The Broad shoe is a shoe with a web of quite twice the thickness of the animal's ordinary shoe, and has this web gradually thinned from the toe backwards until at the heels the shoe is at its thinnest (see Fig. 119).

The excessive thickness of the shoe serves two purposes. It allows of the requisite amount of slope being given to the web, and so enables the animal readily to throw himself back on to his heels, a position in which, as we have already indicated, he obtains the greatest ease. It also minimizes to some extent the effects of concussion.



With forced exercise, as practised by Mr. Broad, this shoe is first applied, and the animal afterwards made to walk upon soft ground, or even upon the roadway, for a half an hour to an hour and a half three times a day.

For our own part, we consider the shoe to be almost if not quite superfluous, so far as its influence upon the progress of the disease is concerned. We therefore dispense with it, and have the animal exercised in his ordinary shoes. To do this, the patient has sometimes to be severely flogged into taking the first few steps. After that progress gradually becomes easier.

It has been said to be cruel. In so far as we knowingly, and of set purpose, occasion the animal pain, cruel it undoubtedly is; but it is cruelty with an aim that is truly benevolent, and the object of our benevolence is the animal upon whom the cruelty is practised.

One word of advice is needed. The forced exercise must be commenced early. In the later stages, when the stage of congestion has passed from that to the acuter stages of the inflammation and the outpouring of the inflammatory exudate, then forced exercise cannot be safely commenced. The loss of adhesion between the pedal bone and the horny box, which we know to be then existent, negatives its advisability.

By many it is advised to always remove the shoes. From what we have already said, it will be seen that this is not our practice. But one argument in favour of so doing appears to us to carry weight, and that is that 'dropping' of the sole is probably prevented from becoming so marked. That condition, however, is entirely dependent upon the changes occurring within the horny box. It is bound to occur with the animal shod or unshod, and to reach a stage when only contact with the ground prevents its further descent. The complication then sometimes following—namely, penetration of the sole by the bone, is not prevented by having the shoes removed. It may, in fact, be thus rendered more likely.

Internal treatment consists in the exhibition of suitable febrifuges and the administration of a dose of aloes.

With regard to the wisdom of the latter proceeding, opinion seems to be divided. Personally, we hold an open mind concerning it. This much is certain: in many cases of laminitis—those cases which have their origin in overfeeding with an irritating food—there is already a strong predisposition to enteritis. The administration of aloes in this case is extremely apt to induce a fatal super-purgation. Aloes is, again, contra-indicated when the laminitis is a result of excessively long journeys, and the patient is already greatly exhausted. Neither can it be advocated in the laminitis occurring as a sequel to septic metritis or to pneumonia.

On the other hand, when the disease has occurred as a result of long standing in the stable and an overloaded condition of the bowels, or where one full meal of some constipating food, such as whole wheat, pea or bean meal, wheat or barley meal, has occasioned the attack, then a dose of aloes at the commencement of the treatment is productive of good.

Suitable febrifuges are found in potassium nitrate, potassium chlorate, sodium sulphate, or magnesium sulphate, either of which or a mixture of two or more of them, the animal will readily take in his drinking-water.

The administration of sedatives is also indicated. In this connection aconite will be found most useful. More especially in the early stages of the disease, when pain is excessive and the temperature high, will its good effects be noticed. This also the animal will often take in his drinking-water. We have been in the habit of so prescribing the B.P. tincture in 1/2-dram doses three times daily. By its use the temperature is rapidly lowered, the pulse reduced in number and in fulness, and the pain in some instances perceptibly diminished. With others hypodermic injections of morphia and atropine have given equally satisfactory results.

Needless to say, good nursing is a sine qua non. During the first stages of the fever a light and easily digested diet should be allowed—bran-mashes, roots and grass when obtainable, and a carefully regulated supply of water. The animal should be warmly clothed and the box well ventilated, even to the opening of the doors and windows. Only in this way is pneumonia as a sequel sometimes prevented. The patient's comfort should be attended to in providing him with a suitable bed. Anything in the shape of long litter should be avoided. When nothing else is at hand, litter that has already been broken and shortened by previous use is best. With this the box floor should be thickly covered, and matting of the material prevented by constant turning. A good bed for the horse with laminitis is peat-moss mixed with short straw. This, without being dragged into irregular heaps, remains springy and elastic with but little attention. Better than all, however, especially with good weather, is an open crewyard. Here the animal has an abundance of fresh air, has a bed that is always soft, and has plenty of room in which to get up and down with some degree of ease.

Leaving the dietetic and medicinal, we may consider other treatments of laminitis that come more particularly under the heading of operative.

The first matter that here demands our attention is that of allowing the exudate to escape at the sole. If after the expiration of three or four days pain and other symptoms of distress continue, then it may be judged that the inflammatory exudate has made its appearance. Operative measures allowing of its escape, though not giving absolute ease, do undoubtedly relieve the more marked expressions of suffering, and should be at once determined on. To do this completely it is necessary to cast the animal. The sole is then thinned at the toe with the drawing-knife until the sensitive structures are reached. A flow of yellow and sometimes blood-stained discharge is immediately obtained, and the sole itself found to be underrun to a considerable extent. An opening sufficiently large to admit of free drainage (about the size of a half a crown-piece) is made, the wounds antiseptically dressed, and the hobbles removed.

If showing an inclination to do so, the animal should then be allowed to remain and rest. In one instance in which we so operated (a case of laminitis in the hind-feet alone), the relief given was at once manifested. For three days previously the animal had remained standing in agonizing pain. On the fourth he was cast, and the discharge—partly inflammatory exudate, and partly a sanious foetid pus—liberated. The hobbles were removed, and the animal allowed to remain down while our attention was drawn to another case. This attended to, we walked back to the field where, our first patient was lying. His breathing, but a short time before distressedly short and catching, was now so slow and deeply regular that for one brief moment the thought flashed across our mind that he was dead. He was in a profound sleep.

Other operators sometimes give the exudate escape while making the grooves in what is now known as 'Smith's Operation.'

In this operation the hoof is so grooved as to allow of its expansion, so relieving the pressure on the sensitive structures within it. Incidentally, the inflammatory exudate is given exit.



The animal is cast, the shoes removed, and three vertical grooves made in the wall. The first is cut down the centre of toe, extending from the coronet to the ground surface. The second is made to the right of this, and the third to the left, each following the direction of the horn fibres, and each distant about 2 inches from the first (see 1, 2, and 3, Fig. 120).

Each of the grooves must run completely from the coronary margin to the ground surface, and each should be carried through the substance of the horn until the horny laminae are reached. This done, the underneath surface of the foot is grooved at the white line (see curved groove 4, Fig. 121) in such a manner as to entirely isolate the two pieces of horn a and b from the remainder of the hoof.

Expansion of the horny box is thus brought about, while at the same time the semicircular groove at the toe is made deep enough to allow of the escape of the exudate.

If thought wise by the operator, the two pieces of horn a and b may be isolated, and the exudate given exit by making the fourth groove in the position of the dotted lines in Fig. 120—that is to say, at the lowermost portion of the sensitive structures. By this means the sole will be left intact.



Fuller instruction for making the grooves and the instruments required will be found described in Section C of Chapter X.

The animal should be afterwards shod, and the bearing on the portions a and b of the wall removed. Almost immediate relief is afforded the patient.

Recorded Cases.—1. 'On the evening of September 28 last, I was called rather hurriedly to attend a posting-horse which had just arrived from a twenty-one miles' journey, and was said to be "very ill." I lost no time in proceeding to the spot, and found my patient "very ill" indeed. No need for long consideration as to diagnosis; the symptoms showed at once that I had an uncommonly severe case of acute founder before me. On examination I found the pulse was 120, the respirations 100, and the thermometer 106 deg. F. The poor brute could not move, the fore-legs were well out before, and the hind-legs thrown back behind; in fact, he was, as one might say, propping himself up with his four legs!

'On examining his feet, I discovered what I had never either seen or heard of before—namely, blood freely oozing out at the coronet of all four feet; if anything, the hind-feet were the worst, and, showing that this bloody discharge at coronets had commenced during progression and before he was stabled, the inside of the thighs were all shotted over with blood, which had been thrown up by his feet while he was trotting or walking. He was completely soaked all over with perspiration.

'My prognosis could not well be otherwise than unsatisfactory. I resolved, however, to do all I could to relieve the poor suffering brute. As a matter of course, jugular phlebotomy was utterly impracticable; so, to relieve the pressure in the feet, I had him (after, with extreme difficulty, removing the shoes) bled, or rather opened, at all four toes, and hot poultices applied. On opening the off-side toe, in both hind and fore feet, I found an escape of very dark-coloured blood, with a great many bubbles of gas, thus showing that the destructive process was fairly established in the two bony extremities mentioned. The near fore and near hind feet showed no signs of gas-bubbles on being opened at the toe.

'I gave a laxative in combination with a diffusible stimulant, and ordered doses of aconite and potassium iodide; I also applied strong sinapisms to each side, immediately behind the shoulders. After three hours I found my patient rather easier; respiration about 90, and temperature 104 deg.; willing to take a little water, and even attempted to take some hay. Ordered continued applications of hot water to the poultices at feet, and clothed him up for the night. Next morning there was little improvement; respirations over 80, and temperature 103.5 deg.. Continue same treatment. Second morning, horse apparently easier; temperature 102.5 deg., but very difficult respiration; laxative had operated during the night; ordered diffusible stimulants. About two hours and a half after my last visit, the horse turned round in his stall and dropped down dead!

'History of the Horse.—He belonged to an extensive horse-hiring establishment; was purchased a short time before for L60—a long price for a post-horse—had recently suffered and been off work from some "severe cold"; was taken out, and did forty-seven miles of a journey the day before I saw him; on forenoon of the day on which he was attacked he did two or three short turns, and then twenty-one miles of a journey in the afternoon, during which he became so ill as scarcely to be able to conclude the twenty-one miles; this was the last turn he was to do. He was a grand stepper, and no doubt was pushed a little during this final journey, as the driver intended, after a short rest, to finish off with the twenty-six miles between this and home. With the short turns on the second forenoon, this would have been over 100 miles in less than two days, with a horse just out of a severe cold.'[A]

[Footnote A: Veterinary Journal, vol. xvii., p. 314 (A.E. Macgillivray).]

2. 'Whilst attending a patient on a farm on September 5 last my attention was called to a cart-horse, five years of age, that had been castrated in the standing position by a travelling castrator about ten days previously.

'I found the animal presenting the following symptoms: Head down, blowing hard, very dull, and disinclined to move, temperature 105 deg. F., hard, rapid, slightly irregular pulse, membranes injected, appetite lost; scrotum, sheath, and penis tremendously swollen, castration wounds unhealthy, and exuding a thin, reddish-brown discharge of a most foetid odour.

'The next day well-marked symptoms of laminitis were present. I finally ceased attending him about the middle of October, and at the end of that month he was turned out for the winter.'[A]

[Footnote A: Veterinary Record, vol. xiv., p. 649 (Charles A. Powell).]

3. 'On July 8 an interesting case of laminitis came under my notice. The subject was a mare, eight years old, which had been running on the common here for some months, and was taken up on the night of July 2 by a boy, who did not observe anything amiss with her. The following morning, on the owner going to the stable, he found the animal in great pain, and at once sent for me. I discovered her to be suffering from laminitis, and saw her again in the evening, when she was much worse. The attack proved to be a most severe one.

'The owner informed me that she had not been allowed any corn for two months, and that she had no distance to travel on the road from the common.

'Though on such a poor pasture, the mare was very fat; she had never been unwell before this attack.

'This is the first case I have seen of laminitis occurring when the animal was on grass.'[A]

[Footnote A: Veterinary Journal, vol. ix., p. 176 (W. Stanley Carless).]

B. CHRONIC.

1. CHRONIC LAMINITIS.

Definition.—A low and persisting type of inflammation of the sensitive structures of the foot, characterized by changes in the form of the hoof, and incurable pathological alterations within it.

Causes.—Chronic laminitis more often than not is a sequel to the acute form we have just described. With an attack of acute laminitis that defies treatment, and does not end in resolution in from ten days to a fortnight, then the chronic form may be expected.

The brittle horn, convex sole, and other changes we have described under Pumiced Foot may, however, be regarded as a chronic laminitis, and this condition, as we have already indicated in Chapter VI., may run a course slow and insidious from the onset.

Symptoms.—When the disease arises without previous acute symptoms, the first thing noticeable is an alteration in the gait. The animal begins to go feelingly, especially when first moved out from the stable. Our opinion is asked as to the cause of the lameness, and an inspection is made. With the changes in the form of the hoof as yet wanting, we have nothing to guide us, and other causes for the lameness suggest themselves, probably corns. Evidence of these is not forthcoming, and we in all probability withhold our opinion until a later visit. On the second or a subsequent call we are perhaps lucky enough to find our patient down. Diagnosis is then rendered easier. Made to rise, the animal stands in the attitude we have described as indicative of laminitis. We have him walked and trotted out. The symptoms of tenderness disappear, and the animal soon goes fairly sound. He is, in fact, workable—that is, by anyone who is careless as to the comfort of his beast.

When following an acute attack, we have the most marked symptoms of pain and distress, somewhat abating after the second or third week. The walk, however, is still painful, and, for a short time after rising from the ground, even difficult.

In short, in both cases we have the horse going on his heels, with a walk that is painful, and with symptoms of pain that are most apparent when moved on after a rest.

Later, the changes in the form of the hoof begin to appear. It seems to have lost its elasticity, and is seen to be dry and chippy, and to have become denuded of its varnish-like outer covering.

In addition, it is of largely altered shape. The toe, by reason of the animal walking on his heels, and by reason of an increased growth of horn, becomes elevated, so that the front of the wall, instead of forming an obtuse angle with the ground, comes to run very nearly horizontal with it. The horn of the heels, as compared with that of the toe, takes on an increased growth. The same thing we have already indicated as happening at the toe, though in lesser degree. Taken together, this increased growth of horn at the toe and at the heels has the result of lengthening the diameter of the foot from before backwards, the transverse diameter remaining more or less normal. The hoof thus loses its circular build, and comes to approach nearer an elongated oval.

[FIG. 122.—FOOT BADLY DEFORMED AS A RESULT OF CHRONIC LAMINITIS.]

At this stage, too, the pathological 'ribbing' of the hoof is observable. The outer surface of the wall becomes marked with a series of ridges encircling the hoof from heel to heel (see Fig. 81, which illustrates a moderate deformity of the hoof occurring after laminitis). In the badly laminitic hoof, however, this deformity is largely increased, until in some cases the shapeless mass can hardly be likened to a foot at all (see Fig. 122).

The inferior or solar surface of the foot also offers certain changes for our consideration. The first thing that strikes one is the convexity of the sole. This, as we have already pointed out, is due to descent of the os pedis, and the highest point of the convex portion is that immediately in front of the apex of the frog. Here the horn is sometimes found to be quite yielding to the finger, is excessively thin, and is more or less granular and inclined to break up under manipulation. As a consequence, any rough use of the drawing-knife, or an accidental wounding with sharp flints or stones, leads to exposure of the sensitive structures and local gangrene.

With the horn of the sole thus deteriorated by reason of excessive and continued pressure upon the parts secreting it, it is not surprising to find that, in many cases, actual penetration of it with the os pedis occurs. It is the anterior portion of the inferior margin of the bone that makes its appearance, and shows itself as a small semicircular white or dark gray line on the sole.



Exposure of the bone is soon followed by its necrosis, in which case the wound takes on an ulcerating character. From it there is a discharge of pus, black in colour and offensive in smell, and, protruding from the opening, are excessive granulations of the remains of the sensitive sole.

The 'white line,' so apparent when a normal foot is cleaned with the knife, can no longer be sharply distinguished from the surrounding horn, while in some cases the horn composing it takes on an abnormal growth at the toe (see Fig. 123). This adds still further to the abnormal lengthening of the antero-posterior diameter of the foot already mentioned.

In other cases horn in this position is altogether wanting, and in its place is a well-defined cavity, into which the blade of a knife can be readily passed. This cavity is bounded in front by the original wall of the hoof, and is here lined by a degenerated and hypertrophied growth of the horny laminae. Posteriorly the cavity is bounded by the front of the os pedis, and is lined by a thin growth of horn secreted by the keratogenous membrane covering the bone. Superiorly the cavity is quite narrow, and extends to near the lower surface of the coronary cushion, while inferiorly, at its open portion, it is often 1/2 inch to 1 inch wide. Laterally it extends on each side of the toe to the commencement of the quarters.



Exploration with a director, or with the blade of a scalpel, removes from the opening a dry detritus. This is composed of the solid constituents of the escaped blood, the dried remains of the inflammatory exudate, and broken-down fragments of cheesy-looking horn. The size to which the cavity may sometimes extend is illustrated in Fig. 124. The thickened horny laminae forming the anterior boundary of the cavity are here depicted, together with commencing perforation of the horny sole by the os pedis. It is this cavity which, when opened at the bottom and discharging its mealy-looking contents, is known as seedy-toe, for a further description of which see p. 293.

The lameness occurring with chronic laminitis does not always persist. As time goes on the sensitive structures accommodate themselves to the altered form and conditions of the horny box. In certain situations—namely, where pressure is greatest—the softer structures become atrophied, and sometimes even wholly destroyed; while in other positions the changes in form of the hoof tend to increase in size of its interior, with a consequent diminution of pressure upon, and increased growth of the structures within it.

Pathological Anatomy.—In detailing the changes to be observed in chronic laminitis, we take up the description where we left it when dealing with the pathological anatomy of the acute form. The alterations to be met with are best observed by taking a foot so diseased and making of it two sections—one longitudinal, from before backwards; the other horizontal, and in such a position as to cut the os pedis through at its centre.

These sections will expose to view the cavity formed by the pouring out of the exudate, and its full extent may be noticed by examining the sections alternately. Taking the horizontal section first, it will be seen that the hollow space extends wholly round the toe, and as far back as the commencement of the quarters. In the latter position one is able to observe laminae still in their normal positions and condition. At the toe, however, the horny and secretive laminae are widely separated, and the space between them filled with a yellow, semi-solid material, the remains of the inflammatory exudate and new horn secreted by the keratogenous membrane. The laminae, both horny and sensitive, are greatly enlarged. This is a hypertrophy, resulting from the continued effects of the inflammation, and leads in time to the formation of laminae quite three or four times their normal size. It is this hypertrophy of the laminae and the pressure of the exudate that causes the bulging and increased growth of the horn at the toe (see Fig. 125), and contributes towards the oval formation of the foot we have mentioned before.



In the longitudinal section the first thing noticeable is the change in position of the bones, more especially in that of the os pedis. The circumstances we have mentioned before—pressure of the exudate upon it in front and tension of the perforans on it behind—have caused it to assume a more upright position than is normal, so much so that in a bad case the front of the bone becomes quite vertical. This vicious direction the other bones of the digit follow (see Fig. 125).

Consequent upon the displacement of the bone, the plantar cushion, by reason of the continued pressure thus put upon it, becomes atrophied, while its hinder half is, as it were, squeezed into taking up a position more posterior and higher in the digit than normally it should. The horn-secreting papillae covering its inferior face thus become directed backwards sooner than downwards, in which way we account in some measure for the noticeable increase of horn at the heels.

Treatment.—Chronic laminitis is incurable. Treatment must therefore be directed towards the palliation of such conditions as are present, with the object of rendering the the animal better able to perform work. When perforation of the sole has occurred, with the attendant formation of pus and necrosis of the os pedis, it is doubtful whether treatment of any kind is advisable. There are on record cases of this description, where careful curetting of the exposed and necrotic portions and the after application of antiseptic dressings, held in position by a plate shoe or a leather sole, has been followed by good results, and the animal restored for a time to labour. In our opinion, however, early slaughter is the most economical course to adopt, and certainly the wisest advice to give to the ordinary client.

When perforation of the sole is absent, and when serious alteration in the shape of the horny box has not occurred, then the most simple treatment is to put the animal straight away to slow work, with the feet protected by suitable shoes.

Here, again, the most useful shoe is the Rocker Bar (Fig. 119). The broad web and deep seating gives ample protection to the convex sole, and with the ease in distributing his weight that this shoe affords the animal is able to perform slow work on soft lands with some degree of comfort.

Should the growth of the horn at the toe and at the heels be unduly excessive, then our attention may be directed towards reducing it to some approach to the normal. This is accomplished by removing with the rasp and the knife those portions indicated by the dotted lines in Fig. 127. Here it will be seen that the bulk of the horn removed is that protruding at the toe. After this the animal should again be suitably shod. In this connection it should be noted that the fact of the animal walking largely on the heels tends to a forward displacement of the shoe. This must be prevented by providing each heel of the shoe with a clip, after the manner shown in Fig. 128; or, in the case of a bar shoe, supplying it with a clip at the centre of the bar.



Among other treatments to be noted we may mention one or two to be found chiefly in Continental works on this subject.

The method of Gross consists in thinning down with a rasp about 1-1/2 inches of the horn of the wall immediately below the coronet, the thinned portion extending from heel to heel. The groove made is filled with basilicon ointment,[A] and the coronet stimulated with a cantharides ointment, In this way there is induced to grow from the coronet a new wall of nearly normal dimensions.

[Footnote A: Basilicon ointment is made by heating together resin 8 parts, beeswax 8 parts, olive oil 8 parts, and lard 6 parts. Allow to cool without stirring.]

By other operators (Bayer, Imminger, Meyer, and Gunther) this treatment has been modified by enlarging upon it and removing the whole of the adventitious horn.



This is done by means of the drawing-knife and the rasp, the ugly-looking pumiced foot being carefully cut and trimmed until, so far as outward appearances are concerned, it is perfectly normal. This done, the whole foot is treated with a suitable hoof ointment, and a shoe applied that affords protection to the sole without imposing pressure upon it. The shoe indicated is either an ordinary shoe with an unusually broad and well-seated web, or the seated Rocker Bar of Broad. With either it is well to additionally protect the sole by means of a leather or rubber pad and tar stopping, or by using the Huflederkitt described on p. 148. In every case the nails must be kept well back in order to avoid the weakened and degenerated horn at the toe, and to take advantage of the greater growth of horn at the heels.

The wisdom of thus removing the whole of the adventitious horn may be questioned. Although a foot of a nearly normal shape is obtained, it must be remembered that the grave alterations within it are unchanged, and that in certain positions the operation must have carried us nearer the sensitive structures than is advisable.

All other treatments failing, the operation of neurectomy has been advised. This we do not think wise. One would imagine that, with degenerative processes already going on in the foot, the tendency to gelatinous degeneration, always to be looked for in neurectomy, would be increased. This, as a matter of fact, is the case, and is borne out by the statements of those who have tried this method of treatment. In many cases the lameness even is not got rid of. Even where it is, the operation is afterwards followed by a great tendency to stumble, by sloughing of the hoof, or by a marked increase in the adventitious horn, and a consequent greater deformity of the foot.

Sooner than risk neurectomy, it seems to us wiser to give a trial to the operation advocated by M.G. Joly, namely, that of ligaturing one of the digital arteries on each affected foot. This operation is performed in the same position as is the higher operation of plantar neurectomy, and may be either internal or external. The vessel is exposed, and a double ligature, preferably of silk, placed on it. The artery is then divided between the two ligatures. The immediate effect of the operation is to cause a considerable diminution in the arterial pressure, and so lessen the intensity of the ostitis in the os pedis. Its consequences are not so serious as those of neurectomy, and it decongests tissues which neurectomy congests.

In cases related by M. Joly this operation, practised both in conjunction with removal of the excess of horn and without it, has resulted in a marked improvement in the gait, the animal going to work one month after the treatment, and remaining sound for some time afterwards.

2. SEEDY-TOE.

Definition.—A defect in the horn of the wall, usually at the toe, but occurring elsewhere, resulting in loss of its substance in either its internal or external layers (see Figs. 129, 130, and 131).

Causes.—The most common factor in the causation of this defect is undoubtedly disease of the sensitive laminae. We have, in fact, just given an excellent example of the formation of a seedy-toe in the sections of this chapter devoted to laminitis (see pp. 265 and 286). The cavity here formed by the outpouring of the inflammatory exudate and the separation of the sensitive and horny laminae persists. It becomes filled with the dried remains of the exudate and perverted secretions from the horny and sensitive laminae (see p. 287). As yet, however, the cavity is closed below, and its existence only surmised. Later, with successive visits to the forge, the layer of solar horn forming its floor is cut away, and the cavity exposed to view. Its mealy-looking contents are removed, and the case reported by the smith.

Although occurring in this way with an acute attack of laminitis, it must be remembered that seedy-toe may arise without previous noticeable cause. The first intimation the owner has is a report from the forge that seedy-toe is in existence. To refer to cases so arising a probable cause is far from easy. At one time it was believed to be due to parasitic infection of the horn. Others have blamed the pressure of the toe-clip, excessive hammering of the wall, or pressure from nails too large or driven too close. Others, again, say that seedy-toe may result from a prick in the forge, from hot-fitting of the shoe, from standing on a dry and sandy soil, or from the use of high calkins on the front shoes. In these cases—cases with an insidious onset—we are inclined to the opinion that the disease of the horn commences from below, and that the sensitive laminae become implicated later. Holding this view, one must account for the commencing disease of the horn by giving, as causes, firstly, those factors (as, for instance, alternate excessive dampness and dryness) leading to disintegration of the horn tubules; secondly, the penetrating into and between the degenerated tubules of parasitic matter from the ground; and, thirdly, the final breaking up of the horn, and spread of the lesion under the invasion thus started.



Symptoms.—Lameness sometimes attends seedy-toe, and sometimes does not. This is an important point to be carried in mind by the veterinary surgeon who is accustomed in his practice to have many animals pass through his hands for examination as to soundness. An animal with advanced seedy-toe—a condition constituting serious unsoundness—may walk and trot absolutely sound, and may give no indication, either in the shape of the wall or the condition of the sole, that anything abnormal is in existence. Later, however, after the veterinary surgeon has passed him, the purchaser lodges the complaint that the horse has a bad seedy-toe, which, so he is told, must have been there for some time. In this case, culpable though he may appear, there is every excuse for the veterinary surgeon.

Once the cavity is opened at the toe in the neighbourhood of the white line, then diagnosis is easy. A blunt piece of wood, the farrier's knife, or a director may be easily passed into it, sometimes as far up as the coronary cushion (see Fig. 129). Issuing from the opening is seen occasionally a little inspissated pus; more often, however, the dry, mealy-looking detritus to which we have before referred. This form of the disease we may term 'Internal Seedy-Toe.' for, plainly enough, it has had its origin in chronic inflammatory changes in the keratogenous membrane.



Disease of the horn and loss of its substance may, however, also commence from without. A report on this condition, under the title of 'External Seedy-Toe,' is to be found in vol. xxix. of the Veterinary Journal, from which we borrow Figs. 130 and 131.

In Fig. 130 it will be seen that the disease commences at the plantar surface of the toe, and extends upwards and inwards. The same condition may also appear anywhere between the coronet and the ground, gradually extending into the substance of the wall, as shown in Fig. 131. According to the writer, Colonel Nunn, the progress of the disease in this latter case appears to be faster in a downward than in an upward direction. This, however, is more apparent than real, as the rate of growth of the horn downwards detracts from the progress of the disease upwards, although it spreads over the horn at the same rate.

Before concluding the symptoms, we may again allude to the fact that, although usually occurring at the toe, the same condition may be met with in other positions—namely, at either of the quarters. In appearance and in other respects it is identical with that occurring at the toe.

When the animal is lame and the existence of seedy-toe is surmised, or when the cause of the lameness is altogether obscure, a little information may perhaps be gathered from noting the wear of the shoe. If the animal has been going lame for any length of time as a result of disease in the sensitive laminae, then the shoe will be greatly thinned at the heels, and the toe but little worn.

Treatment.—As with diseased structures elsewhere, the most rational treatment, when possible, is that of excision. The entire portion of the wall forming the anterior boundary of the cavity is thinned down with the rasp and afterwards removed with the knife, wholly exposing the hypertrophied, but usually soft layer of horn covering the sensitive structures. These hypertrophied portions are also removed, and every particle of the dust-like detritus cleaned away. After-treatment consists in dressing the parts with a good hoof ointment, protecting them, if necessary, with a pad of tow and a stout bandage. It may be that the removal of a large portion of the wall may for some time throw the animal out of work. Acting on Colonel Fred Smith's suggestion, this may be avoided by having made a thin plate of sheet-iron, slightly larger in circumference than the portion of horn removed, and shaped to follow the contour of the foot. This made, it is sunk flush with the wall by hot-fitting it, and kept in position by several small steel screws fixed into the sound horn, just as in the treatment for sand-crack (see p. 174). This will serve the useful purpose of maintaining in position any dressing that may be thought necessary, of acting as a support to the horn left on each side of the portion removed, and of keeping the exposed structures free from dirt and grit.

Practical points to be remembered in fitting plates of this description to the feet are: The plate must never quite reach the shoe, or it will participate in the concussion of progression, and so loosen the screws that hold it in place. For the same reason, that portion of the sole adjoining the piece of horn removed must have its bearing on the shoe relieved. The screws holding the plate should be oiled to prevent rusting, and should take an oblique direction in order to obtain as great a hold as possible on the wall.

When excision is deemed unwise or unnecessary, treatment should be directed towards maintaining the cavity in a state of asepsis. To this end it should be thoroughly cleaned of its contents, and afterwards dressed with medicated tow. The ordinary tar and grease stopping is as suitable as any. This, together with the tow, is tightly plugged into the opening and kept in position by a wide-webbed shoe. Instead of the tar stopping and the tow, there may be used with advantage the artificial hoof-horn of Defay (see p. 152). Before using this the cavity should again be thoroughly cleaned out, and should in addition be mopped out with ether. The latter injunction is important, as unless the grease is thus first removed, the composition will fail to adhere to the horn. With the cavity thus cleaned and prepared, the artificial horn, melted ready to hand, is poured into it and allowed to set.

In every case, no matter what else the treatment, the bearing of the horn adjacent to the lesion should be removed from the shoe.

Whether practising the method of plugging the cavity or that of excision of the wall external to it, attempts to quickly obtain a new growth of horn from the coronet should be made. To further that, frequent stimulant applications should be used. Ointment of Biniodide of Mercury 1 in 8, of Cantharides 1 in 8, or the ordinary Oil of Cantharides, either will serve.

3. KERAPHYLLOCELE.

Definition.—By this term is indicated an enlargement forming on the inner surface of the wall. In shape and extent these enlargements vary. Usually they are rounded and extend from the coronary cushion to the sole, sometimes only as thick as an ordinary goose-quill, at other times reaching the size of one's finger. Often they are irregular in formation and flattened from side to side.



Causes.—Keraphyllocele is very often a sequel to the changes occurring at the toe in laminitis. Probably, however, the most common cause is an injury upon, or a crack through, the wall. It may thus occur from excessive hammering of the foot, from violent kicking against a wall or the stable fittings, and from the injury to the coronet known as 'tread.' It may also occur as a sequel to complicated sand-crack, and to chronic corn.

That fissures in the wall are undoubtedly a cause has been placed on record by the late Professor Walley, who noticed the appearance of these horny growths following upon the operation of grooving the wall.[A]

[Footnote A: Journal of Comparative Pathology and Therapeutics, vol. iii, p. 170.]

This gentleman had a large Clydesdale horse under his care for a bad sand-crack in front of the near hind-foot, and, as the lameness was extreme, he adopted his usual method of treatment—viz., rest, fomentations, poulticing, and the making of the V-shaped section through the wall, and subsequently the application of an appropriate bar shoe to the foot, and repeated blisters to the coronet. In a short time the lameness passed off, and the horse was put to work. A few days later the animal met with an accident, and was killed.

On examining a section of the hoof it was found that a vertical horny ridge corresponding to the external fissure had been formed on the internal surface of the wall, and that a well-marked cicatrix extended upwards through the structure of the hoof at the part forming the cutigeral groove; furthermore, a similar ingrowth had been taking place in the line of the oblique incisions made for the relief of the sand-crack.

This case has an important bearing on the operation of grooving the wall, which operation we have several times in this work advocated for the relief of other diseases. It teaches us that the incisions should not be carried so completely through the horn as to interfere with and irritate the sensitive laminae, and so set up the chronic inflammatory condition leading to hypertrophy of the horn.

From the position on the os pedis of the indentation made in it by the keraphyllocele (see Fig. 133) it has been argued that pressure of the toe-clip is a cause of the new growth. This, we should say, cannot be a very strong factor in the causation, for, while we admit that the continual pressure of the clip, and the heavy hammering that sometimes fits it into position, is likely to set up a chronic inflammatory condition of the sensitive laminae in that region, we must still point out that the rarity of keraphyllocele, as compared with the fact that clips are on every shoe, does not allow of the argument carrying any great weight.

Symptoms.—Except under certain conditions this defect is difficult of detection. As a rule, lameness is not produced by it. In making that statement we are led largely by the conclusion arrived at by Professor Walley. This observer noted the fact that ingrowths of horn such as we are describing nearly always take place in false quarter, or after a sand-crack has been repaired, and that they commonly occur after the operation of grooving the wall in the manner we have just shown.

Now, we know that quite often under these circumstances the horse goes perfectly sound. Thus, while we know that in all probability keraphyllocele is in existence, we have ocular demonstration that the animal is quite unaffected by it.

In some cases, however, lameness is present. During the early stages of the growth's formation it is but slight, increasing as the keraphyllocele enlarges. Should this be the case, other symptoms present themselves. The coronet is hot, and tender to the touch, sometimes even perceptibly swollen, and percussion over the wail is met with flinching on the part of the animal. In other cases one is led to suspect the condition by the prominence of the horn of the wall of the toe. This is distinctly ridge-like from the coronet to the ground, while on either side of it the quarters appear to have sunk to less than their normal dimensions. We believe this to be an illusion, as a ridge of any size at the toe readily gives one the impression of atrophy behind it, without this latter condition being actually present.

Should this ridge-like formation and the accompanying symptoms of pain and lameness occur after repair of a sand-crack, then keraphyllocele may, with tolerable certainty, be diagnosed. When these outward signs are wanting, however, and the true nature of our case is a matter of mere conjecture, a positive diagnosis may still be made at a later stage—that is, when the abnormal growth of horn reaches the sole. In this case either there is met with when paring the sole a small portion of horn, circular in form, distinctly harder than normal, and indenting in a semicircular fashion the front of the white line at the toe, or solution of continuity between the tumour and the edge of the sole and the os pedis takes place, and the lameness resulting from the ingress of dirt and grit thus allowed draws attention to the case.

Pathological Anatomy.—With the sensitive structures removed from the hoof by maceration or other means, these growths are at once apparent. They may occur in any position, but are usually seen at the toe, and they may extend from the coronary cushion to the sole, or they may occupy only the lower or the upper half of the wall. In places the tumour (or 'horny pillar' as the Germans term it) is roughened by offshoots from it, and does not always exhibit the smooth surface depicted in Fig. 132. Commonly, the horn composing the new growth is hard and dense. Sometimes, however, it is soft to the knife, and is then found to be itself fistulous in character, a distinct cavity running up its centre, from which issues a black and offensive pus.

In a few cases the sensitive laminae in the immediate neighbourhood are found to be enlarged, but in the majority of cases atrophy is the condition to be observed. Not only are the sensitive structures found to be shrunken and absorbed, but the atrophy and absorption extends even to the bone itself (see Fig. 133). This latter is a result of the continued pressure of the horny growth, in a well-marked case ending in a sharply-defined groove in the os pedis in which the keraphyllocele rests. The fact that the softer structures, and even the bone, thus accommodate themselves to the altered conditions is, no doubt, the reason that lameness in many of these cases is absent.

Treatment.—It is doubtful whether anything satisfactory can be recommended. When we have suspected this condition ourselves, it has been our practice to groove the hoof on either side of the toe, after the manner illustrated in Fig. 120, and, at the same time, point-firing the coronet and applying a smart cantharides blister. Certainly, after this operation, lameness has often disappeared—whether, however, as a result of the treatment adopted or by reason of the structures within accommodating themselves to the condition, we would not care to say.



Other writers advocate the removal of that portion of the wall to which the tumour is attached, after the manner described on p. 182, and illustrated in Fig. 98. This, however, should be a last resource, and should be adopted only when weighty reasons, such as excessive and otherwise incurable lameness, appear to demand it.

4. KERATOMA.

In our nomenclature the terms 'Keratoma' and 'Keraphyllocele' are both used to indicate the condition we have just described. There are some, however, who reserve the term 'Keratoma' for horny tumours occurring only on the sole, and for that reason we draw special attention to the word here. Keratoma may thus be used to describe what we have called keraphyllocele directly that growth makes its appearance at the sole, and is there able to be cut with the knife. Similar hard and condensed growths may, however, make their appearance on the sole in other positions quite removed from the white line, plainly being secreted by the villous tissue of the sensitive sole, and having no connection whatever with the sensitive laminae. They appear as circular patches, varying in size from a shilling to a two-shilling piece. Compared with the surrounding horn, they stand out white and glistening, while in structure they are dense and hard, and offer a certain amount of resistance to the knife. They are of quite minor importance, and, beyond keeping them well pared down, need no attention. Keratoma probably offers us the best analogy we have to corn of the human subject.

5. THRUSH.

Definition.—A disease of the frog characterized by a discharge from it of a black and offensive pus, and accompanied by more or less wasting of the organ.

Causes.—The primary cause of this affection is doubtless the infection of the horn, and later the sensitive structures, with matter from the ground. Those factors, therefore, leading to deterioration of the horn, and so exposing it to infection, may be considered here. Such will be changes from excessive dampness to dryness, or vice versa; work upon hard and stony roads; prolonged standing in the accumulated wet and filth of insanitary stables, or long standing upon a bedding which, although dry, is of unsuitable material.

In this latter connection may be mentioned the harm resulting from the use of certain varieties of moss litter. This we find pointed out by J. Roalfe Cox, F.R.C.V.S.[A] Tenderness in the foot was first noticed, and, on examination, the horn of the sole and of the frog was found to be peculiarly softened. It afforded a yielding sensation to the finger, not unlike that which is imparted by indiarubber, and on cutting the altered horn it was almost as easily sliced as cheese-rind. The outer surface being in this way slightly pared off, the deeper substance of the horn was discoloured by a pinkish stain. The horn of the frog was in many instances found detaching from the vascular surface, which was very disposed to take on a diseased action, somewhat allied to canker, and became extremely difficult to treat.

[Footnote A: Veterinary Journal, vol. xvi., p. 243.]

Conditions such as these, although not constituting the disease itself, certainly lay the frog open to infection, especially if afterwards the animal is called upon to work in the mud of the streets of a large town, or to stand in a badly drained and damp stable.

A further cause of thrush is to be found in the condition of the frog, brought about by contraction of the heels (see p. 118). We have already seen that one of the most prominent factors in the causation of contraction is the removal of the frog from the ground by shoeing, with its consequent diminution in size and deterioration in quality of horn. This leads to fissures in the horny covering, and favours infection of the sensitive structures beneath. Thrush is, in fact, nearly always present in the later stages of contracted foot.

By some thrush is believed to be but the commencement of canker. With this, however, we do not hold. We believe both to be due to specific causes as yet undiscovered, but that the cause of thrush is not the one operating in canker. In arriving at this conclusion we are guided by clinical evidence. The two conditions are quite dissimilar, even in appearance, and, while one is readily amenable to treatment, the other is just as obstinately resistant.

Symptoms.—The symptoms of thrush are always very evident. Probably the first thing that draws one's attention to it is the stench of the puriform discharge. The foot is then picked up and the characteristic putrescent matter found to be accumulated in the median, and often in the lateral, lacunae. The organ is wasted and fissured, the horn in the depths of the lacunae softened and easily detachable, and portions of the sensitive frog often laid bare.

With a bad thrush lameness is present, the frog itself is tender to pressure, and often there is considerable heat and tenderness of the heels and the coronet immediately above. More especially is this noticeable after a journey.

It is, perhaps, more common in the hind-feet than in the fore, and more often met with in heavy draught animals than in nags. The hind-feet are, of course, more open to infection by reason of their being constantly called upon to stand in the animal discharges in the rear of stable standings, while it is a well-known fact that heavy animals have their stables kept far less clean, and their feet less assiduously cared for, than do animals of a lighter type.

In a nag-horse with thrush of both fore-feet lameness becomes sometimes very great. The gait when first moved out from the stable is feeling and suggestive of corns, while progress on a road with loose stones is sometimes positively dangerous to the driver.

Treatment.—When this condition has arisen, as it often does, from want of counter-pressure of the frog with the ground, this pressure must be restored after the manner described when dealing with the treatment of contracted foot (see p. 125) either by the use of tip or bar shoes, or by suitable pads and stopping.

So far as direct treatment of the lesion itself is concerned, the first step is to carefully trim away all diseased horn and freely open up the lacunae in which the discharge has accumulated. Good results are then often arrived at by poulticing, afterwards followed up by suitable antiseptic dressings. With us a favourite one is the Sol. Hydrarg. Perchlor. of Tuson, used without dilution. Others use a dry dressing, and dust with Calomel, with a mixture of Sulphate of Copper, Sulphate of Zinc and Alum, or with Subacetate of Copper and Tannin.

With restoration, so far as is possible, of the frog functions, and with careful dressing, a cure is nearly always obtained.

6. CANKER.

Definition.—Under this unscientific, yet expressive term, is indicated a chronic diseased condition of the keratogenous membrane, commencing always at the frog, and slowly extending to the sole and wall, characterized by a loss of normal function of the horn secreting cells, and the discharge of a serous exudate in the place of normal horn.

Causes.—The exact cause of canker has still to be discovered. Therefore, before expressing an opinion as to what the probable cause may be, we may state here that such opinion can only be based upon clinical observation. Such being the case, we are almost duty bound to give the views of older authors before those of more modern writers.

From the mass of material ready to hand we may select the following as serving our purpose.

The earliest opinion appears to have been that canker, as the name indicates, was of a cancerous or cancroid nature. This was also believed by Hurtrel D'Arboval, who looked upon canker as carcinoma of the recticular structure of the foot. The same theory we find enunciated in the Veterinary Journal so late as 1890. Although the word 'cancer' or 'carcinoma' is not there used, the author employs the terms 'Papilloma' and 'Epithelioma' with the evident intention of expressing his belief in the malignant nature of the disease.

Another early opinion was that the disease was a spreading ulcer, gradually extending and changing the tissues which it invaded.

A further early theory, and one which if not still believed in, has died a hard death, is the constitutional theory. This was believed in by nearly all the older writers, and is mentioned so late as 1872 by the late Professor Williams. In his 'Principles and Practice of Veterinary Surgery,' he says: 'Canker is a constitutional disease due to a cachexia or habit of body, grossness of constitution, and lymphatic temperament.' This, we believe, is credited to-day by some, and yet, quite 100 years before the date of the 1872 edition of Williams's work—in 1756, to be exact—we find a veterinary writer when talking of grease (a disease, by-the-by, very closely allied to canker) exclaiming against this habit of referring everything which we do not rightly understand to some ill-humour of the body. The wisdom his words contain justifies us in giving them mention here. 'It is a very foolish and absurd Notion,' he says, 'to imagine a Horse full of Humours when he happens to be troubled with the Grease. But such Shallow Reasoning will always abound while Peoples' Judgments are always superficial. Therefore, to convince such unthinking Folks, let them take a thick Stick and beat a Horse soundly upon his Legs so that they bruise them in several Places, after which they will swell, I dare say, and yet be in no danger of Greasing. Now, pray, what were these offending Humours doing before the Bruises given by the Stick?'

At the present day it is safe to assert that neither the ulcerative, the cancerous, nor the constitutional theory is believed in widely, and, among the mass of contrary opinions as to the cause of this disease, we may find that even quite early many of the older writers had discarded them.

Quoting from Zundel, we may say that Dupuy in 1827 considered canker as a hypertrophy of the fibres of the hoof, admitting at the same time that these fibres were softened by an altered secretion; while Mercier in 1841 stated that canker was nothing more than a chronic inflammation of the reticular tissue of the foot, characterized by diseased secretions of this apparatus.

Saving that they make no mention of a likely specific cause, these last two statements express all that we believe to-day. As early as 1851, however, the existence of a specific cause was hinted at by Blaine in his 'Veterinary Art.' We find him here describing canker as a fungoid excrescence, exuding a thin and offensive discharge, which inoculates the soft parts within its reach, particularly the sensitive frog and sole, and destroys their connections with the horny covering.

The use of the word 'fungoid,' and particularly that of 'inoculate,' is suggestive enough, and is evidence sufficient that either Blaine or his editor recognised, simply through clinical observation, the working of a special cause.

Four years later, Bouley is found holding the opinion that canker was closely allied to tetter, thus recognising for it a local specific cause. The same observer also pointed out that the secretion of the keratogenous membrane instead of being suspended was greatly increased, taking care to explain, as did Dupuy, that the products of the secretion were perverted and had lost their normal ability to become transformed into compact horn.

In 1864 this slowly growing recognition of a specific cause received further impetus from the statements of Megnier. This observer claimed to have discovered in the cankerous secretions the existence of a vegetable parasite (namely, a cryptogam, as in favus), which he termed the keraphyton, or parasitic plant of the horn.

Modern research, though failing to substitute anything more definite, has not confirmed this. The exact and exciting cause of canker is therefore still an open question, and a matter for research. We may, however, sum the matter up by briefly discussing the causes, so far as clinical observation teaches us. This we shall do under two headings—namely, Predisposing and Exciting.

Predisposing Causes.—Starting with the assumption that the disease is due to local infection, we may relate as predisposing causes anything having a prejudicial effect upon the horn, disintegrating it, and so laying the tissues beneath open to attack. The most prominent in this connection is certainly a continued dampness of the material on which the animal has to stand. Particularly is this the case when the material is also excessively foul and dirty, contaminated with the animal discharges, and presumably swarming with the lower forms of animal and plant life. We shall therefore find bad cases of canker in stables where the "sets" are irregular, or where no paving at all is attempted, where the drainage is defective, and where darkness and want of proper ventilation favours organismal growth. The fact that with modern drainage and a general hygienic improvement in stabling, canker has to a large extent died out, supports this contention.

Again, as with thrush, anything removing the counter-pressure of the frog with the ground and throwing that organ out of play, may be looked upon as a predisposing cause. The atrophy of the frog thus occurring, the deterioration in the quality of its horn and the fissures in its surface lay it specially open to infection. That one of the principal factors in the treatment of canker is a restoration of ground-pressure to the frog and the sole is sufficient proof of this.

Further, it is well to note that, although playing no part in the actual causation, certain constitutional conditions may in some measure predispose the foot to attack. Clinical observation teaches us that animals of a lymphatic nature, with thick skins and an abundance of hair, with flat feet and thick, fleshy frogs, are far more liable to attack than are animals with reverse points.

Exciting Causes. Those who give this subject careful consideration cannot fail to arrive at the conclusion that canker is most certainly due to local infection with a specific poison, and that poison a germicidal one from the ground. The symptoms arising may be due to the action of a single germ, or to two or more germs acting in conjunction. As to whether the parasitic invasion is single or multiple we cannot feel certain, but that it is parasitic we feel absolutely assured.

It is simply the light that bacteriological advance has made during the last two decades that enables us to make the statement with such feelings of assurance. We arrive at our conclusions by reasoning from analogy. Here we have a disease always exhibiting the same symptoms, more or less peculiar to one class of animal, always with a similar characteristic appearance and smell, always obstinately refractory to treatment, showing always a tendency to spread to the other feet of the same animal, and often to the feet of other animals near enough to become infected, and always cured—when cured it is—by a treatment which may be summed up in two words as 'rigid antisepsis.' Other diseases, with points in common with this, have been directly proved to be due to a specific cause. Common regard for logic compels us to admit the same for canker.



Symptoms and Pathological Anatomy.—The symptoms of canker are seldom noticeable at the commencement of an attack. The disease is slow in its progress; for some time confines its ravages to the sub-horny tissues unseen, and is quite unattended with pain. It is not observed, therefore, until considerable damage has been done, and the disease is far advanced. What is usually first seen is a peculiar softening and raising of the horn of the frog. The infective material has set up a chronic inflammation of the keratogenous membrane, leading to abnormal secretion, and, in place of the horny cells it should normally secrete, is thrown out an abundance of a serous fluid.

This upraised and softened horn once thrown off is not again renewed, and the whole of the sensitive frog and perhaps a portion of the sensitive sole is left uncovered. In place of the normal horn, however, is often found a hypertrophy of the elements of the keratogenous membrane leading to huge fungoid-looking growths with a papillomatous aspect, damp in appearance and offensive in smell, and readily bleeding when injured (see Fig. 131).

The horn immediately surrounding the lesion is loose and non-adherent to the sensitive structures. This indicates, of course, that the disease has spread further beneath the horny covering than is at first sight apparent. Portions of this loose horn removed reveal beneath it a caseous foetid matter, easily removed by scraping (the perverted secretion of the keratogenous membrane). When this is carefully scraped away, the sensitive structures appear to be covered with a thin, smooth membrane, gray in colour and almost transparent, while beneath it may be seen the red appearance of normal sensitive structures.

If the horn surrounding the lesion is not touched with the knife, but little is seen of the extent of the disease, for that removed by natural means is often very small in quantity. To all intents and purposes the disease appears to be confined to the frog. This appearance is misleading, especially if the disease has been in existence for some time, for it may have easily spread to the whole of the sole, and even to the greater portions of the laminae secreting the wall.

It is, in fact, not until the pressure exerted by the normal horn is removed by its breaking away that the vascular structures of the keratogenous membrane begin to swell, and the perverted secretions to enlarge in size. Once the pressure is removed, however, this quickly comes about, and the characteristic fungoid growths rapidly make their appearance.

This tendency to spread is highly indicative of canker. The serous matter exuding from the diseased keratogenous membrane appears, in fact, to be highly infective. Once its flow is commenced, it slowly, but surely, invades the sensitive structures near it, appearing, as Elaine has put it, to 'inoculate' them. What is really the case, of course, is not that the discharge itself is infective, but that it is contaminated with infective material.

The fungoid-looking growths to which we have before referred are, in reality, nothing more than the villi of the sensitive frog and sole greatly hypertrophied and irregular in shape. At times the hypertrophy is as a huge and compact enlargement occupying the position of the frog. Sometimes, however, it occurs as numerous elongated and twisted fibrous bundles, separated from each other by deep clefts, and the clefts filled with the offensive cankerous discharge (see Fig. 134).



At a very advanced stage canker leads to destruction of much of the horny sole and frog; or even parts of the wall may become separated from the tissues beneath, and break away from the foot (see Fig. 135). At other times the disease brings about a deformity of the whole of the foot. Its longitudinal and transverse diameters become enormously increased, and the whole foot apparently flattened from above to below (see Fig. 136). This indicates that not only has the horny sole been entirely destroyed, but that the destructive process has also extended to the greater part of the lower half of the wall, with a consequent hypertrophy of exposed soft structures, and a sinking of the bony column, similar to that which occurs in laminitis, but not so pronounced.



A further aspect of the badly-cankered foot is to be found in an apparently enormous increase in the length of the wall. This we have seen protruding for quite 5 inches beyond the plane of the sole. It simply indicates that, in order to keep the animal at work, the smith has at every shoeing spared the wall, so that the diseased structures might be kept from contact with the ground.

As we have said before, pain and other symptoms of distress are quite absent. Animals affected with canker for a long time maintain their condition, feed well, and are quite capable of performing work under ordinary conditions.

Differential Diagnosis and Prognosis.—Perhaps the only disease with which canker may be confounded is thrush. They should, however, be easily distinguishable. The discharge from thrush is not so profuse, and is thicker and darker in colour, while the loosening of the horn is almost entirely absent. Furthermore, thrush shows no tendency to spread, and, even when left untreated, may remain confined to the frog for months, and even years. Canker, on the other hand, is slowly progressive, and soon shows the characteristic fungoid excresences, which growths are in thrush never seen. A further point of difference is discovered when treatment is commenced. Canker is found to be refractory to a point that is absolutely disheartening, while thrush, with careful attention, is soon got under hand, and a permanent cure effected.

The prognosis must be guarded. By many canker has been said to be incurable. This, however, has been clearly shown to be wrong. When the animal is young, and treatment may reasonably be judged to be economical, then a favourable prognosis may be indulged in, provided the veterinary surgeon intends to put into that treatment a more than ordinary amount of individual care and attendance. Even then, however, he will have to be very largely guided by the condition of his case. He should see that it is not too far advanced, and that a great deformity of the hoof, or actual exploration, does not indicate disease of the greater part of the wall.

Treatment.—From what has gone before, it will be seen that the eradication of canker is no easy task, that it is, in fact, a most difficult matter, and one not to be lightly undertaken. At the risk of recapitulating what we have said before, we may mention here the two points which the veterinarian must bear in mind. (1) That there is no actual disease or alteration in structure of the deep layers of the keratogenous apparatus. It is only the superficial, or horn-secreting, layer that concerns us. (2) That the disease of this superficial layer is infection with a material that may reasonably be presumed to be infective.

Put thus, treatment of canker would at first sight appear to be easy. One would imagine that a simple and long-continued soaking of the entire foot in a strong enough antiseptic would be all that was needed. Clinical observation, however, shows that this is not so, and for this there must be reasons.

The reasons are these: (1) Between us and the diseased layer upon which our attention must be directed is often a layer of normal horn, effectually protecting the tissues beneath from any dressing which we might consider beneficial. (2) Anything applied with the object of destroying septic material, but strong enough, or caustic enough, to injure the membrane upon which we are working, only makes the case worse. The superficial layer of the keratogenous membrane in which we have judged the disease to exist is, after all, but a delicate structure. When attacked by the application of too potent a drug its horn-secreting layer is easily destroyed, and thus, although we may succeed in establishing asepsis, we cannot expect at the point of injury a growth of horn. In its place we are confronted with large outgrowths of inflammatory fibrous tissue. (3) Shedding of the diseased horn and removal of the pressure exerted by the hoof faces us with hypertrophy of the exposed villi. The difficulty of meeting this with an adequate and evenly-distributed pressure is well enough known, and we find in that a further reason that the treatment of canker is superlatively difficult. (4) The material on which the animal has to stand is a distinct bar to the maintaining of a strict asepsis.

When we have said this, it is easy to understand that canker is not to be successfully met with any so-called specific—that it makes but little difference what the application may be so long as it is antiseptic, and is used by a man thoroughly conversant with the difficulties he has to contend with, and with his mind firmly set upon surmounting them.

With this point established, we will not devote more of our space to a consideration of the various dressings that have at different times been highly advocated in the treatment of the disease. It is interesting, however, to note that intensely irritating and caustic applications have been greatly in favour. Nitric acid, sulphuric acid (either alone or its action reduced by the addition of alcohol, oil, or turpentine), arsenic, butter of antimony, creasote, chromic acid, carbolic acid, arsenite of soda, and the actual cautery, have all been used.

Without dwelling further on that, we may say at once that a correct treatment consists in (1) the removal of all horn overlying infected portions of the keratogenous membrane, (2) the application of an antiseptic not too powerfully caustic in its action, (3) frequent changes of the dressings in order to insure a maintenance of antisepsis, and (4) the application of an adequate pressure to the exposed soft structures. Thus combated, canker is curable.

The man who, at the expense of much time and trouble, has demonstrated the truth of these axioms is Mr. Malcolm, of Birmingham. The determination with which he clung to his point that canker was, with correct treatment, in every case curable, was some years ago provocative of much discussion in veterinary circles. That he was successful in proving his contention is more to our point here. It is his method of treatment, therefore, that we shall give, and this we shall do by liberal extracts from Mr. Malcolm's own writings.

'On the first occasion of operating upon and dressing the cankered foot, it is usually necessary to cast the horse, and this may have to be done at intervals for a second or even third time; but in most cases once is sufficient, subsequent dressing being usually accomplished without much difficulty, frequently even without the aid of a twitch. After the horse has been secured, the drawing-knife is first employed; and if the frog alone is affected, it is unnecessary even to pare the sole, the removal of all frog horn not intimately adherent to its secreting surface being all that is required. But if both sole and frog be involved, the whole of the sound horn should be first thinned until it springs under the thumb, and then, using a sharp knife, every particle of diseased horn must be carefully removed from both sole and frog, a process much more easily, and with far greater certainty, secured by the previous thinning of the horn.

'The removal of diseased horn should always commence at the most dependent part of the foot, so that any haemorrhage produced may be below the parts still to be operated on, a matter of considerable moment for effective treatment. But with due care there will be little haemorrhage, as, except in the initial stage, there is no real union between the diseased horn and the diseased vascular secreting surface.

'After all apparently diseased horn has been removed by the knife, any still remaining should be at once destroyed by the actual cautery, by which it can be identified. All the diseased secreting surface should be carefully scraped with a thin hot iron,[A] fungoid growths excised and cauterized, and, indeed, every particle of cankered tissue should, if possible, be eradicated. In securing this more reliance can be placed on the actual cautery than on any other, whether liquid or solid: it is more under control in application, more decisive in effect, and its results can be anticipated with a far greater certainty. Moreover, its aid in diagnosis is of immense value; applied to the thinned horn or secreting surface it unmistakably demonstrates the presence or absence of canker. Healthy tissue chars black; cankered tissue, on the contrary, bubbles up white under the hot iron, and presents an appearance not unlike roasted cheese.

'Although this test is certain for horn thinned to the quick, it is not to be relied upon with thick horn, the outside of which may be practically healthy and char black, while its underlying surface may be cankered. With this exception the test is an infallible one, as by it the demarcation between cankered and healthy tissue can be clearly traced, and as a result we can with equal confidence radically remove[A] all cankered tissue, and conserve all healthy. As the object of that abominably cruel and barbarous operation of stripping the sole is the exposure of all canker, and as this can be done with equal certainty with the aid of the hot iron, there can be no necessity for performing it. The pain of cauterizing cankered tissue, which is a necessary operation, is infinitesimal (canker largely destroying sensation), compared with the pain produced in the totally unnecessary process of tearing healthy horn from a highly sensitive tissue.

[Footnote A: The words in italics are alterations in the original article made by Mr. Malcolm in a private letter to the author (H.C.K.).]

'Having by means of the knife and cautery removed every known particle of disease, the next procedure is to pack the surface of the sole and frog thus exposed with a mild dressing, such as vaseline; but if the cankered surface has not been efficiently, scraped, than there is required a more [A] powerful astringent or caustic dressing, which may vary considerably according to the individual fancy. A great favourite of mine consists of equal parts of sulphates of copper, iron, and zinc, mixed with strong carbolic acid, a very little vaseline being added to give the mass cohesion. The dressing, covered by a pledget of tow, is held in position by a shoe with an iron or leather sole, and the dressing and tow together should be of sufficient bulk to produce slight pressure on the sole when the nails of the shoe are drawn up. This insures contact between the dressing and the exposed surface, as well as any benefit derivable from pressure.

[Footnote A: The words in italics are alterations in the original article made by Mr. Malcolm in a private letter to the author (H.C.E.).]

'The dressing of the foot and nailing of the shoe can usually be more expeditiously performed when the horse is on his feet than when prone. If only the frog, or the frog and a small part of the sole, be involved, the horse should be kept at work, but if a large part or the whole of the sole a few days' rest may be necessary; but as soon as the condition of the foot will allow, work should be resumed, and it is simply marvellous how sound a horse will walk while minus the greater part of his sole from canker.

'On the second day following the shoe should be removed, and the foot redressed. To effect this it is necessary to recast the horse. Commencing at the edge of the sound horn, at the most dependent part of the foot, all new horn, no matter what its condition, must be pared to the quick, especial care being taken to effectually remove any lingering disease. Want of success is frequently attributable to neglect of this precaution. A small particle of canker remains undetected, forms a new centre of infection, and just when success is anticipated, much to your chagrin you have to deal with a fresh outbreak of canker, instead of a rapidly-healing foot. Parenthetically, I may here remark that the amount of more or less imperfect new horn produced by a cankered surface after an effective but not too destructive cauterization is almost incredible, and one cannot fail to be struck with the very active proliferation here compared with the meagre production of new horn by the healthy surface.

'After all disease has been excised, carefully clean the foot with waste, thoroughly protect any raw surface resulting from overcauterization by some mild agent, such as a saturated calomel ointment, reapply an astringent dressing over the whole affected surface, and nail on the shoe. This method of procedure should now be thoroughly carried out daily for a time, and as it is proceeded with a successful issue soon becomes assured in nearly every case. Where, in spite of these efforts, the disease still persists, depend upon it the fault is with the operator, who has failed to eradicate some centre of infection. Under these circumstances it may be necessary to recast the patient, repare the foot, and by the aid of eye, knife, and cautery, endeavour to find the cause, and having found it, which can invariably be done, remove it. The usual treatment will then speedily become successful. As the case proceeds dressing every other day will soon be sufficient, then twice a week, and finally, once a week until sufficiently cured.

'During this healing process, and after the complete eradication of canker it may be again repeated, no agent seems to have a more beneficial effect than calomel, and for this purpose it is best used as a dry powder. Under this dressing any remaining spot of canker is readily detected by the wet condition of the calomel when the shoe is removed the next day. In dealing with such a spot, a very good plan, after all apparently diseased tissue has been excised, is to touch the cankered part with solid nitrate of silver, or a feather dipped in one of the strong mineral acids, and then reapply calomel over the surface. The result of this treatment is frequently very gratifying.

'In successful treatment the shoe must be removed each time—an adjustable plate will not do, as no man can thoroughly pare and examine a foot with the shoe on, and imperfect dressings are worse than useless. Indeed, it is better not to pare or thin the horn at all, than to imperfectly pare, since canker, if undestroyed, develops far more rapidly under thin horn than under thick.

'In conclusion, I would again urge the necessity, at the very first operation, when the horse is down, of removing every single particle of the diseased tissue, either by excision or effectual cauterization, but at the same time taking very great care to guard against the latter being too destructive. The cautery should be laid aside as soon as the tissue cauterized ceases to burn white. The moment at which the canker has thus been eradicated without destroying sound tissue is indicated by the appearance of healthy horn, by the intimate union of that with the secreting surface, and by the healthy aspect of the exuded blood when paring has been carried to the quick.

'Should subjacent healthy structures be destroyed during the process, that is shown by the production of a raw sore, or of a sore to which a "sit-fast," coextensive to the injury, is firmly attached. This seriously retards recovery. The secreting surface having been destroyed, no new horn can be produced directly from the part, and a new secreting surface and new horn have now to grow inwards from the surrounding undestroyed tissue, and that is a slow process. At the same time, on the principle of choosing the least of two evils, practical experience teaches that it is better to produce a small sore or a "sit-fast" than to leave a part of the canker undetected; but, on the other hand, it is better to leave a small part of canker undetected, which can be recognised and removed at the next examination, than to cause a large slough. The object of the skilful surgeon is, naturally, to avoid both extremes; and if trouble be taken to carry out the procedure described, there need be no fear of the result.'[A]