Special Report on Diseases of the Horse Part 51

Wounds in the heel and in the posterior parts of the frog are attended with but little danger, unless they are so deep as to injure the lateral cartilages, when quittor may follow. Punctured wounds of the anterior parts of the sole are more dangerous, for the reason that the coffin bone may be injured, and the suppuration, even when the wound is not deep, tends to spread and always gives rise to intense suffering. The most serious of the punctured wounds are those which happen to the center of the foot, and which, in proportion to their depth, involve the plantar cushion, the plantar aponeurosis, the sesamoid sheath, the navicular bone, or the coffin joint.

Punctured wounds are more liable to be deep in flat or convex feet than in well-made feet, and as a rule, recovery is neither so rapid nor so certain. These wounds are less serious in animals used for heavy draft than in those required to do faster work; for the former may be useful, even if complete recovery is not effected. Lastly, punctured wounds of the fore feet are more serious than of the hind feet, for the reason that in the former the instrument is liable to enter the foot in a nearly perpendicular line, and, consequently, is more liable to injure the deeper structures of the foot; in the hind foot, the injury is generally near the heels and the wound oblique and less deep.

_Symptoms._--A nail or other sharp instrument may penetrate the frog and remain for several days without causing lameness; in fact, in many cases of punctured wound of the frog the first evidence of the injury is the finding of the nail or the appearance of an opening where the skin and frog unite, from which more or less pus escapes. Even when the sole is perforated, if the injury is not too deep, no lameness develops until suppuration is established. In all cases of foot lameness, especially if the cause is obscure, the foot should be examined for evidence of injury.

The lameness from punctured wounds, accompanied with suppuration, is generally severe, the patient often refusing to use the affected member at all. The pain being lancinating in character, he stands with the injured foot at rest or constantly moves it back and forth. In other cases the patient lies down most of the time with the feet outstretched; the breathing is rapid, the pulse fast, the temperature elevated, and the body covered with patches of sweat.

When the plantar aponeurosis is injured, the pus escapes with difficulty and the wound shows no signs of healing; the whole foot is hot and very painful. If the puncture involves the sesamoid sheath, the synovial fluid escapes. At first this fluid is pure, like joint water, but later becomes mixed with the products of suppuration and loses its clear, amber color. Suppuration generally extends up the course of the flexor tendon, an abscess forms in the hollow of the heel, and finally opens somewhere below the fetlock joint. The whole coronet is more or less swollen, the discharge is profuse and often mixed with blood, yet the suffering is greatly relieved from the moment the abscess opens.

If the puncture reaches the navicular bone the lameness is intense from the beginning; but the only certain way to determine the existence of this complication is by the use of the probe; and unless there is a free escape of synovia it must be used with the greatest of care, else the coffin joint may be opened. If the coffin joint has been penetrated, either by the offending instrument or by the process of suppuration, acute inflammation of the joint follows, accompanied with high fever, loss of appet.i.te, etc. The ankle and coronet are now greatly swollen, and dropsy of the leg to the knee or hock, or even to the body, often follows. If the process of suppuration continues, small abscesses appear at intervals on different parts of the coronet, the patient rapidly loses flesh, and may die from intense suffering and blood poisoning. In other cases the suppuration soon disappears, and recovery is effected by the joint becoming stiff (anchylosis).

When the wound is forward, near the toe, and deep enough to injure the coffin bone, caries always results. The presence of the dead pieces of bone can be determined by the use of the probe; the bone feels rough and gritty. Furthermore, there is no disposition upon the part of the wound to heal.

Besides the complications above mentioned, others equally as serious may be met with. The tendons may soften and rupture, the hoof may slough off, quittors develop, or sidebones and ringbones grow. Finally, laminatis of the opposite foot may happen if the patient persists in standing, or lockjaw may cause early death.

_Treatment._--In all cases the horn around the seat of injury should be thinned down, a free opening made for the escape of the products of suppuration, and the foot placed in a poultice. If the injury is not serious, recovery takes place in a few days. When the wound is deeper it is better to put the foot into a cold bath or under a stream of cold water, as advised in the treatment for quittor.

If the bone is injured, cold baths, containing about 2 ounces each of sulphate of copper and sulphate of iron, may be used until the dead bone is well softened, when it should be removed by an operation. The animal must be cast for this operation. The sole is pared away until the diseased bone is exposed, when all the dead particles are to be removed with a drawing knife, and the wound dressed with 3 per cent compound cresol solution or a 5 per cent solution of carbolic acid, oak.u.m b.a.l.l.s, and a roller bandage.

Wounds of the bone which are made by a blunt-pointed instrument, like the square-pointed cut nail, in which a portion of the surface is driven into the deeper parts of the bone, always progress slowly, and should be operated upon as soon as the conditions are favorable. Even wounds of the navicular bone, accompanied with caries, may be operated on and the life of the patient saved; but the most skillful surgery is required and only the experienced operator should undertake their treatment.

If there is an escape of pure synovial fluid from a wound of the sole, without injury to the bone, a small pencil of corrosive sublimate should be introduced to the bottom of the wound and the foot dressed as directed above.

The other complications are to be treated as directed under their proper headings.

After healing of the wounds has been effected, lameness, with more or less swelling of the coronary region, may remain. In such cases the coronet should be blistered or even fired with the actual cautery, and the patient turned to pasture. If the lameness still persists, and is not due to a stiff joint, unnerving may be resorted to in many cases with very good results. If the joint is anchylosed, no treatment can relieve it, and the patient must either be put to very slow work or kept for breeding purposes only.

"_p.r.i.c.k in shoeing_" is an injury which should be considered under the head of punctured wounds of the foot. The nails by which the shoe is fastened to the hoof may produce an injury followed by inflammation and suppuration in two days, by penetrating the soft tissues directly or by being driven so deep that the inner layers of the horn of the wall are pressed against the soft tissues with such force as to crush them. In either case, unless the injury is at the toe, the animal generally goes lame soon after shoeing, when the first evidence of the trouble may be the discharge of pus at the coronet. If lameness follows close upon the setting of the shoes, without other appreciable cause, each nail should be lightly struck with a hammer, when the one at fault will be detected by the flinching of the animal.

Treatment consists in drawing the nail, and if the soft tissues have been penetrated or suppuration has commenced, the horn must be pared away until the diseased parts are exposed. The foot is now to be poulticed for a day or two, or until the lameness and suppuration have ceased. If the discharge of pus from the coronet is the first evidence of the disease, the offending nail must be found and removed, the horn pared out, and a weak solution of carbolic acid or compound cresol injected at the coronet until the fistulous tract has healed.

CONTRACTED HEELS, OR HOOFBOUND.

Contracted heels, or hoofbound, is a common disease among horses kept on hard floor in dry stables, and in such as are subject to much saddle work. It consists in an atrophy, or shrinking, of the tissues of the foot, whereby the lateral diameter of the heels is diminished. It affects the fore feet princ.i.p.ally; but it is seen occasionally in the hind feet, where it is of less importance, for the reason that the hind foot first strikes the ground with the toe, and consequently less expansion of the heels is necessary than in the fore feet, where the weight is first received on the heels. Any interference with the expansibility of this part of the foot interferes with locomotion and ultimately gives rise to lameness. Usually but one foot is affected at a time, but when both are diseased the change is greater in one than in the other. Occasionally but one heel, and that the inner one, is contracted; in these cases there is less liable to be lameness and permanent impairment of the animal's usefulness. According to the opinion of some of the French veterinarians, hoofbound should be divided into two cla.s.ses--total contraction, in which the whole foot is shrunken in size, and contraction of the heels, when the trouble extends only from the quarters backward. (Pl. x.x.xV, figs. 4 and 7.)

_Causes._--Animals raised in wet or marshy districts, when taken to towns and kept on dry floors, are liable to have contracted heels, not alone because the horn becomes dry, but because fever of the feet and wasting away of the soft tissues result from the change. Another common cause of contracted heels is to be found in faulty shoeing, such as rasping the wall, cutting away the frog, heels, and bars; high calks and the use of nails too near the heels. Contracted heels may happen as one of the results of other diseases of the foot; for instance, it often accompanies thrush, sidebones, ringbones, canker, navicular disease, corns, sprains of the flexor tendons, of the sesamoid and suspensory ligaments, and from excessive knuckling of the fetlock joint.

_Symptoms._--In contraction of the heels the foot has lost its circular shape, and the walls from the quarters backward approach to a straight line. The ground surface of the foot is now smaller than the coronary circ.u.mference; the frog is pinched between the inclosing heels, is much shrunken, and at times is affected with thrush. The sole is more concave than natural, the heels are higher, and the bars are long and nearly perpendicular. The whole hoof is dry and so hard that it can scarcely be cut; the parts toward the heels are scaly and often ridged like the horns of a ram, while fissures, more or less deep, may be seen at the quarters and heels following the direction of the horn fibers. (Plate x.x.xVI, fig. 10.) When the disease is well advanced lameness is present, while in the earlier stages there is only an uneasiness evinced by frequent shifting of the affected foot. Stumbling is common, especially on hard or rough roads. In most cases the animal comes out of the stable stiff and inclined to walk on the toe, but after exercise he may go free again. He wears his shoes off at the toe in a short time, no matter whether he works or remains in the stable. If the shoe is removed and the foot pared in old cases, a dry, mealy horn will be found where the sole and wall unite, extending upward in a narrow line toward the quarters.

_Treatment._--First of all, the preventive measures must be considered.

The feet are to be kept moist and the horn from drying out by the use of damp sawdust or other bedding; by occasional poultices of boiled turnips, linseed meal, etc., and greasy hoof ointments to the sole and walls of the feet. The wall of the foot should be spared from the abuse of the rasp; the frog, heels, and bars are not to be mutilated with the knife, nor should calks be used on the shoe except when absolutely necessary. The shoes should be reset at least once a month to prevent the feet from becoming too long, and daily exercise must be insisted on.

As to curative measures, a diversity of opinion exists. A number of kinds of special shoes have been invented, having for an object the spreading of the heels, and perhaps any of these, if properly used, would eventually effect the desired result. But a serious objection to most of these shoes is that they are expensive and often difficult to make and apply. The method of treatment which I have adopted is not only attended with good results, but is inexpensive, if the loss of the patient's services for a time is not considered a part of the question.

It consists, first, in the use of poultices or baths of cold water until the horn is thoroughly softened. The foot is now prepared for the shoe in the usual way, except that the heels are lowered a little and the frog remains untouched. A shoe, called a "tip," is made by cutting off both branches at the center of the foot and drawing the ends down to an edge. The tapering of the branches should begin at the toe, and the shoe should be of the usual width, with both the upper and lower surfaces flat. This tip is to be fastened on with six or eight small nails, all set well forward, two being in the toe. With a common foot rasp begin at the heels, close to the coronet, and cut away the horn of the wall until only a thin layer covers the soft tissues beneath. Cut forward until the new surface meets the old 2-1/2 or 3 inches from the heel. The same sloping shape is to be observed in cutting downward toward the bottom of the foot, at which point the wall is to retain its normal thickness. The foot is now blistered all round the coronet with Spanish-fly ointment; when this is well set, the patient is to be turned to pasture in a damp field or meadow. The blister should be repeated in three or four weeks, and, as a rule, the patient can be returned to work in two or three months.

The object of the tip is to throw the weight on the frog and heels, which are readily spread after the horn has been cut away on the sides of the wall. The internal structures of the foot at the heels, being relieved of excessive pressure, regain their normal condition if the disease is not of too long standing. The blister tends to relieve any inflammation which may be present, and stimulates a rapid growth of healthy horn, which, in most cases, ultimately forms a wide and normal heel. In old, chronic cases, with a shrunken frog and increased concavity of the sole, accompanied with excessive wasting of all the internal tissues of the foot, satisfactory results can not be expected and are rarely obtained. Still, much relief, if not an entire cure, may be effected by these measures.

When thrush is present as a complication, its cure must be sought by measures directed under that heading. If sidebones, ringbones, navicular disease, contracted tendons, or other diseases have been the cause of contracted heels, treatment will be useless until the cause is removed.

SAND CRACKS.

A sand crank is a fissure in the horn of the wall of the foot. These fissures are quite narrow, and, as a general rule, they follow the direction of the h.o.r.n.y fibers. They may occur on any part of the wall, but ordinarily are only seen directly in front, when they are called toe cracks; or on the lateral parts of the walls, when they are known as quarter cracks. (Plate x.x.xVI.)

Toe cracks are most common in the hind feet, while quarter cracks nearly always affect the fore feet. The inside quarter is more liable to the injury than the outside, for the reason that this quarter is not only the thinner, but during locomotion receives a greater part of the weight of the body. A sand crack may be superficial, involving only the outer parts of the wall, or it may be deep, involving the whole thickness of the wall and the soft tissues beneath.

The toe crack is most likely to be complete--that is, extending from the coronary band to the sole--while the quarter crack is nearly always incomplete, at least when of comparatively recent origin. Sand cracks are most serious when they involve the coronary band in the injury. They may be complicated at any time by hemorrhage, inflammation of the laminae, suppuration, gangrene of the lateral cartilage and of the extensor tendon, caries of the coffin bone, or the growth of a h.o.r.n.y tumor known as a keraphyllocele.

_Causes._--Relative dryness of the horn is the princ.i.p.al predisposing cause of sand cracks. Excessive dryness is perhaps not a more prolific cause of cracks in the horn than alternate changes from damp to dry. It is even claimed that these injuries are more common in animals working on wet roads than those working on roads that are rough and dry; at least these injuries are not common in mountainous countries. Animals used to running at pasture when transferred to stables with hard, dry floors are more liable to quarter cracks than those accustomed to stables. Small feet, with thick, hard hoofs, and feet which are excessively large, are more susceptible to sand cracks than those of better proportion. A predisposition to quarter cracks exists in contracted feet, and in those where the toe turns out or the inside quarter turns under.

Heavy shoes, large nails, and nails set too far back toward the heels, together with such diseases as canker, quittor, grease, and suppurative corns, must be included as occasional predisposing causes of sand cracks.

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

QUARTER-CRACK AND REMEDIES.]

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

FOUNDERED FEET.]

Fast work on hard roads, jumping, and blows on the coronet, together with calk wounds of the feet, are accidental causes of quarter cracks in particular. Toe cracks are more likely to be caused by heavy pulling on slippery roads and pavements or on steep hills.

_Symptoms._--The fissure in the horn is ofttimes the only evidence of the disease; even this may be accidentally or purposely hidden from casual view by mud, ointments, tar, wax, putty, gutta-percha, or by the long hairs of the coronet.

Sand cracks sometimes commence on the internal face of the wall, involving its whole thickness excepting a thin layer on the outer surface. In these cases the existence of the injury may be suspected from a slight depression, which begins near the coronary band and follows the direction of the h.o.r.n.y fibers; but the trouble can only be positively diagnosed by paring away the outside layers of horn until the fissure is exposed. In toe cracks the walls of the fissure are in close apposition when the foot receives the weight of the body, but when the foot is raised from the ground the fissure opens. In quarter crack the opposition is true; the fissure closes when the weight is removed from the foot. As a rule, sand cracks begin at the coronary band, and as they become older they not only extend downward, but they also grow deeper.

In old cases, particularly in toe cracks, the horn on the borders of the fissure loses its vitality and scales off, sometimes through the greater part of its thickness, leaving behind a rough and irregular channel extending from the coronet to the end of the toe.

In many cases of quarter crack, and in some cases of toe crack as well, if the edges remain close together, with but little motion, the fissure is dry; but in other cases a thin, offensive discharge issues from the crack and the ulcerated soft tissues, or a funguslike growth protrudes from the narrow opening.

When the cracks are deep and the motion of their edges considerable, so that the soft tissues are bruised and pinched with every movement, a constant inflammation of the parts is maintained and the lameness is severe.

Ordinarily the lameness of sand crack is slight when the patient walks, but it is greatly aggravated when he is made to trot, and the harder the road the worse he limps. Furthermore, the lameness is greater going downhill than up, for the reason that these conditions are favorable to an increased motion in the edges of the fissure. Lastly, more or less hemorrhage accompanies the inception of a sand crack when the whole thickness of the wall is involved. Subsequent hemorrhages may also take place from fast work, jumping, or a misstep.

_Treatment._--So far as preventive measures are concerned, but little can be done. The suppleness of the horn is to be maintained by the use of ointments, damp floor, bedding, etc. The shoe is to be proportioned to the weight and work of the animal; the nails holding it in place are to be of proper size and not driven too near the heels; sufficient calks and toe pieces must be added to the shoes of horses working on slippery roads; also, the evils of jumping, fast driving, etc., are to be avoided.

When a fissure has made its appearance, means are to be adopted which will prevent it from growing longer or deeper; this can only be done by arresting all motion in the edges. The best and simplest artificial appliance for holding the borders of a toe crack together is the Vachette clasp. These clasps and the instruments necessary for their application can be had of any prominent maker of veterinary instruments.

(Pl. x.x.xVI.) These instruments comprise a cautery iron, with which two notches are burned in the wall, one on each side of the crack, and forceps with which the clasps are closed into place in the bottom of the notches and the edges of the fissure brought close together. The clasps, being made of stiff steel wire, are strong enough to prevent all motion in the borders of the crack. Before these clasps are applied the fissure should be thoroughly cleansed and dried, and if the injury is of recent origin the crack may be filled with a putty made of 2 parts of gutta-percha and 1 part of gum ammoniac. The number of clasps to be used is to be determined by the length of the crack, the amount of motion to be arrested, etc. Generally the clasps are from one-half to three-quarters of an inch apart. The clasps answer equally as well in quarter crack if the wall is sufficiently thick and not too dry and brittle to withstand the strain.

In the absence of these instruments and clasps a hole may be drilled through the horn across the fissure and the crack closed with a thin nail made of tough iron, neatly clinched at both ends. A plate of steel or bra.s.s is sometimes fitted to the parts and fastened on with short screws; while this appliance may prevent much gaping of the fissure, it does not entirely arrest motion of the edges, for the reason that the plate and screw can not be rendered immobile.

If, for any reason, the measures above fail or can not be used, recourse must be had to an operation. The horn is softened by the use of warm baths and poultices, the patient cast, and the walls of the fissure entirely removed with the knife. The horn removed is in the shape of the letter V, with the base at the coronet. Care must be taken not to injure the coronary band and the laminae. The wound is to be treated with mild stimulant dressings, such as compound cresol solution, a weak solution of carbolic acid, tincture of aloes, etc., oak.u.m b.a.l.l.s, and a roller bandage. After a few days the wound will be covered with a new, white horn, and only the oak.u.m and bandages will be needed. As the new quarter grows out, the lameness disappears, and the patient may be shod with a bar shoe and returned to work.

In all cases of sand crack the growth of horn should be stimulated by cauterizing the coronary band or by the use of blisters. In simple quarter crack recovery will often take place if the coronet is blistered, the foot shod with a "tip," and the patient turned to pasture.

The shoe in toe crack should have a clip on each side of the fissure and should be thicker at the toe than at the heels. The foot should be lowered at the heels by paring, and spared at the toe, except directly under the fissure, where it is to be pared away until it sets free from the shoe.

When any of the complications referred to above arise, special measures must be resorted to. For the proper treatment of gangrene of the lateral cartilage and extensor tendon and caries of the coffin bone reference may be had to the articles on quittors. If the h.o.r.n.y tumor, known as keraphyllocele, should develop, it is to be removed by the use of the knife. Since this tumor develops on the inside of the h.o.r.n.y box and may involve other important organs of the foot in disease, its removal should only be undertaken by a skillful surgeon.