Special Report on Diseases of the Horse Part 49

_Symptoms._--Lameness, lasting from one to three or four days, nearly always precedes the development of the strictly local evidences of quittor. The next sign is the appearance of a small, tense, hot, and painful tumor in the skin of the coronary region. If the skin of the affected foot is white, the inflamed portion will present a dark-red or even a purplish appearance near the center. Within a few hours the ankle, or even the whole leg as high as the knee or hock, becomes much swollen. The lameness is now so great that the patient refuses to use the foot at all, but carries it if compelled to move. As a consequence, the opposite leg is required to do the work of both, and if the animal persists in standing a greater part of the time it, too, becomes swollen. In many of these cases the suffering is so intense during the first few days as to cause general fever, dullness, loss of appet.i.te, and increased thirst. Generally the tumor shows signs of suppuration within 48 to 72 hours after its first appearance; the summit softens, a fluctuating fluid is felt beneath the skin, which soon ulcerates completely through, causing the discharge of a thick, yellow, b.l.o.o.d.y pus, containing shreds of dead tissue which have sloughed away. The sore is now converted into an open ulcer, generally deep, nearly or quite circular in outline, and with hardened base and edges. In exceptional cases large patches of skin, varying from 1 to 2-1/2 inches in diameter, slough away at once, leaving an ugly superficial ulcer. These sores, especially when deep, suppurate freely, and if there are no complications they tend to heal rapidly as soon as the degenerated tissue has softened and is entirely removed. When suppuration is fully established, the lameness and general symptoms subside. When but a single tumor and abscess form, the disease progresses rapidly, and recovery, under proper treatment, may be effected in from two to three weeks; but when two or more tumors are developed at once, or if the formation of one tumor is rapidly succeeded by another for an indefinite time, the sufferings of the patient are greatly increased, the case is more difficult to treat, and recovery is more slow and less certain.

This form of quittor is often complicated with the tendinous and subh.o.r.n.y quittors by an extension of the sloughing process.

_Treatment._--The first step in the treatment of an outbreak of quittor should be the removal of all exciting causes. Crowding animals into small corrals and stables, where injuries to the coronet are likely to happen from trampling, especially among unbroken range horses, must be avoided as much as possible.

Watering places accessible without having to wade through mud should be provided. In towns, where the mud or dust is largely impregnated with mineral products, it is not possible to adopt complete preventive measures. Much can be done, however, by careful cleansing of the feet and legs as soon as the animal returns from work. Warm water should be used to remove the mud and dirt, after which the parts are to be thoroughly dried with soft cloths.

The means which are to be adopted for the cure of cutaneous quittor vary with the stage of the disease at the time the case is presented for treatment. If the case is seen early--that is, before any of the signs of suppuration have developed--the affected foot is to be placed under a constant stream of cold water, with the object of arresting a further extension of the inflammatory process. To accomplish this, put the patient in slings in a narrow stall having a slat or open floor. Bandage the foot and leg to the knee or hock, as the case may be, with flannel bandages loosely applied. Set a tub or barrel filled with cold water above the patient, and by the use of a small rubber hose of sufficient length make a siphon which will carry the water from the bottom of the tub to the leg at the top of the bandage. The stream of water should be quite small, and is to be continued until the inflammation has entirety subsided or until the presence of pus can be detected in the tumor. When suppuration has commenced, the process should be aided by the use of warm baths and poultices of lineseed meal or boiled turnips. If the tumor is of rapid growth, accompanied with intense pain, relief is obtained and sloughing largely limited by a free incision of the parts.

The incision should be vertical and deep into the tumor, care being taken not to divide the coronary band entirely. If the tumor is large, more than one incision may be necessary.

The foot should now be placed in a warm bath for half an hour or longer and then poulticed. The hemorrhage produced by the cutting and encouraged by the warm bath is generally very copious and soon gives relief to the overtension of the parts.

In other cases it will be found that suppuration is well under way, so that the center of the tumor is soft when the patient is first presented for treatment. It is always good surgery to relieve the tumor of pus whenever its presence can be detected; hence, in these cases a free incision must be made into the softened parts, the pus evacuated, and the foot poulticed.

By surgical interference the tumor is now converted into an open sore or ulcer, which, after it has been well cleaned by warm baths and poultices applied for two or three days, needs to be protected by proper dressings. The best of all protective dressings is made of small b.a.l.l.s, or pledgets, of oak.u.m, carefully packed into the wound and held in place by a roller bandage 4 yards long, from 3 to 4 inches wide, made of common bedticking and skillfully applied.

The remedies which may be used to stimulate the healing process are many, and, as a rule, they are applied in the form of solutions or tinctures.

In my own practice I prefer a solution of bichlorid of mercury 1 part, water 500 parts, with a few drops of muriatic acid or a few grains of muriate of ammonia added to dissolve the mercury. The b.a.l.l.s of oak.u.m are wet with this solution before they are applied to the wound.

Among the other remedies which may be used, and perhaps with equally as good results, will be noted the sulphate of copper, iron, and zinc, 5 grains of either to the ounce of water; chlorid of zinc, 5 grains to the ounce; carbolic acid, 20 drops dissolved in an equal quant.i.ty of glycerin and added to 1 ounce of water; and nitrate of silver, 10 grains to the ounce of water.

If the wound is slow to heal, it will be found of advantage to change the remedies every few days.

If the wound is pale in color, the granulations transparent and glistening, the tincture of aloes, tincture of gentian, or the spirits of camphor may do best.

When the sore is red in color and healing rapidly, an ointment made of 1 part of carbolic acid to 40 parts of cosmoline or vaseline is all that is needed.

If the granulations continue to grow until a tumor is formed which projects beyond the surrounding skin, it should be cut off with a sharp, clean knife, and the foot poulticed for twenty-four hours, after which the wound is to be well cauterized daily with lunar caustic and the bandages applied with great firmness.

The question as to how often the dressings should be renewed must be determined by the condition of the wound, etc. If the sore is suppurating freely, it will be necessary to renew the dressing every 24 or 48 hours; if the discharge is small in quant.i.ty and the patient comfortable, the dressing may be left on for several days; in fact, the less often the wound is disturbed, the better, so long as the healing process is healthy. When the sore commences to "skin over," the edges should be lightly touched with lunar caustic at each dressing. The patient may now be given a little exercise daily, but the bandages must be kept on until the wound is entirely healed.

TENDINOUS QUITTOR.

This form of quittor differs from the cutaneous in that it not only affects the skin and subcutaneous tissues, but involves also the tendons of the leg, the ligaments of the joints, and, in many cases, the bones of the foot as well.

Fortunately, this form of quittor is less common than the preceding, yet any case beginning as simple cutaneous quittor may at any time during its course become complicated by the death of some part of the tendons, by gangrene of the ligaments, sloughing of the coronary band, caries of the bones, or inflammation and suppuration of the synovial sacs and joints, thereby converting a simple quittor into one which will, in all probability, either destroy the patient's life or maim him for all time.

_Causes._--Tendinous quittor is caused by the same injuries and influences that produce the simple form. Zundel believes it to be a not infrequent accompaniment of distemper. In my own experience I have seen nothing to verify this belief, but I am convinced that young animals are more liable to have tendinous quittor than older ones, and that they are much more likely to make a good recovery.

_Symptoms._--When a case of simple quittor is transformed into the tendinous variety the change is announced by a sudden increase in the severity of all the symptoms. On the other hand, if the attack primarily is one of tendinous quittor, the earliest symptom seen is a well-marked lameness. In those cases due to causes other than injuries this lameness is at first very slight, and the animal limps no more in trotting than in walking; later on, generally during the next 48 hours, the lameness increases to such extent that the patient often refuses to use the leg at all. An examination made during the first two days rarely discloses any cause for this lameness; it may not be possible even to say with certainty that the foot is the seat of the trouble. On the third or fourth day, sometimes as late as the fifth, a doughy-feeling tumor will be found forming on the heel or quarter. This tumor grows rapidly, feels hot to the touch, and is extremely painful. As the tumor develops, all the other symptoms increase in intensity; the pulse is rapid and hard; the breathing quick; the temperature elevated 3 or 4; the appet.i.te is gone; thirst increased; and the lameness so great that the foot is carried if locomotion is attempted. At this stage of the disease the patient generally seeks relief by lying upon the broad side, with outstretched legs; the coat is bedewed with a clammy sweat, and every respiration is accompanied with a moan. The leg soon swells to the fetlock; later this swelling gradually extends to the knee or hock, and in some cases reaches the body. As a rule, several days elapse before the disease develops a well-defined abscess, for, owing to the dense structure of the bones, ligaments, and tendons, the suppurative process is a slow one, and the pus is prevented from readily collecting in a ma.s.s.

I made a post-mortem examination on a typical case of this disease, in which the animal had died on the fourth day after being found on the range slightly lame. The suffering had been intense, yet the only external evidences of the disease consisted in the shedding of the hoof from the right fore foot and a limited swelling of the leg to the knee.

The sloughing of the hoof took place two or three hours before death, and was accompanied with but little suppuration and no hemorrhage. The skin from the knee to the foot was thickened from watery infiltration (edema), and on the inside quarter three holes, each about one-half inch in diameter, were found. All had ragged edges, while but one had gone deep enough to perforate the coronary band. The loose connective tissue beneath the skin was distended, with a gelatinous infiltration over the whole course of the flexor tendons and to the fetlock joint over the tendon in front. The soft tissues covering the coffin bone were loosened in patches by collections of pus which had formed beneath the sensitive laminae. The coffin and pastern joints were inflamed, as were also the coffin, navicular, and coronet bones, while the outside toe of the coffin bone had become softened from suppuration until it readily crumbled between the fingers. The coronary band was largely destroyed and completely separated from the other tissues of the foot. The inner lateral cartilage was gangrenous, as was also a small spot on the extensor tendon near its point of attachment on the coffin bone. Several small collections of pus were found deep in the connective tissue of the coronary region; along the course of the sesamoid ligaments; in the sheath of the flexor tendons; under the tendon just below the fetlock joint in front; and in the coffin joint.

But all cases of tendinous quittor are by no means so complicated as this one was. In rare instances the swelling is slight, and after a few days the lameness and other symptoms subside, without any discharge of pus from an external opening. In most cases, however, from one to half a dozen or more soft points arise on the skin of the coronet, open, and discharge slowly a thick, yellow, fetid, and b.l.o.o.d.y matter. In other cases the suppurative process is largely confined to the sensitive laminae and plantar cushion, when the suffering is intense until the pus finds an avenue of escape by separating the hoof from the coronary band, at or near the heels, without causing a loss of the whole h.o.r.n.y box. When the flexor tendon is involved deep in the foot, the discharge of pus usually takes place from an opening in the follow of the heel; if the sesamoid ligament or the sheath of the flexors are affected, the opening is nearer the fetlock joint, although in most of these cases the suppuration spreads along the course of the tendons until the navicular joint is involved, and extensive sloughing of the deeper parts follows.

_Treatment._--The treatment of tendinous quittor is to be directed toward the saving of the foot. First of all an effort must be made to prevent suppuration; if the patient is seen at the beginning, cold irrigation, recommended in the treatment for cutaneous quittor, is to be resorted to. Later, when the tumor is forming on the coronet, the knife must be used, and a free and deep incision made into the swelling.

Whenever openings appear, from which pus escapes, they should be carefully probed; in all instances these fistulous tracts lead down to dead tissue which nature is trying to remove by the process of sloughing. If a counter opening can be made, which will enable a more ready escape of the pus, it should be done at once; for instance, if the probe shows that the discharge originates from the bottom of the foot, the sole must be pared through over the seat of trouble. Whenever suppuration has commenced the process is to be stimulated by the use of warm baths and poultices. The pus which acc.u.mulates in the deeper parts, especially along the tendons, around the joints, and in the hoof, is to be removed by pressure and injections made with a small syringe, repeated two or three times a day. As soon as the discharge a.s.sumes a healthy character and diminishes in quant.i.ty, stimulating solutions are to be injected into the open wounds. When the tendons, ligaments, and other deeper parts are affected, a strong solution of carbolic acid--1 to 4--should be used at first; or strong solutions of tincture of iodin, sulphate of iron, sulphate of copper, bichlorid of mercury, etc., may be used in place of the carbolic; after this the remedies and dressings directed for use in simple quittor are to be used. In those cases in which the fistulous tracts refuse to heal it is often necessary to burn them out with a saturated solution of caustic soda, equal parts of muriatic acid and water, or, better still, with a long, thin iron, heated white hot.

But no matter what treatment is adopted, a large percentage of the cases of tendinous quittor fail to make good recoveries. If the entire hoof sloughs away, the growth of a new, but soft and imperfect hoof may be obtained by carefully protecting the exposed tissues with proper bandages. When the joints are opened by deep sloughing, recovery may eventually take place, but the joint remains immovable ever after. If caries of a small part of the coffin bone takes place, it may be removed by an operation; but if much of the bone is affected, or if the navicular and coronet bones are involved in the carious process, the only hope for a cure is in the amputation of the foot. This operation is advisable only when the animal is valuable for breeding purposes. In all other cases in which there is no hope for recovery the patient's suffering should be relieved by death. In tendinous quittor much thickening of the coronary region, and sometimes of the ankle and fetlock, remains after suppuration has ceased and the fistulous tracts have healed. To stimulate the reabsorption of this new and unnecessary tissue, the parts should be fired with the hot iron, or, in its absence, repeated blistering with the biniodid of mercury ointment may largely accomplish the same results.

SUBh.o.r.n.y QUITTOR.

This is the most common form of the disease. It is generally seen in but one foot at a time, and more often in the fore than in the hind feet. It nearly always attacks the inside quarter, but may affect the outside, the band in front, or the heel, where it is of but little consequence.

It consists in the inflammation of a small part of the coronary band and adjacent skin, followed by sloughing and suppuration, which in most cases extends to the neighboring sensitive laminae.

_Causes._--Injuries to the coronet, such as bruises, overreaching, and calk wounds, are considered as the common causes of this disease. Still, cases occur in which there appears to be no existing cause, just as in the other forms of quittor, and it seems fair to conclude that subh.o.r.n.y quittor may also be produced by internal causes.

_Symptoms._--At the outset the lameness is always severe, and the patient often refuses to use the affected foot. Swelling of the coronet close to the top of the hoof causes the quarter to protrude beyond the wall. This tumor is extremely sensitive, and the whole foot is hot and painful. After a few days a small spot in the skin, over the most elevated part of the tumor, softens and opens or the hoof separates from the coronary band at the quarter or well back toward the heel. From this opening, wherever it may be, a thin, watery, often dark, offensive discharge escapes, at times mixed with blood and always containing a considerable percentage of pus.

Probing will now disclose a fistulous tract leading to the bottom of the diseased tissues. If the opening is small, there is a tendency upon the part of the suppurative process to spread downward; the pus gradually separates the hoof from the sensitive laminae until the sole is reached, and even a portion of this may be undermined.

As a rule, the slough in this form of quittor is not deep, and if the case receives early and proper treatment complications are generally avoided; but if the case is neglected, and, occasionally, even in spite of the best treatment, the disease spreads until the tendon in front, the lateral cartilage, or the coffin bone and joint as well are involved.

In all cases of subh.o.r.n.y quittor much relief is experienced when the slough comes away, and rapid recovery is made. If, however, after the lapse of a few days, the lameness remains and the wound continues to discharge a thin, unhealthy matter, the probabilities are that the disease is spreading, and pus collecting in the deeper parts of the foot. In Zundel's opinion, if the use of the probe now detects a pus cavity below the opening, a cartilaginous quittor is in the course of development.

_Treatment._--Hot baths and poultices are to be used until the presence of pus can be determined, when the tumor is to be opened with a knife or sharp-pointed iron heated white hot. The hot baths and poultices are now continued for a few days or until the entire slough has come away and the discharge is diminished, when dressings recommended in the treatment for cutaneous quittor are to be used until recovery is completed. In cases in which the discharge comes from a cleft between the upper border of the hoof and the coronary band, always pare away the loosened horn, so that the soft tissues beneath are fully exposed, care being taken not to injure the healthy parts. This operation permits of a thorough inspection of the diseased parts, the easy removal of all gangrenous tissue, and a better application of the necessary remedies and dressings. The only objection to the operation is that the patient is prevented from being early returned to work.

When the probe shows that pus has collected under the coffin bone the sole must be pared through, and, if caries of the bone is present, the dead parts cut away. After either of these operations the wound is to be dressed with the oak.u.m b.a.l.l.s, saturated in the bichlorid of mercury solution, as previously directed, and the bandages tightly applied.

Generally the discharge for the first two or three days is so great that the dressings need to be changed every 24 hours; but when the discharge diminishes, the dressing may be left on from one to two weeks. Before the patient is returned to work, a bar shoe should be applied, since the removed quarter or heel can only be made perfect again by a new growth from the coronary band.

Tendinous or cartilaginous complications are to be treated as directed under those headings.

CARTILAGINOUS QUITTOR.

This form of quittor may commence as a primary inflammation of the lateral cartilage, but in the great majority of cases it appears as a sequel to cutaneous or subh.o.r.n.y quittor. It may affect either the fore or hind feet, but is most commonly seen in the former. As a rule, it attacks but one foot at a time, and but one of the cartilages, generally the inner one. It is always a serious affection for the reason that, in many cases, it can only be cured by a surgical operation, requiring a thorough knowledge of the anatomy of the parts involved, and much surgical skill.

_Causes._--Direct injuries to the coronet, such as trampling, p.r.i.c.ks, burns, and the blow of some heavy falling object which may puncture, bruise, or crush the cartilage, are the common direct causes of cartilaginous quittor. Besides being a sequel to the other forms of quittor, it sometimes develops as a complication in suppurative corn, canker, grease, laminitis, and punctured wounds of the foot. Animals used for heavy draft, and those with flat feet and low heels, are more liable to the disease than others, for the reason that they are more exposed to injury. Rough roads also predispose to the disease by increasing liability to injury.

_Symptoms._--When the disease commences as a primary inflammation of the cartilage, lameness develops with the formation of a swelling on the side of the coronet over the quarter. The severity of this lameness depends largely upon the part of the cartilage which is diseased, for if the disease is situated in that part of the cartilage nearest the heel, where the surrounding tissues are soft and spongy, the lameness may be very slight, especially if the patient is required to go no faster than a walk; but when the middle and anterior parts of the cartilage are diseased, the pain and consequent lameness are much greater, for the tissues are less elastic and the coffin joint is more liable to become affected.

Except in the cases to be noted hereafter, one or more fistulous openings finally appear in the tumor on the coronet. These openings are surrounded by a small ma.s.s of granulations which are elevated above the adjacent skin and bleed readily if handled. A probe shows these fistulous tracts to be more or less sinuous, but always leading to one point--the gangrenous cartilage. When cartilaginous quittor happens as a complication of suppurative corn, or from punctured wounds of the foot, the fistulous tract may open alone at the point of injury on the sole.

The discharge in this form of quittor is generally thin, watery, and contains pus enough to give it a pale-yellow color; it is offensive to the sense of smell, due to the detachment of small flakes of cartilage which have become gangrenous and are seen in the discharge as small, greenish-colored particles. In old cases it is not unusual to find some of the fistulous openings heal at the surface; this is followed by the gradual collection of pus in the deeper parts, forming an abscess, which in a short time opens at a new point. The wall of the hoof, over the affected quarter and heel, in very old cases becomes rough and wrinkled like the horn of a ram, and generally it is thicker than the corresponding quarter, owing to the stimulating effect which the disease has upon the coronary band.

Complications may arise by an extension of the disease to the lateral ligament of the coffin joint, to the joint itself, to the plantar cushion, and by caries of the coffin bone.

_Treatment._--Before recovery can take place all the dead cartilage must be removed. In rare instances this is effected by nature without a.s.sistance. Usually, however, the disease does not tend to recovery, and active curative measures must be adopted. The best and simplest treatment, in a majority of cases, is the injection of strong caustic solutions, which destroy the diseased cartilage and cause its discharge, along with the other products of suppuration. In favorable cases these injections will secure a healing of the wound in from two to three weeks. While the saturated solution of sulphate of copper, or a solution of 10 parts of bichlorid of mercury to 100 parts of water, has given the best results in my hands, equally as favorable success has been secured by others from the use of caustic soda, nitrate of silver, sulphate of zinc, tincture of iodin, etc. No matter which one of these remedies may be selected, however, it must be used at least twice a day for a time.

The solution is injected into the various openings with force enough to drive it to the bottom of the wound, after which the foot is to be dressed with a pad of oak.u.m, held in place by a roller bandage tightly applied. While it is not always necessary, it is often of advantage to relieve the pressure on the parts by rasping away the hoof over the seat of the cartilage; the coronary band and laminae should not be injured in the operation.

If the caustic injections prove successful, the discharge will become healthy and gradually diminish, so that by the end of the second week the fistulous tracts are closing up and the injections are made with much difficulty.

If, on the other hand, there is but little or no improvement after this treatment has been used for three weeks, it may reasonably be concluded that the operation for the removal of the lateral cartilage must be resorted to for the cure of the trouble. As this operation can be safely undertaken only by an expert surgeon, it will not be described in this connection.