Part 92

With some aggravation of the condition the skin is felt to be somewhat rough and uneven by reason of the encrustations of epidermis, dried secretions and dust over its surface, which may convey to the finger a slightly oily sensation. In many cases these epidermic and exudation products form scabby elevations, and a chronic condition of this kind may persist indefinitely, constituting what is known in America as scratches. This will vary by reason of the detachment of these concretions with the formation of abrasions and sores of various sizes, which may heal, or extend by coalescence, chapping, or ulceration.

In other cases, even at an early stage, the formation of chaps or cracks is a marked feature. At times this may seem to be the result of over distension in the inflamed superficial layers of the skin which have lost their natural pliancy and cohesion. They will, sometimes, form under slight exercise, but not when at rest. They may simply extend through the epidermis, exposing the papillary layer, or in bad cases one or more fissures may extend through the integument and expose the tendons beneath. They may extend forward on the sides of the pastern or upward over the back of the fetlock and metatarsus.

In all cases, when the local inflammation is acute, some swelling of the limbs appears, and this keeps pace with the character and extent of the trouble. With extensive chaps or fissures it becomes extreme, extending up toward the hocks and attended by great pain and stiffness. The sores become the seat of active suppuration, with it may be considerable destruction of tissue. Even in the milder forms there may often be seen a fœtid muco-purulent secretion in the depth of the folds of the pastern, and in the worst cases this extends to the whole surface after the manner of grease.

Prognosis. The milder uncomplicated cases recover readily and perfectly under rest and judicious treatment; the more advanced cases are liable to leave swelled legs with susceptibility to a relapse, and in cases associated with a constitutional diathesis or chronic internal disease, recovery may become problematical and uncertain.

Treatment. In all cases the cause must be done away with, whether filthy stalls, reeking dunghills, septic pools, work in irritating road mud, or melting snow, washing the heels with caustic soaps, drying them in cold draughts, pricking with stubble or clipped hairs, and all the causes of stocking of the limbs. If heels are washed, use pure tepid water, and, if necessary, the best Castile soap, and rub them dry at once. If this cannot be done bandage them rather than leave them in a cold draught.

Give rest in a clean stall and thoroughly clean the affected heel, then wrap in a bandage wet with an acetate of lead or sulphate of zinc lotion (1 ∶ 50), or apply benzoated oxide of zinc, or cream of glycerine and salicylic acid.

When chaps have formed they will often promptly heal under standard solution of sulphurous acid 1, glycerine 1, and water 1. This is applied on soft cotton and covered by a rubber bandage to confine the acid. The sulphurous acid solution should be recently prepared, since it will prove injurious if it has oxidized into sulphuric acid. To one or other of these preparations the addition of a little carbolic acid, creolin, pyoktannin, or lysol will often prove useful. When the cracks have healed, zinc ointment, chrysarobin ointment, chrysophanic acid 1, vaseline 15, or other soothing and antiseptic agent may be employed till all inflammation has subsided, and the animal must not be returned to work until the skin has been restored to its former healthy and elastic condition.

It may be desirable to greatly restrict the grain during treatment and even to giving cooling laxatives or diuretics. With a constitutional diathesis arsenic or other alterative may be tried, and any internal disease must be attended to. For stocking, use careful bandaging, hand-rubbing and exercise.

With the formation of the deeper fissures the same antiseptic agents may be employed, or salol, iodoform, glutol, aristol, or some tincture of iodine, or iodide of starch may be used. A weak solution of copper sulphate has often an excellent effect. The measures advised below for grease will usually apply in this condition.

SEBORRHŒA OF THE DIGITAL REGION: DIGITAL IMPETIGO, GREASE: STREPTOCOCCIC DERMATITIS IN HORSES.

A sequel of erythema or cracked heels. Causes: constitutional predisposition in lymphatic draught horses, rare in ass and mule, anatomical conditions, wet damp regions, digestive disorder, overfeeding and lack of exercise, diseases of liver or kidney, change to stable life, cold water, slush, mud, salted snow, steaming manure, urine in mares, infection, streptococcus pyogenes. Symptoms: swelling, heat, and tenderness of pastern hollow, itching, hairs erect, unctuous exudate, vesicles, excoriations, discharge opaque, grayish, sticky, fœtid, chaps, knuckling, resting on toe, kicking: in severe cases discharge purulent, more opaque, sloughs, excessive granulations, “grapes,” extensions forward, upward, downward, canker, quittor, sand crack, etc. Lesions: first, congestion of derma, hair follicles full, hairs loose, connective tissue infiltrated, or thickened, ligaments: and bones involved, grapes in superposed clusters pediculated. Diagnosis: from horsepox. Treatment: remove causes, secure cleanliness, laxative, diuretics, moderate grain ration, or tonic regimen; locally, soothing antiphlogistic, antiseptic treatment, lead, zinc, phenol, creolin, lysol; when advanced, antiseptic dusting powders, calomel, salicylic acid, iodine, zinc oxide, salol, or solutions, zinc chloride, tar. Value of changes. For “grapes” actual cautery, excision, ligature.

This may develop as an advanced condition of the erythema or cracked heels already described. Yet it is so distinctive in its habit of profuse secretion, the eruption of vesicles or pustules and the abundant, fœtid sebaceous discharge that it deserves a special consideration.

Causes. Something depends on constitutional predisposition. This is preëminently a disease of the heavy, lymphatic, draught horse, being rare in racers and trotters, with fine sinewy limbs, no long hair on the fetlock, delicate skins, and less abundant sebaceous glands. It is almost, though not quite, unknown in the spare limbs of ass and mule, and though claimed by Reynal as attacking cattle its occurrence is equally rare in them. Much of this may be attributed to conformation. The limb of the draught horse is so much thicker and coarser, with a great excess of connective tissue and lymph plexus which become readily gorged in idleness, inducing stocking, congestion and debility of the whole limb. This same condition operates as a powerful predisposition to lymphangitis. Again the great length and profusion of the long hairs, entails the necessary compliment of an excessive development of the sebaceous glands which become over-stimulated by congestion, and afford a much more open and favorable infection atrium for the pus microbes. These structural conditions are much more marked in the draught horses of wet regions as in Ireland, the western counties of Great Britain, Belgium, Holland, and the Atlantic provinces of France, and in these the affection is remarkably prevalent. In our Eastern States and on the Plains, where the progeny of imported draught horses lose their digital hair, the malady is comparatively rare. A similar immunity has long been noticed in the horses of Spain and Africa. Disturbances of the digestion in heavily fed horses, subjected to transient confinement in the stall, and diseases of the liver and kidneys, must be recognized as further predisposing causes. The age of five and six when many horses change hands, and are subjected to extreme changes of stabling, feed and work, has furnished the greatest number of cases.

External causes we find in all those conditions already enumerated which favor chapped heels. Wet, mud, gritty masses, irritant fumes of manure, cold, heat, filth are potent factors. In connection with these are the pus and septic microbes that are always present in stables, farm yards, manure, street dust, etc. No one of these can be adduced as the constant and exclusive cause, and it is inevitable that a complex infection should be present, yet the propagation and persistence of the disease may often be connected with the streptococcus pyogenes.

As emphasizing the importance of such external irritants and infections, it should be noted that the disease bears an appreciable relation to the filth and wet of the stable and farm yard, and to the absence of cleanliness in dealing with the feet, and that the extension of good pavement and protection from road mud have invariably lessened its prevalence. The irritant action of the urine renders mares more susceptible in the hind limbs than horses.

Symptoms. The disease may appear as a swelling, heat and tenderness of the hollow back of the pastern, involving the fetlock and lower part of the metatarsus or metacarpus, and this may last for one or two weeks, the engorgement lessening or disappearing during exercise and reappearing when at rest in the stall. The local tenderness is great as manifested by the prompt and excessive lifting of the leg when the heel is touched, as well as by the lameness when first moved, which subsides with further exercise. Itching may be shown by kicking the floor, or by a disposition to rub the pastern. The hairs of the affected part are rigidly erect, and a slightly moist, soapy sensation is felt on the skin. Close examination may detect the presence of small vesicles with as yet limpid contents, but the greater part of the liquid product is traceable to the openings of the hairs and gland ducts. This is followed by small excoriations taking the place of the ruptured vesicles, and the discharge becomes more profuse, opaque, white or grayish white, sticky, and fœtid. It covers the entire affected surface, mats together the hair in tufts and forms a thicker grayish border. The hairs are loosened in their follicles and easily pulled out. The erosions become complicated by chaps, and the swelling increases around the pastern and above the fetlock. When at rest in the stall the foot may be rested on the toe only, or held suspended and occasionally kicked backward as if to dislodge the cause of irritation, yet if moved the patient may gradually get over the greater part of the lameness, and the swelling partially subside.

In severe, protracted cases the discharge becomes essentially purulent, but often with a darker, greenish, reddish or blackish tinge, and portions of the skin may slough, leaving deep intractable sores. Still more commonly the raw surfaces become the seat of hypertrophied granulations, which grow out to form raw, red fungous like, pediculated neoplasms familiarly known as grapes. Between these the spaces are filled with tufts of hairs and the condensed discharges, in process of active septic change, and giving off a most repulsive odor. Like the preceding eruption these grapes may extend around the front and sides of the pastern, and upward beyond the fetlock, but especially behind.

This advanced condition shows no tendency to spontaneous recovery and the connective tissue and lymphatic plexus becoming involved, the leg often swells to enormous dimensions, from six to twelve inches in diameter at the fetlock. It may last indefinitely until the patient is worn out, or it may extend to other organs by contiguity or embolism. Canker of the frog and sole, fistula (quittor), sand crack and seedy toe may be named as complications, also septicæmia or pyæmia with abscesses in the lungs, liver, brain or bowels.

Lesions. In the first stage there is mainly the congestion of the skin extending into the large and numerous hair follicles of the pastern. If pressed, a transparent serum bedews the surface, and if sectioned the follicles around the hair bulb are seen to be distended by a similar product. The hairs are easily pulled out. The subcutaneous connective tissue is filled with a yellowish serosity and at intervals may be seen a red point of vascular stagnation or blocking. Later these products are more abundant and those on the now swollen and excoriated surface are distinctly fœtid. The infiltrated lymph plexuses in the connective tissue are more distended, their walls thickened and consolidated, and the rigid skin is thus firmly bound to the structures beneath. A careful examination shows the presence of subepidermic vesicles of various sizes. The congestion may extend deep enough to involve the periosteum of the digital bones and the ligaments of the joints. The grapes are each attached by a pedicle from which branch out cauliflower-like, fine papillary processes, that aggregate into a solid cluster. They are very vascular and grow out cluster above cluster until they reach large dimensions.

Diagnosis from Horse Pox. Since the days of Jenner the claim has been constantly made that grease and horse pox were one and the same. Horse pox is however to be distinguished by its transient course, its inoculability, its incubation of three days, its abundant exudate concreting on the hairs of the pastern as a yellow mass suggestive of crystalline structure, by the red pit in the skin in which this mass is imbedded, by the spontaneous recovery in about 15 days, and by the immunity on a subsequent inoculation. It is communicable to cattle and to man, producing the characteristic large umbilicated vesicle and scab.

Treatment. The first consideration is to remove the causes of local irritation and infection, give a clean sweet stall, with dry floor, and allow no contact with putrid liquids, mud, cold water, melting snow or other irritant. If exercise is needful to obviate stocking of the legs give it on dry clean ground.

If inflammation runs high with fever and costiveness a laxative will be valuable and it may be well to follow this in some cases with cooling diuretics. When the animal has been on a heavy grain ration this should be largely cut down in keeping with enforced idleness, or restricted work. If on the other hand condition is low, and the discharge profuse a more generous ration may be desirable.

Local treatment is essentially soothing and antiphlogistic, and in view of the infection should be antiseptic. White lotion (acetate of lead and sulphate of zinc of each ½ oz., water 1 quart) has been long used with fair success, for although lead sulphate is thrown down, it is in part freed again through contact with the exudate. It will be materially improved by the addition of 1 dr. carbolic acid, creolin, lysol or chloro-naphtholeum or by some other antiseptic. Lead acetate alone with an antiseptic is an excellent substitute. In mild cases the surface may be wet with the lotion several times a day: while in severe ones the lotion may be applied on a bandage kept constantly wet. When secretion is well established it may be better to use dry applications, as calomel; salicyclic acid 10 parts, with iodine 10 parts; calomel and lamp black; carbolated oxide of zinc or burned alum, salol, etc. After washing and drying the skin, dust this freely even into the deepest wrinkles and cover with cotton and bandage. Dress twice daily. For very fœtid cases, Robertson recommends zinc chloride 1 oz. in 1 qt. water with the addition of glycerine and phenol, and again a saturated solution of copper sulphate with carbolized glycerine. For profuse secretion after the subsidence of active inflammation Renal highly recommends wood tar with 5 to 10 drops of sulphuric acid to the ounce. Under these circumstances a powder of gloss starch 5 ozs. with iodine ½ oz. may be employed twice daily. Or again, 1 oz. each of carbolic acid, tincture of iodine and glycerine may be employed. When one agent seems to be losing effect, it is well to change for another and never to neglect the regular dressing, until full recovery has been secured.

In case of grapes the actual cautery is the most efficient measure. Heat a blacksmith’s fire shovel to a bright red and use this to cut through the pedicles, a cool shovel being kept constantly beneath it and in contact with the pedicles, so as to protect the adjacent skin from injury by the radiated heat. The lower shovel must be dipped in cold water at very frequent intervals to cool it and prevent cauterization of the skin between the pedicles. This not only removes the diseased and infected masses, but leaves the stumps of the pedicles aseptic. Another method is to cut off the “grapes” and staunch the blood with the actual cautery at a dull red heat. Still another is to tie the pedicle of each excrescence separately so as to cut off circulation and secure sloughing. This is, however, a long, tiresome process, and entails prolonged contact with much infecting dead tissue. After either method the parts must be dressed with antiseptics, and dealt with generally like cases in which the excrescences had not formed.

CUTANEOUS HEMORRHAGE: BLOODY SWEAT: HÆMATIDROSIS. HÆMATOPEDESIS.

Forms of cutaneous hæmorrhage; in specific diseases; in parasitism; in insect bites; in congestions of sweat glands; in deranged innervation; in hæmophilia. Section of sympathetic. Salt on sciatic. Hysteria. Sclerosis of cord. Inflammation. Symptoms: drops, crusts. Hæmorrhagic nodules. Treatment: styptics, cold, ice, snow, tannin, matico, iron chloride, alum, gelatine, atropine, ergot, lead acetate, quinia. Gravitation.

The escape of the blood by the skin is seen in a variety of morbid conditions, due it may be to profound changes in the blood and capillary walls, as in petechial fever, anthrax, scorbutus, septicæmia, swine erysipelas, etc., in which this is only a subsidiary phenomenon of a general disorder:—to the presence of parasites (Filaria hæmorrhagica,) in the skin:—to insect bites:—to violent congestions implicating the sweat glands (bloody sweat):—or to deranged innervation of the part as in cases of trauma of the sympathetic or sciatic nerve, or disease of the nerve centres. It may further be a manifestation of hæmophilia in which any slight lesion becomes the occasion of persistent hæmorrhage.

Cases that appear in the course of specific contagious diseases and those dependent on filaria will be considered under these headings, and we may confine our attention here to the forms of sweating and oozing of blood from independent causes. German writers draw attention to its frequency in eastern horses, attributing it to the great development of the vascular system especially of the skin, but its comparative infrequency in the English racer and American trotter would throw doubt on this doctrine. It may be questioned whether the frequency of the disease in Oriental horses is not to be ascribed rather to filariasis. This idea is not contradicted by the especial prevalence of the bleeding in summer when the filaria is most active, but when also the skin is the most vascular and its tissues most relaxed.