hard diffused tumor is formed on the anterior face of the cannon, which
resists cauterization. Still, it does not seem to disturb the action of
galloping (Cagny).
Rest is the first indication of a rational treatment ; blistering does the
rest. Seldom is firing required. Williams advises subcutaneous perios-
totomy, which, for him, would diminish the duration of the lameness. In
some cases where the opera,tion has been made with insufficient asepsy,
periostitis has become suppurative and complicated with partial necrosis
of the principal metacarpal.
VI. — Ringbones — Sidebones — Phalangeal Exostosis.
Under the name of ringbones are designated exostosis of the phalangeal
regions. According to their location, they are divided into those of the
paste7'n and those of the coronet. These are divided into phalangeal '
and cartilaginous.'^ Those exostosis present great interest from the
surgical point of view ; as long as they develop, they give rise to lameness,
which often lasts long, because the growth interferes with the action
of tendons and ligaments, or presses painfully on the tissues of the foot.
All the causes likely to give rise to producing osteo'-periostitis may bring
on those exostosis ; among them particularly are efforts of locomotion
which, through the stretchings of the ligaments, irritate the osteogenous
coat ; violent reactions of the ground, dry arthritis, chronic inflammation
of the peri-bony tissues, diffused exostosis of the pastern and coronet.
After splits or fractures of the phalanges, or after the operation for deep nail
in the fo'^t, they are frequently observed. Bony neoformations developed
on a level with the insertion of ligaments, near the articular surfaces,
sometimes spread and mingle together, surround the joint and bring on a
false ankylosis.
While ringbones are often seen on the hind legs, sidebones almost
exclusively belong to forelegs. " Everyone knows the special affinity
that fibro-cartilaginous tissue has for the elements of bone. As soon as
1 Ringbones. ^ Sidebones.
EXOSTOSIS. 479
scutiform layers are inflamed, lime chalks are deposited in them, bony-
Fig. loS. — Phalangeal Ringbone.
degeneration takes place " (Bouley). Violent reactions, not proportioned
to the resistance of the tissues, traumatisms, wounds on the coronet, car-
Fig. 109. — Sidebones with atrophy of the third phalanx.
tilaginous quittor treated by caustic injections, are as many causes of this
ossification of fibro-cartilages. Among the other etiological influences
.480 VETERINARY SURGICAL THERAPEUTICS.
>Tnust be mentioned the bad formation of the foot, the vicious direction of
the pastern, improper shoeing, heredity. Flat feet are much predisposed
to sidebones. Tapon does not beUeve in the influence of heredity,
mentioned by the majority of authors ; for him sidebones of colts are
<iue to permanent stabulation.
The diagnosis of these troubles, like that of splints, is often difficult at
the beginning. All the lameness of youth are not due to periostitis of the
cannon; there are those which have for causes phalangeal periostitis or
incipient ossification of the cartilages, and sometimes a slight tumefaction
of the pastern or coronet with an abnormal sensibility are scarcely detected
by careful exploration.
The prognosis varies much according to the size of the growth, its origin,
its situation. If, in general, large exostosis produce stiffness or permanent
lameness, there are many small ones which produce no pain, no func-
tional disturbance. Periostosis produced by articular phlegmasias are, by
the fact of the ankylosis which follows, extremely dangerous. In general,
phalangeal exostosis which are limited, are specially serious when they are
situated low, interest the horny box, are within it ; cartilaginous exostosis
are so much more serious that they are more anterior.
To pare the foot in such a manner that the standing of the digital
region be firm and normal, apply a proper shoe (Coleman or bar shoe,
according to the form of the foot), avoid excessive work, violent reactions on
the pavement for young subjects, whose tissues are not yet fully developed ;
laise the colts in liberty : such are the principal indications of the pro-
phylaxis of those tumors. Turning out would often be followed by the
resolution of incipient sidebones. Tapon says that he saw three colts,
kept in stabulation, have exostosis in two weeks ; they were turned out ;
they disappeared on one, diminished on another and remained in the
third.
The therapeutics of these diseases includes numerous methods among
which a choice must be made. Often one is consulted at their beginning,
when there exists only a little thickening, or an abnormal sensibility. Cold
baths, continued irrigation, poultices, astringent applications, and rest
sometimes give good results ; but blistering frictions are generally pre-
ferred. They hasten the march of the disease and shorten the duration of
the lameness. Ointment of bichromate of potassse has been beneficial with
Toelen and Peuch.
When the exostosis is formed, it is yet to alteratives that one must resort.
If blisterings may relieve the lameness due to a young tumor, made of
spongy vascular tissue, they are generally powerless with old, hard and
â– compact growths. Cauterization itself, though more powerful, is truly good
.only against recent growths ; it is applied in lines, superficial or needle
EXOSTOSIS. 481
points. But it remains powerless with old, large or eburnated exostosis.
To relieve sidebones, with firing are associated a proper shoeing and
grooving of the foot (Weber). Lameness is partly due to the pressure of
the tissues situated between the horny structure and the bony growth.
To relieve the pains and help the dilatation of the posterior parts of the
foot, division of the foot is resorted to. Ordinarily three grooves per-
pendicular to the ground or slightly oblique downwards and backwards
are made in the quarter, on the side where the growth exists. Another
mode consists in making, one centimeter below the coronary band, an
horizontal groove, from the heel to the anterior boundary of the sidebonej
and two others converging slightly downwards : the superior has for object
to permit the expansion of the coronary band. These grooves must not
extend to the soft tissues, as they might bring on podophyllitis, necrosis,
caries of the os pedis or a cartilaginous quittor. By daily applications of
hoof ointment, tar or a dressing, the desiccation of the hoof and the
formation of seams are prevented. Zundel, Humbert and others have
recommended the thinning of the quarter with the drawing knife or the
rasp ; the effects are the same on the painful region, the results are good.
Sidebones producing contraction of the plantar region, special shoes
indicated against this ailment shall be applied. In general, the bar shoe
is recommended, with paring of the heels and relieving the quarter from
pressure on the diseased side. The shoeing of Coleman-Poret is also very
advantageous. As soon as the inflammatory phenomena due to cauteriza-
tion have passed off, it is indicated to use the animal to slow walking
exercise. By degrees the horny box spreads, the pressure diminishes, and
the lameness may disappear notwithstanding the fact that the tumor re-
mains. When the sidebone is very large, if one will not resort to
neurotomy, a portion of the quarter can be extracted, extending from an
oblique line made in a direction backwards and downwards from the
coronary band a little in front of the sidebone. After a few weeks, the
.animal is returned to work. The foot spreads below the exostosis, the
new-formed quarter does not press as painfully as the old one ; the lame-
ness diminishes and sometimes disappears.
Extirpation is only practicable with sidebones and only in cases where
the unossified part of the cartilage is affected with necrosis. Thin the
quarter, isolate the coronary band on a level with the tumor as in the
operation for quittor, cut it at its base with the narrow drawing knife,
raise it, separate it from the tissues underneath, carefully avoiding the
synovial cul-de-sac ; such are the various steps of the operation. Mangin
has advised to divide the coronary band to operate more easily and to use
a blunt bistouri to loosen the growth. The classic method is to be pre-
ferred.
^182
VETERINARY SURGICAL THERAPEUTICS.
.«*'-^
We will mention periostotomy only to proscribe it. It never gave but
bad results.
When ringbones and sidebones remain rebel to the treatments we have
considered, neurotomy may be resorted to, to remove the lameness and
render the animal useful.
Low neurotomy — the division of the posterior branch of the plantar
nerve — is not sufficient. The operation must be made above the fetlock,
so as to destroy the sensibility below it.
To perform the metacarpal ox metatarsal neurotomv, the animal is cast
and the leg secured accord-
ingly. If the operation is to
be made on both sides, the in-
side is operated first ; the animal
being turned over to complete
the operation on the other side.
When the fetlock and the
inferior part of the cannon are
free from disease, the nerve is
readily felt, alongside the lateral
face of the tendons,a little above
the fetlock. If the swelling
prevent its detection, the line
of the incision shall be made
along the border of the cylin-
drical mass formed by the ten-
dons. The region prepared,
the skin and cellular tissue are
divided (2^-2 to 3 centimeters
long) ; the nerve is isolated
with the bistouri or the grooved
director ; taken hold off with
forceps, the bistouri is intro-
duced underneath it with sharp edge turned upwards, and the nerve
divided towards the superior extremity of the incision ; the free portion of
the nerve is then amputated below. The wound is closed with one or two
stitches, covered with collodion and a wadded dressing.
Some horses, as soon as up, are free from lameness ; in others, this
does not disappear except by degrees. When asepsy has been used there
is no complication to fear ; cicatrization takes place rapidly. Sometimes
the lameness is only reduced, which is due to the recurrent sensibil-
ity or a stiffness of the articulations ; in these cases double or low neuro-
tomy is indicated. It must be double where there are phalangeal peri-
Fig, no. — High neurotomy,
vein ; a, artery.
n, nerve i y,
EXOSTOSIS. 485
ostosis or sidebones on both sides. The patient must be left to rest one
month to six weeks, and the senseless foot must be watched for the
traumatic lesions that may occur in it. If the foot affected with exostosis
is the seat of acute symptoms, neurotomy is to be postponed until these
have subsided.
Renault in 1831 already mentioned the advantages of this neurotomy.
Rey says he has used it often and obtained many satisfactory results with
it (1867). Yet its use did not spread. It was accused of promoting soft-
ening of tendons (Goubaux), producing slough of the foot. In 1881-83
Nocard rehabilitated its use. He obtained many successes with it and never
had an accident. Yet, he performed it on both sides, taking all necessary
precaution ; such as : operate on legs free from acute inflammation of the
feet, give the animal from five to six weeks of rest afterward, remove only
a short piece of nerve, about one centimeter, so as to obtain as quick as
possible nervous regeneration, which returns to the leg a portion of its
sensibility.
Many practitioners, Trasbot, Benjamin, Jacoulet among them, have
been less fortunate. With them, high and double neurotomy has been
followed with diffuse gangrenous inflammation and slough of the hoof.
Even if performed on one side, it has not been entirely harmless. It is
true, these accidents are exceptional ; and the fact must not be lost sight
of that the operation is performed only on patients that have resisted
all treatments and were useless. Therefore, notwithstanding the compli-
cation of sloughings of the foot with which the operation is credited,
we never have hesitation in performing it for large unilateral exostosis,
rather than to lose time with useless cauterization.
Let us add that contraction of the heels, which so frequently compli-
cates the disease, often disappears after a few months, through the free
function of the extremity. Nocard and Mollereau have shown that after
the operation, the side of the exostosis sometimes diminishes in large pro-
portions. In a horse treated by them, the bony tumor had, after six
months, lost more than half its dimensions.
High, single or double neurotomy, is not the only one that can be used,
Peters, Goldmann, Blanchard have obtained good results with tnedian
7ieurotomy. Sensibility is not abolished in the external half of the foot ;
still, most commonly, lameness subsides.
With phalangeal exostosis of the hind leg, high or again sciatic neu-
rotomy is indicated, when firing has failed.
These exostosis sometimes occur upon the anterior and lateral faces of
the toes of cattle (Cruzel, Faulon). As in the horse, they are due to efforts
or traumatisms. Generally they are only on one toe, and give rise to
lameness, hence their seriousness.
484 VETERINARY SURGICAL THERAPEUTICS.
At first, cold applications are resorted to (continued irrigation, cold
or astringent compresses). Later, blisterings, specially with the bichro-
mate of potass (2 to 4 parts in 30), fine points of needles cauterization.
Often, by simple change in shoeing, the lameness can be relieved and the
animal be able to do his work or be fattened (Faulon). To this effect, the
diseased toe is relieved from carrying weight ; the height of the hoof is
reduced by paring it low, no shoe is put on that side ; while on the con-
trary the hoof of the sound side is left untouched, and a pad of leather
placed between it and the shoe. It is prudent to exercise the animal
for some time on soft ground. In some cases, like Gutteridge, neurotomy
has to be performed.
VIII.
RACHITISM.
This expression must be reserved to name the softening of bones in young
animals, and that of osteomalacia for the same alterations occurring in adults.
These two morbid conditions seem to have similar causes and the differ-
ences observed in the lesions depend invariably on the condition of de-
velopment of the diseased bones ; in osteomalacia, the bone, already cal-
cified, loses all its lime salts which are taken up by the circulation and
eliminated, while the alterations in rachitism are the result of an insuf-
iicient calcification.
Relatively frequent in young dogs and pigs, rachitism is observed some-
times in colts, calves, sheep, wild carnivora kept in captivity (lion, tiger),
monkeys and gallinacious. The special conformation of the members of
some species of dogs (the basset), considered by Daubenton as the result of
rachitism, arrested in its progress and afterwards transmitted by heredity, is
no longer considered as pathological, but as a character special to this
breed. Yet rachitism is frequent in dogs, specially the Danish. Young
pigs of improved breeds (English and other crossings) seem predisposed
to it. Ordinarily the disease is manifested by general symptoms and
local troubles. The alterations of bones vary much. On the extremi-
ties, epiphysar swellings are observed, the bones are bent ; the front legs,
deviated forwards, backwards, outwards or inwards, assume special aspect.
The vertebral column may be curved upwards (cyphosis) or downwards
(lordosis) or sideways (scoliosis). Bony growths are sometimes seen at
the union of the ribs and their cartilage (rachitic bead) or on the sternum
(chicken chest). The bones of the cranium present in some cases fon-
tanels. In pigs and young goats, the maxillaries are swollen. The same
occurs in horses. The case of Laquerriere, was that of a four years
old horse, in which both jaws were affected. The little mare men-
tioned by Soula was affected when three years old. The branches of
RACHITISM
485
the lower maxillary had lost their consistency ; the superiors were swollen.
Mastication was impossible, in a three-year-old mare seen by Benjamin
:and Redon.
The pathogeny of rachitism is yet obscure. L. Lafosse accuses bad
hygienic conditions, damp habitations, those badly kept, exposed to the
north where sunlight never goes. Feeding with fodder poor in calcareous
substances has been incriminated. Guerin, Roloff, Voit, Chossat,
Milne, Edwards, have produced it artificially in dogs and pigs, by sub-
mitting them to a regime poor in lime salts. But Tripier and Weiske,
who renewed the same experiments, failed in obtaining the same results.
For some authors, Heitzmann among them, the rachitic bone is decalci-
fied by lactic or phosphoric acid ; the administration of the first by the
digestive canal and in subcutaneous injec-
tions has produced the disease in young
â– carnivora (dogs and cats). The negative
experiments of Toussaint and Tripier
upset this theory. Is rachitism the result
of an inflammation of the bone? and
does phosphorus, recommended by Kas-
sowitz, give rise really to a beneficial in-
flammatory work ? Is there always, at the
beginning of the disease, dilatation of
the stomach and digestive troubles, as
said by Comby? Those are as many
unanswered questions of the day. Rach-
itism is after all but the result of a unique
cause ; it is the result of a " degeneration
â– with numerous causes." All that which
Aveakens a young subject, that disturbs its
nutrition, favors the softening of bone,
in/asion of the disease occurs with the time of weaning ; hence the indi-
cations not to deprive the young subjects too early of the mother's milk,
which alone possesses the digestible qualities necessary to the stomach of
the newly born. Potatoes in great quantity predispose pigs to rachitism.
Roll has seen it in young lions fed with meat, free from bone. The same
has been observed in dogs.^ " The too simple uniformity in food free
from condiments, and specially want of outdoor exercise and natural light.
Fig. Ill — Rachitic goat. (From a
photograph.)
Lafosse has remarked that the
1 On two occasions, the translator had the opportunity to witness corroboration
of the remark of Roll. A large litter of cubs being left to a lioness to nurse, the
little fellows became rachitic after being weaned and being fed with boneless meat.
Most of them died except two which were fed artificially with plenty of bone dust,
but they remained always deformed, and more or less weak.
486 VETERINARY SURGICAL THERAPEUTICS.
seemed to have played a prominent part in several cases that I have
observed in dogs and goats." (Trasbot.)
The prophylaxy is indicated by the consideration of those etiological-
conditions. The hygiene and the good quahty of the food should be
watched. A diet as rich as possible should be prescribed. To palliate
the insufficiency in the proportion of phosphate of lime, a greater quantity
of grain should be given in each ration. If diarrhoea occurs, the ordinary
treatment is indicated.
The curative treatment is complicated. It is proper to prescribe the
soluble preparations of lime, specially the chlorhydro-phosphate or the
lacto-phosphate. In syrup shape, these preparations are given in doses
of two or three tablespoons a day for a dog of middle size. As adjunct,
bone dust, in two or three tablespoons according to cases, should be given.
But Springer has shown that mineral substances, to be utilized by the
organism, must be combined with the treatment. Phosphate of lime
obtained from the mineral kingdom, as well as the phosphates of bones,
can not be absorbed ; they can be found entire in the faeces. The
author advises a decoction of cereals of which he gives the formula :
Place in four litres of water, two tablespoonfuls of each of the following :
wheat, oats, barley, rye, bran, corn ; boil them for three hours, filter and
add water to make a litre. ^ This decoction may be used for all animals,
specially for dogs. For herbivora it is better to give the grains in
nature. Since Bretonneau, cod-liver oil has been recommended by nu-
merous practitioners ; it is an analeptic tonic containing iodine and phos-
phorus. In dogS; the dose is one or two tablespoonfuls a day. Kassowitz
has recommended phosphorus (i milligram a day for dogs, i to 5 centi-
grams for large size colts.) It could be given dissolved in sweet or cod-
liver oil :
Cod-liver oil 100 gramme.
Phosphorus ........ i centigramme.
All that can brace the appetite and stimulate nutrition must be used.
Iron-tonics, quinine, gentian, are to be recommended. Salt is very good
for sheep and calves.
L. Lafosse advocated blistering applications upon the swelling of the
head and irritating frictions (alcohol and spirits of turpentine) on the
legs. To prevent the deformity of the bones of the legs, he also advised,
at the beginning of the disease, the application of splints or plasters. The
general treatment is far the most important.
When improvement begins, the lame patient gets up more willingly and
walkSjthe appetite returns ; the bones that were flexible, harden, but remaia
^ Springer, Semaine Medicale, 1894, p. 393.
OSTEOMALACIA — OSTEOCLASTIA — OSTEOPOROSIS. 487
"tent; however, it frequently happens that aft^r a certain time, by regular
exercise and good diet, the deviations of the bones disappear almost com-
pletely. As soon as the bony nutrition is reestablished, at both extrem-
ities of the bent diaphysis, the bone grows straight, the periostic ap-
positions take place most exclusively in the concavity of the diaphysis, to
such an extent that after complete development, the bone has a normal
shape.
When, on the contrary, a deformity remains upon one of the bones of
the extremities, there is no hope to straighten it except by osteoclasia or
osteotomy ; operations which will never enter in our surgery. What is
difficult, is not to break up the bone — the osteoclasts of Colin and Robin
answer that purpose (osteoclasia), — or to divide it with shears after inci-
sion of the skin (osteotomy) ; but to keep them in good position. Our
patients are restless, they constantly move and displace their dressings ;
the regular union of the separated ends would be uncertain. Therefore,
with them, the treatment of rachitism is almost exclusively medical.
Rachitism is not very rare in birds kept in captivity or domesticity (Lar-
cher, M^gnin.) It is observed specially in chickens, pheasants, turkeys,
pigeons, ducks, geese and blackbirds. It appears ordinarily in the first
months of life. Sometimes all the bones are affected, at others it is
limited to a few, habitually to the bones of the trunk (vertebrae, ribs,
rsternum, pelvis.) Life outside, strengthening diet, stimulating frictions of
the legs (alcohol, hot wine), such is the treatment to follow.
IX.
OSTEOMALACIA— OSTEOCLASTIA— OSTEOPOROSIS.
Some authors describe in special chapters osteo?naIacia, osieoclastia
and osteoporosis. Osteomalacia, seen in horses, dogs, and goats, is
characterized, as we have said, by the softening of bones in adult sub-
jects. In osteoclastia, special to bovines, there is no softening, no de-
formation of bones ; the spongy substance is partly resorbed and the med-
ullary canal increased. Osteoporosis consists specially in a dilatation of
the Haversian canals with resorption of the compact bony substance.
•Germain has observed this affection upon our horses in Cochinchina, with
an enzootic character. Most pathologists, with Friedberger and Frohner,
make no difference in those affections ; they consider them only as mor-
bid forms having causes of similar order, from which at last results an abnor-
mal fragility of the bony tissue, due to the resorption of its spongy, of its
•compact substance or of its calcareous salts. This fragility is principally
observed in bovines (cachexia ossifraga.)
The disease begins either by rheumatismal pains or by synovitis : these
488 VETERINARY SURGICAL THERAPEUTICS.
were frequently seen by Germ*ain. After a certain length of time, the
maxillaries become thick ; the face is swollen, its normal shape gives place
to a more or less marked enlargement. Respiration and specially masti-
cation becomes difficult. The subject dies in a state of marasmus. The
different bones of the legs do not present any malformation during the
life of the animal. In cattle, the head is rarely affected ; the legs are,
more commonly, and on that account the animal assumes the decubital
position. With a capricious and diminished appetite, there is paresis of