The result of the inflammatory changes in the tendon, aided possibly by the use of the high-heeled shoe, is to afterwards bring about contraction. Where this has occurred, and the animal walks continuously on his toe, the shoe with the projecting toe-piece (Fig. 84) must be applied. When the continual use of the toe-piece appears inadvisable, the shoe devised by Colonel Nunn may be used in its stead (see Fig. 108).

The toe-piece is screwed into the toe of the shoe when the horse is about to be exercised, and forms a powerful point of leverage with which to stretch the contracted tendon, and the shoe, being thin at the heels, admits of this. The advantage of this form of toe-piece over the ordinary form of fixed toe-lever is that it can be removed when the horse is in the stable; while the curved point diminishes the danger of the horse hurting itself—a danger always present if it is on a hind-foot. (See also Treatment of Purulent Arthritis in Chapter XII.)



Should a Sinuous Wound remain in the region of the Lateral Cartilage, it should be explored, and its depth and likely number of branches ascertained. Should this exploration denote that the cartilage itself is diseased, or that the wound is not able to be sufficiently drained from the sole, then we know that we have on our hands a case of quittor. The treatment necessary in such a case will be found described in Chapter X.

When the Complication of Purulent Arthritis has arisen, the surgeon has to admit to himself, reluctantly no doubt, that the case is often beyond hope of aid from him. Nothing can be done save to order continuous antiseptic baths and antiseptic irrigation of the wounds with a quittor syringe, and to attend to the general health and condition of the patient. At the best it is but a sorry look-out both for the veterinary attendant and the owner of the animal. Even with resolution incurable lameness results, and the animal is afterwards more or less a walking exhibition of the limitations of surgery, while the owner, unless the animal is valuable for the purpose of breeding, finds himself encumbered with a life that is practically useless. (See Treatment of Purulent Arthritis, Chapter XII.)

In the case of Lameness Persisting after the healing of all appreciable lesions, then neurectomy is followed by good results. The animal, apparently recovered, is for a long time useless. Lameness persists for several months, as if the nail had at the moment of its penetration caused lesions, which doubtless it sometimes does, similar to those of navicular disease. Examination of the foot in this case reveals no lesion, and the pain has evidently a deep origin. The lameness caused by it is subject to variation. Frequently it becomes lessened during rest, and increased by hard work, while sometimes it is very much more pronounced at starting than after exercise.

It is here that neurectomy is called for. The operation does nothing to impede the work of healing going on, and allows free movement of the foot and pastern to take place. At the same time suffering and emaciation cease, and the animal is rendered workable.[A]

[Footnote A: Veterinary Record, vol. ii., p. 371.]

C. CORONITIS (SIMPLE).

TREAD, OVERREACH, ETC.

1. Acute.

Definition.—Under the heading of simple coronitis in its acute form we intend to describe those inflammatory conditions of the skin and underlying structures of the coronet occurring without specific cause. Specific coronitis will be found described in Chapter IX.

Causes.—This condition is almost invariably set up by an injury—either a bruise or an actual wound—to the coronet. By far the most common among such injuries are those inflicted by the animal himself by means of the shoes.

That known as 'tread' is caused by the shoe on the opposite foot, and may happen in a variety of ways. More often than not it is met with in the feet of heavy draught animals, and is there caused by the calkin, either when being violently backed or suddenly turned round. It may also occur in horses with itchy legs, as a result of the animal rubbing the leg with the shoe of the opposite limb. The irritation in this case is nearly always due to parasitic infection (Symbiotes equi), and becomes sometimes so unbearable as to render the animal unmindful of the injury he may be inflicting so long as he experiences the relief obtained by the rubbing.

Self-inflicted tread is also sometimes met with when horses are worked abreast at plough. The animal in the furrow, with one foot sometimes in and sometimes out of the hollow, is caused to make a false step, and so brings the injury about.

Animals worked in pairs are further liable to receive a tread from the foot of their companion. This is commonly seen in heavy animals at agricultural labour in fields, where the walking is uneven, and abrupt turning constant. It is not uncommon either in animals at work in vans in town, and is occasionally met with in the feet of carriage-horses.

'Overreach' is the term used to indicate the injury inflicted on the coronary portion of the heel of the fore-foot by the shoe of the hind. Ordinarily, overreach occurs when the animal is at a gallop, and is thus met with in its severest form in hunters and steeplechasers. It can only occur when the fore-foot is raised from the ground and the hind-foot of the same side reached right forward. When the feet separate the injury takes place. In its movement backwards the inner border of the shoe of the hind-foot catches the coronet of the fore, and tears it backwards with it. Quite frequently a portion of the skin is removed entirely, but often it hangs as a triangular flap. The flap in such a case is always attached by its hindermost edge, and indicates plainly enough that the direction of the blow that cut it must have been from before backwards.

Although ordinarily inflicted at the gallop, the same injury may, nevertheless, be caused by allowing a fast trotter, and one with extreme freedom of action behind, to push forward at the utmost limit of his pace. The outside heel is the one most subject to the injury.

While the common form of injury to the coronet is, as we have described, that occasioned by the animal's own shoe, or that of a companion, it is evident that the foot is also open to similar injuries from quite outside sources. Falls of the shafts when unyoking animals from a heavy cart, blows or wounds from the stable fork, wounds resulting from the foot becoming fixed in a gate or a fence, either may equally well set up the mischief.

Apart from severe injury, a particularly troublesome form of coronitis may arise from the condition of the roads. We refer to the conditions attendant on a thaw after snow. The animal is called upon to labour in, or perhaps stand for long periods in, a mixture of snow and water, or snow and mud. That this must have a prejudicial effect upon the structure of the coronet is plain. The circulation of the part, already predisposed to sluggishness by reason of its distance from the heart, is farther impeded by the action of the cold. Small abrasions of the skin, so small as to scarce be noticeable, are in this case freely open to infection with the septic matter the mud contains. Necrosis and consequent sloughing of the skin is bound to follow, and an extensive ulcerous wound, or a spreading suppuration of the coronary cushion is the result.

Symptoms.—We will take first the case in which no actual wound is observable. Here the first indication of the trouble is the appearance of an inflammatory swelling, confined usually to one side, but extending sometimes to the whole of the coronet. Always the part is hot and tender, and with it the patient is lame—so much so, in many cases, as to be unable to put the foot to the ground, the toe alone being used.

In a mild case, uncomplicated by septic infection, these symptoms rapidly subside, and resolution occurs.

Always, however, the presence of septic infection must be suspected and looked for. When this has occurred, the inflammatory swelling becomes larger and more diffuse, and the animal fevered. This is then followed by a slough of the injured part. A portion of the skin first becomes gray, or even black, in appearance, and around it oozes an inflammatory exudate, or even pus. The skin immediately adjoining the spot of necrosis is swollen and hyperaaemic, and extremely painful and sensitive. Later, the necrosed portion becomes cast off, and an open wound remains. This as a rule marks the turning-point in the case. The pain and other symptoms rapidly abate, and the wound, with proper attention, is not more than ordinarily difficult to treat.

In the case of an actual wound the symptoms are probably less severe. The injury is, in this instance, the sooner detected, and remedial measures put into operation. In this manner the formation of septic material is often checked, and nothing but the treatment of a simple wound demands attention.

There are, however, complications.

Complications—(a) Diffuse Purulent Inflammation of the Sub-coronary Tissue.—This condition is brought about by the spread into the loose tissue of the coronary cushion of the septic material introduced by the tread. The whole coronet in this instance becomes excessively swollen, hot, and painful, and the dangerous nature of the complication is evident enough when the structure and situation of the parts involved is considered. The amount of tendinous and ligamentous material in the neighbourhood offers a strong predisposition to necrosis, and the necrosis, with its attendant formation of pus, offers a further danger when the close proximity of the pedal articulation and the unyielding character of the horny box is considered with it.

The pus formed in this condition may remain confined to the coronet and break through the skin as an ordinary abscess, or it may, before so doing, burrow beneath the wall, and invade the sensitive laminae. In this case, whenever portions of the secreting layer of the keratogenous membrane are destroyed, or perhaps only temporarily prevented from fulfilling their horn-producing functions, then corresponding cavities in the horn are the result (see Fig. 109).

(b) Purulent Arthritis.—Only too readily the pus so formed tends to penetration of the articulation and the causation of an incurable arthritis (see Chapter XII.).



(c) Necrosis of the Extensor Pedis.—This may arise either as a result of spreading purulent infection of the coronary cushion, or as a result of direct injury immediately over it. The close relation of the terminal portion of this tendon with the pedal articulation, and the incomplete protection from outside injuries here afforded to the joint by the horny box, sufficiently points out the gravity of the condition.

(d) Penetration of the Articulation.—This also may be a result either of the inroads made by pus, or of an actual wound. When occurring from the latter, it is seen more often than not in the hind-foot, being there caused by the calkin of the opposite foot. Where a wound in this position is characterized by an excessive flow of synovia, the condition should be suspected, and, if the wound be large enough, the little finger should be introduced in order to ascertain. Needless to say, the injury is a grave one.

(e) Sand-crack.—Sand-crack is likely to result from tread when an injury is inflicted in the region of the quarter by a severe overreach. Treads, too, especially with the calkin of the hind-shoe, are especially apt to end in this way. In this latter instance the sand-crack usually has its origin in a nasty jagged tear at the top of the wall of the toe.

(f) Quittor.—In one respect any suppurating wound at the coronet may be deemed a quittor. By indicating quittor as a complication of coronitis, however, we denote the more serious form of this disease, in which the wound has taken on a sinuous character, and conducted pus to invasion of the lateral cartilage. It is one of the worst complications we are likely to meet with in this condition, and will be found fully described in Chapter X.

(g) False Quarter.—This complication of coronitis occurs when the injury or after-effect of the formation of pus has been severe enough to destroy outright a comparatively large portion of the papillary layer of the coronary cushion. To this condition we devote Section D of this chapter.

Prognosis.—In giving a prognosis in a case of coronitis, attention should be paid to the manner in which the condition originated, and the extent, when present, of the wound.

When the inflammatory swelling has arisen from bruising alone, without actual division of the skin, when the weather is that of winter, and the swelling showing a marked tendency to spread, then the prognosis must be guarded. As we have seen, this state of affairs is probably ushering in a condition of spreading suppuration of the coronary cushion, and considerable gangrene and sloughing of the skin. We have here no intimation as yet of how far the suppurative process may run, nor what important structures it may involve. Consequently, the guarded prognosis we have mentioned is imperative.

Where an actual wound is to be seen, and where advice is sought early, then a more favourable opinion may be advanced. In this case antiseptic measures, commenced early and persisted in, may prevent the rise of further mischief.

It goes without saying that, should there arise any other of the complications we have mentioned (viz., Arthritis, Necrosis of the Extensor Pedis, Sand-crack, Quittor, and False Quarter), the fact should be pointed out to the owner, and the prognosis regulated thereby.

Treatment—Preventive.—Seeing that at any rate the majority of cases of coronitis result from injuries inflicted by the shoes, we may look at once to that particular for a means of prevention.

Take first the case of 'treads'. There is no doubt that they are most common in animals shod with heavy shoes and with high and sharp calkins. This suggests at once that a preventive is to be found in substituting a calkin that is low and square.

Where the injury is an overreach, and where, on account of the animal's pace and manner of gait it is in risk of being constantly inflicted, the shoeing should be seen to at once.

We have already pointed out that it is the inner border of the lower surface of the toe of the hind-shoe which, in the act of being drawn backwards, inflicts the injury. (See Fig. 110).

In this case prevention may be brought about either by shoeing with a shoe whose ground surface is wholly concave, or by bevelling off the sharp border (see Fig. 110, a, p. 236). When the tendency to overreach is not excessive, prevention may in many cases be effected by simply placing the shoe of the hind-foot a trifle further backwards than would ordinarily be correct, thus allowing the horn of the toe to project beyond the shoe. This at the same time does away with the annoyance of 'forging' or 'clacking,' which, as a rule, accompanies this condition.

While recognising the value of shoeing in these cases, we must not forget that a great deal may be brought about by careful horsemanship. The animal should be held together and kept well up to the bit, but should not be allowed to push forward at the top of his pace. With many animals of fast pace and free action overreach is more an indiscretion of youth than any defect in action or conformation, and his powers should therefore be husbanded by the driver until the animal has settled down into a convenient and steady manner of going.



Curative.—Although in some cases it is so small as to go undetected, we may take it that in all cases of coronitis there is a wound, with consequent danger of septic infection of the surrounding parts. Therefore, after attention to the shoeing and removal of the cause, the first indication in the treatment will be to render the parts aseptic. This is best done by removing the hair from the coronet and soaking the whole foot in a cold antiseptic solution. After removal from the bath, the coronet may be dressed with a moderately strong solution of carbolic acid or perchloride of mercury. When the injury is slight and recent, such is sufficient to effect resolution.

When marked swelling persists, however, and the increase in heat and tenderness denotes the formation of pus, recovery is not so easily obtained. In this case the application of hot poultices or hot baths is called for. By these means suppuration is promoted and induced to early break through in the most favourable position—namely, the softened skin of the coronet. The pus so escaping is always more or less blood-stained, and contains both large and small pieces of broken down and decomposed tissue. After discharge of the pus, the cavity remaining should be mopped out with an antiseptic solution, and a pledget of antiseptic tow or other material left in position. All that is then needed is constant dressing in a suitable manner. We prefer in this instance washing some three or four times a day with hot water until a perfectly clean wound is obtained, and, after the washing, painting the raw surface with a strong solution (1 in 200, or 1 in 100) of perchloride of mercury.

When the abscess we have described as forming is extremely large, or where it is more than ordinarily slow in 'pointing,' the likelihood of its having burrowed for some distance below the upper margin of the wall must be suspected. Here it is sometimes wise to thin the wall with the rasp immediately below the point of greatest swelling of the coronet. This will serve to lessen pressure on the sensitive structures beneath.

Immediately the abscess contents have found exit at the coronet, the cavity formerly occupied by the pus should be explored. If to any extent it is found then to have 'pocketed' beneath the upper border of the wall, a counter-opening should be made where the horn of the wall has been thinned with the rasp.

When it so happens, either from extensive bruising or from the action of excessive cold, that we have or suspect the condition of sloughing, then the first indication is to aid the live tissues to throw off the necrosed portion. In spite of what is sometimes urged to the contrary, a hot poultice is, perhaps, the best means of bringing this about. Directly the necrosed piece is shed, a wound remains which, so far as treatment is concerned, may be regarded exactly as that left by the formation of pus. Hot water applications, some three or four times daily, will serve both to cleanse the wound and also to maintain vitality in the tissues immediately surrounding it. After each washing, the use of a strong antiseptic solution to the wound is again beneficial.

In the case of an actual wound, whether, as in overreach, affecting the coronet alone or involving destruction of part of the wall, or, as in the case of toe-tread, penetrating the pedal articulation, the treatment to be followed is simple enough, in theory, if not always easy to carry out. It consists solely in maintaining a rigid asepsis of the parts until healing is well advanced or complete. The whole foot, including the coronet, should first be thoroughly washed in warm water. At the same time there should be used some agent that will tend to remove the natural grease of the parts. In this manner cleansing will be rendered more thorough, and penetration of the antiseptic solution to be afterwards applied made the more certain. The most ready way of effecting this is to use the ordinary stable 'water'-brush, and plenty of a freely-lathering soap.

This done, the foot should be rinsed in cold water, and afterwards constantly soaked in a cold antiseptic bath. Where it is inconvenient or impossible to have the constant bathing carried out, a dry antiseptic dressing may be tried in its stead. In this case the foot should first be thoroughly washed and dressed as before. Afterwards an antiseptic powder in the shape of a mixture of iodoform 1 part, boracic acid 10 parts, should be freely dusted on the wound, a pledget of carbolized tow or cotton-wool placed over it, and the whole maintained in position with a bandage previously soaked in a 1 in 500 solution of perchloride of mercury. Once on, this dressing should be allowed to remain until healing is complete. Should the animal manifest pain, however, by constantly pawing, or should swelling and heat of the parts be suspected, the bandage should be removed, and the condition of the wound ascertained.

An excellent example of the value of this method of treatment is that given below:

'I call to mind a valuable hunter in my practice a few seasons since, who, whilst hunting, we suppose, struck himself in the way we suggest. He not only removed the superior portion of the inner heel, but tore about 3 inches of the hoof from the top nearly to the bottom. This was clapped back by the owner, tied with a handkerchief, and the horse removed home. When the handkerchief was removed, I confess I did not think the horse looked at all like hunting again. The heel was fairly pulled down, the portion of the hoof that was hanging to it I could easily have wrenched off. The parts were fomented, however, with warm water which was slightly carbolized. I then removed a great portion of the heel and the lateral cartilage, which was split; placed the portion of hoof again on the laminae, smothered the wound with iodoform pulv., covered it with cotton-wool packing, and all the boracic acid I could get it to hold. A piece of linen bandage was then tightly wrapped a few times round, and the lot enclosed in a plaster-of-Paris bandage. I did not undo it for a fortnight, when, to my great pleasure, the heel and hoof presented a highly satisfactory appearance. I did it up in much the same way for another ten days, then put the sand-crack clamps into the hoof and fixed it to the sound part. The hoof remained in position while the new horn grew from the top, and the horse hunted again the same season.'[A]

[Footnote A: Veterinary Record, vol. ix., p. 501 (Bower).]

Sequels.—Either of the complications we have mentioned—as, for instance, Arthritis, Sand-crack, or Quittor—may persist and remain as sequels to the case. In addition to these, there may be left behind a cavity in the horn of the wall (see Fig. 109), or a loss of the horn-substance of the wall proper, as that depicted in Fig. 112, or described under the heading of False Quarter.



The treatment of Arthritis, Sand-crack, Quittor, False Quarter, and Seedy-toe, will be found in the chapters devoted to their consideration.

2. Chronic.

Definition.—Coronitis in which, owing to the persistence of the cause, inflammatory phenomena continue, resulting in the growth of large fibrous tumours about the coronet.

Causes.—In many cases it is possible, of course, that abnormal large growths in this position may have an origin similar to that of neoplasms elsewhere—that is to say, an origin as yet undiscovered. There is no doubt, however, that the majority of the huge enlargements about the coronet have their starting-point in one or other of the diseases to which the foot is liable, in which the cause remains, and a low type of inflammation persists.

In chronic and neglected suppurating corn, in untreated quittor, and in long-standing complicated sand-crack, for instance, we have conditions in which pus and other septic matters find ready entrance into the subcoronary tissues. Should either of these be neglected, or should the pus formation from the onset take on a slow but gradually spreading form (in other words, should either of these cases run a chronic rather than an acute course) then, with the persistence of the inflammatory phenomena so caused, is bound to result a steady and increasing growth of inflammatory fibrous connective tissue. This, as it grows, becomes in its turn penetrated by the ever-invading pus, and, under the stimulus thus caused, itself throws out new tissue. And so, constantly excited, the tumour-like mass tends to steady increase in size, until enlargements are formed which one may sometimes truly term enormous.

Symptoms.—The appearance of the growth is, of course, immediately evident. Usually these swellings are slow in forming, so that the size of the enlargement depends entirely upon its age. We may thus meet with growths of this description, varying in weight from 4 or 5 pounds to the almost incredible size of 33-1/2 pounds. In the majority of cases a discharging sore is to be found upon it—in some cases several. Explored, these sores reveal their true nature. Their lip-like openings, and the ready manner in which they may be searched by the probe, show them to be sinuses.

In a few cases, however, the outer surface of these tumours is intact. When this is the case, it is possible that the growth is a true fibroma—that is to say, a non-inflammatory new growth of fibrous connective tissue. On the other hand, it may have resulted from one or other of the causes we have enumerated, and its exact diagnosis have been impossible until operative measures had been proceeded with. In this case, small and encysted foci of inspissated pus scattered more or less throughout the growth indicate its true nature.

Pain as a rule is absent, and, unless the growth, on account of its size, interferes with progress, the animal walks perfectly sound. Here the patient may, without offending the dictates of humanity, be put to slow work.

Treatment.—In very many cases, possibly on account of the decreased circulation and vitality of the parts, these growths occur in aged animals. Here treatment is not economic, and may for that reason be put out of the question. Further, the growths are more common in heavy cart animals of a lymphatic type than in those of a lighter breed. Couple this with the fact that the tumour is often unattended with pain, and we see that the animal is still able to perform his accustomed labour. Here, again, treatment is contra-indicated.

For still another reason surgical treatment, which is the only treatment likely to be of benefit, must not be undertaken rashly. A large and open wound is bound to be left behind. So large is it in many cases that the complete covering of the exposed surface with epidermal growths from the circumference cannot possibly be looked for. There is then left a large and horny-looking scar, which is an even worse eyesore than was the original enlargement.

When the patient is a young and otherwise valuable animal, however, and when the case, judged either by the size of the swelling or its outside appearance, promises a fair measure of success, operative measures may be determined on.

In this case the author's practice has been, after casting the animal, to apply a tourniquet to the limb and proceed to excision. A lozenge-shaped incision, extending to near but not quite the circumference of the swelling, should be made with a large knife right through the skin and deeply into the growth. The whole is then removed, proceeding in an excavating manner under the thickened skin at the margin. Haemorrhage, though proceeding from several apparently large vessels in the structure of the tumour, and oozing generally over the whole of the outer surface, is rarely profuse enough to interfere with the operation, and is easily controlled by cold water douches and the application of the artery forceps to one or more of the larger vessels. The operation completed, the larger bleeding-points should be secured by exerting torsion with the artery forceps, and the surface oozing stayed by frequent dashing with cold water.

When the haemorrhage has sufficiently ceased, an ordinary flat firing-iron should be passed over the whole of the cut surface, and an effectual eschar formed.

Following this, and before removing the tourniquet, the wound should be filled with pledgets of carbolized tow, and the whole tightly secured by a stout and broad linen bandage of not less than 6 yards in length.

Reported Case.—'The patient, a middle-aged cart mare, had a pair of fore-feet the like of which I never saw. As the result of long-standing and imperfectly-treated quittor all over the seat of side-bone on the outer side of each fore-foot, beginning pretty far forward, and extending to the heel on the inner side, filling up the hollow and reaching nearly to the fetlock, was a big, bulging, hard, calloused enlargement or tumour standing out 3 or 4 inches all round, covered with thick horny skin and stubby hair, and having on its surface the small openings of several sinuses leading deeply down to the ossified and diseased cartilage underneath. And yet with all this diseased undergrowth the mare, strangely enough, walked and trotted sound. I was told that this mare had been troubled with suppurating corns and quittor, that many unsuccessful attempts had been made at cure, but that, getting worse instead of better, these tumours had formed.

'After casting and anaesthetizing, a strong rubber tourniquet was placed above the knee and the operation commenced. With a surgeon's amputating knife all the big fibrous mass which I could safely remove was cut and sliced off, and the coronet and pastern reduced as nearly as possible to its natural dimensions. The diseased cartilage, or side-bone, gave some trouble, a considerable portion having to be cut and scraped, and the sinus in it gouged out; but its complete removal did not appear to be called for.

'There was little if any haemorrhage until release of the tourniquet, when the whole broad surface became deluged with blood, three or four small arteries spurting and veins flowing in all directions, so much so that I was glad to reafix the clasp, and with the firing-iron seal up the vessels, searing gently all over the surface.



'A good dusting with antiseptic powder, a thick pad of carbolized wool, and two long calico bandages wound tightly round, completed the work.

'The other, the near-leg, was then dealt with in the same way.

'The mass removed weighed a little over 9-1/2 pounds—5 pounds from the off-foot and 4-1/2 pounds from the near. Its structure was fibrous tissue, almost as firm and hard as cartilage, and with no appearance of malignancy.

'The after-treatment consisted simply of fresh dry dressings—copper, sulphate, zinc sulphate, and calamine, equal parts—applied every third or fourth day, after first bathing the feet in a shallow tub of warm antiseptic water.

'At the end of eight or ten weeks a fairly presentable appearance existed. The greater part of what had been raw surface was covered with healthy skin, and the remainder had become dry and horny.'[A]

[Footnote A: Veterinary Record, vol. xiv., p. 201 (C. Cunningham, M.R.C.V.S.).]

A further form of chronic coronitis is that shown in Fig. 113.

This condition is commonly the result of a severe and jagged tread with the calkin, and takes the form of an ulcerous and excessively granulating wound. As time goes on the granulations become hard and horny-looking, and their fibrous tissue as hard and unyielding as tendon or cartilage.

These if treated in the early stages with repeated dressings of caustic, or, if very exuberant, the use of the knife, usually yield to treatment. If neglected until the condition depicted in the figure is arrived at, then treatment, as a rule, is of no avail. Neither is treatment of any use if any great loss of the coronary cushion has occurred.

D. FALSE QUARTER.

Definition.—False quarter is the term applied to that condition of the horn of the quarter in which, owing to disease or injury of the coronet, the wall is grown in a manner that is incomplete.

Symptoms.—This condition of the foot appears as a gap or shallow indentation, narrow or wide, in the thickness of the wall, with its length in the direction of the horn fibres. By this we do not mean that the sensitive laminae are bared and exposed. Horn of a sort there is, and with this the sensitive structures are covered. Running down the centre of the incomplete horn is usually a narrow fissure marking the line of separation in the papillary layer of the coronary cushion, which, as we shall later see, is responsible for the malformation.

On either side of the indentation, as if wishing to aid further than ordinarily it should in bearing the body-weight, the horn takes on an increased growth, and stands above the level of the horn surrounding it. It may, as perhaps it really is, be regarded as a form of hypertrophy, brought about by the increased work that the loss of substance in the region of the false quarter puts upon it.

So long as the sensitive structures are protected the animal remains sound. Sometimes, however, from the effects of concussion or of the body-weight, a fissure appears in the narrow veneer of horn that covers them. Into this, which, of course, is but a form of sand-crack, gravel and dirt penetrate, and so set up inflammatory changes in the keratogenous membrane. As a result suppuration ensues, and the animal is lame.

Causes.—False quarter may result from any disease of the foot that involves destruction of a portion of the coronary cushion. As we may see from a reference to Chapter III., it is from the papillae of this body that the horn tubules of the wall are secreted. Destruction of any portion of it necessarily results in a corresponding loss of horn in that position. The disease occasioning this more often than any other is perhaps quittor. It may also result from suppurating corn, from a severe tread or overreach, or from the effects of a slowly progressing suppurating coronitis.

Treatment.—A radical treatment of false quarter is not to be found. Once destruction of the secreting layer of the coronary cushion has occurred, the appearance of the fissure in the wall will always have to be reckoned with. A false quarter, therefore, not only renders the horse liable to occasional lameness, but also renders weaker that side of the hoof in which it occurs.

The only method of treatment that can be practised, therefore, is that of palliation. Seeing that the trouble the veterinary attendant will have to deal with is loss of a portion of the weight-bearing surface, his attention is immediately directed to the shoeing. As with sand-crack, so with false quarter, the frog and the bars must be called upon to take more of the body-weight than commonly they do with the ordinary shoe. The indication, then, is a bar shoe. At the same time, the bearing of the wall on the shoe on either side of the fissure should be eased by slightly paring it, and the hypertrophied horn on the outer surface of the wall removed with the rasp.

In cases where penetration of the sensitive structures has occurred, complicated with the formation of pus, the same treatment as for complicated crack is to be followed. The foot should be poulticed for several days with hot antiseptic dressings, and thorough cleansing of the infected parted brought about. Afterwards strong solutions of suitable antiseptics should be applied daily until such time as the horny covering has renewed itself. This done and the bar shoe applied, the fissure may be plugged with any effectual stopping. Either a mixture, such as Percival's, of pitch 2 parts, tar 1 part, and resin 1 part, melted and mixed together, or one of the artificial hoof-horns may either be used with advantage.

E. ACCIDENTAL TEARING OFF OF THE ENTIRE HOOF.

Causes.—Seeing that this accident to, and consequent severe wounding of, the keratogenous membrane nearly always occurs in but one way, it is worthy of special mention. So far as we are able to ascertain, it is an accident peculiar to horses continually engaged in shunting operations either in pits or station-yards. At the moment the animal is released from the waggon he has been pulling, and should turn to the right or the left in order to allow it to pass him, the shoe either becomes wedged in between two converging rails, or is trapped by the wheel of the waggon. Either the approaching waggon with the added weight its impetus gives it then pushes the animal suddenly away, leaving a part of his foot still fixed to the rails, or the animal himself, feeling securely held, makes a sudden effort to release himself, and draws his foot cleanly out of the imprisoned horny box.

The author calls to mind a case in which entire removal of the horn of the foot of an ox occurred through the passing over it of the wheel of a heavily-laden cart. It is therefore quite conceivable that the same accident might occur to the horse. As a matter of fact, we find one case on record where one-half of the horny box was thus removed.[A]

[Footnote A: Veterinary Record, vol. xiii., p. 129.]

So far as we are able to gather, it is more a result of imprisonment of the shoe than of the foot. It appears, further, to be always a result of the animal being newly shod, and the clinches firmly secured; so much so that it would be probable, with imperfectly secured clinches, that the animal would draw the hoof from the clinches and the shoe rather than the foot from its horny covering.

Therefore, as the author of one of the cases we shall afterwards relate suggests, it should be proposed as a preventive that the shoe-nails of animals regularly engaged in work on the metals should not be clinched in the regulation manner, but should have their points merely screwed off, and the nails afterwards rasped level with the wall.

These cases are particularly interesting as illustrating the rapid manner in which a new hoof is afterwards formed, and the way in which the exposed sensitive laminae take their share in adding to, though not forming the bulk of, the horn of the wall.

From the cases we are able to record it will be seen that this accident need not be looked upon as fatal, nor the injury itself beyond hope of repair. Dependent largely upon the temperament of the animal, the amount of pain that is caused, and the way in which the animal bears it, recovery may be looked for. Even from the very commencement of the accident, however, the pain may be so acute and the animal so violent with it that slaughter becomes necessary.

Treatment.—This consists in applying an antiseptic and sedative dressing to the injured parts (for example, Carbolized Oil and Tincture of Opium, equal parts) and afterwards bandaging.

From the only data we are able to work on, it appears that this dressing should be repeated daily, the bandage being removed, each time, the foot well bathed in warm water, and the dressing and bandage afterwards replaced. On first sight, it would appear that once cleansed and bandaged the dressings might be left in situ for several days. Seeing, however, that suppuration, if once set up, would add further to the intense pain the animal is already suffering, and considering the always constant exposure of the foot to infection, it is perhaps wise to persist in daily changing of the dressings.

At the same time, the general health of the animal should be attended to. Suitable febrifuges should be administered, either in the shape of a dose of physic, or salines and liq. ammonia. acetatis; and the pain, if appearing unbearable, allayed by doses of choral and hypodermic injections of morphia.

Recorded Cases.—1. 'A short time ago I was called to see a horse which had had his hoof torn off in a railway "point." When I arrived at the stable the injury had been done two hours, and the horse had been led from the railway to a loose-box nearly half-a-mile off. On going to this box I was surprised and horrified to find the poor animal mad with pain, rolling and dashing himself about. When on his back he would struggle and kick the walls with the injured foot, as though unconscious of pain. Not one moment was he still, and as I could see that the sensitive structures were much damaged by his violence, I obtained a gun and put him out of his pain.

'The accident happened in this way. The horse was employed in shunting coal-waggons, and had just drawn four loaded trucks up to a point at which they diverged to the left, and the horse, being unhooked, ought to have turned to the right. Here, unfortunately, the near fore-foot became wedged in between two converging railway plates, one of which formed a part of the waggon-way, on which the trucks were running. The horse was a big animal, and freshly shod with heavy shoes, on which a toe-piece and calkins were used. The shoe was roughly but strongly nailed on with eight nails, the clinches of which were all firm. This shoe was fitted wide at the heels, and when the foot was fixed in the points (toe downwards) it protruded over the face of the rail. When the trucks reached it they pressed it down, and, the horse leaning forward, the hoof was drawn off like a glove. The hoof was almost as clean inside as if taken off by maceration—only towards the toe was a small portion of the coffin-bone and some torn laminae left inside the hoof.

'As soon as possible after the accident, so I was told, the foot was bound up with tow and a bandage; then a sack was cut up and placed over all, and the horse slowly led to his loose-box. He "carried" the leg all the way, limping along on the three sound ones. Almost immediately after reaching the box he lay down, but only for a short time. The standing position was not long maintained—profuse perspiration set in, and the alternations of position became more rapid and violent, till plunging and rolling were added to the other signs of excruciating pain. I was also told that the groaning of the poor animal was almost constant, and at times so loud and prolonged as to amount to a shriek.

'I have no experience of a similar case, and I should not have supposed that this accident would have caused such acute suffering and violent symptoms. I think I have heard of such cases making a complete recovery; but I feel sure that, in this case, I only anticipated death by, at most, a few hours.'[A]

[Footnote A: Veterinary Record, vol. iv., p. 127.]

2. 'The case I am about to give you an account of, being one of rare occurrence, I thought would not prove uninteresting to the members of the Veterinary Medical Association. It is an instance of complete removal of the hoof by mechanical force.

'Our patient was a brown mare, five years old, the property of Messrs. Crawshaw and Co., railway contractors on the Sheffield and Manchester line.

'On June 20 the mare was, as usual, working on the line, drawing one of the waggons for the removal of soil from one place to another, and, as was the custom, the pace is generally increased at about the distance of from sixty to eighty yards from where the unloading takes place, in order to add to the velocity, so that the contents of the waggons might roll down so great a precipice. It was at this increased action, when the mare was being removed from the waggon, that she stepped between the ends of two iron rails, sufficiently apart to admit the foot only, when one end of the rail inserted itself between the sole and toe of the shoe, the other at the top and in front of the crust.

'The mare, finding herself fixed, endeavoured to disengage herself, and, in doing so, got in front of the waggon, which, coming at a great pace, forced her down into the pit, leaving behind the off fore-hoof, which was only removed from its situation between the two rails by a large hammer, it being so firmly wedged in. The shoe and hoof were bent in a very peculiar manner, as the accompanying cuts will show, the inside heel being completely raised from above the level of the frog, not one of the nails being unclenched, or in the slightest degree having given way to so large an amount of force imposed upon them, although the toe of the shoe was raised from the sole by the rail being immediately under it (see Fig. 114). The mare had been shod the day before, and, having a good sound foot, the shoe was firmly put on.

'Being a mile from home, she was with some difficulty made to travel that distance. On her arrival, my preceptor, Mr. Taylor, was immediately sent for, who found her, as I have before stated, with the off fore-foot hoofless.

'Proceeding to examine the foot, he ascertained that it had bled considerably, which, however, was stopped by bandages to the foot and a ligature round the coronet. The laminae on one side and a small portion of the sensitive sole, though not to any great extent, were lacerated. The coffin-bone was not at all injured. The bleeding having nearly ceased, she was put into slings, the foot carefully washed with warm water, and immediately bound up with pledgets of tow saturated with the simple tincture of myrrh and tincture of opium, of each equal parts.



'The dressing was ordered to be allowed to remain on all night, and on the following morning to be removed. The foot was then bathed, as before, in warm water, and the application of the tinctures repeated night and morning. The medicine internally given was castor oil, with tinct. opium, and this, in a diminished dose, was ordered the next morning. Blood was also abstracted from the jugular vein, to the amount of 6 quarts, so as to allay the inflammatory fever set up. The food consisted of bran and linseed, with small portions of hay and water. The mare being in a highly excited state, and suffering such severe pain, the opinion Mr. Taylor gave was that, should she get over the first four days (which appeared quite uncertain), he had no doubt of her ultimately getting well, and also that she would have a perfect hoof formed. It was now left for the owners' consideration, whether they thought the mare worth her keep till such took place, the time mentioned by Mr. Taylor being four or five months. She was seen again the fourth day after the accident, and was then found to be perfectly tranquil and feeding well; her pulse, which at the first visit could not be counted, was now not more than 65 beats in the minute. On removing the dressings, the foot presented a very favourable appearance, the treatment therefore varied only in the application of a linseed-meal poultice over the former dressings of tinctures of opium and myrrh, confining the whole in a soft leather boot. Diet as before, in addition to which give a few oats. Should the bowels become constipated, repeat the castor oil without the opium.

'June 28.—The animal was again seen, and appeared to be going on very favourably. The poultices were directed to be discontinued, and the parts dressed every other day with sol. sulph. cupri, as the granulations were getting rather luxuriant.

'July 6.—To-day she was found to have gone on so well, having two days before been removed from the slings, that it was thought justifiable to turn her out, protecting the foot with a boot, and ordering the dressings to be repeated.

'July 23.—She was seen by me in the field, where I had the boot removed, and so much had she improved, that not less than 2 inches of crust, proceeding from the coronary ring, had been formed, and the foot looked remarkably healthy.

'It will be seen that the accident occurred on June 20, a fortnight after which time I observed the horny crust to be forming from the coronet, and the insensitive laminae at the same time, in which on every visit an increase of growth was perceptible, and it soon attained a thickness exceeding that of the other hoof, but which at the same time presented a more upright appearance. It was not until three weeks after our first visit that any formation of new sole or frog was to be seen. Of the two the sole was the first, being secreted by the sensitive sole, the growth proceeding from the heels. In like manner the insensitive frog was being produced by the sensitive.



'During the last week in October the mare, having her foot protected with a bar shoe plated at the bottom, and so formed as to open without necessity of removing the shoe, in order to facilitate the applications of the tinctures, was put to light work, which has since been gradually increased, and she now performs her usual labour equal to any other horse.

'The growth of the wall or crust and insensitive laminae is not yet quite complete, nor is the sole, there being wanting about an inch of the horny substance of it, the entire completion of which I should rather doubt, as I mentioned in my former communication that the sensitive laminae and a small portion of the sole were lacerated, and it is in these parts that the imperfections exist.

'The yet imperfectly-formed wall not admitting of the insertion of nails all around it, the shoe is held on partly by nails and partly by a strap attached to it bound round the coronet.'[A]

[Footnote A: Veterinary Record, vol. iv., p. 182 (B. Cartledge).]

3. 'This case is related by Mr. A. Rogerson, F.R.C.V.S. It occurred to an animal regularly engaged in shunting, and happened through the corner of the shoe becoming "trapped" between a line of metal and the wheel of a truck. It is particularly interesting on account of the photograph accompanying it, and which we here reproduce in Fig. 115.

'The photograph shows plainly the manner in which the holding of the "clinches" on the left side of the hoof has resulted in drawing it off from the foot. Had these clinches, as Mr. Rogerson suggests, been left unfastened, then the accident in all probability would not have occurred. The animal was destroyed.'[A]

[Footnote A: Ibid., vol. xiii., p. 2.]



CHAPTER IX

INFLAMMATORY AFFECTIONS OF THE KERATOGENOUS APPARATUS

A. ACUTE.

ACUTE LAMINITIS.

Definition.—The term 'laminitis' is used to indicate a spontaneous and diffuse inflammation of the whole of the sensitive structures of the foot, more particularly the sensitive laminae. Usually it occurs in the two front feet, often in all four, and occasionally in the hind alone.

Causes.—In dealing with the causes of laminitis, we will first dispose of those coming under the heading of traumatic. Correctly speaking, however, lesions of the laminae thus occurring do not present the same symptoms, nor run an identical course with the disease we now purpose describing, and for which we would prefer to entirely reserve the term 'laminitis.' The fact, however, that traumatic causes are detailed in other works on the same subject compels us to give them mention here.

Strictly traumatic causes giving rise to a limited inflammation of the sensitive laminae are violent blows upon the foot, either purely accidental, or self-inflicted by violent kicking.

A similar limited laminitis is to be found in the conditions we have described under 'Nail-bound and Punctured Foot.' It is met with also in the injuries resulting from tread and overreach, and in the tissue-changes accompanying corn.

The tenderness following upon excessive hammering in the forge, or of too long an application of the shoe in hot-fitting has also been described as laminitis.

With either of the conditions we have mentioned, it goes without saying that there is either a simple congestion or an actual inflammation, localized or general, of the laminae of the injured foot. In neither case, however, can the resulting mischief be closely compared with the lesions attending an attack of laminitis proper, a disease which appears to have an almost specific cause, and to run a course peculiarly its own.

The specific cause we have indicated as existing can, in the present state of our knowledge, be only vaguely described as a poisoned state of the blood-stream. This, as clinical evidence teaches us, may result from a variety of causes.

Among these, by far the most common is that state of the circulation induced by excessive feeding with too stimulating or too irritating a diet. In any case, where the use of old oats as a staple diet is departed from, and where the quantity and manner of using the substitute is left to the discretion of careless or unskilled attendants, trouble is likely to ensue. The food more prone, perhaps, than any other to bring about an attack is wheat improperly prepared—that is, uncooked or unground. So much so is this the case that one full meal of this provender to an animal unused to it is sufficient to lead to a train of symptoms often ending fatally.

Beans, peas, barley, rye, new maize, or even new oats, are all liable, if carelessly used, to have the same effect.

It is the laminitis following feeding on new oats that has caused us to apply to the food the adjective 'irritating.' Here, more often than not, the peristaltic action of the bowels is found to be abnormally in evidence, and the excessive use of the diet is always accompanied by a more or less fluid discharge of the intestinal contents.

In addition to the foods we have mentioned, many others might be enumerated, more especially the numerous 'made-up' feeding materials now on the market. Many are composed of substances that may be regarded as absolutely opposed to the correct feeding of a horse, and their use can only be followed by this and other evil results.

Another most fruitful cause of laminitis is a severe and continued inflammatory condition of the system elsewhere. It is the laminitis known to veterinary surgeons as 'metastatic,' and perhaps the two most notable examples of it are the laminitis following a prolonged attack of pneumonia, and the 'Parturient Laminitis' occurring as a concomitant of septic metritis.

Parturient laminitis it is that offers us the most striking illustration of the truth that a poisoned state of the blood-stream is a sure factor in the causation of an attack. From the direct evidence of our senses (namely, manual exploration of the infected womb, and the stench of the exuding discharge) we know that we have in the interior of the womb matter in a state of putrescence. From the experience of previous post-mortems we know, further, that the putrescent matter thus originating often gains the blood-stream, and forms foci of septic lesions elsewhere—liver or lung. When, therefore, during an attack of septic metritis a condition of laminitis supervenes, we are justified in attributing it to the escape of septic matter from the already infected uterus.

In the same category of laminitis from metastasis may also be placed the laminitis occurring as a result of an overdose of aloes. The enteritis thus set up is often followed by laminitis, and that of a serious type.

Prolonged and excessive work upon a hard road is also apt to induce an attack. When this occurs it in many cases resolves itself into a case of cruelty. (See reported case, No. 1, p. 279.)

Laminitis from this cause was frequent among coach and carriage horses in the pre-railroad period, and resulted from attempting to obtain from the animal a faster pace and a greater number of miles than he was physically capable of giving.

In our day, however, it is more often a result of gross feeding, combined with only that amount of work which the horse, if ordinarily fed, would be easily able to perform. An excellent example of this is the laminitis occurring in the Shire stallion when commencing his rounds of service in the spring and early summer. At this season these animals are constantly supplied with a more than sufficient supply of a highly stimulating and nutritious diet. In this case the blood is already in that state in which it is predisposed to the disease. Add to this the unwonted exercise—for during all the winter the animals are idle—and congestion of the venous apparatus of the extremities is not to be wondered at.

Passing from these, the more common, we may consider other and less frequent causes of the disease. Congestion of the laminal blood-vessels and consequent laminitis occurs when animals are made to maintain a standing position for prolonged periods, as, for instance, when making sea voyages. A long and painful disease of one foot, necessitating the whole of the weight being borne by the other, ends often in laminitis of the second member. It may thus occur as a sequel to quittor, complicated sand-crack, suppurating corn, and punctured wounds of the feet.

Laminitis has also been known to occur as a result of septic infection of the blood-stream consequent on the operation of castration. (See recorded case, No. 2, p. 281.)

A sudden lowering of the surface circulation at a time when the animal is excessively perspiring is also said to favour an attack, as also is the giving to drink of cold water to an animal just in from a long and tiring journey. Also, according to Zundel, 'the influence of the season cannot be denied, and it is during the summer months that laminitis is more frequent, while it is rare in winter, as well as in the spring and autumn.'

Further, laminitis has been described as occurring when the animal is at grass, and when all causes—at any rate, active ones—have appeared to be absent. (See reported case, No. 3, p. 282.)

Regarding heredity, we may safely say that, as a cause of laminitis, it may be almost totally disregarded. That a bad form of foot, either a flat-foot or a foot with heels contracted, and already thus affected with a mild type of inflammation, did not offer a certain predisposition, we should not like to assert. There must, however, be an exciting cause—namely, a poisoned condition of the blood-stream. This latter cannot, of course, be in any way regarded as hereditary.

In short, the dietetic cause is by far the most common, and, in prosecuting inquiries as to the starting-point of an attack, the veterinarian's attention should be directed in the main to that particular.

Symptoms.—Laminitis is always ushered in by a set of symptoms indicative of a high state of fever. The pulse is raised from the normal to as many as 80 or 90 a minute, muscular tremors are in evidence, the respirations are short and hurried, and the temperature rises to 105 deg., 106 deg., or 107 deg. F. The visible mucous membranes are injected, that of the eye, in addition to the hyperaemia, often tinged a dirty yellow. The mouth is dry and hot, the urine scanty, and the bowels frequently torpid. As yet, however, the walk is sound.

Called in during this early stage, the veterinarian is often puzzled as to the exact significance of the symptoms. Enteritis, lymphangitis, or pneumonia he knows to be often heralded in the same manner. In this connection, Zundel says: 'Laminitis, in most instances, is preceded by certain general symptoms, such as are premonitory of the invasions of ordinary inflammatory diseases, but of an uncertain significance.'

So far we agree with him, but to what we have already said we would add that, even in this early stage, there is an additional symptom, unmentioned by Zundel, which often leads one to an exact diagnosis. The feet are in turn lifted a short distance from the ground, and almost immediately replaced. This movement ('paddling,' we may term it) is constant, the animal appearing to obtain ease in no one position for more than a few moments at a time.

Seen but a few hours later, when the swelling caused by the hyperaemia and outpouring of the inflammatory exudate has led to compression of the sensitive structures within the horny box, the symptoms presented admit of no misreading, save by the most casual and careless observer. The patient now stands as though fixed to the ground. The pulse is hard and frequent, the respirations tremendously increased in number, the body wet with a patchy perspiration, and the countenance indicative of the most acute suffering. Only with difficulty, and often only at the instigation of the whip, can the animal be induced to move. This he does by throwing his weight, so far as he is able, on to the heels of the feet affected, and putting the feet slowly forward in a shuffling and feeling manner. The feet themselves give to the hand a sensation of abnormal heat, percussion upon them with the hammer is followed by painful attempts at withdrawal, while any effort we may make to remove one foot from the ground is useless, so great an aversion does the animal show to placing a greater weight upon the opposite foot.

According as the front-feet alone, the hind-feet alone, or all four feet are affected, the symptoms will vary.

With all four feet diseased, the animal stands with the two front-feet extended in front of him, while the hind-limbs are at the same time propped as far beneath him as is possible. The horse is, in fact, standing upon the extreme hindermost portions of the feet.

Why the animal should thus distribute his weight is easily explained. Standing in the normal position, the body-weight is borne by the sensitive laminae, the sole, of course, sharing in the burden, but the laminae taking by far the greater part of the pressure thus exerted. With the vessels of the laminae gorged with blood, and the laminal connective tissue infiltrated with a profuse inflammatory exudate, the most excruciating pain is bound to result by reason of the compression of the diseased tissues within the non-yielding structures. In some little measure the suffering animal may afford himself relief by partly removing pressure from the fore-parts of the hoof. When placing the body-weight behind, the pressure, instead of falling upon the highly sensitive laminae, is directed to the follicular and fatty tissues of the plantar cushion: from there, with only a small portion of the sensitive sole intervening, to the horny frog, and from thence to the ground.

The same distribution of weight also places the foot in a position of greatest expansion, thus, by giving greater room to the diseased parts, again affording relief of pressure on the inflamed lamina, while it at the same time relieves of weight the foremost portions of the sensitive sole.

With the fore-feet alone attacked, the animal affects exactly the same position of standing as that just described. The fore-feet are again extended, and the hind propped far beneath him. The fore extended, in order to obtain the relief occasioned by standing on the heels; the hind in this case carried forward in order to take a greater share of the body-weight, and thus relieve the congested members in front.

With the hind only attacked, then the fore and the hind feet are more closely approximated than in the normal position. The reason, of course, is that the hind-feet are carried forward in order to be placed upon the heels, while the fore are taken backwards to relieve the hind of the body-weight.

In like manner the movements of the animal will vary with the feet affected. With only the front-feet diseased the animal is, comparatively speaking, comfortable. The hind-feet take the weight, and the animal stands for long periods together, resting alternately first one fore-foot and then the other, moving often in a circle of which his body is the radius, and his hind-limbs the centre. If urged to move forward, then immediately his countenance and movements manifest the pain to which he is put. Only with reluctance does he cause the fore-feet to take weight. They are shuffled forward quickly one after the other, so that weight may not be placed upon them for one instant longer than is necessary, and the hind-limbs immediately brought again with two short, awkward movements beneath the body. Progress thus takes place in a succession of movements 'half hobble,' 'half jump.'

Painful though this may appear, progress is still more difficult when the hind-feet alone are diseased. Afraid that, in placing his fore-members freely forward, he will add to the pain in his hind, the walk takes place in a series of extremely short steps, with the feet more or less closely approximated. The gait is thus rendered extremely awkward, and Zundel, by saying that 'the animal appears as if treading on sharp needles,' most fitly describes it.

Movement with all four feet affected, though less awkward in appearance, is doubtless more painful than in either of the other conditions. Here the animal can hardly be induced to shift his position at all. Only by flogging, and that severe, can he be made to go forward. When so induced to move, the agonizing pain to which the patient is subjected may be gathered by noting his countenance and manner of progression.

With each movement forward, muscular tremors affect the limbs; each step is short, jerky, and convulsive; the respirations and pulse are almost immediately greatly quickened, and the lower lip is hung pendulous, and moved almost unconsciously up and down with a flapping noise against the upper. A patchy perspiration breaks out about the body and quarters, and the tail is outstretched and quivering. At the same time the lines of the face become drawn, the commissures of the lips pulled upwards, the eyes staring and haggard, the eyelids puckered, the nostrils extended, and the whole expression indicative of the intense and agonizing pain of the disease.

One can perhaps better give one's client some vague idea of the patient's suffering by likening the pain to the throbbing sensation of a festered finger-nail. Tell him that each hoof of the horse is similarly, or, if anything, more delicately, constructed, that in each foot the same process of 'festering' is going on, and that upon them the animal has perforce to stand.

As one might expect, the position of greatest ease is the decumbent. Strange to say, though, in many cases of laminitis the animal persists in maintaining a standing posture. Once down, however, one has sometimes the greatest difficulty in persuading him again to rise. The lying position is so long maintained that bedsores begin to make their appearance, and the animal rapidly loses flesh, not only by reason of the fever and the pain, but by giving to rest the time he should normally give to feeding.

Difficulty in rising is greatest when all four feet are affected; is nearly as great when the hind-limbs only are in trouble, but is least when the disease exists alone in the two fore-feet.

THE COURSE OF THE DISEASE AND ITS PATHOLOGICAL ANATOMY.—As with most inflammations of any severity, so with this we may consider the pathological changes taking place in the foot under three headings: (a) The period of Congestion; (b) the period of Exudation; (c) the period of Suppuration.

(a) Congestion.—In the early stages of laminitis there is a state of engorgement of the vessels of the keratogenous apparatus generally, but more particularly the laminal portion of it. With the hoof removed at this stage the sensitive laminae are found to be swollen, dark red in colour, and affording a distinct feeling of increased thickness when pressed between the fingers, Incised, there escapes from the cut surface a large flow of dark venous-looking blood. At this stage haemorrhages of the laminal vessels occur. The escaping blood infiltrates the surrounding connective tissue, and in many cases destroys the union between the horny and sensitive laminae. This change is most noticeable in the region of the toe and the commencement of the quarters, the os pedis appearing as though pushed backwards by the escaping fluid collected between the wall and the bone. In severe cases, fortunately but rarely seen, the blood so escaping continues to infiltrate, and separate the tissues until it is seen to be freely oozing at the region of the coronet. (See reported case, No. 1, p. 279.)

(b) Exudation.—The period of exudation marks the outpouring of the inflammatory fluid. This, even more than the haemorrhages attending the stage of congestion, tends to destroy the intimacy between the sensitive and the horny laminae, leading finally to their complete separation at the region of the toe. Fig. 116 illustrates this state of affairs after laminitis has existed for a week. The sensitive and horny laminae are here shown to be distinctly separated from each other, a well-marked cavity existing between them, which cavity is greatest in extent at the toe of the os pedis. With the sensitive structures thus detached from the wall, it is evident that very much that formerly held the os pedis in normal position has been destroyed. What then happens is that the whole of the body-weight is placed upon the sole. Never intended to bear the strain thus imposed, it naturally sinks. With the sinking is a corresponding 'dropping' of the pedal bone—in fact, of the whole of the bony column. Seeing that the structures above the hoof are still normally adherent to the bones, it follows that they must, as the os pedis sinks, be carried with it. As a consequence we get a marked depression at the coronet (see Fig. 117, a), which depression may be often noticed after the second or third week of a severe attack of the disease.



Here, again, though to a greater extent than that caused by the haemorrhage alone, the os pedis appears to be pushed backwards, the space at the toe between the bone and the horny box being closely filled with the yellow, slightly blood-stained exudate. This condition is well depicted in Fig. 117.



With the descent of the os pedis we get in many cases a penetration of the horny sole (see Fig. 117), leading always to serious displacement of the sensitive sole (see Fig. 117, b), and often to caries of the exposed bone.

The backward displacement of the os pedis may be accounted for in two ways. Firstly, the greater vascularity of the membrane covering its front leads to a greater outpouring of inflammatory fluid in that particular position. Here, therefore, loss of adhesion with the wall is greatest, while into the cavity so formed is poured a large quantity of a fluid that is practically incompressible. The os pedis must be pushed backwards. Secondly, the manner in which the animal distributes his weight—namely, upon the heels—is calculated to aid in the bone's backward movement, for with his feet in this position tension upon the extensor pedis is relaxed, while that upon the flexor perforans is greatly increased.

(c) Suppuration.—Should the animal survive the pain and exhausting calls made upon his system by the accompanying fever of the foregoing conditions, the case ends either in resolution or suppuration. When suppuration occurs it is found, as a rule, at the sole, leading to almost entire separation of the sensitive and horny structures. The pain, if possible, is even worse than in either of the foregoing stages, and relief for the suffering patient is only obtainable by the natural exit of the pus at the coronet, or by giving it escape with the knife at the sole. As a rule, suppuration in laminitis is rare, and then only occurs when the disease has been of some several days' duration. It has been the author's experience, however, to meet with it in a case but three days' old. This particular animal had laminitis restricted to the hind-feet. The condition was diagnosed and pus liberated at the sole of one foot during the third day of the lameness. The animal was cast on the fourth day, and pus obtained from the sole of the opposite foot.

Complications.—In a moderate case, carefully treated, laminitis terminates at the end of three or four days in resolution. The general symptoms of fever gradually subside, the appetite returns, and the walk becomes easier. Cases thus terminating fortunately leave behind them no change of serious importance, either in the sensitive tissues or in the horny envelope. Should resolution, however, be longer delayed, then the case, although eventually terminating successfully so far as soundness in gait is concerned, leaves more or less evidence behind in the shape of rings about the wall and alterations in the build of the sole.

When the happy ending of rapid resolution is denied us, then, in addition to the condition we have described as suppuration, we may meet with one or other of the following complications:

(a) Metastatic Pneumonia.—This complication is not uncommon, and, when occurring, more often than not ends fatally. It may be accounted for indirectly by the greater work the lungs are called upon to perform in carrying out the increased number of respirations occasioned by the general fever and pain, and directly by the poisonous materials circulating in the blood-stream.

(b) Metastatic Colic.—This may be either a subacute obstruction of the bowel or an enteritis accompanied by an offensive purge.

A striking case of the former is related in the Veterinary Journal (vol. xvi., p. 180) by H. Thompson, of Aspatria. Here no evacuation of the bowels occurred for three days, and the pains of laminitis were added to by the usual pains of intestinal obstruction.

The colic of enteritis is in some cases caused by the nature of the food, giving rise to laminitis. In our opinion, however, it is more often occasioned by the drastic action of the aloes nearly always resorted to in the treatment of the disorder. As does the pneumonia, the enteritis thus brought about nearly always has a fatal termination.

(c) Gangrene of the Structures within the Hoof.—This complication is the one most to be dreaded. It occurs as a result of the great pressure exerted by an excessive exudation, and doubtless affects first the laminae and softer structures. Once commenced, however, it rapidly extends to death of the other structures (ligament, tendon, and even bone), and gives a fatal ending to the case.

That gangrene of the tissues ("mortification" as our older writers called it) has occurred is soon made evident to the veterinarian by the symptoms shown by the patient. The agonizingly acute pains suddenly subside, the feet are placed firmly and squarely to the ground, and the animal walks with ease. Perhaps but the night before the patient is seen racked with excruciating pain; the morning sees the astounding change of apparent absolute recovery. Too well, however, the eye of the experienced veterinary surgeon sees that such is not the case. Even before proceeding to take a record of the other symptoms, he knows that it is but the commencement of the end. Methodically, however, he notes the other conditions. The pulse he finds small and imperceptible, save at the radial. The thermometer registers a subnormal temperature, the extremities are cold, and cold sweats bedew the body. To the same experienced eye the countenance of the animal is almost suggestive of what has occurred. The drawn and haggard expression, to which we have previously referred, becomes more marked, and the angles of the lips are drawn back in what has been described by some writers as a 'sardonic' grin.

We can best express what the whole look of the animal's countenance indicates to us by saying that it gives us the impression that the animal himself knows that some serious change, and a change fatally inimical to his chances of life, has taken place in his feet.

It may be that in some odd cases, although it has not yet been our lot to meet with them, gangrene may terminate in the casting off of one or more hoofs. Needless to say, there can still be but one termination to the case.

(d) Periostitis and Ostitis.—This complication is referred to by other writers under the term of 'Peditis.' It signifies, of course, that the periosteum and the bone have become invaded by the inflammatory process. It is our opinion that these two conditions, even including an actual arthritis, always exist, even in an attack of laminitis that ends favourably. We do not claim, however, to be able to relate any means, save that of post-mortem examination, by which it may be singled out from the other changes occurring in the foot. The high fever and pain occasioned by the inroads of the inflammation into the other sensitive structures serves to effectually mask whatever evidence of it we might otherwise obtain. It may be sometimes only small in degree, but we feel confident that inflammation, at any rate of the outer layer of the periosteum, is in laminitis constant even, we repeat, in a mild case.



When the case is a serious one we have ample evidence to show that ostitis exists, and exists in a severe form. The bones become vastly altered in shape, a process of absorption leads to the formation of large, irregular cavities within their substance, and what of the bone is left is rendered hard and ivory-like (condensed) near what was the original centre, while the edges and other portions show often a tendency to become brittle and porous.

Fig. 118 illustrates the effects of a severe ostitis in pedal bones removed from hoofs with laminitis of several weeks' standing.

(e) Chronic Laminitis.—The most common complication—or, perhaps, rather we should term it 'sequel'—to acute laminitis is the chronic form of the disease. For this condition we have reserved a separate section of our work. It will be found described in Section B 1 of this chapter.

Diagnosis and Prognosis.—One is almost tempted to state that the diagnosis of laminitis offers no difficulty. In the very early stages, however, it may, as we have already indicated, be mistaken for the oncoming of Enteritis, Lymphangitis, or even Pneumonia. The paddling of the feet may help us. If this is absent, however, nothing but a most careful examination, or, if necessary, the withholding of our opinion until the following visit will prevent a blunder being made.

Even when well established, laminitis has been mistaken for paralysis, for tetanus, for rheumatic affections of the loins, or even for some undiscovered affection of the muscles of the arms and chest. This latter is no doubt suggested to the uninitiated by the reluctance the animal shows to move the muscles apparently of that region, and led the older writers to give to the disease its name of 'Chest-founder.' It is only fair to add, however, that these blunders in diagnosis are nearly always committed by persons without a veterinary training.

Thus warned, the veterinary surgeon of average ability should have no difficulty in establishing a distinction between the diseases we have enumerated as likely to be confounded with it, and the one this chapter is describing.

The prognosis in laminitis should, in our opinion, always be guarded. No advice given in a work of this description can be of any real use, for every case must be judged entirely on its merits. The severity of the symptoms, the cause of the attack, the complications, and the idiosyncrasies of the patient, have all to be taken into account. These the veterinarian must be left to judge for himself.

Treatment.—The treatment of acute laminitis in its early stage must be based upon the fact that we have to deal with a congested state of the circulatory apparatus of the whole of the keratogenous membrane. This fact was well enough known to the older veterinarians. It is not surprising, therefore, to learn that jugular phlebotomy was at once resorted to as the readiest means of relieving the overcharged vessels of their blood. As a matter of fact, bleeding from the jugular is still advocated by modern authorities. We cannot say, however, that we unhesitatingly recommend it. Mechanically, of course, the removal of a large quantity of blood is bound to result in a lowering of the pressure in the vessels. The effect, however, is but transient. Blood removed in this way is again quickly returned to the vessels so far as its fluid matter is concerned, and the pressure, removed for a time, is again as great as before. With the other and more vital constituents of the blood-stream—namely, the corpuscles—restoration is not so rapid. We have, in fact, a weakened state of the system, in which it is probable it will not so successfully combat the adverse conditions the disease may induce.

With these prefatory remarks, we may advise bleeding under certain conditions. The quantity removed must be moderate (7 to 8 pints), and the pulse and other conditions must show no signs of weakness or collapse.

Local bleeding, either from the toe or the coronet, is also advised. In the former situation the sole is thinned down until a sufficient flow is obtained, while at the coronet scarification is the method adopted. Bleeding locally, however, is far less effectual than the jugular operation. Neither must it be forgotten that wounds in these situations, more particularly at the toe, are extremely liable, especially with the existing poisoned state of the blood-current, to take on a septic character. What might possibly have remained a comparatively simple inflammation is induced by the operation itself to terminate in the more complicated and serious condition of suppuration.

Other means of combating the congested state of the membrane are principally those of local applications. With many veterinary surgeons warm poulticing is still largely advocated and practised. We do not believe in it. Warmth, as a means of removing local congestion, can only be successful when applied widely round the congested area, and so dilating surrounding bloodvessels and lymphatics. Applied to the congested area itself, and to that alone, it is almost worse than useless.

With the foot, both around and below it, a surrounding area is denied us. The only vessels we are able to dilate with the warmth, and so enable them to carry off the fluid from the congested foot, are those in the limb above. That poulticing cannot be successfully there applied is self-evident. Apart from that, it is an open question whether poultices may not do actual harm in inducing suppuration in cases where, probably, it would not otherwise occur.

For these reasons we hold to the opinion that when a local application is determined on it should be a cold one. Various methods of applying cold are in vogue. Cold swabs are perhaps most in favour. They must, however, be kept cold. When a suitable water-course, pond, or other expanse of shallow water is at hand, then the animal may be kept standing therein, or preferably walked about in it. When suitable apparatus is obtainable, a constant stream over each foot from a rubber hosepipe is most beneficial.

Astringent baths, containing solutions of alum, of copper sulphate, of iron sulphate, or of common salt, or composed of a mixture of two or more of the salts mentioned, may also be used with advantage. In addition to the fact that such solutions are for a time below the temperature of simple water, we have the advantage that they have also a more or less antiseptic property.

While on the subject of the relief of the congestion, we must not forget to mention a treatment which we ourselves have practised with considerable success—namely, that of forced exercise. It appears to have been first brought into prominence by Mr. Broad, of Bath, and the two terms 'Forced Exercise and Rocker Shoes' and 'Broad's Treatment' have come to be synonymous.