[Footnote A: _Ibid_., vol. xiii., p. 2.]

CHAPTER IX

INFLAMMATORY AFFECTIONS OF THE KERATOGENOUS APPARATUS

A. ACUTE.

ACUTE LAMINITIS.

_Definition_.--The term 'laminitis' is used to indicate a spontaneous and diffuse inflammation of the whole of the sensitive structures of the foot, more particularly the sensitive laminae. Usually it occurs in the two front feet, often in all four, and occasionally in the hind alone.

_Causes_.--In dealing with the causes of laminitis, we will first dispose of those coming under the heading of _traumatic_. Correctly speaking, however, lesions of the laminae thus occurring do not present the same symptoms, nor run an identical course with the disease we now purpose describing, and for which we would prefer to entirely reserve the term 'laminitis.' The fact, however, that traumatic causes are detailed in other works on the same subject compels us to give them mention here.

Strictly traumatic causes giving rise to a limited inflammation of the sensitive laminae are violent blows upon the foot, either purely accidental, or self-inflicted by violent kicking.

A similar limited laminitis is to be found in the conditions we have described under 'Nail-bound and Punctured Foot.' It is met with also in the injuries resulting from tread and overreach, and in the tissue-changes accompanying corn.

The tenderness following upon excessive hammering in the forge, or of too long an application of the shoe in hot-fitting has also been described as laminitis.

With either of the conditions we have mentioned, it goes without saying that there is either a simple congestion or an actual inflammation, localized or general, of the laminae of the injured foot. In neither case, however, can the resulting mischief be closely compared with the lesions attending an attack of laminitis proper, a disease which appears to have an almost specific cause, and to run a course peculiarly its own.

The specific cause we have indicated as existing can, in the present state of our knowledge, be only vaguely described as a poisoned state of the blood-stream. This, as clinical evidence teaches us, may result from a variety of causes.

Among these, by far the most common is that state of the circulation induced by excessive feeding with too stimulating or too irritating a diet.

In any case, where the use of old oats as a staple diet is departed from, and where the quant.i.ty and manner of using the subst.i.tute is left to the discretion of careless or unskilled attendants, trouble is likely to ensue.

The food more p.r.o.ne, perhaps, than any other to bring about an attack is wheat improperly prepared--that is, uncooked or unground. So much so is this the case that one full meal of this provender to an animal unused to it is sufficient to lead to a train of symptoms often ending fatally.

Beans, peas, barley, rye, new maize, or even new oats, are all liable, if carelessly used, to have the same effect.

It is the laminitis following feeding on new oats that has caused us to apply to the food the adjective 'irritating.' Here, more often than not, the peristaltic action of the bowels is found to be abnormally in evidence, and the excessive use of the diet is always accompanied by a more or less fluid discharge of the intestinal contents.

In addition to the foods we have mentioned, many others might be enumerated, more especially the numerous 'made-up' feeding materials now on the market. Many are composed of substances that may be regarded as absolutely opposed to the correct feeding of a horse, and their use can only be followed by this and other evil results.

Another most fruitful cause of laminitis is a severe and continued inflammatory condition of the system elsewhere. It is the laminitis known to veterinary surgeons as 'metastatic,' and perhaps the two most notable examples of it are the laminitis following a prolonged attack of pneumonia, and the 'Parturient Laminitis' occurring as a concomitant of septic metritis.

Parturient laminitis it is that offers us the most striking ill.u.s.tration of the truth that a poisoned state of the blood-stream is a sure factor in the causation of an attack. From the direct evidence of our senses (namely, manual exploration of the infected womb, and the stench of the exuding discharge) we know that we have in the interior of the womb matter in a state of putrescence. From the experience of previous post-mortems we know, further, that the putrescent matter thus originating often gains the blood-stream, and forms foci of septic lesions elsewhere--liver or lung.

When, therefore, during an attack of septic metritis a condition of laminitis supervenes, we are justified in attributing it to the escape of septic matter from the already infected uterus.

In the same category of laminitis from metastasis may also be placed the laminitis occurring as a result of an overdose of aloes. The enteritis thus set up is often followed by laminitis, and that of a serious type.

Prolonged and excessive work upon a hard road is also apt to induce an attack. When this occurs it in many cases resolves itself into a case of cruelty. (See reported case, No. 1, p. 279.)

Laminitis from this cause was frequent among coach and carriage horses in the pre-railroad period, and resulted from attempting to obtain from the animal a faster pace and a greater number of miles than he was physically capable of giving.

In our day, however, it is more often a result of gross feeding, combined with only that amount of work which the horse, if ordinarily fed, would be easily able to perform. An excellent example of this is the laminitis occurring in the Shire stallion when commencing his rounds of service in the spring and early summer. At this season these animals are constantly supplied with a more than sufficient supply of a highly stimulating and nutritious diet. In this case the blood is already in that state in which it is predisposed to the disease. Add to this the unwonted exercise--for during all the winter the animals are idle--and congestion of the venous apparatus of the extremities is not to be wondered at.

Pa.s.sing from these, the more common, we may consider other and less frequent causes of the disease. Congestion of the laminal blood-vessels and consequent laminitis occurs when animals are made to maintain a standing position for prolonged periods, as, for instance, when making sea voyages.

A long and painful disease of one foot, necessitating the whole of the weight being borne by the other, ends often in laminitis of the second member. It may thus occur as a sequel to quittor, complicated sand-crack, suppurating corn, and punctured wounds of the feet.

Laminitis has also been known to occur as a result of septic infection of the blood-stream consequent on the operation of castration. (See recorded case, No. 2, p. 281.)

A sudden lowering of the surface circulation at a time when the animal is excessively perspiring is also said to favour an attack, as also is the giving to drink of cold water to an animal just in from a long and tiring journey. Also, according to Zundel, 'the influence of the season cannot be denied, and it is during the summer months that laminitis is more frequent, while it is rare in winter, as well as in the spring and autumn.'

Further, laminitis has been described as occurring when the animal is at gra.s.s, and when all causes--at any rate, active ones--have appeared to be absent. (See reported case, No. 3, p. 282.)

Regarding heredity, we may safely say that, as a cause of laminitis, it may be almost totally disregarded. That a bad form of foot, either a flat-foot or a foot with heels contracted, and already thus affected with a mild type of inflammation, did not offer a certain predisposition, we should not like to a.s.sert. There must, however, be an exciting cause--namely, a poisoned condition of the blood-stream. This latter cannot, of course, be in any way regarded as hereditary.

In short, the dietetic cause is by far the most common, and, in prosecuting inquiries as to the starting-point of an attack, the veterinarian's attention should be directed in the main to that particular.

_Symptoms_.--Laminitis is always ushered in by a set of symptoms indicative of a high state of fever. The pulse is raised from the normal to as many as 80 or 90 a minute, muscular tremors are in evidence, the respirations are short and hurried, and the temperature rises to 105, 106, or 107 F. The visible mucous membranes are injected, that of the eye, in addition to the hyperaemia, often tinged a dirty yellow. The mouth is dry and hot, the urine scanty, and the bowels frequently torpid. As yet, however, the walk is sound.

Called in during this early stage, the veterinarian is often puzzled as to the exact significance of the symptoms. Enteritis, lymphangitis, or pneumonia he knows to be often heralded in the same manner. In this connection, Zundel says: 'Laminitis, in most instances, is preceded by certain general symptoms, such as are premonitory of the invasions of ordinary inflammatory diseases, but of an uncertain significance.'

So far we agree with him, but to what we have already said we would add that, even in this early stage, there is an additional symptom, unmentioned by Zundel, which often leads one to an exact diagnosis. The feet are in turn lifted a short distance from the ground, and almost immediately replaced. This movement ('paddling,' we may term it) is constant, the animal appearing to obtain ease in no one position for more than a few moments at a time.

Seen but a few hours later, when the swelling caused by the hyperaemia and outpouring of the inflammatory exudate has led to compression of the sensitive structures within the h.o.r.n.y box, the symptoms presented admit of no misreading, save by the most casual and careless observer. The patient now stands as though fixed to the ground. The pulse is hard and frequent, the respirations tremendously increased in number, the body wet with a patchy perspiration, and the countenance indicative of the most acute suffering. Only with difficulty, and often only at the instigation of the whip, can the animal be induced to move. This he does by throwing his weight, so far as he is able, on to the heels of the feet affected, and putting the feet slowly forward in a shuffling and feeling manner. The feet themselves give to the hand a sensation of abnormal heat, percussion upon them with the hammer is followed by painful attempts at withdrawal, while any effort we may make to remove one foot from the ground is useless, so great an aversion does the animal show to placing a greater weight upon the opposite foot.

According as the front-feet alone, the hind-feet alone, or all four feet are affected, the symptoms will vary.

With all four feet diseased, the animal stands with the two front-feet extended in front of him, while the hind-limbs are at the same time propped as far beneath him as is possible. The horse is, in fact, standing upon the extreme hindermost portions of the feet.

Why the animal should thus distribute his weight is easily explained.

Standing in the normal position, the body-weight is borne by the sensitive laminae, the sole, of course, sharing in the burden, but the laminae taking by far the greater part of the pressure thus exerted. With the vessels of the laminae gorged with blood, and the laminal connective tissue infiltrated with a profuse inflammatory exudate, the most excruciating pain is bound to result by reason of the compression of the diseased tissues within the non-yielding structures. In some little measure the suffering animal may afford himself relief by partly removing pressure from the fore-parts of the hoof. When placing the body-weight behind, the pressure, instead of falling upon the highly sensitive laminae, is directed to the follicular and fatty tissues of the plantar cushion: from there, with only a small portion of the sensitive sole intervening, to the h.o.r.n.y frog, and from thence to the ground.

The same distribution of weight also places the foot in a position of greatest expansion, thus, by giving greater room to the diseased parts, again affording relief of pressure on the inflamed lamina, while it at the same time relieves of weight the foremost portions of the sensitive sole.

With the fore-feet alone attacked, the animal affects exactly the same position of standing as that just described. The fore-feet are again extended, and the hind propped far beneath him. The fore extended, in order to obtain the relief occasioned by standing on the heels; the hind in this case carried forward in order to take a greater share of the body-weight, and thus relieve the congested members in front.

With the hind only attacked, then the fore and the hind feet are more closely approximated than in the normal position. The reason, of course, is that the hind-feet are carried forward in order to be placed upon the heels, while the fore are taken backwards to relieve the hind of the body-weight.

In like manner the movements of the animal will vary with the feet affected. With only the front-feet diseased the animal is, comparatively speaking, comfortable. The hind-feet take the weight, and the animal stands for long periods together, resting alternately first one fore-foot and then the other, moving often in a circle of which his body is the radius, and his hind-limbs the centre. If urged to move forward, then immediately his countenance and movements manifest the pain to which he is put. Only with reluctance does he cause the fore-feet to take weight. They are shuffled forward quickly one after the other, so that weight may not be placed upon them for one instant longer than is necessary, and the hind-limbs immediately brought again with two short, awkward movements beneath the body. Progress thus takes place in a succession of movements 'half hobble,'

'half jump.'

Painful though this may appear, progress is still more difficult when the hind-feet alone are diseased. Afraid that, in placing his fore-members freely forward, he will add to the pain in his hind, the walk takes place in a series of extremely short steps, with the feet more or less closely approximated. The gait is thus rendered extremely awkward, and Zundel, by saying that 'the animal appears as if treading on sharp needles,' most fitly describes it.

Movement with all four feet affected, though less awkward in appearance, is doubtless more painful than in either of the other conditions. Here the animal can hardly be induced to shift his position at all. Only by flogging, and that severe, can he be made to go forward. When so induced to move, the agonizing pain to which the patient is subjected may be gathered by noting his countenance and manner of progression.

With each movement forward, muscular tremors affect the limbs; each step is short, jerky, and convulsive; the respirations and pulse are almost immediately greatly quickened, and the lower lip is hung pendulous, and moved almost unconsciously up and down with a flapping noise against the upper. A patchy perspiration breaks out about the body and quarters, and the tail is outstretched and quivering. At the same time the lines of the face become drawn, the commissures of the lips pulled upwards, the eyes staring and haggard, the eyelids puckered, the nostrils extended, and the whole expression indicative of the intense and agonizing pain of the disease.

One can perhaps better give one's client some vague idea of the patient's suffering by likening the pain to the throbbing sensation of a festered finger-nail. Tell him that each hoof of the horse is similarly, or, if anything, more delicately, constructed, that in each foot the same process of 'festering' is going on, and that upon them the animal has perforce to stand.

As one might expect, the position of greatest ease is the dec.u.mbent.

Strange to say, though, in many cases of laminitis the animal persists in maintaining a standing posture. Once down, however, one has sometimes the greatest difficulty in persuading him again to rise. The lying position is so long maintained that bedsores begin to make their appearance, and the animal rapidly loses flesh, not only by reason of the fever and the pain, but by giving to rest the time he should normally give to feeding.

Difficulty in rising is greatest when all four feet are affected; is _nearly_ as great when the hind-limbs only are in trouble, but is least when the disease exists alone in the two fore-feet.