Chapter XIX: Part 19

_Cause._--It may be caused by falling upon a hard surface, and is usually compound and comminuted. Healing seldom occurs, and when it does there is usually a stiffness of the joint from arthritis.

_Symptoms._--As a result of this fracture there is inability to bear weight on the foot. The leg is flexed as in complete radial paralysis, or fracture of the ulna. There is abnormal mobility of the bones of the knee, but crepitation is usually absent.

_Prognosis._--Healing is hard to effect, as one part of the knee is drawn upward by the two flexor muscles which separate it from the lower part. The callus which forms is largely fibrous, and if the animal is put to work too quickly this callus is liable to rupture. In favorable cases healing takes place in two or three months. Many horses during the treatment develop founder, with consequent drop sole in the sound leg, as a result of pressure due to continuous standing.

_Treatment._--Place the animal in the slings, bring the pieces of bone together if possible, and try to keep them in place by a tight plaster-of-Paris dressing about the leg, extending down to the fetlock. Place the animal in a roomy box stall well provided with bedding so that he can lie down, to prevent founder.

FRACTURE OF THE FEMUR.

The protection which this bone receives from the large mass of muscles in which it is enveloped does not suffice to invest it with immunity in regard to fractures.

_Cause._--It contributes its share to the list of accidents of this description, sometimes in consequence of external violence and sometimes as the result of muscular contraction; sometimes it takes place at the upper extremity of the bone; sometimes at the lower; sometimes at the head, when the condyles become implicated; but it is principally found in the body or diaphysis. The fracture may be of any of the ordinary forms, simple or compound, complete or incomplete, transverse or oblique, etc. A case of the comminuted variety is recorded in which 85 fragments of bone were counted and removed.

The thickness of the muscular covering sometimes renders the diagnosis difficult by interfering with the manipulation, but the crepitation test is readily available, even when the swelling is considerable, and which is liable to be the case as the result of the interstitial hemorrhage which naturally follows the laceration of the blood vessels of the region involved.

_Symptoms._--If the fracture is at the neck of the bone the muscles of that region (the gluteal) are firmly contracted, and the leg seems to be shortened in consequence. Locomotion is impossible. There is intense pain and violent sweating at first. Crepitation may in some cases be discerned by rectal examination, with one hand resting over the coxo-femoral (hip) articulation. Fractures of the tuberosities of the upper end of the bone, the great trochanter, may be identified by the deformity, the swelling, the impossibility of rotation, and the dragging of the leg in walking. Fracture of the body is always accompanied with displacement, and as a consequence a shortening of the leg, which is carried forward. The lameness is excessive, the foot being moved, both when raising it from the ground and when setting it down, very timidly and cautiously. The manipulations for the discovery of crepitation always cause much pain. Lesions of the lower end of the bone are more difficult to diagnosticate with certainty, though the manifestation of pain while making heavy pressure upon the condyles will be so marked that only crepitation will be needed to turn a suspicion into a certainty.

_Treatment._--The question as to treatment in fractures of this description resolves itself into the query whether any treatment can be suggested that will avail anything practically as a curative measure; whether, upon the hypothesis of reduction as an accomplished fact, any permanent or efficient device as a means of retention is within the scope of human ingenuity. If the reduction were successfully performed, would it be possible to keep the parts in place by any known means at our disposal? At the best the most favorable result that could be anticipated would be a reunion of the fragments with a considerable shortening of the bone and a helpless, limping, crippled animal to remind us that for human achievement there is a "thus far and no farther."

In small animals, such as dogs and cats, however, attempts at treatment are justifiable, and we are convinced that in many cases of difficulty in the application of splints and bandages a patient may be placed in a condition of undisturbed quiet and left to the processes of nature for "treatment" as safely and with as good an assurance of a favorable result as if he had been subjected to the most heroic secundum artem doctoring known to science. As a case in point, mention may be made of the case of a pregnant bitch which suffered a fracture of the upper end of the femur by being run over by a light wagon. Her "treatment" consisted in being tied up in a large box and let alone. In due time she was delivered of a family of puppies, and in three weeks she was running in the streets, limping very slightly, and nothing the worse for her accident.

FRACTURE OF THE PATELLA.

This, fortunately, is a rare accident, and can result only from direct violence, as a kick or other blow. The lameness which follows it is accompanied with enormous tumefaction of the joint, pain, inability to bear weight upon the foot, and finally disease of the articulation. Crepitation is absent, because the hip muscles draw away the upper part of the bone. The prognosis is unavoidably adverse, destruction being the only termination of this incurable and very painful injury. Most of the reported cases of cures are based upon a wrong diagnosis.

FRACTURES OF THE TIBIA.

Of all fractures these are probably more frequently encountered than any others among the class of accidents we are considering. As with injuries of the forearm of a like character, they may be complete or incomplete; the former when the bone is broken in the middle or at the extremities, and transverse, oblique, or longitudinal. The incomplete kind are more common in this bone than in any other.

_Symptoms._--Complete fractures are easy to recognize, either with or without displacement. The animal is very lame, and the leg is either dragged or held clear from the ground by flexion at the stifle, while the lower part hangs down. Carrying weight or moving backward is impossible. There is excessive mobility below the fracture, and well-marked crepitation. If there is much displacement, as in an oblique fracture, there will be considerable shortening of the leg.

While incomplete fractures can not be recognized in the tibia with any greater degree of certainty than in any other bone, there are some facts associated with them by which a diagnosis may be justified. The hypothetical history of a case may serve as an illustration:

An animal has received an injury by a blow or a kick on the inside of the bone, perhaps without showing any mark. Becoming very lame immediately afterwards, he is allowed a few days' rest. If taken out again, he seems to have recovered his soundness, but within a day or two he betrays a little soreness, and this increasing he becomes very lame again, to be furloughed once more, with the result of a temporary improvement, and again a return to labor and again a relapse of the lameness; and this alternation seems to be the rule. The leg being now carefully examined, a local periostitis is readily discovered at the point of the injury, the part being warm, swollen, and painful. What further proof is necessary? Is it not evident that a fracture has occurred, first superficial--a mere split in the bony structure, which, fortunately, has been discovered before some extra exertion or a casual misstep had developed it into one of the complete kind, possibly with complications? What other inference can such a series of symptoms thus repeated establish?

The prognosis of fracture of the tibia, as a rule, must be unfavorable.

_Treatment._--The difficulty of obtaining a union without shortening, and consequently without lameness, is proof of the futility of ordinary attempts at treatment, but though this may be true in respect to fractures of the complete kind, it is not necessarily so with the incomplete variety, and with this class the simple treatment of the slings is all that is necessary to obtain consolidation. A few weeks of this confinement will be sufficient.

With dogs and other small animals there are cases which may be successfully treated. If the necessary dressings can be successfully applied and retained, a cure will follow.

FRACTURES OF THE HOCK.

Injuries of the astragalus which had a fatal termination have been recorded. Fractures of the os calcis have also been observed, but never with a favorable prognosis, and attempts to induce recovery, as might have been expected, have proved futile.

FRACTURES OF THE CANNON BONES.

Whether these occur in the fore or hind legs, they appear either in the body or near their extremities. If in the body as a rule the three metacarpal or metatarsal bones are affected, and the fracture is generally transverse and oblique. On account of the absence of soft tissue and tightness of the skin, the broken bones pierce the skin and render the fracture a complicated one. The diagnosis is easy when all the bones are completely broken, but the incomplete fracture can be only suspected.

_Symptoms._--There is no displacement, but excessive mobility, crepitation, inability to sustain weight, and the leg is kept off the ground by the flexion of the upper joint.

No region of the body affords better facilities for the application of treatment, and the prognosis on this account is usually favorable. We recall a case, however, which proved fatal, though under exceptional circumstances. The patient was a valuable stallion of highly nervous organization, with a compound fracture of one of the cannon bones, and his unconquerable resistance to treatment, excited by the intense pain of the wound, precluded all chance of recovery, and ultimately caused his death.

_Treatment._--The general form of treatment for these lesions will not differ from that which has been already indicated for other fractures. Reduction, sometimes necessitating the casting of the patient; coaptation, comparatively easy by reason of the subcutaneous situation of the bone; retention, by means of splints and bandages--applied on both sides of the region, and reaching to the ground as in fractures of the forearm--these are always indicated. We have obtained excellent results by the use of a mold of thick gutta-percha, composed of two sections and made to surround the entire lower part of the leg as in an inflexible case.

FRACTURE OF THE FIRST PHALANX.

The hind extremity is more liable than the fore to this injury. It is usually the result of a violent effort, or of a sudden misstep or twisting of the leg, and may be transverse, or, as has usually been the case in our experience, longitudinal, extending from the upper articular surface down to the center of the bone, and generally oblique and often comminuted. The symptoms are the swelling and tenderness of the region, possibly crepitation; a certain abnormal mobility; an excessive degree of lameness, and in some instances a dropping back of the fetlock, with perhaps a straightened or upright condition of the pastern.

The difficulty of reduction and coaptation in this accident, and the probability of bony deposits, as of ringbones, resulting in lameness, are circumstances which tend to discourage a favorable prognosis.

The treatment is that which has been recommended for all fractures, so far as it can be applied. The iron splint which has been mentioned gives excellent results in many instances, but if the fracture is incomplete and without displacement, a form of treatment less energetic and severe should be attempted. One case is within our knowledge in which the owner lost his horse by his refusal to subject the animal to treatment, the post-mortem revealing only a simple fracture with very slight displacement.

FRACTURES OF THE SECOND PHALANX (CORONET).

Though these are generally of the comminuted kind, there are often conditions associated with them which justify the surgeon in attempting their treatment. Though crepitation is not always easy to detect, the excessive lameness, the soreness on pressure, the inability to carry weight, the difficulty experienced in raising the foot, all these suggest, as the solution of the question of diagnosis, the fracture of the coronet, with the accompanying realization of the fact that there is yet, by reason of the situation of the member, immobilized as it is by its structure and its surroundings, room left for a not unfavorable prognosis. Only a slight manipulation will be needed in the treatment of this lesion. To render the immobility of the region more fixed, to support the bones in their position by bandaging, and to establish forced immobility of the entire body with the slings is usually all that is required. Ringbone, being a common sequela of the reparative process, must receive due attention subsequently. One of the severest complications liable to be encountered is an immobile joint (anchylosis). Neurectomy of the median nerve may relieve lameness after a fracture of the phalanges.

FRACTURES OF THE THIRD PHALANX (OS PEDIS).

These lesions may result from a penetrating street nail, or follow plantar or median neurectomy. In the latter instance it is caused by the animal setting the foot down carelessly and too violently, and partly due to degeneration of bone tissue which follows nerving.

Though these fractures are not of very rare occurrence, their recognition is not easy, and there is more of speculation than of certainty pertaining to their diagnosis. The animal is very lame and spares the injured foot as much as possible, sometimes resting it upon the toe alone and sometimes holding it from the ground. The foot is very tender, and the exploring pinchers of the examining surgeon cause much pain. During the first 24 hours there is no increased pulsation in the digital and plantar arteries, but on the second day it is apparent.

There is nothing to encourage a favorable prognosis, and a not unusual termination is an anchylosis with either the navicular bone or the coronet.

No method of treatment needs to be suggested here, the hoof performing the office of retention unaided. Local treatment by baths and fomentations will do the rest. It may be months before there is any mitigation of the lameness.

An ultimate recovery depends to a great extent upon whether the other foot can support the weight during the healing process without causing a drop sole in the supporting foot.

FRACTURE OF THE SESAMOID BONES.

This lesion has been considered by veterinarians, erroneously, we think, as one of rare occurrence. We believe it to be more frequent than has been supposed. Many observations and careful dissections have convinced us that fractures of these little bones have been often mistaken for specific lesions of the numerous ligaments that are implanted upon their superior and inferior parts, and which have been described as a "giving way" or "breaking down" of these ligaments. In my post-mortem examinations I have always noted the fact that when the attachments of the ligaments were torn from their bony connections minute fragments of bony structure were also separated, though we have failed to detect any diseased process of the fibrous tissue composing the ligamentous substance.

_Cause._--From whatever cause this lesion may arise, it can hardly be considered as of a traumatic nature, no external violence having any apparent agency in producing it, and it is our belief that it is due to a peculiar degeneration or softening of the bones themselves, a theory which acquires plausibility from the consideration of the spongy consistency of the sesamoids. The disease is a peculiar one, and the suddenness with which different feet are successively attacked, at short intervals and without any obvious cause, seems to prove the existence of some latent, morbid cause which has been unsuspectedly incubating. It is not peculiar to any particular class of horses, nor to any special season of the year, having fallen under our observation in each of the four seasons.

_Symptoms._--The general fact is reported in the history of most cases that it makes its appearance without premonition in animals which, after enjoying a considerable period of rest, are first exercised or put to work, though in point of fact it may manifest itself while the horse is still idle in his stable. A hypothetical case, in illustration, will explain our theory: An animal which has been at rest in his stable is taken out to work, and it will be presently noticed that there is something unusual in his movement. His gait is changed, and he travels with short, mincing steps, without any of his accustomed ease and freedom. This may continue until his return to the stable, and then, after being placed in his stall, he will be noticed shifting his weight from side to side and from one leg to another, continuing the movement until rupture of the bony structure takes place. But it may happen that the lameness in one or more of the extremities, anterior or posterior, suddenly increases, and it becomes evident that the rupture has taken place in consequence of a misstep or a stumble while the horse is at work. Then, upon coming to a standstill, he will be found with one or more of his toes turned up; he is unable to place the affected foot flat on the ground. The fetlock has dropped and the leg rests upon this part, the skin of which may have remained intact or may have been more or less extensively lacerated. It seldom happens that more than one toe at a time will turn up, yet still the lesion in one will be followed by its occurrence in another. Commonly two feet, either the anterior or posterior, are affected, and we recall one case in which the two fore and one of the hind legs were included at the same time. The accident, however, is quite as liable to happen while the horse is at rest in his stall, and he may be found in the morning standing on his fetlocks. One of the earliest of the cases occurring in my own experience had been under care for several weeks for suspected disease of the fetlocks, the nature of which had not been made out, when, apparently improved by the treatment which he had undergone, the patient was taken out of the stable to be walked a short distance into the country, but had little more than started when he was called to a halt by the fracture of the sesamoids of both fore legs.

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 instituted it can be employed only with any rational hope of benefit during the incubation, and with the anticipatory 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 classes 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, constituting 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 passage 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 circumference. They are more or less tense, according to the quantity 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 constitute 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 circumstance 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 pass 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 circumstance which will, of course, justify its classification 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 asserted 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 indorsement 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 repetitions 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 periostitis 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 pass 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 assuming 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 associated 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 anticipation of nature's evident intent in the quick and easy execution of the sentence.

DISLOCATION OF SHOULDER AND ELBOW

Bourgelat's apparatus]

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.

Dislocations and luxations are interchangeable terms, meaning the separation and displacement of the articulating surfaces of the bones entering into the formation of a joint. This injury is rarely encountered in our large animals on account of the combination of strength and solidity in the formation of their joints. It is met with but seldom in cattle and less so in horses, while dogs and smaller animals are more often the sufferers.

_Cause._--The accident of a luxation is less often encountered in the animal races than in man. This is not because the former are less subject to occasional violence involving powerful muscular contractions, or are less often exposed to casualties similar to those which result in luxations in the human skeleton, but because it requires the cooperation of conditions--anatomical, physiological, and perhaps mechanical--present in the human race and lacking in the others, which, however, can not in every case be clearly defined. Perhaps the greater relative length of the bony levers in the human formation may constitute a cause of the difference.

Among the predisposing causes in animals may be enumerated caries of articular surfaces, articular abscesses, excessive dropsical conditions, degenerative softening of the ligaments, and any excessive laxity of the soft structures.

_Symptoms and diagnosis._--Three signs of dislocation must usually be taken into consideration. They are: (1) An alteration in the shape of the joint and in the normal relationship of the articulating surfaces; (2) an alteration in the length of the limb, either shortening or lengthening; (3) an alteration in the movableness of the joint, usually an unnatural immobility. Only the first, however, can be relied upon as essential. Luxations are not always complete; they may be partial; that is, the articulating surfaces may be displaced but not separated. In such cases several symptoms may not be present. And not only may the third sign be absent, but the mobility of the first be greatly increased when the character of the injury has been such as to produce extensive lacerations of the articular ligaments.

In addition to the above signs, a luxation is usually characterized by pain, swelling, hemorrhage beneath the skin from damaged or ruptured blood vessels, and even paralysis, when important nerves are pressed on by the displaced bones.

Sometimes a bone is fractured in the immediate vicinity of a joint. The knowledge of this fact requires us to be able to diagnose between a dislocation and such a fracture. In this we generally have three points to assist us: (1) The immobility of a dislocated joint as against the apparently remarkable freedom of movement in fracture; (2) in a dislocation there is no true crepitus--that peculiar grating sensation heard as well as felt on rubbing together the rough ends of fractured bones; however, it must be remembered that in a dislocation two or three days old the inflammatory changes around the joint may give rise to a crackling sensation similar to that in fracture; (3) as a rule, in luxations, if the ligamentous and muscular tissues about the joint are not badly torn, the displacement, when reduced, does not recur.

_Prognosis._--The prognosis of a luxation is comparatively less serious than that of a fracture, though at time the indications of treatment may prove to be so difficult to apply that complications of a very severe character may arise.

_Treatment._--The treatment of luxations must, of course, be similar to that of fractures. Reduction, naturally, will be the first indication in both cases, and the retention of the replaced parts must follow. The reduction involves the same steps of extension and counter extension, performed in the same manner, with the patient subdued by anesthetics.

The difference between the reduction of a dislocation and that of a fracture consists in the fact that in the former the object is simply to restore the bones to their true, normal position, with each articular surface in exact contact with its companion surface, the apparatus necessary afterwards to keep them in situ being similar to that which is employed in fracture cases, and which will usually require to be retained for a period of from 40 to 50 days, if not longer, before the ruptured retaining ligaments are sufficiently firm to be trusted to perform their office unassisted. A variety of manipulations are to be used by the surgeon, consisting in pushing, pulling, pressing, rotating, and, indeed, whatever movement may be necessary, until the bones are forced into such relative positions that the muscular contraction, operating in just the right directions, pulls the opposite matched ends together in true coaptation--a head into a cavity, an articular eminence into a trochlea, as the case may be. The "setting" is accompanied with a peculiar, snapping sound, audible and significant, as well as a visible return of the surface to its normal symmetry.

_Special dislocations._--While all the articulations of the body are liable to this form of injury, there are three in the large animals which may claim a special consideration, viz:

THE SHOULDER JOINT.

We mention this displacement without intending to imply the practicability of any ordinary attempt at treatment, which is usually unsuccessful, the animal whose mishap it has been to become a victim to it being disabled for life. The superior head of the arm bone as it is received into the lower cavity of the shoulder blade is so situated as to be liable to be forced out of place in four directions. It may escape from its socket, according to the manner in which the violence affects it--outward, inward, backward, or forward--and the deformity which results and the effects which follow will correspondingly differ. We have said that treatment is generally unsuccessful. It may be added that the difficulties which interpose in the way of reduction are nearly insurmountable, and that the application of means for the retention of the parts after reduction would be next to impossible. The prognosis, from any point of view, is sufficiently grave for the luckless animal with a dislocated shoulder.

THE HIP JOINT.

This joint partakes very much of the characteristics of the humero-scapular articulation, but is more strongly built. The head of the thigh bone is more separated, or prominent and rounder in form, and the cup-like cavity, or socket, into which it fits is much deeper, forming together a deep, true ball-and-socket joint, which is, moreover, reenforced by two strong cords of funicular ligaments, which unite them. It will be easily comprehended, from this hint of the anatomy of the region, that a luxation of the hip joint must be an accident of comparatively rare occurrence; yet cases are recorded in which the head of the bone has been affirmed to slip out of its cavity and assume various positions--inward, outward, forward, or backward.

The indications of treatment are those of all cases of dislocation. When the reduction is accomplished the surgeon will be apprised of the fact by the peculiar, snapping sound usually heard on such occasions.

PSEUDO-LUXATIONS OF THE PATELLA.

This is not a true dislocation. The stifle bone is so peculiarly articulated with the thigh bone that the means of union are of sufficient strength to resist the causes which usually give rise to luxations, yet there is sometimes discovered a peculiar, pathological state in the hind legs of animals, the effect of which is closely to simulate the manifestation of many of the general symptoms of dislocations. This condition originates in muscular cramps, the action of which is seen in a certain change in the coaptation of the articular surfaces of the stifle and thigh bone, resulting in the exhibition of a sudden and alarming series of symptoms which have suggested the phrase of "stifle out" as a descriptive term.

_Symptoms._--The animal so affected stands quietly and firmly in his stall, or perhaps with one of his hind legs extended backward, and resists every attempt to move him backward. If urged to move forward he will either refuse or comply with a jump, with the toe of the disabled leg dragging on the ground and brought forward by a second effort. There is no flexion at the hock and no motion at the stifle, while the circular motion of the hip is quite free. The leg appears to be much longer than the other, owing to the straightened position of the thigh bone, which forms almost a straight line with the tibia from the hip joint down. The stifle joint is motionless, and the motions of all the joints below it are more or less interfered with. External examination of the muscles of the hip and thigh reveals a certain degree of rigidity, with perhaps some soreness, and the stifle bone may be seen projecting more or less on the outside and upper part of the joint.

This state of things may continue for some time and until treatment is applied, or it may spontaneously and suddenly terminate, leaving everything in its normal condition, but perhaps to return again.

_Cause._--Pseudo-dislocation of the patella is liable to occur under many of the conditions which cause actual dislocation, and yet it may often occur in animals which have not been exposed to the ordinary causes, but which have remained at rest in their stables. Sometimes these cases are assignable to falls in a slippery stall, or perhaps slipping when endeavoring to rise; sometimes to weakness in convalescing patients; sometimes to lack of tonicity of structure and general debility; sometimes to relaxation of tissues from want of exercise or use. A straight leg, sloping croup, and the young are predisposed to this dislocation.

_Treatment._--The reduction of these displacements of the patella is not usually attended with difficulty. A sudden jerk or spasmodic action will often be all that is required to spring the patella into place, when the flexion of the leg at the hock ends the trouble for the time. But this is not always sufficient, and a true reduction may still be indicated. To effect this the leg must be drawn well forward by a rope attached to the lower end, and the patella, grasped with the hand, forcibly pushed forward and inward and made to slip over the outside border of the trochlea of the femur. The bone suddenly slips into position, the excessive rigor of the leg ceases with a spasmodic jerk, and the animal may walk or trot away without suspicion of lameness. Though this may end the trouble for the time, and the restoration seem to be perfect and permanent, a repetition of the entire transaction may subsequently take place, and perhaps from the loss of some proportion of tensile power which would naturally follow the original attack in the muscles involved the lesion might become a habitual weakness.

Warm fomentations and douches with cold water will often promote permanent recovery, and liberty in a box stall or in the field will in many cases insure constant relief. The use of a high-heeled shoe is recommended by European veterinarians. The use of stimulating liniments, with frictions, charges, or even severe blisters, may be resorted to in order to prevent the repetition of the difficulty by strengthening and toning up the parts.

DISEASES OF MUSCLES AND TENDONS.

SPRAINS.

This term expresses a more or less complete laceration or yielding of the fibers of the muscles, tendons, or the sheaths surrounding and supporting them. The usual cause of a sprain is external violence, such as a fall or a powerful exertion of strength, with following symptoms of soreness, heat, swelling, and a suspension of function. Their termination varies from simple resolution to suppuration, and commonly fibrinous exudation difficult to remove. None of the muscles or tendons of the body are exempt from liability to this lesion, though naturally from their uses and the exposure of their situation the extremities are more liable than other regions to become their seat. The nature of the prognosis will be determined by a consideration of the seat of the injury and the complications likely to arise.

_Treatment._--The treatment will resolve itself into the routine of local applications, including warm fomentations, stimulating liniments, counterirritation by blistering, and in some cases even firing. Rest, in the stable or in a box stall, will be of advantage by promoting the absorption of whatever fibrinous exudation may have formed, or absorption may be stimulated by the careful persevering application of iodin in the form of ointments of various degrees of strength.

There are many conditions in which not only the muscular and tendinous structures proper are affected by a strain, but, by contiguity of parts, the periosteum of neighboring bones may become involved, with a complication of periostitis and its sequelae.

LAMENESS OF THE SHOULDER.

The frequency of the occurrence of lameness in the shoulder from sprains entitles it to precedence of mention in the present category, for, though so well covered with its muscular envelope, it is often the seat of injuries which, from the complex structure of the region, become difficult to diagnosticate with satisfactory precision and facility. The flat bone which forms the skeleton of that region is articulated in a comparatively loose manner with the bone of the arm, but the joint is, notwithstanding, rather solid, and is powerfully strengthened by tendons passing outside, inside, and in front of it. Still, shoulder lameness or sprain may exist, originating in lacerations of the muscles, the tendons or the ligaments of the joint, or perhaps in diseases of the bones themselves. "Slip of the shoulder" is a phrase frequently applied to such lesions.

The identification of the particular structures involved in these lesions is of much importance, in view of its bearing upon the question of prognosis. For example, while a simple superficial injury of the spinatus muscles, or the muscles by which the leg is attached to the trunk, may not be of serious import and may readily yield to treatment, or even recover spontaneously and without interference, the condition is quite changed in a case of tearing of the flexor brachii, or of its tendons as they pass in front of the articulation, or, what is still more serious, if there is inflammation or ulceration in the groove over which this tendon slides, or upon the articular surfaces or their surroundings, or periostitis at any point adjacent.

_Causes._--The frequency of attacks of shoulder lameness is not difficult to account for. The superficial and unprotected position of the part and the numerous movements of which it is capable, and which, in fact, it performs, render it both subjectively and objectively preeminently liable to accident or injury. It would be difficult and would not materially avail to enumerate all the forms of violence by which the shoulder may be crippled. A fall, accompanied with powerful concussion; a violent muscular contraction in starting a heavily loaded vehicle from a standstill; a misstep following a quick muscular effort; a jump accompanied with miscalculated results in alighting; a slip on a smooth, icy road; balling the feet with snow; colliding with another horse or other object--indeed, the list may be indefinitely extended, but without profit or utility.

_Symptoms._--Some of the symptoms of shoulder lameness are peculiar to themselves, and yet the trouble is frequently mistaken for other affections--navicular disease more often than any other. The fact that in both affections there are instances when the external symptoms are but imperfectly defined, and that one of them especially is very similar in both, is sufficient to mislead careless or inexperienced observers and to occasion the error which is sometimes committed of applying to one disease the name of the other, erring both ways in the interchange. The true designation of pathological lesions is very far at times from being of certain and easy accomplishment, and, owing to the massive structure of the parts we are considering, this is especially true in the present connection. Still there are many cases in which there is really no reasonable excuse for an error in diagnosis by an average practitioner.

Shoulder lameness will, of course, manifest itself by signs and appearances more or less distinct and pronounced, according to the nature of the degrees and the extent of the originating cause. We summarize some of these signs and appearances: