Recorded Case of the Treatment. - A cart-horse, aged six years, was sent to the Alfort School by a veterinary surgeon for having picked up a nail in the hind-foot. Professor Cadiot, judging the necessity for the complete operation, performed it on January 14, and spared the plantar cushion as much as possible. In consequence of the plantar aponeurosis being extensively necrosed, it was advisable to scrape the navicular bone and a part of the semilunar crest. The wound having been washed with a 1 per cent. solution of perchloride of mercury, it was dusted with iodoform and packed with gauze, and covered with a cotton-wool dressing, kept in position by means of a suitable shoe.

On January 16 there was no snatching up of the limb when the horse was made to put weight upon it; he ate his food well, and his condition improved every day. On January 21 the dressing was removed; the wound appeared pinky and granular, and there was no suppuration. The clot remaining from the haemorrhage after the operation was removed, the wound was irrigated with a hot solution of sublimate, and then dusted with iodoform and covered with a dressing of iodoform gauze and absorbent wool. At this date the horse could stand on the injured limb. On January 31 a second dressing was made, and the animal almost walked sound. On February 7 the wound had almost closed up, save in its central part, where there was a small cavity, and the lameness had disappeared. On February 15 the wound had completely healed, and its borders were covered by a layer of thin horn. As the animal was sound it was sent to work.

The author directs attention to the rapidity with which a large and complete wound cicatrizes after the operation for gathered nail.[A]

[Footnote A: Veterinary Record, vol. XV., p. 226 (Jourdan).]

In the case of Penetrated Navicular Bursa, unaccompanied by the formation of any large quantity of pus, and uncomplicated by necrosis of the aponeurosis, our aim must be to maintain the wound in that happy condition. This is doubtless best done by keeping the foot continually in a cold bath, rendered strongly antiseptic by the addition of sulphate of copper and perchloride of mercury. Should there be intervals when the bath must be neglected, the foot in the meantime must be kept clean by antiseptic packing and bandaging, and a clean bag over all. This treatment should be continued so long as the character of the discharge denotes that synovia is running. If, in spite of our precautions, the discharge becomes purulent, then the track made by the penetrating object should be syringed twice daily with a 1 in 1,000 solution of perchloride of mercury.

During the treatment it will be wise to shoe the animal with a high-heeled shoe. We do not know as yet the full extent of the injury. The navicular bone may be tending to caries; or necrosis of the plantar aponeurosis, all unknown, gradually becoming pronounced. This calls for a relief of tension on the perforans, and is only to be brought about by the high-heeled shoe.

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

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

Fig. 108.   Colonel Nunn's Shoe With Detachable Toe Extension

Fig. 108. - Colonel Nunn's Shoe With Detachable Toe Extension.

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

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

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

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

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