treatment started early, it can be avoided.
534 VETERINARY SURGICAL THERAPEUTICS.
In the preceding chapter, we have indicated the various therapeutic;
means employed during this century to treat articular wounds and
traumatic arthritis: bleeding, diet, emollients, dressings with tintcure of
aloes, camphorated preparations, alum, tannin, sulphate of copper, blis-
ters, caustics, firing, continued irrigation, aegyptiacum, glycerine, cau-
terization of the fistula, lines or points cauterization. The greater
part of these methods have been left aside.
Antiseptic injections and blistering applications or continued irriga-
tion remain the practical treatments to oppose to traumatic arthritis at its
beginning. During recent years, facts have multiplied which demon-
strate the superiority of antisepsy, for traumatic arthritis as well as for
recent articular wounds. When the wounded synovial is the seat of an
infectious inflammation, injections and antiseptic irrigations are far sup-
erior to the methods or the agents of old therapeutics, not excepting
caustics or aegyptiacum.
If already the infectious lesions are deep, if the synovial is much
thickened and granulating, if the cartilages are on the road to destruction,
all hopes to save the joint its normal mobility must be banished.
Nevertheless, antiseptics will diminish the general disturbance, conjure
infectious and putrid infections and assist ankylosis â€” relatively for-
tunate termination for certain categories of wounded (breeding or small
animals.) They may do more, at the beginning of the articular phlo-
gosis. The synovial alone is infected, sometimes only in a part of its
extent, the synovia is but little modified in its properties, the cartilages
are still with their normal polish ; recovery is possible. If a little stiff-
ness and swelling of the joint remain, massage, blisters, or cauterization
should be resorted to.
One must not be afraid to enlarge a narrow wound, to permit injec-
tions and washings to be made more easily, more complete and active.
Mauri, Labat and others have related facts which show beyond doubt the
beneficial action of sublimate. In the first case of Mauri, it was a mare,
which, in falling, had opened her right fore fetlock. Ten days after,
notwithstanding astringents and camphorated preparations, "the animal
grew worse and worse. She moves with difficulty, on three legs, in her
box ; she sufifers a great deal from her lame leg. The swelling of the
joint is hot, exceedingly painful; the edges of the wound are swollen ;
the synovial, reddish-yellow, escapes in abundance ; it coagulates in
large clots on the anterior face of the first phalanx and exliales a pecu-
liar, characteristic foetid odor. The swelling has spread to the lower
part of the fetlock ; lymphatic cords starting from the diseased region
extend towards the superior parts of the leg." A blister was ap-
plied on the joint and injections of Van Swieten were made in the fistu-
TRAUMATIC ARTHRITIS. 535
lous tract. Seven days later, the synovial discharge had stopped, the
fistula obliterated, the animal was gay. During a week, burnt alum
was applied on the granulations to keep them under control. A few
running water baths completed the recovery.'
Immobilization is important. By means varying according to cases
(wadded dressing with or without plastered bandage, blisters, hobbles,
slings) the movements of the joint must be limited as much as possible.
When arthritis runs its course, treatment is very long. Fistulas must
he freely enlarged, abscesses punctured, irrigations abundant. Often
the suppuration lasts for weeks, sometimes months, and numerous
patients, exhausted by the pains, covered with bed-sores, succumb to the
For the study of the traumatic lesions of joints individuall}^ we have
â– not sepcLrs.ted the />eHetratwg wount^s horn art/in'ts. It would seem, a
_priori, that in the three, four or five days following the opening of a
synovial, this must be invaded by purulent phlegmasia, and quite
numerous observations are found of rapid recovery in synovial wounds
-of eight, ten and fifteen days ; on the other hand, the general phenom-
â€¢ena and the lameness are not absolutely characteristic of arthritis.
The grouping of the observations would have been difficult, even arbi-
trary, for many among them. To consider separately articular wounds,
and in particular arthritis, would have been of no advantage in the prac-
tical point of view.
Articular Wounds and Traumatic Arthritis of Extremities.
/. â€” Scapulo-Hunieral Jomt.
Penetrating wounds of the scapulo-humeral joint are rare. For many-
observations, positive diagnosis was not made, the lesions of the bicep>-
ital groove not being distinguished from those of the joint itself. Rey
has mentioned two cases where recovery was obtained with sublimate
corrosive ; one was published by Schaack, the other by Pierre. This
last author introduced in the wound a tent covered with populeum and
dusted it with sublimate ; a second application two days after ; six days
later, the synovia escaped no longer ; after six weeks the horse was
cured. Romant, having a mule to treat which presented on the exter-
nal face of the right shoulder-joint, a little back of the most prominent
part of the angle of the shoulder, a deep transversal wound, with synovia
escaping, covered the region with a blister, and applied a little subli-
mate every day on the wound. After three days, a thick scab was
â€¢ 1 Mauriâ€” Rev. Vet., 1SS9, p. 62.
536 VETERINARY SURGICAL THERAPEUTICS.
formed, the synovia stopped running, the swelling and the lameness had
disappeared. Fifteen days later, recovery was complete. With injec-
tions of perchloride of iron, Leblanc stopped a synovial discharge of the
shoulder in eight days.
In our day, one must resort to antisepsy to prevent the infectioa
of the joint. Called for a recent wound, the veterinarian should
disinfect it with solution of sublimate, phenic acid or cresyl. If it is a
prick, it will be closed with iodoformed or sublimated collodion. Large
Avounds should be reduced by stitches on their upper angle and covered
with iodoform or a plaster of sublimate. If already the infection is pro-
duced, if the synovia runs purulent, by a free incision the joint must be
opened and irrigations made with Van Swieten fluid. Most generally it
is better to destroy the animal. As remarked by Mitaut, scapulo-hu-
meral arthritis seems, indeed, to be one of the most severe of the ex-
//. â€” Uumero-Radio- Cubital Joint.
According to Percivall, penetrating wounds of the elbow must be
classed among the most rebel. Rey says that they are those which
have seemed to be most dangerous. Mitaut has never cured any. Still,
some successes are recorded.
Mercier has related the case of a horse suffering with a deep wound
of the external face of the joint ; there existed a narrow fistula, with
escape of synovia ; the wound was cauterized with the red iron, so as
to form a superficial eschar ; recovery was obtained in two weeks. The
patient of Pauleau presented alarming symptoms. After the prick of a
fork in the elbow there occurred a large swelling, warm, very painful,
and accompanied with high febrile reaction; a few days after a rough
surface could be seen on the humerus and radius at the bottom of the
â– wound. The diseased bony surfaces were cauterized and frequent
injections of tincture of aloes were made in the joint ; recovery took
place after a long time. A few successes have been obtained by Tisser-
ant with emollients and blisters ; by Rey with the red iron, and Rabel
water ; by Delorme with sublimate. The first observation of Verrier re-
lates to a penetrating wound of the elbow produced by a kick. The horse
was very lame, a warm and painful swelling extending from the middle
part of the arm to the elbow ; fever was high ; synovia escaped in clots,
through the wound. During twenty-one days, emollients, tincture of
aloes and cauterization were successively employed, all in vain. In
two weeks, with aegyptiacum introduced three times a day in the fistula,,
the synovial discharge was stopped and the lameness removed. Again
with aegyptiacum, Salle obtained the recovery in a month, without blem-
TRAUMATIC ARTHRITIS. 537
ish or lameness, of an open elbow which had been treated for five
weeks by blisterings and injections of all kinds.
Continued irrigation has given a recovery to Trasbot. It was a
horse which presented at the upper part of the forearm an oval wound
measuring from five to six centimeters in its transversal diameter. This
wound, oblique backwards and inwards, was ten or twelve centimeters
deep, reached to the external side of the elbow joint. During four days
cleaning and antiputrid injections were made, but the swelling of the
joint became enormous and the discharge of synovia abundant. Digital
exploration discovered the rupture of the external lateral ligament. An
S probe was easily introduced in the articulation. A counter-opening
was made about twelve centimeters back of the external wound, a drain
tube introduced into the new tract made and continued irrigation
started. Ten days after the synovial discharge had stopped, the fever
subsided and the lameness gone. Hydrotherapy does not always
succeed as well : we had two occasions to use it and two failures to
When one is called to a recent penetrating wound of the elbow, and
the local disorders do not impose the immediate condemnation of
the patient, antisepsy is the treatment to choose. The wound and its
surroundings shall be disinfected, and the clots of blood, the hair and
foreign bodies removed ; it will be irrigated freely with tepid Van
Swieten fluid, and covered with collodion coating and a wide wadded
dressing, held in place by rollers crossed over the withers and in the
axilla. Instead of this dressing, an application of blisters can be re-
If the wound is infected, there is but little chance of recovery.
Wherever is the seat of the wound, injected fluids cannot penetrate deep
enough, and disinfection of the joint is impossible. After free incision,
it is again injections of tepid Van Swieten solution that must be used.
When, after eight or ten days of treatment, the discharge of synovia is
still purulent, the whole articulation is swollen and the general symp-
toms aggravated, the animal ought to be destroyed.
///. â€” Knee-joint.
Traumatic lesions of carpal joints are almost always the result of falls
on the anterior legs. In front and behind those joints, there are tendons
provided with special synovial sheaths ; the escape of synovia, in wound
of the knee, is not then a positive sign of the opening of the articular
synovial. Penetrating wounds of the anterior face of the knee are less
dangerous than those of the posterior. According to Trasbot, this dif-
538 VETERINARY SURGICAL THERAPEUTICS.
ference is due specially to the fact that the capsular ligament is more
organized and apt to become vascular and granulate than ordinary fibrous
tissue ; it is also on account of the greater anatomical complexity of the
posterior carpal region.
A great number of treatments have been used with success. In several
cases of recent articular wounds antiphlogistic treatment has given good
recoveries to Corroy and Auboyer. The animal treated by Corroy had
fallen going down a hill, and after the accident had been obliged to
travel, trotting or galloping, eight leagues. The synovial capsula was
open in two places, the bones widely exposed. Recovery was obtained
in eighteen days ; the lameness disappeared entirely. With Pressecq,
other practitioners added to that treatment the cauterization of the bones
exposed. Coagulating agents and caustics have been recommended :
Mercier has related two cases of recovery with Rabel water ; Causse
twenty-two with tannin ; Guilmot a few with starched bandage ; Mazzini
five with plastered dressings ; Key two with sublimate. Nitrate of silver
has often succeeded with Barthe. Mitaut has recommended blistering
applications on the diseased joint ; Cagnat, slight and repeated cauteriza-
tion of the wound with caustic tar.
Verrier has had several successes with aegyptiacum. His case of
Observation IV was a fearfully broken knee ; the wound involved the
skin, the cellular tissue, tendons, capsular ligament and the anterior part
of the carpal bones ; there was high fever and great pain. After
bleeding and emollient poultices, sprinkled with decoction of poppy
heads, which gave no results, aegyptiacum was used : in ten days the
recovery was certain. There remained but a superficial wound, and the
lameness had disappeared. The same result was obtained with Observa-
tion V. The horse treated by Robert was in the worst condition, when
aegyptiacum was resorted to : recovery was rapid. Royer and other
military veterinarians have published similar results.
Although cold water in continued irrigation is a practical means, highly
recommended, immobilization should be preferred to it under a wadded
iodoform dressing. The wound ordinarily contains gravel, earth ; the
tissues are bruised and ragged : wash with boiled water, then a strong
antiseptic solution, apply a coat of iodoform and a wadded dressing.
With padded splints or frames applied upon the lateral and posterior
faces of the knee, it is easy to bind, in a great measure, the movements
of the joint. Already Mercier had recommended immobilization. " Take
five strong laths, cut them the length of the leg, apply four straps with
buckles on one of their faces at even distances, wrap the laths with
oakum and lay the apparatus round the injured region. With one of
those bandages, the leg is kept constantly in extension and the joint in
TRAUMATIC ARTHRITIS. 539
immobility." ' Three padded splints can be applied, extending from
the middle of the forearm to that of the cannon, being held in place by
dextrined rollers or straps with buckles. A blister upon the lateral face
of the hock is also a simple and useful means of immobilization.
When suppurative inflammation has invaded the articular synovial,
the " game must not be considered as lost," as Barreau did, although
the prognosis is most serious. Instead of any of the treatments pro-
posed, antisepsis and blisterings will be preferred. Subjects of little
value should be destroyed.
Sometimes the knee remains large, wrinkled, and a lameness remains,
varying in its severity : cauterization must be used, or median neuro-
/ V. â€” Fevioro-Tibio-PatcIIar Joint.
Deep wounds of this articulation are common. According to Rey,
they are the most frequent of all articular wounds observed among
solipeds ; they are also the least serious. Treated early, when the synovia
is not yet purulent or the infection of the synovial is neither diffused or
deep, they ordinarily close rapidly. Often a blister has been sufficient
to obtain a recovery, as shown by the observations of Tisserant, Delorme
and Rey. Out of twenty horses treated by Rey, eighteen were cured
by blister and one by sublimate ; only one died. And yet the symptoms
seemed at times very serious. The mare of Observation II had re-
ceived, eight days before, a kick on the external face of the thigh ; a
large swelling had formed, which had been punctured. When Rey saw
the patient, the articulation was hot, painful, the swelling extended down
to the hock, the synovial discharge was abundant. Two frictions of
blisters were made, twenty-four hours apart ; after nine days the mare was
entirely cured. In the Observation III, it was a mare injured two weeks
previously : a kick had opened the femoro-patellar joint. A blister
having failed, a trochiscus of sublimate corrosive was introduced into
the fistula ; eight days later, it was obliterated. Superficial cauteriza-
tion of the wound (Dubois), tannin (Causse), have also obtained cures.
Many successes have been related by the use of continued cold water
irrigation. Let us mention specially those of Sepulchre, Barreau, Eloire.
The observation of this last author is that of a horse that had fallen in
going down a stiff hill and had been dragged by the vehicle. The stifle
presented a wound large enough to admit the fist. " It left exposed on
the right the internal vastus, which has received the shock almost alone ;
on the left, the tendon of insertion of the long abductor of the leg, some
1 Mercier, Rec. de Med. Vet., 1840, p. 461.
540 VETERINARY SURGICAL THERAPEUTICS.
centimeters above the point where it is inserted upon the internal patellar
ligament ; at the bottom and between these muscles, some centimeters-
deep, the right articular surfaces of the corresponding condyle of the
femur, as well as the anterior face of the right inter-articular meniscus,
could be recognized, and then above and in front the patella.
" From the gaping wound, which widened transversely when the
leg was flexed, abundant discharge of synovia escaped, spreading over
the surface of the leg and there coagulating." * Submitted to irrigations
of cold water, to which was added a weak proportion of sub-acetate of
lead and phenic acid, the patient recovered rapidly.
It is to careful disinfection of the trauma that one must resort at first
in all cases. A few stitches of suture and a drain are sometimes neces-
sary. Wadded dressing being difficult to apply in that region, the
Avound should be closed with iodoformed collodion (Michotte), a plaster
of sublimate or a strong blister. With large wounds, antiseptic injections-
V. â€” Hock /omt
The extreme severe nature of deep wounds of the hock is due both
to the anatomical complexity of the hock, and to the frequency and
extent of its movements. Let us mention the few successes obtained
by antiphlogistic treatment (Corroy, Auboyer), by cauterization of the
fistulas (Desmoulieres, Arnal, Feuvrier), witli tannin (Causse), cam-
phorated paste (Delwart), starched bandage (Guilmot), Rabel water,
Plasse's caustic (Mares) Rey with a deep wound of the internal face
of the hock, made by a nail, applied as many as six cauterizations with
sublimate ; the horse recovered. Blisters, advised by Tisserant and
Rey, Pjave often been used in connection with the caustics introduced
into the fistulas. In Saussol's case, the synovial was open, on the inside
of the leg, with a wound one centimeter wide : the ragged edges were
smoothed over with scissors, a twisted suture put on, and a coat of
mustard and vinegar was applied on the whole internal face of the
region. In twenty days, the animal resumed work. Duvieusart treated
with cold water a deep wound of the hock, through which the finger
could readily enter the joint, and which was already accompanied with
febrile reaction and marked general symptoms. Recovery was complete
in a month.
^gyptiacum has been no less advantageous than with the other joints.
In a serious wound of the hock, which had remained rebel to emollient and.
P.abel water, Verrier obtained recovery in ten days. In Observation I^
1 Eloire, Archives Veterin., 1S78, p. 609.
TRAUMATIC ARTHRITIS. 54I
of Salle, it was a mare that, from a kick on the antero-internal face of the
hock, had the joint opened. Ten days of eegyptiacum treatment brought
on recovery. Let us also mention the cures obtained by repeated in-
jections of glycerine in the fistulas.
But with all these treatments, failures have been numerous. Anti-
septic means ought to be preferred. Sublimate or nitrate of silver in-
troduced in the fistula (Barthe, Ribaud) are not as good as injections of
With extensive wounds, after disinfection, the edges must be brought
together with few sutures.
If already inflammation has spread to the synovial, again antiseptic
irritation must be preferred. When there are bony lesions, as in the
case of Barreau, where the cuboid was fractured, no treatment ought to be
VI. â€” Fetlock Joint.
This articulation is one of the most exposed to injuries. With emol-
lients, Gelle has obtained the cicatrization of a deep wound of the fetlock
produced with a prick of a fork. In the case of Corroy, emollients and
tincture of aloes dressings also brought on recovery. .Pretot treated
with baths and dressings of tincture of aloes an articular wound of the
fetlock, following too severe firing, and complicated with partial necrosis
of the first phalanx ; recovery was obtained in twenty-five days. With a
deep wound of the metacarpo-phalangeal joint, Feuvrier used first emol-
lients, afterwards lines firing all over the fetlock. In less than a month,
the horse resumed work.
In one of the observations of Rey, there was a large wound on the
anterior face of the fetlock with synovial discharge. The joint was very
painful and the leg swollen up to the hock. Several blistering applica-
tions were followed by radical recovery. Sublimate has also given ex-
cellent results. In the Observation III of Rey, there was a deep wound
of the right hind fetlock, with purulent synovial discharge ; in eleven
days he was cured with three successive applications of sublimate.
Observation IV presented, on the left anterior fetlock, a bruised wound,
15 centimeters long and 10 wide, complicated with open joint ; three
applications of sublimate arrested the synovial flow. In the case of
Knoll, it was a horse which had a wide deep wound of the left fore fet-
lock, the joint and the great sesamoid sheath were open. After trying
emollients for fifteen days, sublimate was resorted to, and the wound
healed in twenty days. Guilmot has advocated starched dressing.
Observations II, III, IV and VIII of his report, relate to the fetlock
joint. In the first, a two-year-colt had it opened with the rope of his
542 VETERINARY SURGICAL THERAPEUTICS.
halter ; the wound was wide, the articular surfaces could be felt with the
finger ; tight linen rollers coated with starch were applied from the
pasterns to the knee ; after a month, the horse worked. In Observation
VIII it was a cow which had one of her metacarpo-phalangeal joints
opened with a hook. The treatment was begun the fifteenth day. A
splinter was first removed, a starched bandage applied ; nineteen days
after, the wound was all healed.
Continued irrigation has its part of success (Duvieusart, Arnal,
Sinoir). In Sinoir's case, the deep wound existed for a week, the
lameness was very great, and the fever high. In a few days, irrigation
brought on the closing of the synovial wound. In the report of Verrier,
recoveries by aegyptiacum are mentioned, which were obtained no less
rapidly. Observation II was a peculiarly serious case. After enlarging
of the wound and segyptiacum injections made three times a day,
recovery' occurred in two weeks. Many other successes were obtained
â– with the same agent. More recently, Aureggio has related cases of
cures by injections or dressings of glycerine.
For arthritis of the fetlock, as for others, all those treatments must
make room for antisepsy. A recent wound should be irrigated with
tepid Van Swieten solution, then covered with an iodoformed wadded
dressing. One of us has published the excellent results obtained with
If already the articular infection exists, free incision of the wound
should be followed by frequent injections in the joint. Mauri and his
pupil Negre have recommended sublimate.
In the case of Mauri, a blister was applied upon the whole joint and
frequent injections of Van Swieten made in the fistula. The third day,
the discharge was already reduced ; the seventh, it had stopped en-
tirely ; the animal walked in its box, resting on the whole plantar sur-
face. With the patient treated by Negre, the same treatment was used
(blister and Van Swieten injections every two hours) ; recovery took
VII. â€” Phalangeal Joint.
Although deep wounds of the Jirst phalangeal ]omt are quite common,
only rare observations are related. In that of Mercier, published in
1826, the joint was open transversely for about one centimeter and a
half ; there was no standing on the leg. Dressings of compound
tincture of camphor brought on recovery in fifteen days. A horse
treated by Verrier had a wound of the anterior face of the pastern ; a
flap of skin had been torn, the joint was open. " Bleeding, baths^
poultices, then aegyptiacum, closed the wound in fourteen days." The
TRAUMATIC ARTHRITIS. 54$:;
lameness lasted a long time, " on account of the hard swelling which
surrounded the diseased region."
With recent wounds, disinfection and an antiseptic dressing constitute
the choicest treatment. When there is arthritis, it is often complicated