If the suppurative process has commenced from within, the pus that is formed is, as a rule, thick and creamy, comparatively unstained, and free from marked odour. If, on the other hand, air has gained access to the joint, or the suppurative process has started from the materials introduced by a foreign body, the joint contents are thin, blood-stained, and stinking.

The inflammatory changes in the joint soon spread to the ligaments, and to the soft structures in contact with them. This means that the ligaments become infiltrated with inflammatory exudate, that the fibrous bundles composing them become separated, and that the ligaments are weakened and easily stretched. As a consequence, a certain amount of displacement or dislocation of the bones is allowed.

In like manner the inflammatory changes keep spreading until we have the periosteum next the ends of the bones affected. The periostitis thus set up invariably takes the osteoplastic form, and as a result of this we have growths of new bone in the near neighbourhood of the joint. It is in the later stages of the disease—that is, when the pus has been evacuated and reparative changes commenced—that this osteoplastic periostitis is most marked, and it plays a large part in bringing about the condition of anchylosis, which we shall afterwards describe.

Grave changes also occur in the articular cartilages. They quickly lose their peculiar glistening polish, their semitransparency is lost, and the natural tint of a pearl-like blue gives way to a dirty yellow. Later this is followed by erosion of the cartilages at such points as they happen to be in greatest contact. The ends of the bones are thus exposed, and their medullary cavities exposed to infection. As a result we get in them the changes we have already described under Ostitis.

Treatment—(a) Preventive.—Seeing that many of these cases have their starting-point in stabs or penetrating wounds of the sole, we shall be concerned first with a consideration of the correct treatment to be adopted when we know the wound to have reached the articulation.

Only too frequently the treatment practised is that of poulticing. In other portions of this work we have pointed out the advantages that a continued antiseptic bathing has over the application of a poultice, the greater readiness with which the solution comes into contact with the deeper parts of the wound, and the far greater chance there is of maintaining water in an antiseptic condition than there is of keeping a poultice in the same state. There is no doubt, that in this case also, the cold or warm antiseptic bath is to be preferred to the poultice. It is questionable, however, whether even the bath is sufficient for our purpose here. We have in this case a deep punctured wound, and a wound that in every probability is infected with the organisms of pus or of putrefaction. It is a wound, moreover, which is likely to impede the thorough access to it of the solution in which the foot is fomented, on account of the flakes of coagulated fibrin which fill it.

The most rational treatment, therefore, if we get to the case early enough, is to irrigate the wound freely with a solution of carbolic acid in water (1 in 20), or with a solution of perchloride of mercury (1 in 1,000), injected by means of a glass syringe, or the pattern of syringe devised for quittor. This injecting should be done thoroughly, and by that we mean that several syringefuls of the solution should be injected, the joint after each injection being manipulated so as to distribute the solution as far as possible over it. When this is done the opening in the sole may be plugged with a little perchloride of mercury, or, better still, with a little piece of tow saturated with a concentrated solution of perchloride of mercury or a solution of iodoform in alcohol and an antiseptic pad of tow or lint placed over all. The foot should then be bandaged and encased in a boot or sacking protective. The bandage should be removed daily and the antiseptic pad changed. At each visit the animal's condition must be carefully noted. So long as constitutional disturbance is slight, the foot appears comfortable, is free from marked heat and tenderness, and pawing movements are absent, and so long as the discharge on the pad appears non-purulent, free from marked odour, and small in quantity, then this dressing may be persisted in.

This treatment of open joint, preventive as it is of arthritis, is also indicated in the case of open navicular bursa. In several instances we have practised this treatment for the dressing of wounds implicating the bursae of tendons and the capsules of joints. It is also spoken of favourably by Mr. C.H. Flynn in the American Veterinary Review for June, 1888, whose treatment is as follows: 'Place the patient in a clean, well-ventilated, and drained stable. Have all the litter removed, and insist on the stall being kept clean. Either place the animal in slings, or tie the head so as to prevent lying down. Clip the hair and cleanse the parts well. He prefers the corrosive sublimate solution (1 in 1,000). Should the wound be of two or more days' standing, inject the joint with the corrosive sublimate solution. Now dry the parts with a clean towel and sprinkle the wound with iodoform. Over this place a thick layer of absorbent cotton-wool, filled with iodoform, bandage securely, and keep the patient on a moderate diet, preserving the utmost quietude possible. Should the bandage remain in position and the animal free from pain, leave the bandage and dressing in place from five days to a week. Then change it, and should the discharge be little, do not disturb it, but renew the iodoform and cotton dressing, leaving it on for another week.'

Other treatments for the same condition are practised, in which the wound is dusted with powdered iodoform, with potassium permanganate, or with corrosive sublimate, or where the wound, instead of being dusted, has the corrosive sublimate applied in the form of a plug. In each case the preliminary irrigation with the corrosive sublimate solution is dispensed with. This, however, should on no account be omitted. In our opinion it constitutes the very essence of the rationality of the treatment.

(b) Curative.—It may happen, however, and often does, that this first injection of an antiseptic is unsuccessful in preventing organismal infection of the wound. In this case grave constitutional disturbance and other untoward symptoms such as we have already described quickly make their appearance.

The animal should now be placed in slings and preparations made for actively treating the wound with antiseptics. Whether we fail or not, we have the satisfaction of knowing that we have given to the patient the best and the only chance of recovery.

It should be remembered, however, and should be pointed out to the owner, that with purulent arthritis fully developed, with the grave constitutional changes it occasions, and with the ever-present danger of a general septic invasion of the blood-stream, that the human surgeon under such circumstances offers to his patient the alternatives of amputation or probable death. With us no such alternative is possible. It is either return the joint to some semblance of its former usefulness, or destroy the patient.

In this case we advise the injection of the original wound, and also such fistulous openings as may have formed, with the 1 in 1,000 sublimate solution. Also, in order to avoid the sometimes abortive attempts of the antiseptic pad, to maintain a condition of asepsis around the wound, we advise the continual soaking of the whole foot in a cold antiseptic bath. This may be either carbolic acid 1 in 20, or—what is less volatile, perhaps more effectual, and certainly more economical—perchloride of mercury 1 in 1,000.

It has been our good fortune, even when we have seen the foot almost detached from the limb by the devastating inroads of the pus, to see the suppurative process by this means gradually overcome, a reparative anchylosis set in, and the animal restored to good health and usefulness, if not to soundness.

Once the suppurative process is checked and anchylosis commences, it is good treatment to smartly blister the whole of the region of the coronet, the pastern, and the wound itself with a mixed blister of cantharides and biniodide of mercury, repeated at intervals of a fortnight. This prevents to some extent further infection of the wound, and assists also in promoting the changes that tend to anchylosis.

(d) ANCHYLOSIS.

The word anchylosis signifies the stiffening of a joint. When one has read the serious changes occurring within the joint in the more serious forms of arthritis, it is easy to understand how it comes about. In suppurative arthritis, for instance, we have the synovial membrane destroyed, the articular cartilages partly or wholly obliterated, and the former boundaries of the joint entirely lost. If the animal lives, nature is bound to make repair of a sort. The synovial membrane and the articular cartilages utterly destroyed, as we have described, cannot again be replaced. Nature can only build again from such materials as are left to her. In this case the material is bone.

It must be remembered, however, that often the bone has been so diseased that spots of necrosis or caries within it are bound to remain unless moved by operative interference. Such diseased portions, when dealing with the foot, are beyond reach of the surgeon's knife, and we have no alternative but to allow them to remain. We get, therefore, in many cases, a condition of rarefactive ostitis occurring side by side with a slowly progressive caries within the bone, while outside is occurring an osteoplastic periostitis. The concurrence of these conditions leads in time to great increase in size of the parts, together with increasing anchylosis and deformity.

C. NAVICULAR DISEASE.

Definition.—Chronic inflammatory changes occurring in connection with the navicular bursa, affecting variously the bursa itself, the perforans tendon, or the navicular bone, and characterized by changes in the form of the hoof and persisting lameness. The disease is commonly noticed in thoroughbreds or in horses of the lighter breeds, and is but seldom observed in heavy cart animals. Usually it is met with in one or both fore-feet. Although of extremely rare occurrence, it has been noticed in the hind.

History.—To English veterinarians appears to belong the credit of discovering navicular disease. As early as 1752 we find one, Jeremiah Bridges, in 'No Foot, No Horse,' drawing attention to 'coffin-joint lameness,' and advocating for its treatment setoning of the frog. It appears, too, that Moorcroft, prior to his departure for India in 1808, was acquainted with what was then known as coffin-joint[A] lameness, having drawn attention to it in 1804 in a letter to Sir Edward Codrington.[B] In 1819 Moorcroft made it even plainer still that he was fully acquainted with what we now know as navicular disease. This we learn from a letter written by him to Sewell, in which he laid claim to being the originator of neurectomy. In this letter he says:

[Footnote A: The coffin-joint at this time included the navicular bursa.]

[Footnote B: Percival's 'Hippopathology,' vol. iv., p. 132.]

'On dissecting feet affected with these lamenesses, the flexor tendon was now and then observed to have been broken, partially or entirely, but more commonly to have been bruised and inflamed in its course under the navicular or shuttle bone, or at its insertion into the bone of the foot. Sometimes, although seldom, the navicular bone itself has been found to have been fractured; at others its surface has been deprived of its usual coating, and studded with projecting points or ridges of new growth, or exhibiting superficial excavations more or less extensive.'[A]

[Footnote A: Ibid.]

Pathology and Point of Commencement of the Disease.—The exact position in which the diseased process starts has for a long time been a subject of discussion, and even now it is doubtful whether the point has been definitely settled. To mention but a few among many: We find Mr. Broad, of Bath, strenuously insisting on the fact that the disease commences in the interior of the navicular bone. Just as strenuously we find the editor of the journal in which the matter is being discussed, the late Mr. Fleming, asserting that the disease commences in the bursa.[A] Others, too, hold that the disease commences primarily in the tendon. Wedded to this view was the discoverer, Mr. Turner, of Croydon; while Percival commits himself to the statement that it is either the central ridge or the postero-inferior surface of the navicular bone, or the opposed concavity in the perforans tendon, that shows the earliest signs of the disease. The observations made by Dr. Brauell, the first Continental writer to fully describe the disease, led him to the statement that neither the bone nor the bursa was the invariable starting-point of the trouble, but that usually it commenced in inflammation of the bursa itself.

[Footnote A: Percival's 'Hippopathology,' vol. iv., p. 132.]

Without, therefore, committing ourselves to an expression of opinion as to the precise starting-point of the affection, we shall describe the pathological changes occurring in navicular disease as noted in (1) the bursa, (2) the cartilage, (3) the tendon, and (4) the bone.

1. Changes in the Bursa.—Upon the internal surface of the bursal membrane is first noticed a slight inflammatory hyperaemia, accompanied by more or less swelling and tumefaction, owing to its infiltration with inflammatory exudate. The portion covering the hyaline cartilage of the navicular bone has lost its peculiar pearl-blue shimmer, and become a dirty yellow.

Remembering that the bursal membrane is a synovia-secreting one, and bearing in mind what happens in ordinary synovitis and arthritis (with which, of course, this may be very closely compared), we shall first expect changes in the bursal contents. It is highly probable, though difficult of proof, that in the very early stages the chronic inflammatory stimulus has the effect of increasing the flow of synovia. In every case, however, where it can with any certainty be said that navicular disease exists, it is too late to meet with this condition. The disease has then progressed until destruction of the secreting layer of the bursal membrane has been seriously interfered with, and in this case we find a distinct deficiency in the quantity of synovia in the bursa. In advanced cases it is even found that the bursa is absolutely dry.

2. Changes in the Cartilage.—Directly that portion of the bursal membrane covering the cartilage is the subject of inflammatory change, the cartilage itself, by reason of its low vitality, soon suffers.

Under a process, which we may term 'dry ulcerative,' the cartilage covering the ridge on the lower surface of the bone commences to become eroded, and in appearance has been likened, both by English and Continental writers, to a piece of wood that has been worm-eaten (see Fig. 161).



'At this stage, or much earlier'—we are quoting Colonel Smith, A.V.D.—'may be found calcareous deposits in the fibro-cartilage and the bone. They are scattered like fine sand here and there, generally across the inferior half of the face of the bone; they are sometimes numerous, frequently scanty, occasionally entirely absent. The amount of calcareous degeneration depends upon the lesions present. If much destruction of bone exists, there will be but few calcareous deposits; whilst if there are many calcareous deposits, there may be but slight ulceration of bone tissue, and perhaps none at all. In fact, I have held the opinion, and see no reason to modify it, that calcareous deposits are safeguards against caries.'[A]

[Footnote A: Journal of Comparative Pathology and Therapeutics, vol. vi., p. 195.]

3. Changes in the Tendon.—The effect of these calcareous deposits on the under surface of the bone is to produce a certain amount of roughness. Seeing that with every movement of the foot the perforans tendon is called upon to glide over this surface, it is clear that a secondary effect must be that of inducing erosion and destruction of the tendon. The point at which this usually commences is at the bottom of the depression that accommodates the ridge on the bone. With erosion of the cartilage and of the tendon at points exactly opposite each other, we have two surfaces come together that are prone to readily unite, and fibrous tissue adhesions often take place between the bone and the tendon. In some measure this accounts for the torn and ragged appearance of the tendon. Adhesions take place, and, under some small strain, are broken down. This may happen more than once or twice, and with each breaking of the adhesion between the bone and tendon, fibres from the latter are lacerated and torn from their place (see Fig. 162).

4. Changes in the Bone.—The changes occurring in the bone are essentially those of a rarefactive ostitis. These changes are described by many writers, and, whether originating primarily in the bone or not, it seems certain that extensive changes may have occurred within the bone, with but little or nothing to be noted on its outer surface. It would seem that the first change is one of congestion of the vessels of the bone's cancellous tissue. With the cause, whatever it may be, in constant operation, the congestion persists until a low type of inflammation is set up, interfering, not only with the flow of synovia in the adjoining bursa, but with the nutrition of the bone itself. As the disease progresses, there is softening and enlarging of the cancellated tissue towards the centre of the bone. The cells break up, and absorption takes place. This goes on until a large portion of the interior of the bone is in a state of dry necrosis, with, in many cases, but slight signs of mischief on the exterior of the bone.

In other cases, however, the changes in the interior of the bone are accompanied by well-marked lesions on its gliding or postero-inferior surface, and by evidences of an osteoplastic periostitis along its edges.

That an osteoplastic periostitis has been in existence is witnessed by the appearance along the edges of the bone of numerous outgrowths of bone, termed osteophytes (see Fig. 163).



The interosseous and postero-lateral ligaments of the articulation often participate in the inflammatory changes, and in many cases become completely ossified. The true articulatory surface of the bone, that articulating with the os pedis and with the os coronae, is never affected.

Causes.—In enumerating the causes of navicular disease, we shall follow the example of Colonel Smith and classify them under certain headings—namely, (1) Hereditary Predisposition; (2) Compression; (3) Concussion; (4) A Weak Navicular Bone; (5) A Defective or Irregular Blood-supply to the Bone; and (6) Senile Decay.



1. Hereditary Predisposition.—That navicular disease is hereditary is a fact that has for a long time been insisted on, and has come to be so generally admitted that we do not intend to dwell on it here. As we have said before, it is found in the lighter breeds of horses (and, according to Zundel, especially in the English breeds), and is there seen to be frequently transmitted from parent to offspring.

2. Compression.—By this is meant the compression of the navicular bone between the os pedis and the os coronae in front, and the perforans tendon behind.

In order to appreciate this explanation of the causation of navicular disease at its true value, it will be well to consider briefly the physiology of the parts in question.

The navicular bone is what we may term a complement of the os pedis. It exists, in fact, simply in order that the os coronae may have a sufficiently large articulatory surface to play upon. One wonders at first that Nature did not arrive at this by originally placing a larger bone below. Colonel Smith explains this by suggesting that this would in all probability have meant its fracture. In progression the hind part of the foot comes to the ground first, and upon the hinder portion of the articulation would fall the first effects of concussion, together with the greater part of the body-weight. A yielding joint was in this position necessary, and that formed by the navicular bone fills all requirements.

In this connection one next considers the part played by the front limbs during progression. As Zundel expresses it, they are columns of support rather than of impulsion, and, as the body-weight is thrown forward by the hind-limbs, it is the duty of the fore-limbs to receive it. The shock or concussion of the body-weight thus thrown forwards is first received by the muscles uniting the limb to the trunk, and a great part of it there minimized by their sling-like attachment. It is further absorbed by the shoulder-joint, and from there passed on to the almost vertical bony column represented by the radius and ulna, the knee, and the metacarpus. On reaching the first phalanx, a portion of the remaining force is passed on to the front of the phalanges and loses itself in front of the hoof, while the other portion is transmitted to the flexor tendons, finally to the perforans, and to the posterior parts of the foot. During progression, therefore, the navicular bone is constantly pushed downwards and backwards by the bony column, and is just as constantly pushed forwards and upwards by the resistance of the perforans tendon. This means, of course, that the navicular bone is more or less constantly subject to compression, and constant pressure, as we know full well, is a pretty sure factor in bringing about malnutrition of the parts, with atrophy or chronic inflammatory changes as an end result.

Even with the limb at rest the pressure on both sides of the navicular bone is still constant. The only circumstances under which we can conceive of it being entirely absent, in fact, are when the tension on the tendon is relaxed, and the body-weight altogether removed by the animal adopting the recumbent position.

The compression theory as to the causation of navicular disease was, we believe, first originated by Colonel Smith. He, at any rate, has laid much stress on it in his writings. If we accept it, and we see every reason that we should, then we must, with the author, admit the possibility of navicular disease arising from long standing in one position.

3. Concussion.—This we are bound to admit as a cause, and in so doing partly explain the comparative, almost total, immunity of the hind-feet from the disease. The fore-limbs, as we have already pointed out, are little more than props of support, and the force of the propelled body-weight is transmitted largely down their almost vertical lines, to end largely in concussion in the foot. With the hind-limbs matters are different. 'These,' as Percival explains it, 'have their bones obliquely placed, so as to constitute, one with the other, so many obtuse angles, to the end, that by forming powerful levers, and affording every advantage for action to the muscles attached to them, they may be fitted for the purpose of propulsion of the body onward.'

The effect of these several obtuse-angled joints in the limb is to absorb the greater part of the force exerted by the body-weight before it reaches the foot. When with this we take the facts that the fore-limbs have to carry the head and neck, and that they have to bear this added weight, plus a propelling force from behind, we see why it is that they should be so subject to the disease, and the hind-limbs so exempt.

As pointing out the part that concussion plays in its causation, we may mention that navicular disease is a disease of the middle-aged and the worked animal. It is interesting to note, too, that it occurs in animals with well developed frogs—in feet in which frog-pressure with the ground is most marked. This at first sight appears to flatly contradict what we have said with regard to frog-pressure in other portions of this work. With this, however, must be reckoned other predisposing causes. In this case it is not to frog-pressure alone we must look, but to the condition of the frog itself, and that of the neighbouring parts. It is when we have a frog which, though well developed and apparently satisfying all demands as to size and build, is at the same time composed of a hard, dry, and non-yielding horn that we must look for trouble.

The foot predisposed to navicular disease is the strong, round, short-toed or clubby foot, open at the heels, with a sound frog jutting prominently out between them. Here is a frog exposed to all the pressure that might be desired for it, bounded at its sides by heels thick and strong, and indisposed to yield, and itself liable, from its very exposure, to become, in the warm stable, hard and dry, and incompressible' (Percival).

Here, instead of acting, as normally it should, as a resilient body, and an aid to the absorption of concussion, it seems rather to play the part of a foreign body, and to bring concussion about. Seeing, then, that the navicular bursa is in very near contact with it, it is conceivable that this joint-like apparatus should suffer, and the pedal articulation be left unaffected, the more so when we take into consideration the compression theory just described.

4. A Weak Navicular Bone.—When the disease commences first in the bone—and there is no denying the fact that sometimes, although not invariably, it does—it may be explained by attributing to the structure of the bone an abnormal weakness in build.

The navicular bone consists normally of compact and cancellated tissue arranged in certain proportions, the compact tissue without, and the cancellated within. These proportions can only be judged of by the examinations of sections of the bone, and when it is found in any case that the cancellated tissue bulks more largely in the formation of the bone than normally it should, we have what we may term a weak navicular bone. In this connection Colonel Smith says: 'Though it is far from present in every case of the disease, still I consider it a factor of great importance.'

5. A Defective or Irregular Blood-supply to the Bone.—This, Colonel Smith considers, is brought about by excessive and irregular work, and by the opposite condition—rest. The author points out that the bloodvessels passing to and from the navicular bone run in the substance of the interosseous ligaments, or in such proximity to them that it is conceivable that under certain circumstances mechanical interference may occur to the navicular circulation. He further points out a fact that is, of course, well known to every veterinarian, that in periods of work the circulation of the foot is hurried, and that in rest there is always a tendency to congestion; and he says in conclusion: 'I cannot help thinking that irregularities in the blood-supply in a naturally weak bone must be a factor of some importance, especially when the kind of work the horse is performing is a series of vigorous efforts followed by rest.'

6. Senile Decay.—With approaching age the various tissues lose their vigour, and are prone to disease. The navicular bone and surrounding structures are not exempt. With the other and more active causes we have described acting at the same time it is not surprising that navicular disease is seen as a result.

In conclusion, it is well, perhaps, to say that, no matter to which particular theory of causation we may lean, we should make up our minds to consider them as a whole. While one cause may be exciting, the other may be predisposing, and the two must act together before evil results are noticed. It may be that even more than two are concerned in bringing on the disease, and to each the careful veterinarian will give due consideration.

Symptoms and Diagnosis.—In the early stages of navicular disease the symptoms are obscure. Pointing of the affected limb is the first evidence the animal gives. This, however, more often than not, goes unnoticed, and the first symptom usually observed by the owner or attendant is the lameness. Even this is such as to at first occasion no alarm, being intermittent and slight, and only very gradually becoming marked. In a few cases, however, lameness will come on suddenly, and is excessive from the commencement. It is the lameness, slow in its onset, intermittent in its character, and gradual in its progress, however, that is ordinarily characteristic of navicular disease.

The animal is taken out from the stable sound, with just a vague suspicion, perhaps, that he moved a bit stiffly. While out he is thought by his driver or rider to be going feelingly with one foot or with both. Even this is not marked, and the driver has some difficulty in assuring himself whether or no he really observed it, or whether it was but imagination.

On the return home the limb is examined, and nothing abnormal is to be found. The leg is of its normal appearance, and neither heat nor tenderness is to be observed in it or in the foot. On the following day the animal again is sound, and the lameness of the previous day is put down to a slight strain or something equally simple. The patient is then, perhaps, rested for a day or two. When next he is worked he again moves out from the stable sound, but again during the going gives the driver the unpleasant impression that something is amiss; and so the case goes on. One day the owner fears the animal is becoming seriously enough affected to warrant him in calling in his veterinary surgeon; the next he is confidently assuring himself that nothing is wrong.

Perhaps the animal is now rested for a week or two, or even for a month or two, hoping that this will put him sound. Immediately on commencing work, however, the same symptoms as before assert themselves, and the veterinary surgeon is called in.

With a history such as we have given the veterinarian's suspicions are aroused. He has the animal trotted, and may notice at this stage that there is an inclination to go on the toes, that the lame limb or limbs are not put forward freely, and that progression is stilty and uncertain; it is such, in fact, as to at once suggest the possibility of corns being present.

In some cases there is just the suspicion of a limp with one limb, and this only at intervals during the trot. At one moment the veterinarian is positive that he sees the animal going lame; at another he is just as confident he sees him coming towards him sound.

Nothing is found in the limb—neither heat, tenderness, nor swelling. There is nothing in the gait (either a limited movement of the radius, or a circular sweep with the leg) to indicate shoulder or other lameness, and the veterinary surgeon, by eliminative evidence, is bound to conclude that the trouble is in the foot.

The foot is then examined—pared, percussed, pinched, and in other ways manipulated—but nothing further is forthcoming. In such a case the veterinary surgeon is wise to declare the abortive result of his examination, to hint darkly of his suspicions, and to suggest a second examination at some future date. It may be that two, three, four, or even more, such examinations are necessary before he can justly pronounce a positive verdict.

Later he is enabled to do this by an increase in the severity of the symptoms, and by the changes that take place in the form of the foot. The lameness is now more marked, and the 'pointing' in the stable more frequent. With regard to the latter symptom, it has been seriously discussed whether the horse with navicular disease points with the heel elevated or with it pressed to the ground. In either case, of course, the limb is advanced; but while some hold that the phalangeal articulations are flexed and the heel slightly raised, in order to relieve the pressure of the perforans tendon on the affected area, and so obtain ease, there are others who hold that the heel is pressed firmly to the ground in order to deaden the pain. It may be, and most probably is, that both are right; but, in our opinion, there is no doubt whatever that pointing with the heel elevated is by far the most common.

The lameness is now excessive, and is especially noticeable when the animal is put to work on a rough or on a hard ground. Even now, however, heat of the foot or tenderness is so slight as to be out of all proportion to the alteration in gait.

With the case thus far advanced, evidence of pain may be obtained by pressing with the thumb in the hollow of the heel. Evidence of pain may also be obtained by using the farrier's pincers on the frog. These methods, however, are never wholly satisfactory, as a horse with the soundest of feet will sometimes flinch under these manipulations.

Extreme and forcible flexion of the corono-pedal articulation also sometimes gives evidence of tenderness. In this case the foot is held up, the animal's metacarpus resting on the operator's knee, and the toe of the hoof pushed downwards with some degree of force.

The same movement of the joint is given by causing the animal to put full weight upon the diseased limb, a small wedge of wood being first placed under the toe. In this manner the pressure of the perforans tendon upon the bursa is greatly increased, and the animal is caused to show symptoms of distress.

The lameness may also be increased, and diagnosis helped, by paring the heels, so as to leave the frog prominent and take the whole of the body-weight. The same end is also obtained by applying a bar shoe. This was originally pointed out by Brauell, and is quoted by Zundel and by Moeller.

The changes in the form of the hoof may now be noticed. These are largely dependent on the fact that more or less constantly the patient saves the heel. The horn of the walls in this region, and the horn of the frog, is thereby put out of action and induced to atrophy. The hoof gradually assumes a more upright shape, and the heels contract. We thus get a hoof which is visibly narrowed from side to side, with a frog that is atrophied and often thrushy, and with a sole that is abnormally concave, hard, and affected with corns.

When occurring in the hind-feet—a condition that is rare, but which has been noticed by Loiset, and quoted by Zundel—the animal is stiff behind, walks on his toes, and gives one the impression that he is suffering from some affection in the region of the loins.

One such case is reported by an English veterinary surgeon, and we quote it here:

'A gray gelding, and a capital hunter, the property of a gentleman in this neighbourhood, became lame in the near fore-foot after the hunting season of 1859. The lameness was believed to be due to navicular disease. The operation of neurectomy was ultimately had recourse to. The horse subsequently did his work as well as ever, and was ridden to hounds regularly till the end of the year 1861, when he went lame of the off fore-foot. From this date he also showed very peculiar action behind, and was at times lame of both hind-limbs without any apparent cause.

'In the year 1862, from the groom's indiscreet use of physic, superpurgation was brought on which caused the animal's death. On a post-mortem examination being made, the horse was found to have navicular disease of all four feet. It is worthy of note that this horse had always "extravagant" action behind, but was a remarkably quick and good jumper.'[A]

[Footnote A: F. Blakeway, M.R.C.V.S., Veterinarian, vol. ii., p. 21.]

Differential Diagnosis.—Navicular disease may be mistaken for ordinary contracted foot. It will be remembered, however, that in the early stages of navicular disease contraction is absent, and that it is only when the disease in the bursa is of long standing that contraction comes on. With ordinary contracted foot, too, careful paring and suitable shoeing soon sees a diminution in the degree of lameness, and a return to the normal in shape (see Treatment of Contracted Foot, p. 125). With navicular disease, however, such shoeing as is beneficial in the treatment of contracted foot (notably the various methods of giving to the frog counter-pressure with ground) soon brings on an aggravation of the lameness.

It is, perhaps, even more likely to be confounded with contraction when we have with the contraction a state of atrophy and thrush of the frog. With a frog in this condition pressure will give rise to pain, and navicular disease be erroneously judged to be present. In such a case we must rely wholly upon either extreme flexion or extreme extension of the joint to guide us, when, if contraction only is the offending condition, no symptom of pain will be shown.

Navicular disease may also be confused with rheumatic affections, with sprain of the posterior ligaments of the first interphalangeal articulation, and with sesamoid lameness. Mistakes are sometimes made, too, especially with a hasty observer, in confounding it with shoulder lameness.

In rheumatism the constant changing of the seat of pain, the sometimes elevated temperature, and the appearance of symptoms of heat, tenderness, and swelling in the affected area should guide one to a right conclusion.

In sprain of the posterior ligaments of the coronet and in sesamoid lameness, nothing but a careful examination and manipulation of the parts will ward off error, for in each of these cases there is 'pointing' and resting of the limb, and considerable disinclination to put weight firmly upon it. If at the same time manipulation gives distinct evidence of pain, all doubt may be set at rest.

Roughly speaking, sesamoid lameness is a condition of the gliding surface of the sesamoids, and the face of the tendon playing over them, similar to that found in navicular disease. All symptoms of pointing, the constant maintaining of the limb in a state of flexion, and a feeling manner of progression are again all present. It is plain from this that in all cases where an animal with a gait at all suggestive of navicular disease is brought for our examination, the manipulation of the limb should be thorough. The character of the lameness is almost sure to deceive us; and it is not until we are able to obtain local symptoms pointing to the one or the other of the conditions we have enumerated that a decisive opinion may be given. In sesamoid lameness the local symptoms are those of heat and pain in the fetlock on palpation, and a swelling of the affected parts, such swelling being at first slight, yielding, and barely distinguishable, and afterwards larger, bony and hard, and more marked. Later still there is distinct evidence of 'knuckling' over at the fetlock and inability to fully flex it.

In cases of shoulder lameness the gait alone should be sufficient to render liability of error small, for with nearly every case there is a manifest inability to 'get the limb forward', and this is best seen at a side view when the animal is trotting past the observer. When trotting towards one, there is a further and unmistakable symptom common to most shoulder lamenesses that serves to distinguish it at once, and that is the peculiar 'sweeping' outwards with the affected limb.

Lastly, with either of the conditions we have just mentioned, it is the exception to get contracted foot follow on. With navicular disease it sooner or later makes its appearance.

Prognosis.—The prognosis of navicular disease (once diagnosed with certainty) must almost of necessity be unfavourable. The facts that the disease has made serious progress before it is really noticeable, that the situation of the parts prohibits operative interference, and that the disease is one of a chronic and slowly progressive type, all point to an unfavourable termination.

Treatment.—We have seen from the pathology of this disease that it may commence either as a rarefactive ostitis, or as a synovitis and tenositis in connection with the bursa. With the former condition in existence, or when this and the synovitis has led to erosion of the cartilage, treatment is probably of no avail, on account of the more chronic nature of these two conditions. When, however, the condition is simply that of synovitis or tenositis, a more or less acute condition, we may assume that suitable treatment and a long rest will bring about resolution.

The first indications in treatment are those of what we may term 'nursing' the foot. It should have sufficient rest, should be placed so as to minimize as far as possible compression of the parts, and should have its posterior half treated so as to render it softer and less liable to concussion.

The period of rest required cannot be satisfactorily advised, and the practitioner is wise who makes it a long one. Best should be advised, in fact, long after symptoms of lameness have disappeared and recovery is judged to have taken place.

Compression of the parts may be somewhat minimized, if the animal be kept in the stable, by allowing the floor upon which the front-feet are to stand to be slightly sloping from behind forwards. The same effect, though not so marked, is obtained by removing the shoes, and considerably lowering the wall at the toe, while allowing that of the heels to remain. It may here be remarked that it is a good practice to allow the shoes to remain on, and this even when the animal is at grass. They should, however, be frequently removed, and the foot trimmed as we have directed.

With the foot thus trimmed so as to most suitably adjust the angles of the articulations, it should next be thoroughly pared and rasped in its posterior half, so as to render the horn of the sole and the frog and the horn of the quarters as thin as possible. The heels, however, should not be excessively lowered, if at all. We now have the foot in a soft condition, and easily expanded. It should, if possible, be kept so; and this may be done either by the use of poultices, by tepid baths, or by standing the animal upon a bedding that may easily be kept constantly damp. Such materials as tan, peat moss, or sawdust, are either of them suitable.

All this, of course, calls for keeping the animal in the stable. It is far better, however, more especially if a piece of marshy land is at hand, to turn him out in that. A moderate amount of exercise is beneficial rather than not, and the feet are thus constantly kept damp without trouble to the attendants.

The second indication in the treatment is that of applying a counter-irritant as near to the diseased parts as possible. Regarding its efficacy we must confess to being somewhat sceptical. The treatment has been constantly practised and advised, however, and we feel bound to give it mention here. A smart blister may, therefore, be applied to the whole of the coronet, and need not be prevented from running into the hollow of the heel.

Instead of blistering the coronet (or in conjunction with that treatment), the counter-irritant may be applied by passing a seton through the plantar cushion or fibro-fatty frog. Setoning the frog appears to have been introduced by Sewell. In many cases great benefit is claimed to have been derived from it, especially by English veterinarians of Sewell's time, and by others on the Continent. Percival, however, was not an advocate for it, and, at the present day, it is a practice which appears to have dropped out of use altogether.



To perform this operation a seton needle of a curved pattern is needed (see Fig. 164). This is threaded with a piece of stout tape dressed with a cantharides, hellebore, or other blistering ointment, and then passed in at the hollow of the heel, emerging at the point of the frog. The course the needle should take will be understood from a reference to Fig. 165.

The seton may be passed with the horse in the standing position. Previously the point of the frog should be thinned, and the animal should be twitched. After-treatment consists simply in moving the seton daily, and dressing it occasionally with any stimulating ointment, or with turpentine.

If, in spite of these treatments, the disease persists, then nothing remains but neurectomy.

D. DISLOCATIONS.

The firm and rigid manner in which the bones of the pedal articulation are held together renders dislocation of this joint an exceedingly rare occurrence, and then it is only liable to happen under the operation of great force. In the literature to our hand we have only been successful in discovering one reported instance, and, strange to say, in this, a well-marked case, the cause was altogether obscure. We quote the case at the end of this section.



A partial dislocation of this articulation is the condition met with in 'Buttress Foot.' In this case the fracture of the pyramidal process, and the consequent lengthening of the tendon of the extensor pedis, allows the os coronae to occupy upon the articulatory surface of the os pedis a more backward position than normally it should.

It is quite probable, too, that slight lesions of the other restraining ligaments and tendons of the articulation may bring about a similar though less marked condition. We may be quite sure of this—that whenever such lesions (as, for example, sprain and partial rupture of the lateral ligaments) do occur, and the normal position of the opposing bones is changed, if only slightly, that great pain and excessive lameness must be the result, and this with but little to show in the foot. Many of our cases of obscure foot lameness might, if capable of demonstration, turn out to be cases of sprain and partial dislocation of the pedal articulation.

Recorded Case.—'The animal, a trooper of the 8th Hussars, was found on the morning of April 17 unable to bear any weight on the limb (the near hind). Cause not known—the heel-rope I thought at first; but on investigation I found the heel-rope had been on the other leg.

Diagnosis.—Dislocation of the left os coronae from the articulating surface of the os pedis in a backward direction.

'Every devisable means were unsuccessful in reducing the limb to its natural position. The horse was thrown, and a strong rope, with four men pulling at it, was fastened round the hoof, whilst I put my knee to the back of the pastern, using all possible force, with one hand to the foot and the other to the fetlock, but all to no purpose. Next day other means were tried. First by throwing the horse and placing him on his belly, with the fore-legs stretched out forwards, and the hind-legs backwards. This I did so as to get the injured limb placed as nearly flat on the ground as possible, with its anterior aspect downwards. Then a very heavy man, with his boots off, was made to jump on the back of the pastern, where the prominence showed most; and afterwards, when these means failed, a strong piece of wood, well covered with leather, was placed (where the hollow of the heel ought to have been) on the most prominent part, and hit several times with a heavy hammer; but all efforts were futile.

'Prognosis.—Unfavourable. During the latter operations I had a very strong pressure applied to the hoof, and the horse firmly fastened in every way, and it appeared as though no amount of force would ever reduce the dislocation.

'Tautological.—The case was destroyed on April 30, being of no further use to the service.

'Post-mortem.—The os coronae was found to have slipped out of the articulating cavity of the os pedis, backwards and past the lateral ligaments. These last-named structures prevented the bone being forced forward into its proper position, being firmly locked over the lateral prominences. The capsular ligament was considerably lacerated and inflamed, causing slight effusion and swelling about the region of the coronet.'[A]

[Footnote A: T. Flintoff, A.V.D., Veterinary Journal, vol. xix., p. 74.]

Treatment.—After the forcible means of reduction related by Mr. Flintoff, we may add that when they are successful, they should be followed by suitable bandaging of the parts, and rest. The first is effected by applying plaster of Paris and linen, and the second by having the animal put in slings.



INDEX

Accidental tearing off of the entire hoof Acute arthritis causes of symptoms of treatment of Acute laminitis causes of complications in congestion in course of definition of diagnosis in exudation in pathological anatomy of prognosis in suppuration in symptoms of treatment of Acute periostitis simple Acute simple coronitis causes of definition of symptoms of prognosis of treatment of Acute simple synovitis Advantages of neurectomy Amputational neuroma after neurectomy Anatomy, pathological, of corn Applying poultices, method of Arteries of the foot Arthritis, acute causes of symptoms of treatment of Arthritis, simple or serous Arthritis, suppurative causes of definition of diagnosis of pathology of symptoms of treatment of Articulation, the first interphalangeal Articulation, the second interphalangeal

Bar pad and a half-shoe in the treatment of contracted feet Bar shoes in the treatment of contraction Bayer's treatment for chronic laminitis Bermbach's treatment for canker Bind Bone, caries of Bones, fracture of the, after neurectomy Bones, fracture of the Bones, necrosis of Bones, the Brittle hoof causes of definition of symptoms of treatment of Broad's treatment of laminitis Broue's expansion shoe Bruised sole, chronic Buttress foot

Canker Bermbach's treatment of causes of definition of differential diagnosis in history of Hoffmann's treatment of Imminger's treatment of Malcolm's treatment of pathological anatomy of prognosis in Rose's treatment of symptoms of treatment of Caries of bone Caries of the os pedis in pricked foot Cartilage, the lateral Cartilaginous quittor Causes of acute laminitis of acute simple coronitis of brittle hoof of canker of chronic coronitis of chronic laminitis of club-foot of corn of contracted feet of coronary contraction of the foot of crooked foot of curved hoof of false quarter of flat-foot of keraphyllocele of nail-bound of navicular disease of pumiced foot of punctured foot of ringed hoof of sand-crack of seedy-toe of side-bone of simple chronic coronitis of simple cutaneous quittor of specific coronitis of sub-horny quittor of thrush of weak heels Caustic solution, Villate's Changes in the bone in navicular disease in the bursa in navicular disease in the cartilage in navicular disease in the internal structures of the foot in contraction in the tendon in navicular disease Charlier shoe, the Charlier shoeing for contracted foot Chemical properties of horn Chronic coronitis, simple causes of definition of symptoms of treatment of Chronic bruised sole treatment of Chronic laminitis Bayer's treatment of causes of definition of Gross's treatment of Gunther's treatment of Imminger's treatment of Joly's treatment of Meyer's treatment of pathological anatomy of surgical shoeing for symptoms of treatment of treatment of, by ligaturing the digital arteries Chronic oedema of the leg after neurectomy Chronic synovitis Clamp, sand-crack, Koster's McGill's Vachette's Clamping sand-cracks, methods of Classification of corns of punctured foot according to the situation of the wound of sand-crack of quittor Club-foot causes of definition of symptoms of treatment of Cocaine injections as an aid to diagnosis in foot lamenesses Colic, metastatic, in laminitis Commencement, point of, in navicular disease Common situations of the wound in punctured foot. Complicated sand-crack, operations for Complications in coronitis in laminitis in pricked foot in sand-crack in simple or cutaneous quittor in sub-horny quittor Compression as a cause of navicular disease Concussion as a cause of navicular disease Conformation, faulty Congestion in laminitis Contracted foot causes of changes in the internal structures of definition of local or coronary prognosis of surgical shoeing for symptoms of treatment of Contraction of the foot, a bar pad and a half-shoe in the treatment of bar shoes in the treatment of expansion shoes in the treatment of Corn causes of classification of definition of pathological anatomy of prognosis in surgical shoeing in symptoms of the dry the moist the suppurating treatment of Coronary contraction of the foot causes of definition of symptoms of treatment of Coronary cushion, the Coronary edge of the wall, expansion and contraction of the Coronitis acute simple causes of complications in definition of prognosis of symptoms of treatment of Coronitis, simple chronic causes of definition of symptoms of treatment of Coronitis, specific causes of definition of symptoms of treatment of Course of acute laminitis Crooked foot causes of definition of symptoms of treatment of Curved hoof causes of definition of treatment of Cushion the coronary the plantar Cutaneous or simple quittor

De Fay's expansion shoe. Defective or irregular blood-supply to the bone a cause of navicular disease Definition of acute laminitis of acute simple coronitis of brittle hoof of canker of chronic coronitis of chronic laminitis of club-foot of contracted foot of corn of coronary contraction of the foot of crooked foot of curved hoof of false quarter of flat-foot of keraphyllocele of nail-bound of navicular disease of pumiced foot of punctured foot of pyramidal disease of quittor of ringed hoof of sand-crack of seedy-toe of side-bone of simple chronic coronitis of specific coronitis of spongy hoof of sub-horny quittor of thrush of weak heels Development of the hoof Diagnosis of acute laminitis of canker of foot lameness by injections of cocaine of navicular disease of punctured foot of pyramidal disease of side-bone of sub-horny quittor Differential diagnosis in canker in navicular disease Diseases arising from faulty conformation Dislocation of the os coronae recorded case of Dislocations Dry corn

Einsiedel's expansion shoe Examining the foot method of Exercise, forced, in the treatment of laminitis Expansion and contraction of the coronary edge of the wall of the hoof under the body-weight of the solar edge of the wall of the sole Expansion shoe Broue's De Fay's Einsiedel's Hartmann's Smith's Expansion shoes in the treatment of contraction Extensor pedis tendon, the Extirpation of the lateral cartilage in quittor of the lateral cartilage, after Moller and Frick of the lateral cartilage, after Bayer Exudation in laminitis

False quarter causes of definition of symptoms of treatment of Faulty conformation diseases arising from Feeding a cause of laminitis Flat-foot causes of definition of symptoms of treatment of Flexor pedis perforans tendon, the Flexor pedis perforatus tendon, the Foot, buttress Foot, changes in the internal structures in contraction of the Foot, contracted causes of definition of prognosis of symptoms of treatment of Forced exercise in laminitis Fractures Fractures of the bones after neurectomy of the navicular bone of the os coronae of the os pedis Frog, the Functions of the lateral cartilages

Gangrene of the sensitive structures in laminitis Gathered nail Gelatinous degeneration after neurectomy Grooving the wall in laminitis (Smith's operation) in treatment of sand-crack in treatment of side-bone (Smith's operation) Gross's treatment of chronic laminitis Growth of hoof, rate of Gunther's treatment of chronic laminitis

Hartmann's expansion shoe Heels, weak causes of definition of symptoms of treatment of Heredity as a cause of navicular disease as a cause of side-bone Histology of horn History of canker of navicular disease of neurectomy Hind-feet, navicular disease in the Hind-limb with the side-line, method of securing Hoffmann's treatment of canker Hoof, the accidental tearing off of expansion and contraction of development of rate of growth of Horn chemical properties of histology of Hutlederkitt

Imminger's treatment for chronic laminitis for canker Immobilizing a sand-crack by grooving the wall, methods of Infection of the limb, septic Injections of cocaine as an aid to diagnosis in foot lameness Interphalangeal articulation the first the second Instruments required in plantar neurectomy in operations on the foot Irregular blood-supply to the bone as a cause of navicular disease

Joly's treatment of chronic laminitis

Koster's sand-crack clamp Keraphyllocele causes of definition of pathological anatomy of symptoms of treatment of Keratoma

Lameness, cocaine injections as an aid to diagnosis in Laminae, the sensitive Laminitis acute Broad's treatment of causes of complications in congestion in course of definition of diagnosis in exudation in feeding, a cause of forced exercise in the treatment of gangrene of the sensitive structures in grooving the wall in the treatment of local applications in the treatment of local bleeding in the treatment of metastatic colic in metastatic pneumonia in neurectomy in opening the sole in the treatment of parturient pathological anatomy of periostitis and ostitis in phlebotomy in the treatment of prognosis in rocker bar shoes in the treatment of Smith's operation in suppuration in symptoms of symptoms of, in the four feet symptoms of, in the fore-feet alone symptoms of, in the hind-feet alone treatment of Laminitis chronic Bayer's treatment of causes of definition of Gross's treatment of Gunther's treatment of Imminger's treatment of Joly's treatment of Meyer's treatment of pathological anatomy of surgical shoeing for symptoms of treatment of Laminitis, parturient Lateral cartilage, the extirpation of, in quittor, after Holier and Frick extirpation of, in quittor, after Bayer functions of necrosed, pathological anatomy of necrosis of ossification of wounds of Leg, chronic oedema of the, after neurectomy Length of rest required after neurectomy Ligaments, the Ligaturing the digital arteries, in chronic laminitis Limb, septic infection of Local applications in laminitis Local bleeding in laminitis Local or coronary contraction of the foot Low ringbone

Malcolm's treatment of canker McGill's sand-crack clamp Median neurectomy Metal plates in the treatment of sand-crack Metastatic colic in laminitis Metastatic pneumonia in laminitis Methods of applying poultices of examining the foot of immobilizing sand-crack by grooving the wall Methods of restraint of securing a hind-limb with the side-line of securing the foot to the cannon of another limb Meyer's treatment of chronic laminitis Moist corn

Nail-bound causes of definition of symptoms of treatment of Nail-tread Navicular bone, the fracture of Navicular bursa, puncture of the, in pricked foot Navicular bursa punctured, treatment of Navicular disease causes of changes in the bone in changes in the bursa in changes in the cartilage in changes in the tendon in definition of diagnosis of differential diagnosis of history of in the hind-feet point of commencement of prognosis of symptoms of treatment of Necrosed lateral cartilage pathological anatomy of Necrosis of bone of tendon and ligament in sub-horny quittor of the lateral cartilage (cartilaginous quittor) Necrotic plantar aponeurosis, treatment of Nerve, reunion of, after neurectomy Nerves, the Neurectomy advantages of amputational neuroma in fracture of the bones after gelatinous degeneration after history of instruments required in in laminitis length of rest required after persistent pruritus after pricked foot after reunion of divided nerve after sequelae of stumbling after use of the horse after Neurectomy median plantar Neuroma, amputational, after neurectomy

Oedema of the leg after neurectomy Opening the sole in the treatment of laminitis Operation for complicated sand-crack for laminitis for necrosed lateral cartilage in quittor for necrosed plantar aponeurosis for side-bone Operations on the foot, instruments required in Operations on the horn, treatment of contracted foot by Os coronae, the dislocation of fracture of Os pedis, the caries of, in pricked foot fracture of Osteoplastic ostitis Osteoplastic periostitis Ostitis in laminitis Ostitis, rarefying osteoplastic Ossification of the lateral cartilages (side-bone) Overreach shoeing for treatment of

Parturient laminitis Pathological anatomy of acute laminitis of canker of chronic laminitis of corn of keraphyllocele of necrosed lateral cartilage of pyramidal disease of simple cutaneous quittor of navicular disease Pedal articulation, puncture of the Perforans tendon, the flexor pedis Perforates tendon, the flexor pedis Periople, the Periostitis and ostitis in laminitis Periostitis, osteoplastic Periostitis, recorded cases of Periostitis, simple acute suppurative Periostitis, treatment of Persistent pruritus after neurectomy Phlebotomy in laminitis Plantar aponeurosis, wounds of the treatment of necrosed Plantar cushion Plantar neurectomy history of instruments required in operation of Pneumonia in laminitis metastatic Point of commencement of navicular disease Poultices, methods of applying Preventive treatment of cutaneous quittor Pricked foot after neurectomy complications of Prognosis in acute simple coronitis in canker in contracted foot in corn in laminitis in navicular disease in punctured foot in sand-crack in simple cutaneous quittor Properties of horn, chemical Protection of sand-crack by metal plates Pruritus after neurectomy Pumiced foot causes of definition of symptoms of treatment of Punctured foot causes of classification of common situation of the wound in complications in definition of diagnosis of prognosis of symptoms of treatment of Puncture of the navicular bursa treatment of Puncture of the pedal articulation Purulent synovitis Pyramidal disease

Quittor classification of definition of Quittor, simple or cutaneous causes of complications in curative treatment of definition of pathological anatomy of preventive treatment of prognosis of symptoms of treatment of sub-horny causes of complications in definition of diagnosis of extirpation of the lateral cartilage in, after Moller and Frick extirpation of the lateral cartilage in, after Bayer necrosis of the lateral cartilage in (cartilaginous quittor) necrosis of tendon and ligament in (tendinous quittor) surgical shoeing in symptoms of treatment of

Rarefying ostitis Recorded case of dislocation of the os coronae of navicular disease in both hind-feet of periostitis of pyramidal disease Rest required after neurectomy, length of Restraint, methods of Reunion of the divided nerve after neurectomy Ringbone, low Ringed hoof causes of definition of treatment of Rocker bar shoes in laminitis Rose's treatment of canker

Sand-crack causes of clamp Koster's McGill's Vachette's clamping, methods of classification of complications in definition of operations for complicated prognosis in surgical shoeing for symptoms of treatment of treatment of, by grooving the wall treatment of, by wedging the fissure Second interphalangeal articulation, the Securing a hind-limb with the side-line, method of Securing the foot to the cannon of another limb, method of Seedy-toe causes of definition of symptoms of treatment of Senile decay as a cause of navicular disease Sensitive laminae, the Sensitive structures, gangrene of, in laminitis Septic infection of the limb Sequelae of neurectomy Serous arthritis Shoe, bar Charlier's Charlier's tip expansion Broue's De Fay's Einsiedel's Hartmann's Smith's for overreach plate rocker bar slipper, Broue's slipper and bar-clip, Einsiedel's three-quarter three-quarter bar thinned tip tip with 'dropped' heel with extended toe-piece with extended toe-piece (Nunn's) with heel-clip with 'set' heel Side-bone causes of definition of diagnosis of heredity a cause of Smith's operation for symptoms of treatment of Side-line, the Simple acute coronitis Simple acute periostitis Simple coronitis acute chronic Simple or cutaneous quittor causes of complications in curative treatment of definition of pathological anatomy of preventive treatment of prognosis of symptoms of treatment of Simple serous arthritis Simple synovitis, acute Smith's expansion shoe operation for laminitis operation for side-bone Solar edge of the wall, expansion and contraction of the Sole, chronic bruised Sole, expansion and contraction of the Sole, the Specific coronitis causes of definition of symptoms of treatment of Spongy hoof definition of symptoms of treatment of Stumbling after neurectomy Sub-horny quittor causes of complications in definition of diagnosis of necrosis of the lateral cartilage in (cartilaginous quittor) necrosis of tendon and ligament in (tendinous quittor) symptoms of treatment of surgical shoeing for Suppurating corn Suppuration in laminitis Suppurative arthritis causes of definition of diagnosis of pathology of symptoms of treatment of Suppurative periostitis Suppurative synovitis Surgical shoeing for corn for chronic laminitis for laminitis, acute for sand-crack for quittor Symptoms of acute simple coronitis of brittle hoof of canker of chronic coronitis of chronic laminitis of club-foot of contracted foot of corn of coronary contraction of the foot of crooked foot of false quarter of flat-foot of keraphyllocele of laminitis of laminitis in all four feet of laminitis in the fore-feet alone of laminitis in the hind-feet alone of nail-bound of navicular disease of pumiced foot of punctured foot of pyramidal disease of sand-crack of seedy-toe of side-bone of simple chronic coronitis of simple cutaneous quittor of specific coronitis of spongy hoof of sub-horny quittor of synovitis, chronic of synovitis, purulent or suppurative of synovitis, simple acute of thrush of weak heels Synovitis, acute simple causes of treatment of

Tearing off of the entire hoof, accidental Tendon the extensor pedis the flexor pedis perforans the flexor pedis perforatus Tendons, the Thrush causes of definition of symptoms of treatment of Tight-nailing Tip-shoes Tissue, the velvety Tread, See Overreach Treatment of acute laminitis of acute simple coronitis of brittle hoof of canker of canker Bermbach's Hoffmann's Imminger's Malcolm's Rose's of chronic bruised sole of chronic coronitis of chronic laminitis of chronic laminitis by ligaturing the digital arteries of club-foot of contracted feet of contracted feet by expansion shoes of contracted feet by operations on the horn of corns of coronary contraction of the foot of crooked foot of curved hoof of cutaneous quittor of false quarter of keraphyllocele of nail-bound of navicular disease of necrotic plantar aponeurosis of periostitis of pumiced foot of punctured foot of punctured navicular bursa of pyramidal disease of ringed hoof of sand-crack of sand-crack by clamping the fissure of sand-crack by grooving the wall of sand-crack by wedging the fissure of seedy-toe of side-bone of simple chronic coronitis of specific coronitis of spongy hoof of sub-horny quittor of synovitis of thrush of weak heels Use of the horse that has undergone neurectomy Vachette's sand-crack clamp Veins, the Velvety tissue, the Villate's caustic solution

Wall, the Weak heels causes of definition of symptoms of treatment of Wedging the fissure in the treatment of sand-crack Wound in punctured foot, common situations of the Wounds of the lateral cartilages Wounds of the plantar aponeurosis



THE END