ostotomy, as being at least useless and certainly dangerous." We will
see that there is indication for it, that it may render service and that,
performed antiseptically, it is harmless.

The ablation of bony tumors is seldom performed. The operation, easy
for pedunculated growths, is difficult for the others, that have a broad base
of attachments on the bone. It is reserved for some exostosis against which
other means would be powerless, specially those of the face. Incomplete
side bones are quite frequently removed, and when a portion of them is
necrosed. As for the gouging out, with the mallet and gouge, in cases of
phalangeal exostosis, splints, spavins, etc., it is a condemned method.

Neurotomy performed above the fetlock, the median or the sciatic,
according to the localization of the exostosis, is a last treatment which
•may succeed when firing has failed.

Exostosis are quite common in birds. They develop in preference on
the bones of the legs, sometimes those of the trunk ; either without ap-
parent cause, or after traumatisms. Hyperostosis of several regions of
legs have been observed (J. Hunter). Muyschel and Adamovics have
related cases of generalized hyperostosis in gallinaceous (Larcher).

Special Exostosis.

/. — Osselets.

Bony tumors of the knee, osselets are generally situated on the lateral
faces of that region and on the head of the metacarpals. They represent
high splints, a name under which they are commonly known. More
frequent on the inside than the outside, they may be double, and in that
case the internal one is more developed than the external. They are
sometimes situated in front of the knee, on the bones which form that joint.
When they are in large number, and in connection with the presence or
the absence of synovial dropsies, the knee is said to be hooped.

The prognosis of those exostosis varies very much according to their
seat. Developed on the anterior and lateral faces of the knee, they in-
terfere with the movements of the joint, produce a pseudo or partial
ankylosis and a more or less lasting lameness, while those located on the
metacarpals, like splints, generally produce only temporary lameness.

More serious than ordinary osselets is the exostosis, met in race horses,
which is spread on a level with the trapezium and the tendons inserted
upon it. This exostosis, almost always following an effort, a partial lacera-



EXOSTOSIS. 469

tion of the tendons at their point of insertion, gives rise to a lameness of
long duration, due to the periostitis and tendinitis, while it grows and in-
terfering with the function after its full development. On a three-year-old
that we watched the lameness lasted fifteen months. On another, for two
years after there remained some stiffness at the start. Most of the
.practitioners who have seen this lesion believe that it is the sequelae of a
fracture of the suscarpal bone.

As soon as the diagnosis is made by the lameness, the sensibility and
a slight swelling of the part, rest must be prescribed. If blistering and
.firing do not obtain the removal of the bony neoformation, they often
have the advantage of removing the lameness. For osselets that resist
firing, median neurotomy is indicated.

//. — Sj>a7nn —Tarsal Osteo-arthritis.

The hereditary transmission of some defective conformations of the
hock (narrow, bent), perhaps also a want of resistance, plays an important
part in the development of spavin. Through the efforts of pulling, rapid
traveling, rearing, jumping, the articulation of the hock receives pressures
liable to injure the ligaments, synovials and bones ; specially in young
animals, whose organs have not reached their full development, these are
the principal causes of the disease.

If spavin is sometimes only a high placed exostosis, most generally it
invades tarsal articulations. In that case, it is at times superficial, due to
ligament tears, and forms on the lower tarsal articulations a kind of callus,
assisting ankylosis (Aronsohn) ; at others, and more frequently, it is the
expression of several dry arthritis which result in the ankylosis of the in-
flamed joints. According to the seat of the bony tumor, we consider the
metatarsal spavin, occupying the superior part of the internal face of the
cannon, and the tarso-metaiarsal or articular, spreading over the articula-
tions of the hock. This last offers several varieties : in the first, the
external tumor and the ankylosis are limited to the articulation of the
cuneiform bones with the metatarsal ; in the second, the lesions involve
also the joint of the scaphoid and cuneiforms ; in the last, the astragalus is
united to the scaphoid. In a similar way, spavin is spread more or less
transversely and when its dimensions are ^educed, its prominence is
situated at times forward, towards the bend of the knee, at others more
backward.

During the development of spavin, when the lameness is already very
great, often no abnormal projection is detected at the base of the hock ;
morbid sensibility is very little marked or absent, which renders the
diagnosis difficult and shows that the lesions truly began in the bottom



470



VETERINARY SURGICAL THERAPEUTICS.



of the articulations. At this stage, the pains due to the osteo-arthritis are
often very great. In walking, there is a sudden flexion of the hock,,
analogous to springhalt. However, this symptom is quite rare, and still it
may be observed when there is no alteration of the tarsal articulations.
That which is most frequently seen is an abnormal, more or less marked,
stiffness of the hock. The sudden flexions of the cannon increase the
lameness ; sometimes the animal falls when turning short. But those
phenomena are not characteristic. Many latent spavins are diagnosed
only by exclusion and by the old ideas of extreme frequency of
hock lamenesses. It is often only after six weeks, two months or even.





Fig. loi. — Spavin, seen from forward, Fig. f02. — Spavin, seen from behind,,
left leg. right leg. (Goubaux and Barrier.)

later, that, on the ordinary seat of spavin, a bony tumor, gradually increas-
ing, is detected. Then the pains resulting from the arthritis being much
reduced, the lameness diminishes little by little.

Without doubt, spavin is one of the most severe lesions of the locomotory
apparatus. One of the most authoritative old hippiatres has said :
** Any horse with one or two spavins of steer will never be useful." The
prognosis varies with the age, size and situation of the tumor. Observa-
tion has taught that spavins are so much more serious and rebel to treat-
ment that they are situated more forward and nearer to the fold of the
hock. We must not count on the " rcstitiio ad integrum " of the invaded
joints ; but in a large number of cases, one succeeds in removing the
lameness. Authors who, like Lemichel, claim that " spavin never for-
gives," have evidently exaggerated the rebel tendency of the affection.-



EXOSTOSIS.



471



The removal of the lameness is obtained in the greater half and even two-'
thirds of cases.

When osteo -arthritis of the hock is considered the cause of a recent lame-
ness, when a spavin is suspected, long rest is the primordial indication.
Even at the outset, it is at least doubtful if long immobilization will succeed
in obtaining the disappearance of the inflammatory symptoms with which
the subastmgalian joints are affected, so that everything will return to its
normal state. In most of cases, a relative recovery only is obtained —





Fig. 103. — Spavin. Front view of dis- Fig. 104. — Vertical transverse section of
sected hock. a spavined hock.

simple or multiple ankylosis, limited or extensive — and all the treatments
recommended act satisfactorily only in favoring it ; existing articular
lesions, even recent, are incurable.

By rest and blistering applications (mercurial blister, red ointment,
sublimate ointment i to 6) on both faces of the joint, the lameness may
be made to disappear, when the spavin is tarsal and on the way to
development ; as soon as the animal is returned to work, the lameness
leturns. Blistering frictions, even repeated, have a too superficial action ;



472 VETERINARY SURGICAL THERAPEUTICS.

they seldom give a successful result. It is an error to hope that by their
use one will succeed in changing or arresting rapidly an articular inflam-
mation, which has its productive conditions always present and will feel
their action as soon as work is resumed.

The application of these agents subcutaneously has been recommended
(Bassi, Buch). Bassi makes over the spavins two or three cutaneous inci-
sions, converging downward, scarifies the subdermic connective tissue
and then applies the blister.

The empiric mentioned by Cattrall made a longitudinal incision on the
skin of the spavin, separated it from the tissues underneath forward and
behind, then introduced powdered sublimate in the wound, which he
sewed with three stitches. Often the slough of a piece of skin, the open"
ing of the synovial or a bony necrosis vvere the sequelae of this treatment-

Setons, recommended y^ars ago, are to-day almost completely aban-
doned. To them blisters and later on firing have succeeded.

Cauterization has a stronger and deeper action than blisters. Lines or
superficial points have their advocates ; but it is better to abstain from
using it in recent spavins. Gerlach has studied comparatively superficial
and deep firing, and condemned the latter, which he said exposes to
arthritis. Modern practice has rehabilitated needle firing. Arthritis is to
be feared only when the operation is badly done and the joints are not
yet protected by periostosis ; when the osseous neoformation exists, the
entrance of the point is not to be feared, when made on its surface. It is
known anyho\t that fine points or needles can without danger perforate
articular synovial. Moller, who claims to be a partisan of deep
cauterization, passes his cautery one, two or three times in the point, and
often completes the operation with a blistering friction (sublimate oint-
ment I to 6). Hoffmann applies over the exostosis fifteen or twenty
points down to the bones. Bottazzi, as well as Nanzio, employed the sub-
cutaneous method.

Several special operations have been recommended against spavin.

Abildgaard, Hering, L. Lafosse, have advised the section of the ciinean
branch. The operation is very simple. The animal thrown on the lame
side, the opposite leg is secured on the corresponding forearm. The line
of incision is indicated by the vertical axis of the internal face of the
hock ; operating too much forward, the saphena vein or the articular
"bursa might be injured. The growth itself gives the best point of repair ;
if it is small, the band is felt over its surface ; if large, it is ordinarily
divided in two portions by a transversal groove, at the bottom of which
the band is situated. Sometimes this is raised, stretched or more or less
deviated by the growth. The hair being clipped, a vertical incision is
made with the convex bistouri on the selected region, with a length of 4



EXOSTOSIS.



473



or 5 centimeters. When friction or firing have been applied, the skin
and subcutaneous tissues are indurated, and sometimes a thick layer of
subcutaneous structure has to be divided before the tendon is exposed; the
hemorrhage is quite abundant. The index finger introduced into the
wound detects the tendons, it is raised with scissors introduced underneath
it, divided with the bistouri and a piece of it amputated. The wound may be
left open or is closed by one or two stitches. The synovial flow soon
becomes purulent and may last for two or three weeks, but gradually
disappears.

There is often advantage to combine tarsal tenotomy with firing. Im-
mediate relief, spoken of by Lafosse and Mandel, must not be expected.
Getting up, animals are ordinarily as lame
after as before the operation : it demands
a certain time for the beneficial effects
to be seen. The mode of action of this
tenotomy is complicated. Not only does
it make the tendinous cord loose, the
pressure of which was one of the causes
of the lasting lameness ; but it also
activates the inflammatory process and
thus hastens ankylosis, in case of recent
osteo-arthritis. On these accounts it is
indicated, no matter what are the size,
the situation or age of the exostosis.

Dieckerhoff has advised the dividing
of the cunean sheath from the fold of
the hock or origin of the tendon to its
insertion on the cuneiform ; he operates
with the bistouri, the animal stand-
ing. After the operation, quite a large

swelling is formed ; the wound suppurates ; cicatrization takes place in
two, three or four weeks. Two weeks later, the animal can be re-
turned to work. In 1875 he made known the results of this practice,
and out of thirty-six cases of spavin with lameness operated upon, twenty-
one made an almost complete recovery, eight were improved, seven failed.

Periostotomy of Peters has given Moller good results. Here is the
modus operandi. The internal face of the hock well exposed, the hair is
cut on the lower parts of the region, on a level with the spa /in ; the skin is
aseptisised. With the bistouri a narrow incision is made, on the inferior
line of the hock, towards the middle and transversely to the internal face,
through which cur\'ed scissors are pushed under the skin, first upward and
forward, and then upward and backward ; thus forming two tracts arranged




Fig.



105. — Cunean tenotomy,
Cunean branch.



BC,



474 VETERINARY SURGICAL THERAPEUTICS.

in V shape. A curved bistouri then introduced into these tracts divide?
the tissues covering the exostosis and encroaches upon this ; passed in
the front tract first, with its sharp edge turned backward to avoid injury
to the vein, then brought over the surface of the bone, with pressure
on the back of the instrument, the fibro-tendinous tissues are divided
and the superficial layer of the exostosis incised. Withdrawn, it is then
passed in the posterior tract, where the same manipulations are executed.
Treated antiseptically, the wound heals in a few days ; no cicatrix
remaining. When, by exception, suppuration occurs, there is no serious
sequelae following. Several times MoUer has carried the instrument into
the bones without the slightest complication. A rest of four or six weeks
is necessary. It has been advised to place the animal in slings to prevent
his lying down. This therapeutic method does not claim to always
cure spavin, but it does not seem to deserve the reproaches cast on it
by Schutt. MoUer has obtained by it many successes. When the result is
incomplete, firing can then be used.

Neurotomies tried by many have generally failed. The same has been
the case with the section of the flexor metatarsi when made a hand's width
above the hock (Klemm).

Although shoeing occupies but a secondary place in the treatment,
Klemm, MoUer, Kosters, recommend to apply a shoe with long and thick
heels.

For cases where the tarsal lesion is complicated with knuckling,
after proper shoeing, treatment will be applied at once on the spavin and
the phalangeal deviation — this last by tenotomy. (See Knuckling.^

III. — J a rdc — J a ; -do n . '

These two expressions are not synonymous. The latter is situated on
the external face and back of the hock in the hollow existing in that
region. The former is applied when the exostosis, more developed, pro-
trudes beyond the posterior line of the hock, which, instead of being
straight, describes a curve more or less marked, on a level with the head
of the external metatarsal. It is proved to-day that this deformation can
be due to several causes : sometimes to the head of the bone which is
more developed and more angular than usual, as seen in the progeniture
of some stallions. That which is commonly taken for a jarde is but a
fibrous tumor, true tendinitis of the perforans (Barrier) ; but here ex-
ploration does not give the feeling of a bony tumor. As remarked by
Jacoulet, growths situated on the posterior face of the principal metatar-
sal, at the origin of the suspensory ligament, or the dropsy of the tarsal

1 This is the "curb" of English authors.



EXOSTOSIS.



475



sheath and some small cysts of that region, may give the impression

of their being true jarde. The researches of Gillet, Sipierre, Goubaux

and Barrier seem to establish that it does not attack the joints of the

hock; but always remains limited to the head of

the rudimentary metatarsal or to the ligament which

unites it to the principal metatarsal ; a localization

which explains its benignity, known for long time and

so expressed by Lemichel : " Jarde forgives always ;

splints sometimes; spavin never." Some authors,

however, claim that it may invade the tarsal joints and

produce a certain tumor of ankylosis analogous to that

of spavin. Whatever it may be, it is certain that few

jardes give rise to lameness of any duration and seldom

do they require treatment. Lameness is great and lasting

only in cases where there is complication of ankylosis

or when there is lesion of the perforans.

Astringents and cool applications are rarely used.
Blisters and deep cauterization are indicated at once.
When there is false jarde (cyst, tarsal or thoroughpin), an
oily fluid escapes through the points.

IV.— Curb. ^




Fig. 1 06. — A, Jard.
(Goubaux and
Barrier.)



Old writers called cu7-b the exostosis which develops outside and
back of the hock. To-day, notwithstanding the remarks of Palat and
Sanson, all authors agree in giving that name to the
bony neoformation developed on the inner side of the
lower extremity of the tibia, reserving that oi jarde and
jardons to those of the external and posterior faces of
the hock.

Curb is a rare exostosis. It is ordinarily due to trau-
matisms and lacerations of the ligamentous apparatus of
the internal face of the hock.

The diagnosis is easy, even when the tumor exists on
both legs. On its internal face, the lower extremity of
the tibia is larger and wider than normal.

Generally there is lameness only during the period of
development of the exostosis : in some cases where it
remains longer, the bony inflammation having reached
the articular surfaces of the hock, the prognosis becomes
more serious.

The treatment of curb does not differ from that of other exostosis. At




Fig. 107. — Curb.
(Goubaux and
Barrier.)



^ This seems to us the " high spavins" of English authors.



476 VETERINARY SURGICAL THERAPEUTICS.

the beginning, blisters, bichromate of potass ointment, ordinarily removes
the lameness ; sometimes the tumor is resorbed. If these means fail and
lameness persists, deep points firing is indicated.

When, by exception, curb extends down the hock, it may give rise to
incurable lameness.

V. — Splints.

They are observed generally on the front legs, sometimes on the hind
legs. Their frequency in horses recently put to work was well known to
old hippiatres. Among young horses, which work on pavement, at fast
gait, many become lame after a few months. Examination of the foot
and of the leg often reveals no lesions ; the shoulder is suspected ; but
this lameness, in horses recently working, has ordinarily for cause a super-
ficial inflammation of the metacarpal bones. Indeed, there soon appears
upon the region, along the rudimentary bones, a slight swelling, first
puffy, which soon becomes well defined ; it is a periostitis of the cannon.
In many of these lame individuals, for the first few weeks, it is very diffi-
cult to detect even by repeated examination the location of the pain
(Abadie). Percussion with the plessimeter is not as good to make it out
as hand examination. The history of the case is important ; ordinarily it
is that of a horse put to work for a few months which has exhibited
some temporary lameness. If the foot is not the seat of some mor-
bid sensibility ; if the coronet, the tendons and the fetlock are clean ; and
if, on the other hand, the region of the small metacarpals is infiltrated or
painful, splints are developing.

When this growth is complete, and the bony inflammation has passed,
the splint does not produce lameness, except in cases where, placed
behind the principal metacarpal, it presses against the suspensory liga-
ments and interferes with the play of tendons or the action of joints.
" Splint does not produce lameness, but when it attacks the styloid bones
or becomes so large that it presses against the tendons lodged between
those bones," it does (Lafosse). "The callus running upward behind
the knee lames the horse " (Solleysel).

Against growing splints, several authors recommend cold baths, pressure,
frictions of camphorated alcohol, embrocations of populeum, emollient
poultices, repeated mercurial frictions. These means are little used, but
the application on both faces of the metacarpus of a mercurial blister
or of biodide of mercury ointment is preferable. The alcoholic solu-
tion of sublimate, the ointment of bichromate of potash (Peuch, Lamour-
oux), may also be used. There are cases where the bony inflammation
disappears rapidly and where no exostosis is formed ; after a few weeks,
the horse returns to work. In others the sensibility remains acute or



EXOSTOSIS. 477

the splint becomes more or less developed ; blistering preparations are nec-
essary.

Hammering with the back of the hammer of the plessimeter, followed
by a blistering application, succeeds in a number of cases. The whole sur-
face of the splint is hammered with light strokes, without bruising the
skin, and then a blister put on.

When, by blistering, one succeeds in reducing or removing the lameness,
although the tumor remains, the animal may be returned to work. It is
useless to try to obtain the resolution of the exostosis by firing ; as remarked
Lagardere and Liard, it often resorbs spontaneously as the animal gets
older.

To obtain the " melting " of splints, massage and pressure have also
been used (L. Lafosse, Moller). This is done by the application of a piece
of sheet of lead or thick leather which is applied on the exostosis and held
up by turns of rollers. Often, in a few weeks, the exostosis has diminished
in a noticeable manner. The dressing is renevwed every day ; the skin,
must be carefully watched to avoid the necrosis.

If these means fail, cauterization must be resorted to — actual firing in
lines, superficial or deep points. Notwithstanding the remarks of Liard,
we use this last mode ; like Abadie and many others, we have obtained
very good results with it. We puncture the skin through by one or two
strokes of the instrument, and apply a stiff blister to complete the action
of the firing.

Periostotomy, recommended by Sewell, has been successful with Bouley,
Haubner, Williams, Dammann, Ehlers. It must be performed aseptically,
to avoid accidents by necrosis. During the eight days following there occurs
a slight inflammation. According to Sewell, the animal can resume work
eight or ten days after the operation; often the growth is resorbed'
entirely.

Ablation of splints is possible only for those that are projecting, pedun-
culated, or situated far from the tendons. L. Lafosse has done it with
chisel and hammer, " without having any accident to regret and without
blemishes afterwards."'

Median neurotomy may relieve splints that resist all those means of
treatment and in which the lameness persists.

English authors call sore-shin a peculiar affection of the cannon bone,
which is common in race-horses. According to Cagny, it is specially fre-
quent in colts of eighteen months to two years ; it is rare at three and
absolutely exceptional in older animals. It always began during training.
The excessive lameness that it gives rise to, when one leg only is affected ;
the peculiar mode of standing of the subjects when both legs are suffering,
may lead us astray in the diagnosis, and make believe to be navicular disease



4/8 VETERINARY SURGICAL THERAPEUTICS.

or acute laminitis. But soon there appears on the anterior face of the
cannon a diffuse and painful tumefaction.

The nature of this affection is still a subject of discussion. Williams,
Cagny, Moller, believe it periostitis. Abadie has described it as " teno-
sitis " of the extensors. Weber says it is due to a lesion of the extensors
and of their sheath.

Whatever may be its nature, the prognosis of the trouble is not serious.
Treated at once by blistering application, everything disappears, leaving no
mark. If, on the contrary, training is kept up, the symptoms increase ; a