the evident injury of the 
 parts this is not likely to confuse. Since all facts concerning 
 etiological agencies are surrounded with so much obscurity, clas- 
 sification does not lend any particular assistance in the consid- 
 eration of this ailment. 
 
 Prog-nosis. — One cannot intelligently give a prognosis in 
 these cases if forecast is expected to state the exact course fol- 
 lowing treatment. However, in a general way, cases of recent 
 affection are thought more favorable than are those of long stand- 
 ing or in old animals where myositis and other muscular and 
 fascial affections exist owing to years of hard service. 
 
 Treatment. — No known line of medicinal treatment is of 
 service, nor is any particular surgical operation to be considered 
 dependable for obtaining relief. Operations of almost every con- 
 ceivable nature have been tried with the hope of securing recov- 
 ery in spring-halt but under no condition can the practitioner 
 as yet be reasonably certain of effecting permanent relief in any 
 case. Treatment is, therefore, entirely empirical. 
 
 Neurectomies have been performed and recoveries follo\\ing 
 were attributed thereto; fascial divisions in the crural region 
 have been done \^•ith good results and this manner of treatment 
 has its favorers. Advocates of tenotomies, likewise, are to be 
 found. Consequently, one may summarize thus : Spring-halt is 
 a disease of unknown origin — the exact cause has not been deter- 
 mined ; therefore, all treatment is, in a way, experimental. The 
 recommendation of any given procedure in handling cases must 
 then be a matter of opinion based either upon practical experi- 
 ence or knowledge of the experiences of others. Divisions of the 
 lateral digital extensor (peroneus) below the tarsus near its 
 point of insertion to the extensor of the digit is recommended 
 here because it is followed by a percentage of recoveries that is 
 as large as in any other method of treatment and the operation 
 
228 
 
 LAMENESS OF THE HORSE 
 
 V 
 
 k 
 
 
 ^^^^£ ■'./ s^ 
 
 
 ^Ifcjbk %i^J 
 
 ^|Hb^' J^^ 
 
 ^jL- ■ ■..•^.- '•: 
 
 ^ 
 
 % 
 
 
 Li 
 
 
 Fig-. 53— Lateral (external) view of tarsus showing effects of generalized 
 tarsitis. 
 
LAMENESS IN THE HIND LEG 229 
 
 is not difficult to perform nor is its performance fraught with 
 any dangerous complications. In selected subjects about fifty 
 per cent of cases recover in from two to six weeks following this 
 operation. 
 
 Open Tarsal Joint. 
 
 Like the tibia the hock is exposed to frequent injuries and in 
 some cases wounds perforate the joint capsule. When due to 
 calk wounds where horses are kicked, the injury is often on the 
 side of the tarsus (medial or lateral) and such wounds not in- 
 frequently result in infectious arthritis. Horses sometimes jump 
 over wire fences and wounds are inflicted which constitute ex- 
 tensive laceration of the joint capsule. In firing for bone spavin, 
 where a deep puncture is made very near the tibial tarsal (tibio- 
 astragular) joint if infection gains entrance, serious and general- 
 ized infection of the open joint cavity supervenes in some cases. 
 
 Symptomatology. — There is no marked difi^erence in the con- 
 stitutional disturbances which are occasioned in this condition 
 and those encountered in other cases of septic arthritis (previ- 
 ously considered herein) except that there is a difference in tlie 
 degree of resultant derangement and local tissue changes. 
 Chiefly, because of the difficulty encountered in keeping the 
 hock joint in an aseptic condition or securely bandaged, open 
 tarsal joint constitutes a more serious condition than a similar 
 affection of the fetlock. Otherwise, a very similar condition ob- 
 tains and the same diagnostic principles serve here that have 
 been described on page 110 in considering open fetlock joint. 
 
 Treatment. — The same plan that is described in detail for 
 treatment of similar conditions aft'ecting Mie fetlock joint is indi- 
 cated in this affection. Exceeding care must be exercised in 
 bandaging the hock, however, lest the animal be so irritated that 
 in the extreme flexion of the tarsus which is often caused by 
 bandaging, the wound dressings may be completely deranged. 
 A wide gauze bandage material is most satisfactory; cotton of 
 long fiber is separated in thin layers and wound about the hock, 
 extending from the site of injury to a point about six inches 
 proximal to the summit of the os calcis. By using an abundance 
 
230 LAMENESS OF THE HORSE 
 
 of cotton in this way, it will not be found necessary to apply the 
 bandages very snugly; with a four-inch gauze bandage material, 
 which is supported above the cap of the hock and brought across 
 the anterior face of the tarsus in a diagonal manner, a comfort- 
 able and very serviceable protective dressing is provided for. 
 Animals so treated will not ordinarily resist because of pressure 
 from the bandages. Pressure is unavoidable in the use of ad- 
 hesive dressings or where careful attention is not given the man- 
 ner of applying cotton to the parts. Such methods are sure to 
 result disastrouslj^ But if subjects are kept quiet after the 
 parts have been properly bandaged, no difficulty is encountered 
 in maintaining asepsis in an uninfected wound. Recovery takes 
 place in favorable cases in from three weeks to three months, de- 
 pending on the nature and extent of injuries inflicted. 
 
 Fracture of the Fibular Tarsal Bone (Calcaneum.) 
 
 Etiology and Occurrence. — This condition though rarely met 
 with in the horse, is the result of violent strain upon the os 
 caleis by the gastrocnemius and superficial flexor tendons in 
 efforts put forth by animals in attempts to regain a footing when 
 the hind feet slip forward under the body, or in jumping and 
 in falls or direct contusion by heavy bodies. Hoare^ reports a 
 case of a mare that had produced fracture in jumping. 
 
 Fracture of the other tarsal bones are very seldom observed 
 but may be occasioned by contusions wherein multiple or com- 
 minuted fractures are produced, such as are to be seen in small 
 animals. Fracture of the tibial tarsal bone (astragalus) is to be 
 observed as a complication in luxations of the tarsal joint and, 
 according to Cadiot, the other tarsal bones may likewise suffer 
 fracture in luxations of the hock. 
 
 Symptomatology. — Great pain attends this accident accord- 
 ing to the observations given in recorded cases. In the case 
 cited by Hoare the animal evinced great pain and uneasiness; the 
 hock was unduly flexed; the calcaneum was displaced forward; 
 and marked crepitation was present. A portion of the body of 
 
 IE. W^allis Hoaro, F. R. C. V. S., American Veterinary Review, Vol. 27, 
 page 1189. 
 
LAMENESS IN THE HIND LEG ?31 
 
 the calcaneum was protruding through the perforated skin. The 
 animal was destroyed and the bone was found l)roken in three 
 pieees. 
 
 Sinee the support for the tendo Achillis is removed in such 
 
 1 
 
 Tuber calcis 
 
 Lateral malleolus 
 
 Short liitiral ligament E_ jp \ 
 
 / 
 
 1 
 
 / Short meiiial ligavjeittn 
 
 ''rochlea of tibial tarsal 
 bone 
 
 T.f.— . ^- 
 T.4 - 
 
 T t. 
 
 Dorsal lii/ament 
 
 Mt. IV , _ - - r. .3 
 
 . Mt. Ill 
 
 Fig. 54 — Right hock joint. Viewed from the front and slightly laterally 
 after removal of joint capsule and long collateral ligaments. T. t., Tibial 
 tarsal bone (distal tuberosity). T. c, central tarsal bone. T. 3. Ridge of 
 third tarsal bone. T. f. Fibular tarsal bone (distal end). T. 4. Fourth tarsal 
 bone. Mt. Ill, Mt. IV. Metatarsal bones. Arrow points to vascular canal. 
 (From Sisson's "Anatomy of the Domestic Animals.") 
 
 fracture and no leverage on the metatarsus obtains, it naturally 
 follows that any attempt to sustain weight must result in extreme 
 flexion of the hock and descent of this part in a manner similar 
 to cases of rupture or division of the Achilles' tendon. The two 
 conditions should not be confused, however, as the parts may be 
 
232 LAMENESS OF THE HORSE 
 
 definitely outlined by palpation and the slack condition of the 
 tendon and displaced summit of the calcaneum, which charac- 
 terize fracture of the fibular tarsal bone, are easily recognized. 
 Treatment. — Prognosis is unfavorable in the majority of 
 cases, but should attempts at treatment be undertaken in young 
 and quiet mares which might prove valualjle for breeding pur- 
 poses in case of imperfect recovery, they should be put in slings 
 and the member is to be immobilized as in tibial fracture. Au- 
 thorities are agreed that prognosis is entirely unfavoralile in 
 mature animals, when the case is viewed from an economic stand- 
 point. 
 
 Tarsal Sprains. 
 
 Etiology and Occurrence. — The hock joint is often sul)jected 
 to great strain because of the structural ju^ture of this part and 
 its relation to the hip as well as the manner in which the tarsus 
 functionates during locomotion. That ligamentous injuries ow- 
 ing to sprain frequently occur and attendant periarticular in- 
 flammations with subsequent hypertrophic changes follow, is a 
 logical inference. Fibrillary fracture of the collateral ligaments 
 may take place in falls or when animals make violent efforts 
 to maintain their footing on slippery streets. In expressing 
 opinions concerning the frequency with which the hock is found 
 to be the seat of trouble in lameness of the pelvic members, dif- 
 ferent writers place the percentage of hock lameness at from 
 seventy-five to ninety per cent. And when one considers the 
 possibility that a goodly proportion of cases of tarsal exostis are 
 the outcome of sprains, the occurrence of tarsal sprains may be 
 more generally admitted. 
 
 Symptomatology. — A mixed type of lameness is present and 
 the nature of the impediment varies, depending upon the loca- 
 tion of the injury. Sprains of the mesial tarsal ligaments cause 
 lameness some^\hat similar to that of spavin. However, in es- 
 tablishing a diagnosis, local evidence in these cases is of greater 
 significance than the manner of locomotion. During the acute 
 stage of inflammation there is to be detected local hyperthermia, 
 some hyperesthesia and a little swelling. Later, when resolution 
 is not prompt, considerable swelling (or perhaps correctly speak- 
 
LAMENESS IN THE HIND LEG 233 
 
 ing, an iiulurated enlargement) variable in size is developed. 
 In some cases the entire tarsal region becomes greatly enlarged 
 and this swelling is very slowly absorbed in part or completely. 
 Sneh snb-acnte cases are observed dnring the winter season and 
 particularly where subjects are kept in tie stalls without exercise 
 for weeks at a time. 
 
 Treatment. — Attention slionld be directed toward i-elief foi- 
 the animal in all acute inflammations. Local applications of 
 heat are helpful and, of course, rest is essential. Towels that 
 are wrung out of hot water and held in position by means of a 
 few turns of a loose bandage and this covered with an imper- 
 vious rubber sheet, will serve as a practical means of application 
 of hydrotherapy. Following this when conditions improve, as 
 in the handling of all similar cases, counterirritation is indi- 
 cated. 
 
 When proper care is given at the onset and where injury does 
 not involve too much ligamentous tissue, recovery takes place 
 in a few weeks but in some cases which occur during the winter 
 season in farm horses, complete recovery does not result until 
 several months have passed. 
 
 Curb. 
 
 The hock is said to be curl)ed when the normal appearance, 
 viewed from the side, is that of bulging posteriorly at any point 
 between the summit of the calcaneum and the upper third of 
 the metatarsus. Among some horsemen a hock is said to be 
 "curby" whenever there exists an enlargement of any kind on 
 the posterior face of the tarsus whether it be due to sprain, 
 exostosis or proliferation of tissue as a result of contusion. 
 
 French veterinarians consider under the title of "courbe," an 
 exostosis situated on the mesial side of the distal end of the tibia. 
 Cadiot and Almy state that this condition (courbe) is of rare 
 occurrence. Percivall defines curb as "a prominence upon the 
 back of the hind leg, a little below the hock, of a curvilinear 
 shape, running in a direct line downwards and consisting of 
 infusion into, or thickening of, the sheath of the flexor tendons. ' ' 
 Moller's version of true curb is a thickening of the plantar liga- 
 ment (calcaneocuboid or calcaneometatarsal). Hughes and Mer- 
 
234 LAMENESS OF THE HORSE 
 
 illat consider curb as a synovitis having for its seat the synovial 
 bursa which is situated between the superficial flexor tendon 
 (l)erforatus) and the plantar ligament. 
 
 Occurrence. — Certain predisposing factors seem to favor the 
 occurrence of curb. A malformation of tlie inferior part of the 
 tai-sus so that its antero-posterior diameter is considei'ably less 
 than normal is a contributing cause. Such hocks are known as 
 "tied-in." Another fault in conformation is the existence of a 
 weak hock that is set low down on a crooked leg, especially when 
 such a member is heavily muscled at the hip. Given such con- 
 formation in an excitable horse, and curb is usually produced be- 
 fore the subject is old enough for service. It is certain that in 
 cases where conformation is bad, greater strain is put upon the 
 plantar ligament. This structure serves to bind the tibial tarsal 
 (calcis) bone to the metatarsus; traction exerted upon its sum- 
 mit by the tendo Achillis is great when animals run, jump or 
 rear and also at heavy pulling. In animals having curby hocks, 
 sprain is likely to result and curb supervenes. 
 
 Symptomatology. — The characteristic swellins: which marl^-s 
 curl) may develop quickly and lameness occur suddenly or the 
 enlargement comes on gradually and slowly, causing little lame- 
 ness. Lameness is not proportionate to the si7e of the swelling 
 and in all cases whether subacute or chronic, the condition im- 
 proves with rest, but lameness is again manifested upon exertion. 
 A horse which "throws a curb" will go lame until the acute 
 inflammatorv condition subsides and depending upon treatment 
 received and conformation of the hock, this requires from three 
 days to two or three weeks. 
 
 The character of the swelling varies; in some cases it is not 
 larsre but rather dense and lacking in evidence of heat and 
 hvperesthesia ; in other eases there is considerable swellinsr, which 
 is hot and doughy, somewhat painful to the touch but not neces- 
 sarilv productive of much lameness. Tn anv event, whether the 
 swelling or enlargement is bier or little, its location makes it 
 conspicuous when viewed in profile. 
 
 Tn most cases after the acute inflammatory period has passed, 
 lameness is slight, if at all present, and in time no interference 
 
(LAMENESS IN THE HIND LEG 
 
 235 
 
 with the subject's usefulness is occasioned because of the curb, 
 but the animals often remain blemished — complete resorption 
 of inflammatory products being- unusual wlien much disturbance 
 has existed. 
 
 Treatment. — The handling of curl) during the acute inflani- 
 niMtdry stage is along the same lines as in sprain — local applica- 
 
 4^ 
 
 Fig. 55 — Spavin. 
 
 tiotis of cold and heat. Subjects must be kept quiet until all 
 inflamnuition has subsided, for there are no cases wherein a 
 little brisk exercise is more likely to cause a recurrence of lame- 
 ness before recovery is complete than in curb. Vesication is in 
 order in a week or ten days after the affection has set in ; in old 
 stubborn cases that have resisted ordinary treatment for a few 
 months, the use of the actual cautery (line firing) is to be recom- 
 mended. 
 
 Spavin. (Bone Spavin.) 
 This term is applied to an affection of the tarsus which is usu- 
 ally characterized by the existence of an exostosis on the mesial 
 
236 LAMENESS OF THE HORSE 
 
 and inferior portion of the liock. There is also included under 
 this name, articular inflammation wherein no external evidence 
 is shown. Spavin lameness has long been recognized and much 
 has been written upon this subject. Since authorities are agreed 
 that most cases of lameness in the hind leg are due to hock 
 affection, and because the majority of cases of lameness which 
 have the tarsal region as the seat of trouble are instances of spa- 
 vin lameness, this disease merits all the attention it has received. 
 
 Etiology and Occurrence. — Causes may well be classified as 
 predisposing and exciting, for there are many etiologic factors 
 to be reckoned with in spavin, some of which are widely different 
 in nature. 
 
 Considered as predisposing causes, hereditary influences play 
 an important role and may, owing to faulty conformation, sub- 
 ject an animal to affections of this kind because of dispropor- 
 tionate development of parts (weak and small joints and heavy 
 muscular hips) ; or as a consequence of inherited traits, a sub- 
 ject may manifest susceptibility to degenerative bone changes 
 which are signalized by the formation of exostoses of different 
 parts on one or more of the legs. Hereditary predispositions 
 make for the presence of spavin in a large percentage of the 
 progeny of sires so aft'ected. This fact has been repeatedly 
 demonstrated in this country as well as elsewhere according to 
 Quitman, Dalrymple and Merillat.^ A number of states have 
 passed stallion inspection laws stipulating that animals having 
 such exostoses as spavin and ringbone cannot be registered ex- 
 cept as ''unsound." 
 
 Asymmetrical conformation, particularly where the hock is 
 obviously small and weak as compared with other parts of the 
 leg, constitutes a noteworthy predisposing cause. 
 
 Peters' theory is plausible that the screw-like joint between 
 the tibia and the tibial tarsal (astragulus) bones causes these 
 structures to functionate in a manner not in harmony with the 
 provisions allowed by the collateral ligaments of the tarsus, per- 
 
 iDiscussions on paper entitled "The Spavin Group of Lamenesses," hy W. L. 
 Williams, Carl W. Fisher and D. H. Udall, Proceedings of American Veteri- 
 nary Medical Association, 1905. 
 
LAMENESS IN THE HIND LEG 237 
 
 mitting movement only in a direction parallel with the long axis 
 of the body. 
 
 Because of the quality of their temperaments, nervous animals 
 possessing no particular congenital structural defects of the 
 hock and having no history of spavined progenitors, are subject 
 to spavin when kept at work likely to produce tarsal sprain. 
 Spavin usually develops early in such subjects and examples of 
 this kind may be frequently observed in agricultural sections 
 of the country. Where spavin develops in unshod colts at three 
 and four years of age, shoeing is not an influencing agency when 
 animals are not worked on pavements. 
 
 Exciting causes of spavin are sprain and concussion. Various 
 hypotheses are recorded as to how sprains are influenced and 
 among others may be mentioned that of McDonough^, which is 
 that the foot is robbed of its normal manner of support by the 
 ordinary three-calked shoe. With such a shoe, little support is 
 given the sides of the foot; hence, undue strain is put upon the 
 collateral ligaments of the tarsus. ^Moreover, the shoe with its 
 calks increases the length of the leg and adds to the leverage 
 on the hock, by virtue of such added length. This makes for 
 greater strain upon the mesial or lateral tarsal ligaments when- 
 ever the foot bears upon a sloping ground surface, so that one 
 side (inner or outer) is higher or lower than the other. But 
 according to McDonougli's theory (a good one concerning horses 
 that work on pavements), the chief error in shoeing lies in that 
 the foot is deprived of its normal base or support on the sides 
 — the three-calked shoe being an unstable support — and that 
 this manner of shoeing city horses working on pavements is an 
 "inhumane" practice, a "diabolical method." 
 
 Wliether spavin has its point of origin within the articulation 
 as a rarefying ostitis of the cancellated structure of the lower 
 tarsal bones as suggested by Eberlein ; or, as Diekerhoff asserts, 
 that the cunean bursa may be the initial point of affection, is 
 unsettled ; but it is reasonable to consider occult spavin as having 
 its origin within the articulation, and that cases readily yielding 
 
 i"Hock-Joint Lameness," by Dr. James McDonough, Proceedings of the 
 A. V. M. A., 1913, page 545. 
 
238 LAMENESS OF THE HORSE 
 
 to cunean tenotomy are primarily due to affection of the cunean 
 bursa. 
 
 Symptomatology. — Where a visible exostosis exists, the pres- 
 ence of spavin is easily detected, yet exostoses that extend over 
 large areas may constitute cause for serious trouble and still be 
 difficult of detection. By observing the internal surface of the 
 hock from various suitable angles, such as from between the 
 forelegs or directly behind the subject, one may note the pres- 
 ence of any ordinary exostosis. 
 
 The position assumed by the spavined horse is often charac- 
 teristic. More or less knuckling is usually present (Liautard, 
 McDonald) . There is abduction of the stifle in some cases, or the 
 toe may be worn in unshod horses so that it presents a straight 
 line at the surface. This is manifested to a great degree in some 
 animals and in others the foot is not dragged and there is no 
 wearing of the hoof at the toe. 
 
 Spavin lameness is so distinctive that one trained and experi- 
 enced in the examination of horses that are spavined, should 
 correctly diagnose the condition in practically every instance 
 without recourse to other means than noting the peculiar char- 
 acter of the gait of the subject. Lameness develops gradually 
 in the majority of instances, and an important feature in spavin 
 lameness is that it disappears after the subject has gone a little 
 way, to return again as soon as the animal has rested for a 
 variable length of time— from a half hour to several hours. This 
 "warming out" is marked during the incipient stage, but less 
 pronounced in most chronic cases. A complete disappearance 
 of lameness is observed in some instances, while in others only 
 partial subsidence is evident. Because of the fact that pain is 
 occasioned both during weight bearing and while the leg is being 
 flexed and advanced, there is manifested the characteristic mixed 
 lameness and exaggerated hip action which typifies spavin. By 
 throwing the hips upward with the sound member it is possible 
 to advance the affected leg with less flexion, hence less pain is 
 experienced in this manner of locomotion. When made to step 
 aside in the stall, a spavined horse will flex the affected member 
 abruptly and when weight is taken on the diseased leg, symp- 
 
(LAMENESS IN THE HIND LEG 239 
 
 toms are evinced of pain, and weight is immediately shifted to 
 the sound limb. This is marked during the incipient stages of 
 spavin. Lameness usually precedes the formation of exostosis, 
 though cases are observed wherein an exostosis is present and 
 no lameness is manifested and no history of the previous exist- 
 ence of lameness is available. 
 
 The "spavin test" is of value as a diagnostic measure when 
 it is employed with other means of examination, though reaction 
 to this test is seen in some cases in old "crampy" horses that 
 have experienced hard service. The test consists in flexing the 
 affected leg (elevating the foot from the ground twelve to 
 twenty- four inches) and holding the member in this position for 
 a minute, whereupon the animal is made to step away immedi- 
 ately at a trot. During the first few steps taken directly there- 
 after, the subject shows pronounced lameness and this constitutes 
 a reaction to the spavin test. 
 
 Where no exostosis is present it becomes necessary to exclude 
 other causes for lameness but the characteristic spavin-lameness 
 is to be relied upon to a greater extent in such cases than are 
 other means of examination. Such cases are known as occult 
 spavin and may be present for months before any external 
 changes in structure are observable. In some instances no ex- 
 toses form even during the course of years. The spavin test is 
 of aid in establishing a diagnosis here but the marked "warm- 
 ing out" peculiar to spavin is not so pronounced in such cases. 
 
 Prognosis. — An animal having hereditary predisposition to 
 spavin is not likely to recover completely whether this predis- 
 position be due to faulty conformation or susceptibility to bone 
 changes. In predicting the outcome, the temperament of the 
 subject is to be taken into account, as well as the character of 
 service the animal is expected to perform. And finally, a very 
 important feature to be noted, is the location of the exostosis. 
 If situated rather high and extending anterior to the hock, there 
 is less likelihood of recovery resulting than where an exostosis 
 is confined to the lower row of tarsal bones. When situated 
 anterior to the tarsus a large exostosis may by mechanical inter- 
 ference to function, cause lameness when all other causes are 
 
240 LAMENESS OF THE HORSE 
 
 absent. In making examinations one must not be deceived 
 by the inconspicuous and seemingly insignificant exostosis which 
 has a broad base. In some eases of this kind, dealers style the 
 condition as "rough in the hock" when as a matter of fact, in 
 some instances, incurable spavin lameness develops. 
 
 Treatment. — Many incipient cases of spavin yield to vesica- 
 tion and a protracted period of rest. Results depend primarily, 
 upon the nature of the affection. However, in every instance 
 if there is involvement of the tibial tarsal (astragalus) bone, 
 complete recovery is highly improbable. When the disease is 
 confined to the lower tarsal bones, lameness subsides as soon as 
 the degenerative changes are checked and ankylosis occurs. 
 
 The use of the actual cautery when properly employed con- 
 stitutes an excellent method of treatment. The "auto-cautery" 
 when equipped with a point of about one-eighth of an inch in 
 diameter and about three-fourths of an inch in length is well 
 suited for this particular operation. Before deciding to cauter- 
 ize, it is necessary to ascertain the extent of area affected. The 
 nearness of the exostosis to the tibiotarsal articulation can be 
 definitely determined by palpation. The hair over the entire 
 surgical field is clipped and the cautery at white heat is pushed 
 through the overlying soft tissues and into the central part of 
 the exostosis. Care is taken to keep the cautery-point away from 
 the articular margin of the tibial tarsal bone about three-fourths 
 of an inch. No danger will result from cauterizing to a depth 
 of three-fourths of an inch in the average case. Two or three 
 (and not more) centrally located points for penetration with the 
 cautery are sufficient. Experience has shown that several (five 
 or six or more) punctures are not productive of good results. 
 When considerable cicatricial tissue is present, due to the action 
 of depilating vesicants or other chemicals, sloughing of tissue 
 is very apt to follow deep cauterization, if one is not careful to 
 keep the punctures at least one-half inch apart when three are 
 made. It is best, in such cases, to make but two deep penetra- 
 tions with the cautery but additional superficial punctures may 
 be made if kept about three-fourths of an inch distant and not 
 nearer than this to one another. Sloughing of tissue is not nec- 
 essarily productive of bad results but there is occasioned an open 
 
LAMENESS IN THE HIND LEG 241 
 
 wound wliieli usually becomes infected and necrosis of tissue may 
 extend into the articulation. No benefit results from sloughing 
 and it should be avoided. In small horses, one deep point of 
 cauterization is sufficient if the osseous tissues are penetrated to 
 a proper depth so that an active inflammation is induced. The 
 cautery may, if necessary, be reintroduced several times. When 
 the field of operation has been properly prepared and it is 
 thought advisable (as where subjects are kept in the hospital for 
 a time), the hock may be covered with cotton and bandaged and 
 no chance for infection w^ill occur. 
 
 After cauterization the subject should be kept quiet in a com- 
 fortable stall for three wrecks; thereafter, if the animal is not 
 too playful, the run of a paddock may be allowed for about ten 
 days and a protracted rest of a month or more at pasture is 
 best. It is unwise in the average case to put an animal in 
 service earlier than two months after having been "fired." 
 
 Where cases progress favorably, lameness subsides in about 
 three weeks after cauterization and little if any recurrence of 
 the impediment is manifested thereafter. However, because of 
 violent exercise taken in some instances when subjects are put 
 out after being confined in the stall, a return of lameness occurs 
 and it may remain for several days or in some cases become per- 
 manent. No good comes from the use of blistering ointments 
 immediately after cauterization. The actual cautery is a means 
 of producing all necessary inflammation and it should be so em- 
 ployed that sufficient reactionary inflammation succeeds such 
 firing. The use of a vesicating ointment subsequent to cauteriza- 
 tion invites infection because of the dust that is retained in con- 
 tact with the w^ound. The employment of irritating chemicals 
 in a liquid form following firing is needless and cruel. 
 
 In many instances lameness is not relieved and subjects show 
 no improvement at the end of six weeks time and it then becomes 
 a question of whether or not recovery is to be expected even with 
 continued rest and treatment. As a rule, such cases are unfavor- 
 able. In one instance the author employed the actual cautery 
 three times during the course of six months and lameness gradu- 
 ally diminished for a year. In this case the spavin was of nearly 
 one year's standing when treatment was instituted. The sub- 
 
242 LAMENESS OB" THE HORSE 
 
 jeet was a nervous and restless but well-formed seven-year-old 
 gelding. Recovery was not complete; recurrent intervals of 
 lameness marked this case, but the horse limped so slightly that 
 the average observer could not detect its existence after the ani- 
 mal had been driven a little way. 
 
 Cunean tenotomy has been advocated and practiced by Abild- 
 gaard, Lafosse, Peters, Herring, Zuill and others and good re- 
 sults have followed in many cases so treated. 
 
 Considering results, the employment of chemicals of various 
 kinds for the purpose of relieving spavin lameness does not com- 
 pare favorably with firing. IMoreover, so many animals have 
 been tortured and needlessly blemished in the attempted cure 
 of spavin that agents which are not of known value, the use of 
 which are likely to result in extensive injury to the tissues, are 
 only to be condemned. 
 
 When spavin is bilateral and lameness is likewise affecting 
 both members, prognosis is at once unfavorable. Such cases are 
 often benefited by cauterization but only one leg at a time should 
 be treated. 
 
 Bossi's double tarsal neurectomy (division of the anterior and 
 posterior tibial nerves) has undoubtedly been of decided benefit 
 in many cases, but is not at present a popular method of treat- 
 ment in this country. This operation has its indications, how- 
 ever, and may be recommended in chronic lameness where no 
 extensive exostosis exists which may mechanically interfere with 
 function. 
 
 Distension of the Tarsal Joint Capsule. (Bog Spavin.) 
 
 Distension of the capsular ligament of the tibial tarsal (tibio- 
 astragular) joint with synovia is commonly known as bog spavin. 
 This condition is separate and distinct fiom that of distension 
 of the sheath of the deep flexor tendon (j^erforans) though not 
 infrequently the two affections coexist. 
 
 Etiolog'y and Occurrence. — Following strains from work in 
 the harness or under the saddle, horses develop an acute syno- 
 vitis of the hock joint, which often results in chronic synovial 
 distension. Debilitating diseases favor the production of this 
 
OLAMENESS IN THE HIND LEG 
 
 243 
 
 affection in some animals. It is also frequently observed in 
 young horses and in draught colts of twelve to eighteen months 
 of age. This condition occurs while the subjects are at pasture 
 
 Fig. 56 — Bog spavin. Showing point of view which may be most advan- 
 tageously taken by the diagnostician in examining for distension of the 
 capsular ligament of the tarsal joint. 
 
 and often spontaneous recovery results by the time the animals 
 are two years of age. 
 
 Symptomatology. — Bog spavin is recognized by the dis- 
 tended condition of the joint capsule which is prominent just 
 below the internal tibial malleolus and this affection is character- 
 
244 LAMENESS OF THE HORSE 
 
 ized by a fluctuatiug swelling which varies considerably in size 
 in different subjects. Except in cases of acute synovitis, lame- 
 ness is not present and in chronic distension of the capsule of 
 the tarsal joint, no interference with the subject's usefulness 
 occurs. In the majority of instances, the disfigurement which 
 attends bog spavin is the jDrincipal objectionable feature. The 
 condition is bilateral in many instances, and in such cases the 
 subjects have a predisposition to this condition or it follows 
 attacks of strangles or other debilitating ailments. Because of 
 a rapid and unusual growth, bilateral affections are of frequent 
 occurrence in some animals. 
 
 Treatment. — The most practical method of handling bog 
 spavin consists in aspiration of synovia and injection of tincture 
 of iodin. Discretion should be employed in selecting subjects 
 for treatment, regardless of the manner in which such cases are 
 to be handled. Where there exists chronic distension of the 
 joint capsule of several years' standing in old or weak subjects, 
 needless to say, recovery is not likely to result. When animals 
 are vigorous and two or three months' time is available, treat- 
 ment may be begun with reasonable hope for success. 
 
 The average subject is handled standing and can be restrained 
 with a twitch, sideline and hood. Aspirating needles and all 
 necessary equipment must be in readiness (sterile and wrapped 
 in aseptic cotton or gauze) so that no delay will occur from this 
 cause when the operation has been started. The central or most 
 prominent part of the distended portion of the capsule is chosen 
 for perforation and an area of an inch and a half in diameter 
 is shaved. The skin is cleansed and then painted with tincture 
 of iodin. The sterile aspirating needle is pushed through the 
 tissues and into the capsule with a sudden thrust. With a large 
 and sharp needle (fourteen gauge), synovia can be drawn from 
 the cavity in most instances and the subject usually ott'ers no 
 resistance. By compressing the distended capsule and surround- 
 ing structures with the fingers, considerable synovia may be 
 evacuated. In singular instances, no synovia is to be aspirated 
 with the needle, and in such cases the amount of iodin injected 
 needs be increased, possibly twenty-five per cent., as experience 
 
[LAMENESS IN THE HIND LEG 245 
 
 will indicate. From two to five cubic centimeters of U. S. P. 
 tincture of iodin is injected through the aspirating needle into 
 the synovial cavity of the joint, and the exterior of the parts are 
 vigorously massaged immediately after injection to stimulate 
 distribution of the iodin throughout the synovial cavity. "Where 
 a bilateral affection exists, two or three weeks' time should inter- 
 vene between the treatments of each leg. A sterile metal syringe 
 equipped with a slip joint for the needle is well adapted to this 
 operation. Lubrication of the plunger with heavy sterile vaseline 
 or glycerin will prevent the syringe from being ruined by the 
 iodin. 
 
 Following the injection, the subject is kept in a stall or in 
 a suitable paddock, so that conditions may be observed for four 
 or five days. The object sought by the introduction of iodin 
 is not only for a local effect upon the synovial membranes in 
 checking secretions, but the production of an active inflamma- 
 tion and great swelling, which will remain from four weeks 
 to three months subsequent to the injection. This periarticular 
 swelling should produce and maintain a constant pressure over 
 the entire affected parts for a sufficient length of time until nor- 
 mal tone is re-established. 
 
 In some cases, swelling does not develop as the result of a 
 single injection of iodin. When marked swelling has not taken 
 place within five days, none will occur and a repetition of the 
 injection may be made within ten days after the first treatment 
 has been given. One may safely increase the amount of iodin 
 at the second injection in such cases by one-fourth to one-third. 
 In Europe this method of treating bog spavin has been em- 
 ployed by Leblanc, Abadie, Dupont and others according to 
 Cadiot; but Bouley, Key, Lafosse and Varrier used it with bad 
 results. Where a perfect technic is executed (and no other is 
 excusable in this operation), no infection will occur if a reason- 
 able amount of iodin is injected. The dilution of iodin with an 
 equal amount of alcohol has been practised by the author in 
 many cases, but later this was found unnecessary. 
 
 Other methods of treatment have been used with success. Per- 
 haps the most heroic consists in opening the joint capsule with a 
 
246 LAMENESS OF THE HORSE 
 
 bistoury or with the actual cautery. Such practice is too hazard- 
 ous for general use and is not to be recommended, although good 
 results should follow the employment of such methods if infec- 
 tious arthritis does not occur. 
 
 Line firing over the distended capsule is a practical method 
 of treatment. This is attended with good results in young ani- 
 mals in many cases, but considerable blemish is caused when 
 sufficient irritation is produced to stimulate resolution. 
 
 Vesication also is successfully employed in some instances. 
 However, only eases of recent origin in young animals — colts of 
 two years or younger — yield to blistering, and in some affected 
 colts no doubt recovery would have been spontaneous had no 
 treatment been instituted. 
 
 Ligation of the saphenous vein at two points, one above and 
 the other below the distended ligamentous capsule, is an old 
 operation, which has undoubtedly given good results in some 
 cases, although it does not seem to be a rational procedure. 
 
 After-Care. — After swelling has fully developed — which oc- 
 curs witliin a week — the subject is turned to pasture and no at- 
 tention is necessary thereafter. A gradual subsidence of the 
 swelling occurs and in the average instance, this completely re- 
 solves within six or eight weeks. 
 
 Complete recovery succeeds the aspiration-and-injection-treat- 
 ment in about seventy-five per cent of cases as the result of one 
 operation, and subjects may be gradually and carefully returned 
 to work in about sixty days after treatment has been given. 
 
 Distension of the Tarsal Sheath of the Deep Digital Flexor. 
 ( Thoroughpin. ) 
 
 The terms ''thoroughpin" or "throughpin" are translations 
 from the French vessignon clieviUe and have the same signifi- 
 cance. They are so named because of the diametrically opposed 
 distensions of the sheath of the deep flexor tendon in such man- 
 ner that the distensions appear to be due to a supporting peg. 
 
 Anatomy. — The theca tlirough whieli the deep digital flexor 
 (perforans) plays in the tarsal region, begins about three inches 
 
LAMENESS IN THE HIND LEG 247 
 
 above the inner tibial malleolus and extends about one-fourth 
 of the way down the metatarsus. The posterior part of the 
 capsular ligament of the hock joint is very thick in its most 
 dependent portions and is in part cartilaginous, forming a suit- 
 able groove for the passage of the deep flexor tendon. 
 
 Etiology and Occurrence. — Strains and sequellae to debili- 
 tating: diseases constitute the usual causes of this affection. As 
 
 Lz^y 
 
 Fig. 57— Thoroughpin. Showing distension of tlie sheath of the deep flexor 
 tendon as it protrudes antero-externally to the fibular tarsal bone (cal- 
 caneum). 
 
 a result of acute synovitis a chronic synovial distension of the 
 tarsal sheath occurs. Bog spavin is often present in case of 
 thoroughpin but the two conditions are separate and distinct 
 excepting in that both may occur simultaneously and as the 
 result of the same cause. Some animals are undoubtedly pre- 
 disposed to disease of synovial structures. The average horse 
 that has been subjected to hard service on pavements or hard 
 roads at fast work suffers synovial distension of bursae, thecae 
 or of joint capsules. Some of the well bred types such as the 
 
248 LAMENESS OF THE HORSE 
 
 thoroughbred liorses may be subjected to years of hard service 
 and still remain "clean limbed" and free from all blemishes. 
 Thus it seems that subjects of rather faulty conformation, ani- 
 mals having lymphatic temperaments and the coarse-bred types, 
 are prone to synovial disturbances such as thoroughpin, bog 
 spavin, etc., sometimes having both legs affected. 
 
 Symptomatology. — Thoroughpin is characterized by a dis- 
 tended condition of the tarsal sheath which is manifested by 
 
 Fig. 58 — Fibrosity of larsus as a complication in clironic thoroughpin. 
 
 protrusions anterior to the tendo Achillis. However, where but 
 moderate distension of the sheath exists, there is little, if any, 
 bulging on the mesial side of the hock and but a small hem- 
 ispherical enlargement is presented on the outer side of the 
 tarsus, anterior to the summit of the os calcis. In some instances 
 the protruding parts assume large proportions, but always, be- 
 cause of the relationship between the fibular tarsal bone (cal- 
 caneum) and the tendon sheath, the larger protrusion is situated 
 mesially. 
 
LAMENESS IN THE HIND LEG 
 
 249 
 
 During the acute inflammatory stage there is marked lameness 
 present but this soon subsides when local antiphlogistic agents 
 are applied to the parts. In fact, spontaneous relief from lame- 
 ness usually results in the course of ten days' time following the 
 appearance of thoroughpin. No lameness marks the advent of 
 
 Fig-. 59 — Another view of same case as illustrated in Fig. 58. 
 
 this affection when it develops as the result of continuous strain 
 and concussion occasioned by hard service, and local changes 
 tend to remain in status quo. 
 
 Treatment. — Rest and the local application of heat or cold 
 will suffice to promote resolution of acute inflammation and lame- 
 ness when present will subside within two weeks. In chronic 
 affections, however, the matter and manner of effecting a cor- 
 
250 LAMENESS OF THE HORSE 
 
 rection of the condition — distended tarsal sheath — merit careful 
 consideration. AVhile drainage of distended thecae and bursae 
 by means of openings made with hot irons was practiced by the 
 Arabs, centuries ago, and good results have attended such heroic 
 corrective measures, nevertheless the occasional serious complica- 
 tions which result from infection likely to be introduced in fol- 
 lowing such procedures, cause the prudent and skilful practi- 
 tioner to employ safer methods of treatment. 
 
 The application of blistering agents is of no value in stimu- 
 lating resorption of an excessive amount of synovia in chronic 
 cases and the actual cautery when employed without perfora- 
 tion of the synovial structure, is of little benefit. Trusses or 
 mechanical appliances for the purpose of maintaining pressure 
 upon the distended parts are of no practical value because 
 of the great difficulty of keeping such contrivances in position. 
 They usually cause so much discomfort to the subject that they 
 are not tolerated. 
 
 A very practical and fairly successful method of treatment 
 consists in the aspiration of a quantity of synovia and injecting 
 tincture of iodin. Cadiot recommends the drainage of synovia 
 with a suitable trocar and cannula and injecting a mixture 
 consisting of tincture of iodin, one part, to two parts of sterile 
 water, to which is added a small quantity of potassium iodid. 
 The latter agent is added to prevent precipitation of the iodin. 
 This authority (Cadiot) further advocates the removal of prac- 
 tically all of the synovia that will run out through the cannula 
 and the immediate introduction of as much as one hundred cubic 
 centimeters of the above mentioned iodin solution. This solu- 
 tion is allowed to remain in the synovial cavity a few minutes 
 and by compressing the tissues surrounding the tendon sheath, 
 the evacuation of as much of the contents of the synovial cavity 
 as is practicable, is effected. Subsequently the subject is al- 
 lowed absolute rest and more or less inflammatory reaction fol- 
 lows. In some cases there occur marked lameness and some 
 febrile disturbance, but where a good technic is carried out, 
 no bad results follow. At the end of four weeks' time, horees 
 so treated may be returned to service, but the full beneficial 
 
[LAMENESS IN THE HIND LEG 251 
 
 effect of such treatment is not experienced until several months' 
 time have elapsed. 
 
 Where good facilities for executing a careful technic in every 
 detail are at hand, incision of the tarsal sheath, evacuation of 
 its contents and uniting its walls again by means of sutures 
 and providing for drainage with a suitable drainage tube, may 
 be practiced. This manner of treatment has been satisfactory 
 in the hands of a number of surgeons. 
 
 Capped Hock. 
 
 Enlargements which occur upon the summit of the os calcis, 
 whether hypertrophy of the skin and rmbcuticular fascia, the 
 result of injury or repeated vesication, distension of the sub- 
 cutaneous bursa or injury to the superficial flexor tendon (per- 
 foratus) or its sheath, are generally known as capped hock. 
 However, the term should be restricted to use in reference to 
 distensions of synovial structures of that region. 
 
 Etiology and Occurrence. — Usually there occurs a hygrom- 
 atous involvement of the subcutaneous bursa due to contusion. 
 As in bog spavin, following certain infectious diseases (influ- 
 enza, purpura hemorrhagica, etc.) there remains a distended con- 
 dition of the subcutaneous bursa, after swelling of the member 
 has subsided. In feeding pens where numbers of young mules 
 are kept in crowded quarters many cases may be observed. In 
 some instances where violent contusions result from kicking 
 cross-bars of wagon shafts (by nymphomaniacs or in habitual 
 kickers where there is opportunity for doing such injury) the 
 superficial flexor tendon and its synovial apparatus are injured 
 and a more serious condition may result. 
 
 Symptomatolog'y. — In acute and extensive inflammation of 
 the pai'ts, lameness is present, but in the average case no in- 
 convenience to the subject results. The prominent site of the 
 affection is cause for an unsightly blemish. This is undesirable, 
 particularly in light-harness or saddle horses. These affections 
 are characterized by a fluctuating mass which has a thin wall 
 and in all cases of long standing the condition is painless. 
 
252 LAMENESS OP THE HORSE 
 
 By careful palpation one may readily distinguish between a 
 hygromatous condition of the superficial bursa and involvement 
 of the underlying structures. Affection of the expanded portion 
 of the flexor tendon and contiguous structures makes for an 
 organized mass of tissue which is somewhat dense and in some 
 instances painful to the subject when manipulated. This is par- 
 
 Fig. 60 — "Capped hock." Distension of the bursa over the summit of tlie 
 OS calcis. 
 
 ticularly noticeable in eases where the parts are regularly and 
 repeatedly injured as in habitual kickers. 
 
 Treatment. — In acute inflammation, antiphlogistic applica- 
 tions arc indicated and the subject must be kept quiet. The 
 matter of bandaging the hock is a difflcult problem in some cases 
 and needs be done with care. As has been previously stated in 
 this volume, the tarsus needs to be well padded with cotton be- 
 fore the bandages are applied and only a moderate degree of 
 tension is employed in applying the bandages lest anemic-necrosis 
 result from pressure. In distension of the . superficial bursa, 
 after clipping the hair over a liberal area and preparing the skin 
 
LAMENESS IN THE HIND LEG 253 
 
 by thoroughly cleansing and painting with tincture of iodin, the 
 capsule is incised with a bistoury. An incision about an inch 
 in length, situated low enough to provide drainage, is made 
 through the tissues and the contents are evacuated. Tincture 
 of iodin is injected into the cavity and the parts are covered 
 with cotton and bandaged. No after-care is necessary except to 
 retain the dressing in position, which is not difficult in the 
 average case if the subject is kept tied. If much resistance is 
 exhibited, such as extreme flexion of the bandaged hock, the 
 animal may be put in a sling and little if any objection to the 
 bandage will be offered thereafter. The wound may be dressed 
 at the end of forty-eight hours and no redressing will be neces- 
 sary in the average instance if infection is not present. But 
 slight local disturbance and little distress to the subject result 
 in cases so treated even when infection occurs, but a good technic 
 is possible of execution in most instances and no infection should 
 take place. 
 
 The surgical wound heals in two or three weeks and inflamma- 
 tion gradually subsides. Bandages are retained one or two 
 weeks, as the case may require, and subsequently a good wound 
 lotion may be employed several times daily. A good lotion for 
 such cases as well as in many others has long been employed 
 with success by Dr. A. Trickett of Kansas City. It consists of 
 approximately equal parts of glycerin, alcohol and distilled ex- 
 tract of witch hazel, to which is added liquor cresolis compositus, 
 two percent, and coloring matter q. s. 
 
 Complete resolution does not occur in the average case. There 
 remains some hyperplastic tissue and even where the enlarge- 
 ment is slight, the prominent situation of the affection precludes 
 its being unnoticed. 
 
 In disease of the flexor tendon and its bursa where contiguous 
 inflammation of tissue is present, the parts are blistered or fired. 
 Line firing is beneficial in such instances but in all cases the 
 cause is to be removed if possible. 
 
 Rupture and Division of the Long Digital Extensor 
 (Extensor Pedis). 
 
 Etiology and Occurrence. — Because of the fact that the long 
 
254 LAMENESS OF THE HORSE 
 
 digital extensor is the only extensor of the phalanges of the 
 pelvic limb, its rupture or division coiistitutes a troublesome 
 condition, which in some eases does not readily respond to treat- 
 ment. 
 
 Rupture of this tendon may occur during work on rough and 
 uneven roads, particularly in range horses that are ridden over 
 ground that is burrowed by gophers or prairie dogs; in such 
 cases, horses are apt to suddenly and violently turn the foot 
 in position of volar flexion, thereby causing undue strain to the 
 digital extensor and its rupture sometimes follows. In foals 
 of one or two days of age, this tendon is sometimes found parted 
 or ruptured and the condition may be bilateral. 
 
 As the result of accidents, the digital extensor may be divided 
 and when the wound becomes contaminated, as it does because 
 of the marked volar flexion (knuckling) which occurs during the 
 course of this affection, regeneration of tissue is checked and re- 
 covery is tardy. 
 
 Symptomatology. — There is no interference with ability to 
 sustain weight in such cases, when the foot is placed in normal 
 position; but immediately upon attempting to walk, the toe is 
 dragged, and if weight is borne with the affected member, it 
 comes upon the anterior face of the fetlock. The flexors are 
 not antagonized and if there be an open wound the parts soon 
 become contaminated; or, in rupture, if animals travel about 
 very much, there soon occurs necrosis of the tissues of the 
 anterior fetlock region and the condition is rendered in- 
 curable. Cases are reported of animals that have suffered rup- 
 ture of the long digital extensor and the subjects learned to 
 throw the member forward during extension, substituting for 
 the extensor tendon the pendulum-like momentum which the foot 
 affords when so employed; and a walking and even a trotting 
 pace was possible without doing injury to the fetlock region. 
 
 Where a subcutaneous division exists as in rupture, the di- 
 vided ends of the tendon may ])e definitely recognized liy palpa- 
 tion. 
 
 Treatment. — Subjects are l)est put in slings and k('i)t so con- 
 fined until regeneration of tendinous structures has been com- 
 
LAMENESS IN THE HIND LEG 255 
 
 pleted. This requires from six weeks to two months' time. In 
 addition, the extremity is kept in a state of extension by means 
 of suitabk- si)lints ;uid shoes, — a shoe equipped with an exten- 
 sion at the toe and perforated so that a steel l)raee may be hooked 
 into the perforation and the brace fashioned to be buckled to 
 the upper metatarsal region. When braces are placed in front 
 of the foot, great care is necessary in properly padding the mem- 
 ber with cotton lest sloughing from pressure occurs at the coro- 
 net ; but this does not apply in rupture of extensors so nuich 
 as where flexors are ruptured. 
 
 Open wounds are treated along general surgical lines, dressed 
 as frequently as occasion demands, and recovery will ]:e complete 
 in a few months' time unless much of the tendon has been de- 
 stroyed. In one instance, the author had occasion to observe 
 such a condition, which, because of the extensive destruction 
 of tendon and lack of facilities for giving proper attention to 
 the subject, results were so unfavorable that it was deemed 
 necessary to destroy the animal. 
 
 Wounds From Interfering. 
 
 When, during locomotion, injury is inflicted upon the mesial 
 side of an extremity by the swinging foot of the other member, 
 the condition is termed interfering. 
 
 Etiolog-y and Occurrence. — Faulty conformation, bad shoe- 
 ing and over-work are the prineipal causes of interfering. 
 Horses that are 'M)ase narrow" or that have crooked legs are 
 quite apt to interfere. Shoes that are put on a foot that is not 
 level or applied in a twisted position, or shoes wide at the heel 
 will often cause interfering and injury. Animals that are driven 
 at fast work until they become nearly exhausted may be expected 
 to interfere. Such cases are frequently observed in \oung horses 
 that are driven over rough roads, particularly when so neai'ly 
 •exhausted or weakened from disease or inanition that the feet 
 are dragged forward rather than picked up and advanced in 
 the normal manner. 
 
 Symptomatology.— Wounds inflicted by striking the extrem- 
 ities in this manner present various appearances and occasion dis- 
 
256 LAMENESS OF THE HORSE 
 
 similar manifestaticns. The hind legs are almost as frequently 
 affected as the front and the fetlock region is most often injured, 
 though wounds may be inflicted to the coronet. In front, the 
 carpus is sometimes the site of injury. 
 
 When only an abrasion is caused, little if any lameness oc- 
 curs, but where interfering is continued and nerves are involved 
 or subfascial infection and extensive inflammation succeed such 
 abrasions, marked lameness and evidence of great pain are mani- 
 fested. Frequently, in chronic eases affecting the hind leg, the 
 fetlock a.ssumes large proportions, and at times during the course 
 of every drive the subject strikes the niflamed part, immediately 
 flexing and abducting the injured member, and the victim hops 
 on the other leg until pain has somewhat subsided. 
 
 Interfering is much more serious in animals that are used at 
 fast work than in draft horses. In light-harness or saddle horses, 
 it may render the subject practically valueless or unserviceable 
 if the condition cannot be corrected. 
 
 Treatment. — AVherever possible, cause is to be removed and 
 if animals are properly used, ordinary interfering wounds will 
 yield to treatment. If the shoeing is faulty, this should be cor- 
 rected, the foot properly prepared and leveled before being shod 
 and suitable shoes applied. In young animals that become "leg- 
 weary ' ' from constant overwork, rest and recuperation are neces- 
 sary to enhance recovery. In such cases it will be found that 
 very light shoes, frequently reset, will tend to prevent injury to 
 the fetlock region such as characterizes these injuries of hind 
 legs. 
 
 Palliative measures of various kinds are employed where 
 cause is not to be remioved and a degree of success attends 
 such effort. In draft horses or animals that are used at a slow 
 pace, shields of various kinds are strapped to the extremity 
 and protection is thus afforded. Or, large encircling pads of 
 leather, variously constructed, serve to cause the subject to 
 walk with the extremities apart. 
 
 Interfering shoes of different types are of material benefit in 
 many instances. Often the principle upon which corrective shoe- 
 ing is based is that the mesial (inner) side of the foot is too 
 lew; the foot is consequently leveled and the innci- l)ranch of the 
 
LAMENESS IN THE HIND LEG 257 
 
 shoe is made thicker than the outer, altering the position of the 
 foot in this way. This is productive of desirable results. How- 
 ever, much depends upon the manner in which the foot in motion 
 strikes the weight-bearing member as to the corrective measures 
 that are indicated. This belongs to the domain of pathological 
 shoeing and the reader is referred to works on this subject for 
 further study of this phase of lameness. 
 
 Lymphangitis. 
 
 Excluding glanders, in the majority of instances, lymphangitis 
 in the horse, such as frequently affects the hind legs, is due to 
 the local introduction of infectious material into the tissues as 
 a result of wounds. However, one may observe in some instances 
 an acute lymphangitis which affects the pelvic limbs of horses 
 and no evidence of infection exists. Consequently, lymphangitis 
 may be considered as infectious and non-infectious. 
 
 INFECTIOUS LYMPHANGITIS. 
 
 Etiolog"y and Occurrence. — Traumatisms of the legs fre- 
 quently result in infection and when such injuries are near 
 lymph glands, even though the degree of infection be slight, 
 more or less disturbance of function of the muscles in the vicinity 
 of such glands occurs and lameness follows. 
 
 The prescapular, axillary and cubital lymph glands when in a 
 state of inflammation, cause lameness of the front leg, and the 
 superficial inguinal and deep inguinal lymph glands not infre- 
 quently become involved also. Because of the location of these 
 lymph glands, they are subject to comparatively fre(|uent injury 
 and inflammation, causing lameness more often than other lynipli- 
 gland-affections. 
 
 Small puncture wounds in the region of the elbow are often 
 met with. These may be inflicted when horses lie down ui)nn 
 sharp stumps of vegetation or shoe-calk injuries nuiy be the 
 means of introducing contaginm, and an infectious inflammation 
 results. A])scess formation, the result of strangles or other in- 
 fection in the prescapular glands, may l)e observed at times. 
 Following castration, the inguinal lymph glands may ])ecome 
 involved in an infectious inflannnation and locomotion is im- 
 
258 LAMENESS OF THE HORSE 
 
 peded to a marked degree. Horses running at pasture sometimes 
 become injured by trampling upon pieces of wood, causing one 
 end of these or of various implements to become embedded in the 
 soft earth and the other end to enter at the inguinal region and 
 even penetrate the tissues to and through the skin and fascia just 
 below the perineal region. 
 
 Nail punctures resulting in infection frequently cause an in- 
 
 Fig-. 61 — Chronic lymphangitis. Showing hypertropliy of the left hind leg, 
 due to repeated inflammation. 
 
 fectious lymphangitis and a marked and painful swelling of the 
 legs supervenes. 
 
 Symptomatology. — Lameness, mixed or swinging-leg, signal- 
 izes the presence of acute lymphangitis. There is always more 
 or less swelling present and manipulation of the affected parts 
 gives pain to the subject. Depending upon the character of the 
 infection and its extent, there is presented a varying degree of 
 constitutional disturbance. There may be a rise in temperature 
 of from two to five degrees, and in sucli instances tliere is an 
 accelerated pulse. Where nnich intoxiccition is present, anorexia 
 and dipsosis are to be noticed. 
 
LAMENESS IN THE HIND LEG 
 
 259 
 
 Swelling may increase gradually and in time discharge of pus 
 may take place spontaneously without drainage being provided 
 for, if the character of the infection does not cause early death. 
 
 Fig. 62 — Elephantiasis. 
 
 In these cases lameness is pronounced and the cause of the dis- 
 turbance is to be sought, particularly if the condition be due to 
 a nail puncture. 
 
 Treatment. — Location of the site of injury is advisable in 
 
260 LAMENESS OF THE HORSE 
 
 all cases and in some instances provision for drainage, as in 
 puncture wounds, is helpful. Locally, curettage and the j.ppli- 
 cation of suitable antiseptics are indicated. Hot fomentations 
 are beneficial and should be continued for several days if neces- 
 sary, to stimulate resolution. A brisk purge should be admin- 
 tered at the onset and strychnin, because of its indirect stimu- 
 lative effect upon the circulation together with its tonic effect 
 upon the musculature, is beneficial. 
 
 In all such cases rational treatment, good hygiene and careful 
 nui*sing are the principal factors which stimulate recovery. In- 
 dividual resistance or lowered vitality has a marked influence 
 on the course of this affection. 
 
 NON-INFECTIOUS LYMPHANGITIS. 
 
 This type of lymphangitis is associated with, or the result of, 
 a derangement of digestion. It affects heavy draft horses, rarely 
 other types of animals, and involves one or both hind legs. 
 
 Occurrence. — In healthy and well nourished horses irregu- 
 larly used, this affection may suddenly manifest itself. It oc- 
 curs in singular instances in mares that are in advanced preg- 
 nancy even when such animals are at pasture. Usually, however, 
 this malady is found in heavy draft horses that have been kept 
 stabled from one to three days. 
 
 Symptomatology. — At the outset in severe cases, there is 
 elevation of temperature, labored breathing, accelerated pulse, 
 anorexia and more or less swelling of the affected memliers. 
 Swelling is very painful and when the affected legs are palpated, 
 pain is manifested by flinching. The inguinal lymph glands 
 are often swollen but in some cases they are not affected in any 
 perceptible degree. In the average case suppuration does not 
 occur and when conditions are favorable, resolution is complete 
 within ten days. Tlie extent of the involvement and the intensity 
 of the affection vary materially in different cases and a chronic 
 lymphangitis may succeed the acute attacks and finally in 
 some instances, elei)liantiasis results. 
 
 Treatment. — An active purgative should be given at once 
 and in the ordinary case, stimulants are indicated. If marked 
 distress is present, morphin is given and where there is much 
 
LAMENESS IN THE HIND LEG 261 
 
 rise of temperature, cold drinking water is offered in abundance 
 and catharsis is enhanced by enemata. Locally, hot appli- 
 cations are of benefit. Hot towels or cotton held in position 
 ny l)andages and kept soaked with warm water will relieve pain 
 and stimulate resolution. Diuretics may be of benefit and ano- 
 dyne applications are to be employed with profit in some cases. 
 Walking" exercise, if not indulged in to excess, is helpful as soon 
 as acute inflammation has subsided. By giving careful attention 
 to the regimen and providing regular exercise for susceptible 
 hubjects, this type of lymphangitis is often forestalled. 
 
INDEX 
 
 A 
 
 \cetabuUini 185 
 
 Acute arthritis 65 
 
 Acute laminitis 162 
 
 Acute tendinitis 135 
 
 Affertions of blood vessels 31 
 
 Affections cf bursae and thecae 27 
 
 Affections of the feet 34 
 
 Affections of ligaments 20 
 
 Affections of lymph vessels and 
 
 glands 32 
 
 Affectioi s of muscles and ten- 
 dons 28 
 
 Affections of nerves 30 
 
 Anamnesis 38 
 
 Anatomo-physiological review 
 
 of parts of fore leg 55 
 
 Anatomo-physiological consid- 
 eration of the pelvic limbs..! 85 
 Anatomv of the joint capsule. .220 
 
 Annular ligament 58 
 
 Antea-spinatus muscle 65 
 
 Anterior brachial revion, 
 
 wounds of 90 
 
 Anterior digital extensor 
 
 muscle 193 
 
 Arteritis 209 
 
 Arterv (brachial), thrombosis 
 
 of the SI 
 
 Arthritis 22, 84 
 
 Arthritis, acute 65 
 
 Arthritis, chronic 65 
 
 Arthritis, infectious 66 
 
 Arthritis, metastatic 25 
 
 Arthritis of the fetlock joint....! 52 
 
 Arthritis, rheumatic 26 
 
 Arthritis, scapulohumeral 65 
 
 Arthritis, tarsal 225 
 
 Arthritis, traumatic 22 
 
 Articular ringbone 121 
 
 Articulation, femeropelvic 1S5 
 
 Articulation, m e t a carpophal- 
 
 angeal 5S 
 
 Articulation, scapulohumeral .. 55 
 Aspiration-and-injection treat- 
 ment of bog spavin... 241 
 
 Aspiration-and-injection treat- 
 ment of capped hock 252 
 
 Aspiration-and-injection treat- 
 ment of thoroughpin 250 
 
 Astragalus 190 
 
 Astragalus, fracture of the 230 
 
 Attitude of the subject 41 
 
 Atrophy of the quadriceps 
 
 muscles 205 
 
 Atrophy, shoulder 73 
 
 B 
 
 Biceps brachii 58, 65, 68, 69 
 
 Bicipital bursa, inflammation 
 
 of 68 
 
 Blood vessels, affections of 3! 
 
 Bog spavin 242 
 
 Bog spavin, aspiration-and-in- 
 jection treatment of .244 
 
 Bog spavin, line firing for 246 
 
 Bog spavin, vesication for 246 
 
 Bone spavin 235 
 
 Bones, degenerative changes in 16 
 
 Bones, tarsal 190 
 
 Bossi's double tarsal neurec- 
 tomy 242 
 
 Brachial artery, thrombosis of 
 
 the 81 
 
 Brachial paralvsis 77 
 
 Bursa intertubercularis 62. 69 
 
 Bursa podotrochlearis, inflam- 
 mation of the 157 
 
 Bursae, affections of 27 
 
LAMENESS OF THE HORSE 
 
 Bursitis 27, l04 
 
 Bursitis, infectious 28 
 
 Bursitis in tlie fetlock region.. ..150 
 
 Bursitis intertubercularis 68 
 
 Bursitis, noninfectious 28 
 
 C 
 
 Calcaneocuboid ligaments 190 
 
 Calcaneo-metatarsal ligaments. .190 
 
 Calcaneum, fracture of the 230 
 
 Calk wounds 170 
 
 Capped hock .....251 
 
 Capped hock, aspiration-and-in- 
 
 jection treatment of 252 
 
 Capsular ligament 190 
 
 Caput muscles 71 
 
 Carpal bones, fmcture of the.. 96 
 Carpal bones, huation of the.... 96 
 Carpal flexors, contraction of 
 
 the 93 
 
 Carpal flexors, inflammation of 
 
 the 93 
 
 Carpal joint 58 
 
 Carpal joint, open 100 
 
 Carpitis 98 
 
 Carpus, inflammation of the.... 98 
 Cartilage, lateral, inflamma- 
 tion of 1 74 
 
 Cartilages of the third phalanx, 
 
 ossification of the 155 
 
 Chronic arthritis 65 
 
 Chronic gonitis 217 
 
 Chronic laminitis 164 
 
 Chronic tendinitis 137 
 
 Cochran shoe for dropped 
 
 soles 169 
 
 Collateral ligaments 190 
 
 Comminuted fractures 17 
 
 Compound fractures 17 
 
 Contracted tendons of foals. ...143 
 Contrat tion of the carpal flexors 93 
 Contraction of the flexor ten- 
 dons 137 
 
 Contusions of the triceps 
 brachii 71 
 
 Contusive wounds 85 
 
 Coracoradialis 58 
 
 Corns 172 
 
 Coronary region, wounds of 
 
 the 170 
 
 Corpora oryzoidea 218 
 
 Cotyloid ligament 185 
 
 Courbe 233 
 
 Crepitation, false 48 
 
 Crepitation, true 47 
 
 Crucial ligaments 188 
 
 Crural nerve, paralysis of the. .204 
 
 Cunean bursa 237 
 
 Cunean tenotomy 242 
 
 Cuneiform magnum 191 
 
 Cuneiform medium 191 
 
 Curb 233 
 
 D 
 
 Deep digital flexor, distension 
 
 of the tarsal sheath of 246 
 
 Deep flexor tendon (perforans) 60 
 Degenerative changes in bones 16 
 
 Diagnosis by exclusion 53 
 
 Diagnosis by use of the X- 
 
 ray 179 
 
 Diagnostic principles 37 
 
 Disease, navicular 157 
 
 Dislocations 21 
 
 Distension of the tarsal joint 
 
 capsule 242 
 
 Distension of the tarsal sheath 
 
 of the deep digital flexor 246 
 
 Division of long digital ex- 
 tensor 253 
 
 Dorsal ligaments 190 
 
 Dropped elbow 71, 80 
 
 Dropped soles, shoe for 169 
 
 Dropped stifle 205 
 
 Dry spavin 225 
 
 E 
 
 Elbow, dropped 71, 80 
 
 Elbow, inflammation of the 84 
 
INDEX 
 
 Elbow joint 58 
 
 Elephantiasis 34 
 
 Etiology, general discussion of 15 
 
 Examination by palpation 43 
 
 Examination, special methods 
 
 of 53 
 
 Examination, visual 39 
 
 Exclusion, diagnosis by 53 
 
 Exostosis of splint bones 107 
 
 Exostosis, phalangeal 118 
 
 Extensor ( long digital ) rupture 
 
 and division of 253 
 
 Extensor of the digit, rupture 
 
 of 145 
 
 Extensor pedis 60 
 
 Extensor pedis, rupture of 145 
 
 Extensor pedis, rupture and di- 
 vision of 253 
 
 F 
 
 False crepitation 48 
 
 Feet, affection of the 34 
 
 Femoral nerve, paralysis of 
 
 the 204 
 
 Femeropatella ligaments 188 
 
 Femeropelvic articulation 185 
 
 Femur 185, 192 
 
 Femur, fracture of the 199 
 
 Femur, luxation of the 201 
 
 Fetlock joint 58 
 
 Fetlock joint, arthritis of the....l52 
 Fetlock joint, luxation of the..l25 
 
 Fetlock joint, open 110 
 
 Fetlock region, thecitis and 
 
 bursitis in 148 
 
 Fetlock, shoe for bracing the.. ..181 
 Fibular tarsal bone, fracture of 
 
 the 230 
 
 Firing, treatment of ringbone 
 
 by 123 
 
 First phalanx 59 
 
 "Fish knees" 145 
 
 Fixed luxations 21 
 
 Fixed patellar disarticulation. .213 
 Flexor brachii 58, 68, 69 
 
 Flexor carpiradialis 93 
 
 Flexor carpiulnaris 93 
 
 Flexor metacarpi externus 94 
 
 Flexor metacarpi internus 93 
 
 Flexor metacarpi medius 93 
 
 Flexor metatarsi 193 
 
 Flexor, superficial digital 194 
 
 Flexor tendons, contraction of 
 
 the 137 
 
 Flexor tendons, inflammation 
 
 of the 135 
 
 Flexor tendons, rupture of 146 
 
 Flexors of phalanges, open 
 
 sheath of 124 
 
 Foals, contracted tendons of.. ..143 
 
 Forearm, wounds of 90 
 
 Fore leg, lameness in the 55 
 
 Fracture of the carpal bones.... 96 
 
 Fracture of the femur 199 
 
 Fracture of the libular tarsal 
 
 bone 230 
 
 Fracture of first and second 
 
 phalanges 131 
 
 Fracture of humerus 82 
 
 Fracture of the ilium 198 
 
 Fracture of the ischial tuber- 
 osity 199 
 
 Fracture of the metacarpus 106 
 
 Fracture of the patella 212 
 
 Fractures of the pelvic bones..l96 
 Fracture of the proximal sesa- 
 moids 128 
 
 Fracture of the pubis 197 
 
 Fracture of the radius 87 
 
 Fracture of the scapula 62 
 
 Fracture of t'he tibia 222 
 
 Fracture of the tibial tarsal 
 
 bone 230 
 
 Fracture of the ulna 86 
 
 Fractures 16 
 
 Fractures, comminuted 17 
 
 Fractures, compound 17 
 
 Fractures, green stick 18 
 
 Fractures, impacted 19 
 
 Fractures, longitudinal 18 
 
LAMENESS OF THE HORSE 
 
 Fractures, multiple .._ IS 
 
 Fractures, multiple longitu- 
 dinal 19 
 
 Fractures, oblique 18 
 
 Fractures, simple 17 
 
 Fractures, simple transverse.... IS 
 
 Fractures, transverse 18 
 
 Fragilitas 199 
 
 Fragilitas osseum 128 
 
 G 
 
 Gait, observing character of.... 4S 
 
 Gastrocnemius 194 
 
 Gluteal tendo-synovitls 203 
 
 Gluteus medius muscle 192, 203 
 
 Gonitis, chronic 217 
 
 Green stick fractures IS 
 
 H 
 
 Hind leg. lamenoss in the ISo 
 
 Hind leg, paralysis of the 204 
 
 Hip lameness 195 
 
 Hip swinney 205 
 
 Hock, capped 251 
 
 Hock joint 1S8 
 
 Hoof testers 53 
 
 Humeroradioulnar joint 58 
 
 Humerus, fracture of 82 
 
 I 
 
 Iliac thrombosis 209 
 
 Iliopsoas 204 
 
 Ilium, fracture of the 198 
 
 Impacted fractures 19 
 
 Infectious arthritis 66 
 
 Infectious bursitis 28 
 
 Infectious inflammation of the 
 
 lateral cartilage 173 
 
 Infectious lymphangitis 257 
 
 Infectious synovitis 124 
 
 Inflammation of the bicipital 
 
 bursa 68 
 
 Inflammation of the bursa 
 
 podotrochlearis 157 
 
 Inflammation of the carpal 
 
 flexors 93 
 
 Inflammation of the carpus 98 
 
 Inflammation of the elbow 84 
 
 Inflammation of the flexor ten- 
 dons 125 
 
 Inflammation of posterior liga- 
 ments of pastern 129 
 
 Inflammation of proximal sesa- 
 moid bones 12 1 
 
 Inflammation of third sesamoid 
 
 and deep flexor tendon 157 
 
 Inflammation of the trochan- 
 teric bursa -^^ 
 
 Infraspinatus muscle 6o 
 
 Injection of fluids for quittor....l77 
 Injuries to scapulohumeral 
 
 joint 6^ 
 
 Interfering, shoeing for 256 
 
 Interfering, wounds from 255 
 
 Ischial tuberosity, fracture of 
 the 199 
 
 Joint capsul'^. anatomy of the..220 
 
 Joint, carpal 58 
 
 Joint, elbow 58 
 
 Joint, fetlock 58 
 
 Joint capsule, tarsal, distension 
 
 of the 242 
 
 Joint, fetlock, arthritis of the....! 52 
 
 Joint, fetlock, luxation of 125 
 
 Joint, hock 18^ 
 
 Joint, humeroradioulnar 58 
 
 Joint, open 67 
 
 Joint, open carpal 100 
 
 Joint, open fetlock 110 
 
 Joint, pastern proximal inter- 
 
 phalangeal 129 
 
 Joint, shoulder 55 
 
 Joint, stifle, open 220 
 
 Joint, tarsal, open 229 
 
INDEX 
 
 L 
 
 Lameness, hip 1!)5 
 
 Lameness, mixed 49 
 
 Lameness in the fore leg 55 
 
 Lameness in the hind leg 185 
 
 Lameness, shoulder 61 
 
 Lameness, supporting-leg 49 
 
 I fimeness, swinging-leg 49 
 
 Laminitis 160 
 
 Laminitis, acute 162 
 
 Laminitis, chronic 164 
 
 Lateral cartilage, infectious in- 
 flammation of the 174 
 
 Lateral cartilages, ossification 
 
 of 155 
 
 Ligaments, affections of 20 
 
 Ligament, capsular 190 
 
 Ligaments, collateral - 190 
 
 Ligament, cotyloid 185 
 
 Ligaments, crucial 188 
 
 Ligaments, dorsal 190 
 
 Ligaments, femeropatella 188 
 
 Lisament, medial 190 
 
 Ligaments, mesial tarsal, 
 
 sprains of the 232 
 
 Ligaments of pastern proximal 
 interphalangeal joint, inflam- 
 mation of 129 
 
 Ligaments, patellar 188 
 
 Ligaments, plantar 190 
 
 Ligament, pubiofemoral 185 
 
 Ligament, superior check 58 
 
 Ligament, suspensory, rupture 
 
 of 146 
 
 Ligaments, volar 129 
 
 Ligament, volar-carpal or an- 
 nular 58 
 
 Ligation of the saphenous vein. .246 
 
 Line firing for bog spavin 246 
 
 Longitudinal fractures IS 
 
 Lumbosacral plexus 204 
 
 Luxation of the carpal bones.... 96 
 
 Luxation of the femur 201 
 
 Luxation of fetlock joint 125 
 
 Luxation of the patella 213 
 
 Luxation cf the patella, out- 
 ward 215 
 
 Luxation of the patella, up- 
 ward 214 
 
 Luxation of scapulohumeral 
 
 joint 67 
 
 Luxations 21 
 
 Luxations, fixed 21 
 
 Luxations, temporary 21 
 
 Lymph vessels and glands, af- 
 fections of 32 
 
 Lymphangitis 32 
 
 Lj'mphangitis, infectious 257 
 
 Lymphangitis, non-infectious..260 
 
 M 
 
 Medial ligament 190 
 
 Median neurectomy 124 
 
 Mesial tarsal ligaments, sprains 
 
 of the 232 
 
 Metacarpophalangeal articula- 
 tion 58 
 
 IMetacarpus, fracture of the 106 
 
 Metastatic arthritis 25 
 
 Mixed lameness 49 
 
 Momentary patellar disarticula- 
 tion 213 
 
 ;Movements, passive 47 
 
 Multiple fractures 18 
 
 Multiple longitudinal fractures.. 19 
 
 Muscles, affections of 28 
 
 Muscle, antea-spinatus 65 
 
 Muscle, anterior digital ex- 
 tensor 193 
 
 Muscle, biceps brachii 58 
 
 ;\Iuscle, caput 71 
 
 Muscle, gluteus medium. ...192, 203 
 
 Muscle, infraspinatus 65 
 
 Muscle, peroneus tertius 193 
 
 Muscle, postea-spinatus 65 
 
 Muscles, quadriceps 193 
 
 Muscles, quadriceps, atrophy 
 
 of the 205 
 
 Muscle, subscapularis 65 
 
 Muscle, supraspinatus 65 
 
LAMENESS OP THE HORSE 
 
 IMuscle, tibialis anticus 193 
 
 Muscle, triceps brachii 58 
 
 Myalgia 195 
 
 N 
 
 Nail punctures 178 
 
 Navicular disease 157 
 
 Nerves, affections of 30 
 
 Nerve, femoral, paralysis of 
 
 the 204 
 
 Nerve, obturator, paralysis of 
 
 th° - 206 
 
 Nerve, sciatic, paralysis of 
 
 the 208 
 
 Nerve, (suprascapular) par- 
 alysis of the 75 
 
 Non-infectious lymphangitis ..260 
 
 Non-infectious bursitis 28 
 
 Neurectomy, Bossi's double 
 
 tarsal 242 
 
 Neurectomy, median 124 
 
 Neurectomy, plantar 124 
 
 O 
 
 Oblique fractures 18 
 
 Observing character of gait 48 
 
 Obturator nerve, paralysis of 
 
 the 206 
 
 Occurrence, general discussion 
 
 of 15 
 
 Omphalophlebitis 25 
 
 Open carpal joint 100 
 
 Open fetlock joint 110 
 
 Open joint 67 
 
 Open sheath of flexors of pha- 
 langes 124 
 
 Open stifle joint 220 
 
 Open tarsal joint 229 
 
 Os corona 60 
 
 Ossification of cartilages of the 
 
 third phalanx 155 
 
 Ossification of the lateral 
 
 cartilages 155 
 
 Os innominatum 196 
 
 Os suffraginis 59 
 
 Osteitis, rarefying 16 
 
 Outward luxation of the pa- 
 tella 215 
 
 P 
 
 Palpption, examination by 43 
 
 Paralvsis. brachial 77 
 
 Paralysis of the femoral nerve. .204 
 
 Paralvsis of the hind leg 204 
 
 Paralysis of the obturator 
 
 nerve - 206 
 
 Paralvsis of the sciatic nerve... .208 
 Paralysis of the suprascapular 
 
 nerve 75 
 
 Paralysis, radial 77 
 
 Paronychia 170 
 
 Passive movements 47 
 
 Pastern proximal interpha- 
 
 langeal joint, inflammation of 
 
 ligaments of 129 
 
 Patella - 18S 
 
 Patella, fracture of the 212 
 
 Patella, luxation of the 213 
 
 Patella, outward luxation of 
 
 the 215 
 
 Patella, upward luxation of 
 
 the 214 
 
 Patellar disarticulation, fixed.. ..213 
 Patellar disarticulation, mo- 
 mentary 21 3 
 
 Patellar ligaments 188 
 
 Pelvic bones, fractures of the. .196 
 Pelvic limbs, anatomo-physio- 
 
 logical consideration of the....l85 
 
 Penetrative wounds 85 
 
 Periarticular ringbone 122 
 
 Peroneus fortius muscle 193 
 
 Phalangeal exostosis 118 
 
 Phalanges, fracture of first and 
 
 second 131 
 
 Phalanges, open sheath of 
 
 flexors of 124 
 
 Phalanx, first 59 
 
 Phalanx, second 60 
 
 Phalanx, third, ossification of 
 
 cartilages of 155 
 
INDEX 
 
 Plantar ligaments 190 
 
 Plantar neurectomy 124 
 
 Polyarthritis 25 
 
 Postea-spinatus muscle 65 
 
 Principles, diagnostic 37 
 
 Proximal sesamoid bones, in- 
 flammation of 127 
 
 Proximal sesamoids, fracture 
 
 of - 128 
 
 Pubiofemoral ligament 185 
 
 Pubis, fracture of the 197 
 
 Punctures, nail 178 
 
 Q 
 
 Quadriceps muscles 193 
 
 Quadriceps muscles, atrophy of 
 
 the 205 
 
 Quittor 174 
 
 Quitter, injection of fluids for.. ..177 
 
 R 
 
 Rachitic ringbone 122 
 
 Radial paralysis 77 
 
 Radius, fracture of the 87 
 
 Rarefying osteitis 16 
 
 Rheumatic arthritis 26 
 
 Rheumatism 196 
 
 Ringbone 118 
 
 Ringbone, articular 121 
 
 Ringbone, periarticular 122 
 
 Ringbone, rachitic 122 
 
 Ringbone, traumatic 122 
 
 Ringbone treated by flring 123 
 
 Roberts shoe for bracing the 
 
 fetlock 181 
 
 Rupture of the extensor pedis. .145 
 Rupture of flexor tendons and 
 
 suspensory ligament 146 
 
 Rupture of long digital ex- 
 tensor 253 
 
 Rupture of the tendo archillis..224 
 
 S 
 
 Saphenous vein, ligation of 
 the 246 
 
 Scapula, fracture of the 62 
 
 Scapulohumeral articulation .... 55 
 Scapulohumeral joint, injuries 
 
 to 66 
 
 Scapulohumeral joint, luxation 
 
 of 67 
 
 Scapulohumeral joint, wounds 
 
 of 67 
 
 Scapulohumeral arthritis 65 
 
 Sciatica 208 
 
 Sciatic nerve, paralysis of the. .208 
 
 Second phalanx 60 
 
 Sesamoid bones 59 
 
 Sesamoid, third, inflammation 
 
 of the 157 
 
 Sesamoids, proximal, fracture 
 
 of 128 
 
 Sesamoiditis 127 
 
 Setons 75 
 
 Sheath of flexors of phalanges, 
 
 open 124 
 
 Sheath (tarsal) of the deep 
 
 digital flexor, distension of 
 
 the 246 
 
 Shoe for dropped soles 169 
 
 Shoeing for interfering 256 
 
 Shoulder atrophy 73 
 
 Shoulder joint 55 
 
 Shoulder lameness 61 
 
 Simple fractures 17 
 
 Simple transverse fractures.... 18 
 
 Soles, dropped, shoe for 169 
 
 Spavin, bog 242 
 
 Spavin, bone 235 
 
 Spavin, dry 225 
 
 Spavin test 239 
 
 Special methods of examina- 
 tion 53 
 
 Sprains of the mesial tarsal 
 
 ligaments 232 
 
 Sprains, tarsal 232 
 
 Splints 107 
 
 Spring-halt 225 
 
 Stifle, dropped 205 
 
 Stifle joint, open 220 
 
LAMENESS OF THE HORSE 
 
 Strangles 25 
 
 Streptococcus equi 25 
 
 String-halt 225 
 
 Subject, attitude of the 41 
 
 Subscapularis muscle 65 
 
 Supporting-leg-lameness 49 
 
 Suprascapular nerve, paralysis 
 
 of the 75 
 
 Supraspinatus muscle 65 
 
 Superficial digital flexor 194 
 
 Superior check ligament 58 
 
 Suspensory ligament, rupture 
 
 of 146 
 
 Sweeny "73 
 
 Swinging-leg-lameness 49 
 
 Swinney 73 
 
 Swinney, hip 205 
 
 Synovial distension of tendon 
 
 sheaths 104 
 
 Synovitis 25 
 
 Synovitis, infectious 124 
 
 T 
 
 Tarsal arthritis 225 
 
 Tarsal bones 190 
 
 Tarsal joint capsule, distension 
 
 of the 242 
 
 Tarsal joint, open 229 
 
 Tarsal sheath of the deep 
 digital flexor, distension of 
 
 the 246 
 
 Tarsal sprains 232 
 
 Tarsus 192 
 
 Temporary luxations 21 
 
 Tendinitis 135 
 
 Tendinitis, acute 135 
 
 Tendinitis, chronic 137 
 
 Tendo achillis, rupture and 
 
 wounds of the 224 
 
 Tendon, deep flexor, inflamma- 
 tion of the 157 
 
 Tendon, deep flexor (per- 
 
 forans) 60 
 
 Tendon, extensor, rupture of. .145 
 
 Tendon, flexor, rupture of ..146 
 
 Tendons of foals, contracted.... 143 
 Tendon sheaths, synovial dis- 
 tension of 104 
 
 Tendons, affections of 28 
 
 Tendons, flexor, contraction of 
 
 the 137 
 
 Tendons, flexor, inflammation 
 
 of the 135 
 
 Tendo-synovitis, gluteal 203 
 
 Tenotomy, cunean 242 
 
 Tensor fascia lata 192 
 
 Test, spavin 239 
 
 Testers, hoof 53 
 
 Thecae, affections of 27 
 
 Thecitis 27, 104 
 
 Thecitis in the fetlock region... .150 
 
 Thoroughpin 246 
 
 Thoroughpin, aspiration-and-in- 
 
 jection treatment of 250 
 
 Thrombosis, iliac 209 
 
 Thrombosis of the brachial 
 
 artery 81 
 
 Tibia ..-- 188 
 
 Tibia, fracture of the 222 
 
 Tibial tarsal bone, fracture of 
 
 the : 230 
 
 Tibialis anticus muscle 193 
 
 Tibioastragular joint, disten- 
 sion of the 242 
 
 Transverse fractures 18 
 
 Traumatic arthritis 22 
 
 Traumatic ringbone 122 
 
 Treatment of bog spavin by 
 
 aspiration and injection 244 
 
 Treatment of capped hock by 
 
 aspiration and injection 252 
 
 Treatment of ringbone by fir- 
 ing 123 
 
 Treatment of thoroughpin by 
 
 aspiration and injection 250 
 
 Triceps brachii 58 
 
 Triceps brachii, contusions of.. 71 
 Triceps extensor brachii 71 
 
INDEX 
 
 Trochanteric bursa, inflamraa- 
 
 tion of the 204 
 
 True crepitation 47 
 
 U 
 
 Ulna, fracture of the 86 
 
 Ulnaris lateralis 94 
 
 Upward luxation of the patella.. 214 
 
 Vein, saphenous, ligation of 
 
 the 246 
 
 Vesication for bog spavin 246 
 
 Vessignon cheville 246 
 
 Visual examination 39 
 
 Volar ligaments 129 
 
 W 
 
 Wounds, calk i7o 
 
 Wounds, contusive 85 
 
 Wounds from interfering 255 
 
 Wounds of anterior brachial 
 
 region 90 
 
 Wounds of coronary region 170 
 
 Wounds of scapulohumeral 
 
 joint 67 
 
 Wounds of tendo achillis 224 
 
 Wounds, penetrative So 
 
 Volar-carpal ligament 
 
 58 X-ray diagnosis 179 
 
AUTHORITIES CITED 
 
 Almy, J 
 
 141, 200, 202, 208, 212, 216, 214, 233 
 
 Bassi 215 
 
 Bauman, S. H 197 
 
 Bell, Roscoe R. 69 
 
 Benard 216 
 
 Berns, Geo. H 77, 218 
 
 Bouley 225 
 
 Bourdelle 147 
 
 Cadiot, P. J....78, 141, 200, 202, 208, 
 
 212, 214, 216, 223, 225, 233, 245, 250 
 
 Campbell, D. M 162, 166, 167 
 
 Castagne - 84 
 
 Cochran, David W 169, 170 
 
 Diekerhoff 237 
 
 Dollar, Jno. A. W 68, 198 
 
 Eberlein 237 
 
 Fisher, Carl W 236 
 
 Frost, J. N 113 
 
 Frost, R. F 128 
 
 Greaves, Thomas 157 
 
 Hoare, E. Wallis 25, 211, 230 
 
 Hughes, Joseph 176, 221 
 
 Hutyra and Marek 205 
 
 Law, James 33 
 
 Leblanc 223 
 
 Liautard, A 84, 199, 238 
 
 Lusk, Wm. V 203 
 
 McDonough, James 237 
 
 Merillat, Edward 210 
 
 Merillat, L. A 80, 96, 175, 210 
 
 Millar, Thomas 145 
 
 Muller, H 119, 156, 211, 222 
 
 Montane 147 
 
 Moore, R. C 162 
 
 Roberts, G. H 181 
 
 Schumacher 215 
 
 Scott, John 208 
 
 Seeley, J. T 176 
 
 Sisson. Septimus 129, 204, 220 
 
 Smith, F., Major General 56, 
 
 60, 155, 188, 194 
 
 Strangeways 193 
 
 Taylor, Henry 71 
 
 Thompson, H 83, 87 
 
 Trickett, A 253 
 
 Udall, D. H 236 
 
 Uhlrich 224 
 
 Walters, Wilfred 83, 97 
 
 Williams. W. L 217, 236 
 
Webster Family Library of Veterinary Medicine 
 Cummings School of Veterinary Medicine at 
 Tufts University 
 200 Westboro Road 
 Norfhf^rafton, MA01536