Part 60

Treatment.--The curative treatment should be similar to the prophylactic, and such means should be used as would tend to prevent the deposit of bony matters by checking the acute inflammation which causes it. The means recommended are the free use of the cold bath; frequent soaking of the feet, and at a later period treatment with iodin, either by painting the surface with the tincture several times daily or by applying an ointment made by mixing 1 dram of the crystals with 2 ounces of vaseline, rubbed in once a day for several days. If this proves to be ineffective, a Spanish-fly blister to which a few grains of biniodid of mercury have been added will effect in a majority of cases the desired result and remove the lameness. If finally this treatment is ineffectual the case must be relegated to the surgeon for the operation of neurectomy, or the free and deep application of the firing iron.

SPAVIN.

(Pls. XXVII-XXIX.)

This affection, popularly termed bone spavin, is an exostosis of the hock joint. The general impression is that in a spavined hock the bony growth should be seated on the anterior and internal part of the joint, and this is partially correct, as such a growth will constitute a spavin in the most nearly correct sense of the term. But an enlargement may appear on the upper part of the hock also, or possibly a little below the inner side of the lower extremity of the shank bone, forming what is known as a high spavin; or, again, the growth may form just on the outside of the hock and become an outside or external spavin. And, finally, the entire under surface may become the seat of the osseous deposit, and involve the articular face of all the bones of the hock, which again is a bone spavin. There would seem, then, to be but little difficulty in comprehending the nature of a bone spavin, and there would be none but for the fact that there are similar affections which may confuse one if the diagnosis is not very carefully made.

But the hock may be "spavined," while to all outward observation it still retains its perfect form. With no enlargement perceptible to sight or touch the animal may yet be disabled by an occult spavin, an anchylosis in fact, which has resulted from a union of several of the bones of the joint, and it is only those who are able to realize the importance of its action to the perfect fulfillment of the function of locomotion by the hind leg who can comprehend the gravity of the only prognosis which can be justified by the facts of the case--a prognosis which is essentially a sentence of serious import in respect to the future usefulness and value of the animal. For no disease, if we except those acute inflammatory attacks upon vital organs to which the patient succumbs at once, is more destructive to the usefulness and value of a horse than a confirmed spavin. Serious in its inception, serious in its progress, it is an ailment which, when once established, becomes a fixed condition which there is no known means of dislodging.

Cause.--The periostitis, of which it is nearly always a termination, is usually the effect of a traumatic cause operating upon the complicated structure of the hock, such as a sprain which has torn a ligamentous insertion and lacerated some of its fibers, or a violent effort in jumping, galloping, or trotting, to which the victim has been compelled by the torture of whip and spur while in use as a gambling implement by a sporting owner, under the pretext of "improving his breed"; the extra exertion of starting an inordinately heavy load, or an effort to recover his balance from a misstep, slipping upon an icy surface, or sliding with worn shoes upon a bad pavement, and other kindred causes. We can repeat here what we have before said concerning bones, in respect to heredity as a cause. From our own experience we know of equine families in which this condition has been transmitted from generation to generation, and animals otherwise of excellent conformation have been rendered valueless by the misfortune of a congenital spavin.

Symptoms.--The evil is one of the most serious character for other reasons, among which may be specified the slowness of its development and the insidiousness of its growth. Certain indefinite phenomena and alarming changes and incidents furnish usually the only portents of approaching trouble. Among these signs may be mentioned a peculiar posture assumed by the patient while at rest, and becoming at length so habitual that it can not fail to suggest the action of some hidden disorder. The posture is due to the action of the adductor muscles, the lower part of the leg being carried inward, and the heel of the shoe resting on the toe of the opposite foot. Then an unwillingness may be noticed in the animal to move from one side of the stall to the other. When driven he will travel, but stiffly, with a sort of sidelong gait between the shafts, and after finishing his task and resting again in his stall will pose with the toe pointing forward, the heel raised, and the hock flexed. Considerable heat and inflammation soon appear. The slight lameness which appears when backing out of the stall ceases to be noticeable after a short distance of travel.

A minute examination of the hock may then reveal the existence of a bony enlargement which may be detected just at the junction of the hock and the cannon bone, on the inside and a little in front, and tangible both to sight and touch. This enlargement, or bone spavin, grows rapidly and persistently and soon acquires dimensions which renders it impossible to doubt any longer its existence or its nature. Once established, its development continues under conditions of progress similar to those to which we have before alluded in speaking of other like affections. The argument advanced by some that because these bony deposits are frequently found on both hocks they are not spavins is fallacious. If they are discovered on both hocks, it proves merely that they are not confined to a single joint.

The characteristic lameness of bone spavin, as it affects the motion of the hock joint, presents two aspects. In one class of cases it is most pronounced when the horse is cool, in the other when he is at work. The first is characterized by the fact that when the animal travels the toe first touches the ground, and the heel descends more slowly, the motion of flexion at the hock taking place stiffly, and accompanied with a dropping of the hip on the opposite side. In the other case the peculiarity is that the lameness increases as the horse travels; that when he stops he seeks to favor the lame leg, and when he resumes his work soon after he steps much on his toe, as in the first variety.

As with sidebones, though for a somewhat different reason, the dimensions of the spavin and the degree of the lameness do not seem to bear any determinate relation, the most pronounced symptoms at times accompanying a very diminutive growth. The distinction between the two varieties of cool and warm, however, may easily be determined by remembering the fact that in most cases the first, or cool, is due to a simple exostosis, while the second is generally connected with disease of the articulation, such as ulceration of the articular surface--a condition which, as we proceed further, will receive our attention when we reach the subject of stringhalt.

An excellent test for spavin lameness, which may be readily applied, consists in lifting the affected leg from the ground for one or two minutes and holding the foot high so as to flex all the joints. An assistant, with the halter strap in his hand, quickly starts the animal off in a trot, when, if the hock joint is affected, the lameness will be so greatly intensified as to lead readily to a diagnosis.

Prognosis.--Having thus fully considered the history of bone spavin, we are prepared to give due weight to the reasons that exist for the adverse prognosis which we must usually feel compelled to pronounce when encountering it in practice, as well as to realize the importance of early discovery. It is but seldom, however, that the necessary advantage of this early knowledge can be obtained, and when the true nature of the trouble has become apparent it is usually too late to resort to the remedial measures which, if duly forewarned, a skillful practitioner might have employed. We are fully persuaded that but for the loss of the time wasted in the treatment of purely imaginary ailments very many cases of bone spavin might be arrested in their incipiency and their victims preserved for years of comfort for themselves and valuable labor to their owners.

Treatment.--To consider a hypothetical case: An early discovery of lameness has been made; that is, the existence of an acute inflammation--of periostitis--has been detected. The increased temperature of the parts has been observed, with the stiffened gait and the characteristic pose of the limb, and the question is proposed for solution, What is to be done? Even with only these comparatively doubtful symptoms--doubtful with the nonexpert--we should direct our treatment to the hock in preference to any other joint, since of all the joints of the hind leg it is this which is most liable to be attacked, a natural result from its peculiarities of structure and function. And in answer to the query, What is the first treatment indicated? We should answer rest--emphatically, and as an essential condition, rest. Whether only threatened, suspected, or positively diseased, the animal must be wholly released from labor, and it must be no partial or temporary quiet of a few days. In all stages and conditions of the disease, whether the spavin is nothing more than a simple exostosis, or whether accompanied with the complication of arthritis, there must be a total suspension of effort until the danger is over. Less than a month's quiet ought not to be thought of--the longer the better.

Good results may also be expected from local applications. The various lotions which cool the parts, the astringents which lower the tension of the blood vessels, the tepid fomentations which accelerate the circulation in the engorged capillaries, the liniments of various composition, the stimulants, the opiate anodynes, the sedative preparations of aconite, the alterative frictions of iodin--all these are recommended and prescribed by one or another. We prefer counterirritants, for the reason, among many others, that by the promptness of their action they tend to prevent the formation of the bony deposits. The lameness will often yield to the blistering action of cantharides, in the form of ointment or liniment, and to the alterative preparations of iodin or mercury. If the owner of a "spavined" horse really succeeds in removing the lameness, he has accomplished all that he is justified in hoping for; beyond this let him be well persuaded that a "cure" is impossible.

For this reason, moreover, he will do well to be on his guard against the patented "cures" which the traveling horse doctor may urge upon him, and withhold his faith from the circular of the agent who will deluge him with references and certificates. It is possible that nostrums may in some exceptional instances prove serviceable, but the greater number of them are capable of producing only injurious effects. The removal of the bony tumor can not be accomplished by any such means, and if a trial of these unknown compounds should be followed by complications no worse than the establishment of one or more ugly, hairless cicatrices, it will be well for both the horse and his owner.

Rest and counterirritation, with the proper medicaments, constitute, then, the prominent points in the treatment designed for the relief of bone spavin. Yet there are cases in which all the agencies and methods referred to seem to lack effectiveness and fail to produce satisfactory results. Either the rest has been prematurely interrupted or the blisters have failed to modify the serous infiltration, or the case in hand has some undiscernible characteristics which seem to have rendered the disease neutral to the agencies used against it. An indication of more energetic means is then presented, and free cauterization with the firing iron becomes necessary.

At this point a word of explanation in reference to this operation of firing may be appropriate for the satisfaction of any among our readers who may entertain an exaggerated idea of its severity and possible cruelty.

The operation is one of simplicity, but is nevertheless one which, in order to secure its benefits, must be reserved for times and occasions of which only the best knowledge and highest discretion should be allowed to judge. It is not the mere application of a hot iron to a given part of the body which constitutes the operation of firing. It is the methodical and scientific introduction of heat into the structure with a view to a given effect upon a diseased organ or tissue by an expert surgeon. The first is one of the degrees of mere burning. The other is scientific cauterization, and is a surgical manipulation which should be committed exclusively to the practiced hand of the veterinary surgeon.

Either firing alone or stimulation with blisters is of great efficacy for the relief of lameness from bone spavin. Failure to produce relief after a few applications and after allowing a sufficient interval of rest should be followed by a second or, if needed, a third firing.

In case of further failure there is a reserve of certain special operations which have been tried and recommended, among which those of cunean tenotomy, periosteotomy, the division of nervous branches, etc., may be mentioned. These, however, belong to the peculiar domain of the veterinary practitioner, and need not now engage our attention.

FRACTURES.

In technical language a fracture is a "solution of continuity in the structure or substance of a bone." It ranks among the most serious of the lesions to which the horse--or any animal--can be subject. It is a subject of special interest to veterinarians and horse owners in view of the fact that it occurs in such a variety of forms and subjects the patient to much loss of time, resulting in the suspension of his earning capacity. Though of less serious consequence in the horse than in man, it is always a matter of grave import. It is always slow and tedious in healing and is frequently of doubtful and unsatisfactory result.

This solution of continuity may take place in two principal ways. In the most numerous instances it includes the total thickness of the bone and is a complete fracture. In other cases it involves only a portion of the thickness of the bone, and for that reason is described as incomplete. If the bone is divided into two separate portions and the soft parts have received no injury, the fracture is a simple one, or it becomes compound if the soft parts have suffered laceration, and comminuted if the bones have been crushed or ground into fragments, many or few. The direction of the break also determines its further classification. Broken at a right angle, it is transverse; at a different angle it becomes oblique, and it may be longitudinal or lengthwise. In a complete fracture, especially of the oblique kind, there is a condition of great importance in respect to its effect upon the ultimate result of the treatment in the fact that from various causes, such as muscular contractions or excessive motion, the bony fragments do not maintain their mutual coaptation, but become separated at the ends, which makes it necessary to add another descriptive term--with displacement. These words again suggest the negative and introduce the term without displacement, when the facts justify that description. Furthermore, a fracture may be intra-articular or extra-articular, as it extends into a joint or otherwise, and, once more, intra-periosteal when the periosteum remains intact. Finally, there is no absolute limit to the use of descriptive terminology in the case.

The condition of displacement is largely influential in determining the question of treatment and as affecting the final result of a case of fracture. This, however, is dependent upon its location or whether its seat is in one or more of the axes of the bone, in its length, its breadth, its thickness, or its circumference. An incomplete fracture may also be either simple or comminuted. In the latter case the fragments are held together by the periosteum when it is intact; in that case the fracture belongs to the intra-periosteal class. At times, also, there is only a simple fissure or split in the bone, making a condition of much difficulty of diagnosis.

Causes.--Two varieties of originating cause may be recognized in cases of fracture. They are the predisposing and the occasional. As to the first, different species of animals differ in the degree of their liability. That of the dog is greater than that of the horse, and in horses the various questions of age, the mode of labor, the season of the year, the portion of the body most exposed, and the existence of ailments, local and general, are all to be taken into account.

Among horses, those employed in heavy draft work or that are driven over bad roads are more exposed than light-draft or saddle horses, and animals of different ages are not equally liable. Dogs and young horses, with those which have become sufficiently aged for their bones to have acquired an enhanced degree of frangibility, are more liable than those which have not exceeded the time of their prime. The season of the year is undoubtedly, though in an incidental way, an important factor in the problem of the etiology of these accidents, for though they may be observed at all times, it is during the months when the slippery condition of the icy roads renders it difficult for both men and beasts to keep their feet that they occur most frequently. The long bones, those especially which belong to the extremities, are most frequently the seat of fractures, from the circumstance of their superficial position, their exposure to contact and collision, and the violent muscular efforts involved both in their constant, rapid movement and their labor in the shafts or at the pole of heavy and heavily laden carriages.

The relation between sundry idiosyncrasies and diathesis and a liability to fractures is too constant and well-established a pathological fact to need more than a passing reference. The history of rachitis, of melanosis, and of osteoporosis, as related to an abnormal frangibility of the bones, is a part of our common medical knowledge. There are few persons who have not known of cases among their friends of frequent and almost spontaneous fractures, or at least of such as seem to be produced by the slightest and most inadequate violence, and there is no tangible reason for doubting an analogous condition in dividuals of the equine race. Among local predisposing causes mention must not be omitted of such bony diseases as caries, tuberculosis, and others of the same class.

Exciting, occasional, or "efficient" causes of fracture are in most instances external traumatisms, as violent contacts, collisions, falls, etc., or sudden muscular contractions. These external accidents are various in their character, and are usually associated with quick muscular exertion. A violent, ineffectual effort to move too heavy a load; a semispasmodic bracing of the frame to avoid a fall or resist a pressure; a quick jump to escape a blow; stopping too suddenly after speeding; struggling to liberate a foot from a rail, perhaps to be thrown in the effort--all these are familiar and easy examples of accidents happening hourly by which our equine servants become sufferers. We may add to these the fracture of the bones of the vertebrae, occurring when casting a patient for the purpose of undergoing a surgical operation, quite as much as the result of muscular contraction as of a preexisting diseased condition of the bones. A fracture occurring under these circumstances may be called with propriety indirect, while one which has resulted from a blow or a fall differently caused is of the direct kind.