While there are no positive premonitory symptoms of these fractures known, we believe that there are signs and symptoms which come but little short of being so, and the appearance of which will always justify a strong suspicion of the truth of the case. These have been indicated when referring to the soreness in standing, the short, mincing gait, and the tenderness betrayed when pressure is made over the sesamoids on the sides of the fetlock, with others less tangible and definable.

_Prognosis._--These injuries can never be accounted less than serious, and in our judgment will never be other than fatal. If our theory of their pathology is the correct one, and the cause of the lesions is truly the softening of the sesamoidal bony structure and independent of any changes in the ligamentous fibers, the possibility of a solid osseous union can hardly be considered admissible.

_Treatment._--In respect to the treatment to be recommended and inst.i.tuted it can be employed only with any rational hope of benefit during the incubation, and with the antic.i.p.atory purpose of prevention.

It must be suggested by a suspicion of the verities of the case, and applied before any rupture has taken place. To prevent this and to antagonize the causes which might precipitate the final catastrophe--the elevation of the toes--resort must be had to the slings and to the application of firm bandages or splints, perhaps of plaster of Paris, with a high shoe, as about the only indications which science and nature are able to offer. When the fracture is an occurred event, and the toes, one or more, are turned up, any further resort to treatment will be futile.

DISEASES OF JOINTS.

Three cla.s.ses of injury will be considered under this head. These are, affections of the synovial sacs, those of the joint structures, or of the bones and their articular surfaces, and those forms of solution of continuity known as dislocations or luxations.

DISEASES OF THE SYNOVIAL SACS.

Two forms of affection here present themselves, one being the result of an abnormal secretion which induces a dropsical condition of the sac without any acute, inflammatory action, while the other is characterized by excessive inflammatory symptoms, with their modifications, const.i.tuting synovitis.

SYNOVIAL DROPSIES.

We have already considered in a general way the presence of these peculiar oil bags in the joints, and in some regions of the legs where the pa.s.sage of the tendons takes place, and have noticed the similarity of structure and function of both the articular and the tendinous bursae, as well as the etiology of their injuries and their pathological history, and we will now treat of the affections of both.

WINDGALLS.

This name is given to the dilated bursae found at the posterior part of the fetlock joint. They have their origin in a dropsical condition of the bursae of the joint itself, also of the tendon which slides behind it, and are therefore further known by the designations of articular and tendinous windgalls, or puffs. (See also p. 401.)

They appear in the form of soft and somewhat symmetrical tumors, of varying dimensions, and generally well defined in their circ.u.mference.

They are more or less tense, according to the quant.i.ty of secretion they contain, apparently becoming softer as the foot is raised and the fetlock flexed. Usually they are painless and only cause lameness under certain conditions, as when they begin to develop themselves under the stimulus of inflammatory action, or when large enough to interfere with the functions of the tendons, or again when they have undergone certain pathological changes, such as calcification, which is among their tendencies.

_Cause._--Windgalls may be attributed to external causes, such as severe labor or strains resulting from heavy pulling, fast driving, or jumping, or they may be among the sequelae of internal disorders, such as strangles or the resultants of a pleuritic or pneumonic attack.

Unnecessary anxiety is sometimes experienced respecting these growths, with much questioning touching the expediency of their removal, all of which might be spared, for, while they const.i.tute a blemish, their unsightliness will not hinder the usefulness of the animal, and in any case they rarely fail to show themselves easily amenable to treatment.

_Treatment._--When in their acute stage, and when the dropsical condition is not excessive, the inflammation may be checked during the day by continuous, cold-water irrigation by means of a hose or soaking tub and at night by applying a moderately tight-roller bandage. Later absorption may be promoted by a Priessnitz bandage,[2] pressure by roller bandages, sweating, the use of liniments, or if necessary by a sharp blister of biniodid of mercury. This treatment should subdue the inflammation, abate the soreness, absorb the excess of secretion, strengthen the walls of the sac, and finally cause the windgalls to disappear, provided the animal is not too quickly returned to labor and exposed to the same factors that occasioned them at first.

If the inflammation has become chronic, however, and the enlargement has been of considerable duration, the negative course will be the wiser one. If any benefit results from treatment it will be of only a transient kind, the dilatation returning when the patient is again subjected to labor, and it will be a fortunate circ.u.mstance if inflammation has not supervened.

Notwithstanding the generally benignant nature of the swelling there are exceptional cases, usually when it is probably undergoing certain pathological changes, which may result in lameness and disable the animal, in which case surgical treatment will be indicated, especially if repeated blisters have failed to improve the symptoms. Line firing is then a preeminent suggestion, and many a useful life has received a new lease as the result of this operation timely performed. Another method of firing, which consists in emptying the sac by means of punctures through and through, made with a red-hot needle or wire, and the subsequent injection of certain irritating and alterative compounds into the cavity, designed to effect its closure by exciting adhesive inflammation, such as tincture of iodin, may be commended. But they are all too active and energetic in their effects and require too much special attention and intelligent management to be trusted to any hands other than those of an expert veterinarian.

BLOOD SPAVIN, BOG SPAVIN, AND THOROUGHPIN.

The blood spavin is situated in front and to the inside of the hock and is merely a varicose or dilated condition of the saphena vein. It occurs directly over the point where the bog spavin is found, and has thus been frequently confused with the latter.

The complicated arrangement of the hock joint, and the powerful tendons which pa.s.s on the posterior part, are lubricated with the product of secretion from one tendinous synovial and several articular synovial sacs. A large articular sac contributes to the lubrication of the shank bone (the tibia) and one of the bones of the hock (the astragalus). The tendinous sac lies back of the articulation itself and extends upward and downward in the groove of that joint through which the flexor tendons slide. The dilatation of this articular synovial sac is what is denominated bog spavin, the term thoroughpin being applied to the dilatation of the tendinous capsule.

The bog spavin is a round, smooth, well-defined, fluctuating tumor situated in front and a little inward of the hock. On pressure it disappears at this point to reappear on the outside and just behind the hock. If pressed to the front from the outside it will then appear on the inside of the hock. On its outer surface it presents a vein which is quite prominent, running from below upward, and it is to the preternatural dilatation of this blood vessel that the term blood spavin is applied.

The thoroughpin is found at the back and on the top of the hock in that part known as the "hollows," immediately behind the shank bone. It is round and smooth, but not so regularly formed as the bog spavin, and is most apparent when viewed from behind. The swelling is usually on both sides and a little in front of the so-called hamstring, but may be more noticeable on the inside or on the outside.

In their general characteristics bog spavins and thoroughpins are similar to windgalls, and one description of the origin, symptoms, pathological changes, and treatment will serve for all equally, except that it is possible for a bog spavin to cause lameness, and thus to involve a verdict of unsoundness in the patient, a circ.u.mstance which will, of course, justify its cla.s.sification by itself as a severer form of a single type of disease.

We have already referred to the subject of treatment and the means employed--rest, of course--with liniments, blisters, etc., and what we esteem as the most active and beneficial of any, early, deep, and well-performed cauterization. There are, besides, commendatory reports of a form of treatment by the application of pressure pads and peculiar bandages upon the hocks, and it is a.s.serted that the removal of the tumors has been effected by their use. Our experience with this apparatus, however, has not been accompanied with such favorable results as would justify our indors.e.m.e.nt of the flattering representations which have sometimes appeared in its behalf.

OPEN JOINTS, BROKEN KNEES, SYNOVITIS, AND ARTHRITIS.

The close relationship which exists among these several affections, their apparently possible connection as successive developments of a similar, if not an essentially identical, origin, together with the advantage gained by avoiding frequent repet.i.tions in the details of symptoms, treatment, etc., are our reasons for treating under a single head the ailments we have grouped together in the present section.

_Cause._--The great, comprehensive, common cause of, sometimes permanent, sometimes only transient, disability of the horse is external traumatism.

Blows, bruises, hurts by nearly every known form of violence, falls, kicks, lacerations, punctures--we may add compulsory speed in racing and cruel overloading of draft animals--cover the entire ground of causation of the diseases and injuries of the joints now receiving our consideration.

In one case, a working horse making a misstep stumbles, and falling on his knees receives a hurt, variously severe, from a mere abrasion of the skin to a laceration, a division of the tegument, a slough, mortification, and the escape of the synovial fluid, with or without exposure of the bones and their articular cartilages.

In another case, an animal, from one cause or another, perhaps an impatient temper, has formed the habit of striking or pawing his manger with his fore feet until inflammation of the knee joint is induced, first as a little swelling, diffused, painless; then as a periost.i.tis of the bones of the knee; later as bony deposits, then lameness, and finally the implication of the joint, with all the various sequelae of chronic inflammation of the knee joint.

In another case, a horse has received a blow with a fork from a careless hostler on or near a joint, or has been kicked by a stable companion, with the result of a punctured wound, at first mild-looking, painless, apparently without inflammation, and not yet causing lameness, but which, in a few hours, or it may be only after a few days, becomes excessively painful, grows worse, the entire joint swells, presently discharges, and at last a case of suppurative synovitis is presented, with perhaps disease of the joint proper, and arthritis as a climax. The symptoms of articular injuries vary not only in the degrees of the hurt but in the nature of the lesion.

Or the condition of broken knees, resulting as we have said, may have for its starting point a mere abrasion of the skin--a scratch, apparently, which disappears without a scar. The injury may, however, have been more severe, the blow heavier, the fall aggravated by occurring upon an irregular surface, or sharp or rough object, with tearing or cutting of the skin, and this laceration may remain. A more serious case than the first is now brought to our notice.

Another time, immediately following the accident, or possibly as a sequel of the traumatism, the tendinous sacs may be opened, with the escape of the synovia, or, worse, the tendons which pa.s.s in front of the knee are torn, the inflammation spreads, the joint and leg are swollen, the animal is becoming very lame; synovitis has set in. With this the danger becomes very great, for soon suppuration will be established, then the external coat of the articulation proper becomes ulcerated, if it is not already in that state, and we find ourselves in the presence of an open joint with suppurative synovitis--that is, with the worst among the conditions of diseased processes, because of the liability of the suppuration to become infiltrated into every part of the joint, macerating the ligaments and irritating the cartilages, soon to be succeeded by their ulceration, with the destruction of the articular surface--or the lesion of ulcerative arthritis, one of the gravest among all the disorders known to the animal economy.

Ulcerative arthritis and suppurative synovitis may be developed otherwise than in connection with open joints; the simplest and apparently most harmless punctures may prove to be sufficient cause. For example, a horse may be kicked, perhaps, on the inside of the hock; there is a mark and a few drops of blood to indicate the spot; he is put to work apparently free from pain or lameness and performs his task with his usual ease and facility. On the following morning, however, the hock is found to be a little swollen and there is some stiffness. A little later on he betrays a degree of uneasiness in the leg, and shrinks from resting his weight upon it, moving it up and down for relief. The swelling has increased and is increasing; the pain is severe; and finally, at the spot where the kick inpinged, there is an oozing of an oily liquid mixed with whitish drops of suppuration. The mischief is done; a simple, harmless, punctured wound has expanded into a case of ulcerative arthritis and suppurative synovitis.

_Prognosis._--From ever so brief and succinct description of this traumatism of the articulations, the serious and important character of these lesions, irrespective of which particular joint is affected, will be readily understood. Yet there will be modifications in the prognosis in different cases, in accordance with the peculiarities of structure in the joint specially involved, as, for example, it is obvious that a better result may be expected from treatment when but a single joint, with only its plain articular surfaces, is the place of injury, than in one which is composed of several bones, united in a complex formation, as in the knee or hock. As severe a lesion as suppurative synovitis always is, and as frequently fatal as it proves to be, still cases arise in which, the inflammation a.s.suming a modified character and at length subsiding, the lesion terminates favorably and leaves the animal with a comparatively sound and useful joint. There are cases, however, which terminate in no more favorable a result than the union of the bones and occlusion of the joint, to form an anchylosis, which is scarcely a condition to justify a high degree of satisfaction, as it insures a permanent lameness with very little capacity for usefulness.

Appreciating now the dangers a.s.sociated with all wounds of articulations, however simple and apparently slight, and how serious and troublesome are the complications which are liable to arise during their progress and treatment, we are prepared to understand and realize the necessity and the value of early and prompt attention upon their discovery and diagnosis.

_Treatment._--For simple bruises, like those which appear in the form of broken knees or of carpitis, simple remedies, such as warm fomentations or cold-water applications and compresses of astringent mixtures, suggest themselves at once. Injuries of a more complicated character, as lacerations of the skin or tearing of soft structures, will also be benefited by simple dressings with antiseptic mixtures, as those of the carbolic-acid order. The escape of synovia should suggest the prompt use of collodion dressings to check the flow and prevent the further escape of the fluid. But if the discharge is abundant and heavily suppurative, little can be done more than to put in practice the "expectant" method with warm fomentations, repeatedly applied, and soothing, mucilaginous poultices. Improvement, if any is possible, will be but slow to manifest itself. The most difficult of all things to do, in view of varying interests and opinions--that is, in a practical sense--is to abstain from "doing" entirely, and yet in the cases we are considering we are firmly convinced that noninterference is the best and wisest policy.

In cases which are carried to a successful result the discharge will diminish by degrees, the extreme pain will gradually subside, the convalescent will begin timidly to rest his foot upon the ground, and presently to bear weight upon it, and perhaps, after a long and tedious process of recuperation, he may be returned to his former and normal condition of usefulness. When the discharge has wholly ceased and the wounds are entirely healed, a blister covering the whole of the joint for the purpose of stimulating the absorption of the exudation will be of great service. If, on the contrary, there is no amelioration of symptoms and the progress of the disease resists every attempt to check it; if the discharge continues to flow not only without abatement but in an increased volume, and not alone by a single opening but by a number of fistulous tracts which have successively formed; if it seems evident that this drainage is rapidly and painfully sapping the suffering animal's vitality, and a deficient _vis vitae_ fails to cooperate with the means of cure--all rational hope of recovery may be finally abandoned. Any further waiting for chances, or time lost in experimenting, will be mere cruelty and there need be no hesitation concerning the next step. The poor beast is under sentence of death, and every consideration of interest and of humanity demands an antic.i.p.ation of nature's evident intent in the quick and easy execution of the sentence.

[Ill.u.s.tration: PLATE x.x.x.

DISLOCATION OF SHOULDER AND ELBOW

Bourgelat's apparatus]

[Ill.u.s.tration: PLATE x.x.xI.

THE SLING IN USE]

One of the essentials of treatment, and probably an indispensable condition when recovery is in any wise attainable, is the suspension of the patient in slings. He should be continued in them so long as he can be made to submit quietly to their restraint.

DISLOCATIONS.