able losses. Observed in all species, it affects particularly colts, calves,,
lambs and young pigs. Up to about the middle of this century, it
killed about one-fifth of the suckling subjects (Lecoq). In the na-
tional haras of Wurtemberg, out of 187 colts that died during a period
of fifteen years, 85 were killed by this disease (Hering). Its frequency
has diminished with the progress of the hygiene of stables and barns,
but its mortality has not diminished in a sensible proportion ; it reaches
yet 70 to 80 per 100 of the subjects affected. And most of those that
survive remain witla chronic swellings of the joints or synovial dropsies^
with despairing tenacity ; hence the axiom of Norman breeders, " Lame
colt, lost colt " (Lecoq).
In the majority of cases, pyohemic arthritis occurs in the few days
following birth. Out of 67 colts treated by Hering, 47 (70 per 100)
died in the three first weeks of life.
No joint is exempt from it, but the hock, knee, stifle, elbow, hip and
shoulder, are those most commonly affected ; it is, however, quite fre-
quent on the fetlock, the coronet and the costal and intervertebral joints.
The invasion is sudden. Ordinarily preceded by general symptoms,
the articular tumefaction, warm, tense, painful, increases rapidly. Al-
most always several articulations are affected simultaneously. Death
may take place after twent3'-four or forty-eight hours, but in general the
march of the disease is not so rapid ; sometimes the inflamed regions
open and give escape to purulent synovia.
Few diseases have had an etiology and therapeutics so changeable ;
few have given rise to so many erroneous conceptions. There have been
successively accused : the change of regime imposed on the mother
1 Patileau : Rec. de Med. Vet., 1869, p. 435.
INFECTIOUS ARTHRITIS. 553
towards the end of gestation (Lecoq), the bad quality of the milk and
the privation of the colostrum (Darreau), heredity, exposures to cold
(Delafond), insufficient feeding (Roloff) . . . and even as far as the
persistency of the foramen of Botal ! Bollinger was the first to consider
the disease as an infection having its origin in the inflamed suppurative
umbilical cord. The infection of the wound of the umbilicus, through the
putrid decomposition of products covering the soil of stables or barns, was
the starting-point of the morbid process. Bollinger mentioned as predis-
posing conditions : the puUings of the umbilical blood-vessels at the
time the cord is torn, its rupture on a point too near the abdomen, the
contusions of the umbilical wound, traumatisms of the abdominal walls?
and, lastly, birth during a cold season. The long sojourn of animals in
stable, increases in it the proportion of putrid matters, and thus pro-
motes the infection of the umbilical wound.
Morot reconsidered this etiology in 1884. For him, the cause of all
the trouble is the persistence of the urachus ; it is the pouring of the
urine, which ferments, becomes irritating, and afterwards brings on the
inflammation of this canal and omphalo-phlebitis. He advises to treat
the urinary fistulas by cauterization or ligature. By leaving a certain
length to the cord, and protecting it from injurious contact by a linen
bandage, these fistulas are prevented. Chassaing claims that exudative
and purulent arthritis are two distinct diseases. The first is due to a
sickly condition of the mother and the bad quality of the milk, while the
second is caused by the inflammation of the urachus or of the umbilical
vein, as taught by Bollinger. Cagny insists in believing that umbilical
phlebitis and arthritis of young animals are two distinct affections ; he
finds them very different in their march, and it is only exceptionally
that they have been observed on the same animal ; for him, umbilical
phlebitis is followed by death in the eight days following birth, before
the appearance of the articular symptoms, while the arthritis has a
slower march, attacks successively various articulations, and in general
kills only after complete cicatrization of the umbilical vein. But these
numerous forms of the disease, these differences observed in its malig-
nancy and march, seem to be the result of the diversity of micro-organisms
able to promote it, or of the degrees of virulence of its producing agent,
in admitting that this should be unique. It is considered as demon-
strated to-day that pyohemic polyarthritis of colts, calves, lambs and
young pigs is, as announced by Bollinger, a general infectious dis-
ease, beginning by a phlegmasia of the umbilical cord and produced
by the agents of this inflammation, principally by the streptococcus vul-
garis (Nocard, de St. Germain).
The treatment has considerably varied, according to the admitted
554 VETERINARY SURGICAL THERAPEUTICS.
pathogenic doctrine. Lecoq advised bleeding, repeated emollient
lotions, cold baths, lotions with sulphate of iron ; the mother was sub-
mitted to a severe diet, and the young one deprived of part of its
ration. Darreau praised purgatives (sulphate of soda, aloes), with
applications of populeum on the joints. The infectious theory of the
disease calls particularly the attention to its prophylaxy : avoid the
infection of the umbilical cord, purify it with strong antiseptic solution
if it is soiled ; keep the place where the animal is as clean as possible ;
such is the indication. Bollinger recommends to ligate the cord, assist
the cicatrization of the umbilical wound with antiseptics and apply on
the abdomen a protective bandage or more simply a coat of tar. The
stable should be well aired ; the faeces and dirty bedding removed often.
The curative treatment includes the disinfection of the umbilical
region (phenic or cresyled water) and the application on the wound of
antiseptic vaseline. Some practitioners continue to give purgatives
(sulphate of soda and cream of tartar); others antiseptics (calomel, salol,
napthol). Salicylate of soda (2 to 8 grammes) has little efifect. Stimu-
lants (alcohol, wine, cofTee) are indicated to sustain the patient. Against
the articular tumefactions, therapeutics can do but little. To the popu-
leum will be preferred vaseline, with or without antiseptic or narcotic sub-
stances. If suppuration occurs free exit must be allowed, by opening
the collection, and then treat with antiseptics. Muscular abscesses
demand the same means. But when such serious lesions exist it is more
economical to sacrifice the subject.
Against chronic articular swellings blisterings and cauterization will
be resorted to. As remarked by Darreau, those synovial tumors aie
ordinarily very difficult to remove.
VIII.
HYDARTHROSIS.
Dropsies of articular synovials have numerous causes — contusions,
luxations, sprains, peri-articular wounds, inflammations of joints. Often
during these affections the articular synovial " swells more or less pain-
fully " on its weak points through an effusion which takes place in its
cavity. Sometimes these phenomena gradually diminish and leave
nothing after them ; at others, the acute symptoms diminish and the
hydarthrosis remains. In animals used as motors, they are ordinarily
seen developing without noticeable inflammatory manifestations. Soft,
fluctuating tumors, painless, appear in some parts of the joint ; they
increase little by little, and at last give rise to lameness. Few horses,
used for a long time to hard work, are free from them. Let us remark
HYDARTHROSIS. 555
again that the joints in which motions are most active are also those
that are more affected. It is, indeed, in the fetlock, hock, knee and
stifle that they are most ordinarily observed. Lymphatism and heredity
have been incriminated as cause. Certainly there are animals in which
hydarthrosis occurs without being promoted by efforts, or hyperf unction
of joints, but, without contestation, exaggerated work is the great occa-
sional cause. Let us add that some dropsies have special causes. They
have been seen to appear during gestation, and disappear generally with
parturition, and without being serious. There are some which develop
after delivery, and are more serious than the preceding ones. Again,
various morbid conditions, general or infectious, particularly rheuma-
tism and distemper, may be accompanied by them.
At the onset of some hydarthroses are sometimes seen a little heat,
pain on palpation and a .slight lameness ; but in general the disease
develops slowly, without producing lameness at the beginning. Little
by little the synovial tumors enlarge, harden ; the " fluid, secreted in
abundance, may become the cause of a lameness resulting specially from
the obstacle its accumulation opposes to the free function of the joint.
At rest, the animal assumes a special position corresponding to the
capacity maxima of the serum. In old dropsies, with abundant effu-
sion, there is sometimes separation of the bony surfaces and a true lux-
ation takes place. At the autopsy of a horse suffering from an old lame-
ness of the hip, Vitet found " such relaxation in the coxo-femoral joint,
that the head of the femur would at times leave the cotyloid cavity and
return into it without difficulty."
With the exception of some rare cases, the diagnosis is easy. At
each joint the synovial makes hernia in special places, always the same ;
which permits the differentiation between hydarthrosis and hygromas and
â– dropsies of tendinous sheaths. Sometimes the clinical physiognomy is
modified by the presence of one or more septums in the dropsical serous.
The distentions of one cul-de-sac may be wanting or only slightly
accused.
The prophylaxy of hydarthrosis must be guided by the consideration
of the causes promoting them. Acute affections of joints (wounds, con-
tusions, sprains, luxations, arthritis) shall be treated according to the
indications we have presented ; the active function of the articulation
shall be avoided before the complete disappearance of the inflammatory
symptoms. The mfluence of exaggerated work, not in proportion with
the age, the resistance of the tissues, demands the methodical training
of young animals. A more judicious selection of the breeders is recom-
mended. " Males which are subject to hydarthrosis ought not properly
to be used for reproduction. Females affected with them must be served
5.56 VETERINARY SURGICAL THERAPEUTICS.
"by stallions with dense tissues. They ought to be used to breed mules.
Subjects born of parents affected with hydarthrosis ought to emigrate
towards dry localities. P'or them aqueous food is contra-indicated.
Feeding with oats, beans and the like is often sufficient to bring on the
disappearance of these affections. But it demands six months and some-
times years to reach this modification." '
The treatment varies according to the age and the degree of the
dropsy, the modifications of the synovial and of the tissues surrounding
it. Against recent hydarthrosis, a number of means are recommended.
Rest of the joint is always beneficial ; it stops the effusion and favors
the absorption of the synovia. Complete immobilization is impossible in
animals, and it is not necessary ; the subject is turned loose in a box or
in the field. Compressions, much used in stables of the rich, helps rest
with advantage. The joint is wrapped with linen or flannel roller from
"below upwards with quite strong compression ; this is increased by
wetting the roller before its application. To-day, especially for race-
horses, rubber stockings of various shapes are used. Some, passed
over the hoof, come to envelop exactly the diseased joint ; others are
laced with strings ; all have the advantage of resisting in a permanent
manner the dilatation of the synovial.
To compression astringents are frequently added : white lotions, styptic
solution, alcohol, tincture of camphor, poultices of clay, paste of com«
mon chalk diluted in vinegar. Cold water is yet, with immobilization,
massage and compression, the treatment par excellence of recent hydar-
throsis. Douches and baths in running water may be utilized. After
each seating of hydrotherapy the joint may be massed and enveloped
â– Avith a roller or a rubber stocking. Against hydarthrosis, aloes, sulphate
of soda, squill, colchicum, nitre, and all the series of diuretics have been
administered internally. These remedies have no action upon the
affected synovial serous.
When hydarthrosis have reached a certain size, these treatments are
no longer sufficient. More active measures are necessary. Blistering
applications are then indicated : tincture of cantharides, blister ointment,
English and French strong liniments, those of Geneau, Boyer, the topic
of James, the ointment of Lebas, that of Me're, those of biodide of
mercury or bichromate of potassa, and a mass of other preparations with
known or concealed composition, all have been recommended.
Even tincture of iodine, in frictions, has had its advocates. Delree
has praised it : " The treatment that I use has given me complete re-
coveries, without relapse, loss of hair, even in well-bred horses, with-
1 Iv. Eafosse, Pathol, vet. t. II, p. 616.
HYDARTHROSIS. 557
out leaving a blemish and without preventing the animals from doing
their regular work.
" The therapeutic agent that I use is iodine in the following for,
mula :
Tincture of iodine 100 grammes
Iodide of potassa 5 do
Distilled water 40 do
" The skin being well covered with this solution, and the hand pro-
tected, a friction of ten to fifteen minutes is made, and renewed twice a
day. After each friction, the skin is coated with a greasy substance
(lard or populeum),
" After a few days, the skin becomes parchment-like, the tumor
softens, diminishes little by little, and ordinarily disappears after four or
six weeks of treatment. I must, however, remark that it is hard to obtain
the complete disappearance when there are clots of synovia deposited
in the cavities." ^
In our hands, tincture of iodine has not proved itself superior to the
other counter-irritants, but the contrary. Delree has been obliged anyhow
to rub it twice a day for four to six weeks. Blisterings have given more
rapid and at least as satisfactory results. In our clinic we use almost
exclusively simple blister ointment, the mercurial or the bi-iodide of
mercury : their action is strong and without severe itching.
Blisters and tincture of iodine can be used alternately. " Often,"
says Lafosse, " after the use of a blister, I make the scabs drop by rub-
bing them with oil of iodine or an alterative ointment, then I prescribe
one friction of tincture of iodine for four or five mornings in succession,
to be done over again if the recovery is not complete." The same
author has obtained good results with plasters made of pitch, turpen-
tine and wax, applied warm over the synovial tumors. This treatment
produces derivation and immobilization ; it also makes a regular and
lasting compression over the synovial tumor, which is very beneficial.
The nature of the blistering agent has not the importance tliat lias been
attributed to it. A simple coating of the hair with a brush, by a blister,
gives little or no effect ; a stiff friction, properly made, will produce bene-
ficial results. From the sixth to the eighth day, hot-water lotions are
made to soften and wash off the scabs ; douches, massage, compres-
sion do the rest.
With large, old, indurated hydarthrosis, cauterization must be resorted
to. Instead of superficial points firing, we prefer that in lines, in fine
points or in needles. The accidents of arthritis spoken of are due, not
1 Delree, Annal de Med. Vet., 1864, p, 456.
558 VETERINARY SURGICAL THERAPEUTICS.
to the method, but the lack of abihty or of experience of those who use
it ; providing the points used are sufficiently fine, no accident is to be
feared, no more for articular synovial than others. With Paquelin and
Bourguet needle or the zoocautery, we pierce the synovial in its most
superficial parts ; the synovia escapes, the serum remains aseptic ; the
therapeutic effects are in general superior to those of superficial
cauterization ; the escape of a certain quantity of fluid is allowed, which,
with the other means, will be resorbed ; the heat carried in the synovial
produces beneficial changes and on the level of the punctures little
fibrous spots are formed whose retraction forms round the joint a true
contentive bandage of great power. Cauterization is the most used and
most practical treatment. It is certainly, as said Lafosse, " the truly
heroic treatment."
Efficacious as it is, firing is not infallible, — and it blemishes. On
that account, and specially for fine horses, other therapeutic means have
been looked for, to take its place. It is centuries since it has been
thought to give escape to that synovia, often thick, grumulous and
with difficulty resorbable. From time immemorial, Arabs opened the
thoroughpins of their horses with the red iron. Bruche (1826) punc-
tured hydarthrosis with the iron carried to white heat, and when they
were voluminous, he enveloped them with points of firing. From time
to time we yet meet with arthritis of the hock or the stifle, consecutive
to the opening of hydarthrosis with the cautery — an operation which is
still performed by horse-shoers and empirics. Already Garsault and
a number of others of the last century, passed, through thoroughpins,
setons animated with " ointment of scarabee." The puncture with the
bistouri has counted many convinced advocates. In 1826, Cross
addressed the Societe Ccntrale {f Agriculture with a paper on the
" Recovery of Dropsies by Puncture with the Bistouri." Dard, Roettger,
Fischer operated often that way and completed the operation by a band-
age and a blistering friction.
These primitive methods have caused many " disasters " : often they
promoted articular inflammation, which soon cools down the most
enthusiastic. To be useful and harmless, the puncture must be capillary
and made in conditions of perfect asepsy. The skin should be shaved,
washed, disinfected. On the prominent point of the hydarthrosis, the
aseptic trocar should be thrust in the synovial, by a sudden motion of
terebration. It is not necessary to make the puncture subcutaneously, in
which the instrument, after running through the skin, passes in the
cellular tissue, one or two centimeters, before entering the synovial. As
soon as the rod is taken off, the fluid escapes through the canula ; smalL
squeezes over the tumor stimulate the flow. With a Dieulafoy or a
HYDARTHROSIS. 559
Potain the serous is more completely emptied. The synovia returns
rapidly, but ordinarily in less quantity ; successes have been obtained
with simple repeated punctures. However, in the majority of cases,
puncture is completed by compression, blistering, cauterization or modi-
fying injections. We generally add to it the lines or deep points firing,
according to the seat and dimensions of the hydarthrosis.
To change the condition of the synovial, it has been injected with
various fluids. For a long time, the operation has seemed most dan-
gerous. Bouley said : " Knowing the alterations, often irretrievable,
that the inflammation may produce when it occurs in those parts, spe-
cially after a traumatic lesion, it is difficult to believe that injections, no
matter of what nature and how carefully they may be made, would
give rise to an inflammation limited only to the necessary degree
required to modify the secretion of the synovial membrane and still
remain unable to alter the structure of the parts." We will not give the
technic of the operation ; it is already done. (See Dropsies of Tendinous
Syjiovials). Among the agents used, tincture of iodine is the most in
vogue. Leblanc and Thierry, after experimenting with it on animals
and having obtained good results, recommended the injection of tincture
of iodine to the third (tincture i part, water 2), for hydarthrosis as well
as for tendinous sheaths. Serious accidents were soon recorded in
Alfort, by Bouley ; at Lyon, by Rey ; at Toulouse, by Lafosse, then by a
number of practitioners. These unfortunate results caused the iodine
injection for the treatment of hydarthrosis to be put aside ; but they
took place at the time when asepsy was ignored. With it, the method
succeeds.
Schede has made known the first successes obtained in man by the
articular washings with strong phenic acid. Many surgeons who employ
this method have found it excellent, and the operation of Schede has
received its " clinical consecration." The following observation of
Labbe deserves to be mentioned. A man thirty-one years old suffered
for seven years with hydarthrosis of the knee. When the author was
called, the articulation was enormous, distended by a great quantity of
fluid ; the muscles of the thigh were much atrophied. Puncture was
made with a large hydrocele trocar ; 4 liters of phenicated water, 5 p.
100, were used to wash the joint thoroughly; the puncture was closed
with collodion taffetas and the joint wrapped in a thick wadded bandage,
tighly applied ; the whole leg was held in immobility. Eighteen days
later, " the knee had resumed its normal aspect. The outlines of the joint
were as well marked as those of the healthy articulation, a condition
"which had not existed for seven years."
Sometimes a trocar of some large dimension has to be used to permit
560 VETERINARY SURGICAL THERAPEUTICS.
the escape of the clots that the iodine or phenic acid make with the
synovia, and which sometimes prevent the washing. So as to prevent
the coagulation, Nocard has recommended solutions of thymic acid
I or 2 p. 1000.
Starting from this fact, that ergotine and morphine " reduce secre-
tions," Laffitte has tried a mixture of equal parts of the two following
solutions :
Ergotine i gramm.
Distilled water 40 do
Muriate of morphia 0.50
Distilled water 35 do
Stottmeister has advised solution of eserine i p. 100 (5 to 10 grammes
to a dose).
After these modifying injections, moderate pressure (flannel, linen or
rubber) with immobilization, or a blistering friction, can be used. Like
Bassi, many practitioners prefer the blister to the bandage.
Against hydarthrosis which have resisted penetrating firing and modify-
ing injections, arthrotoiny can be resorted to. It comprehends the same
rules as synoviotomy. The region, material of operation, surgeon and
assistant must be thoroughly aseptic. Hemostasis is obtained with a
rubber cord. With an incision made parallel to the large vessels and
nerves, the synovia is allowed to escape, the false menbranes are removed,
and the synovial membrane carefully cleaned out. Sometimes a piece
of skin has to be excised on both edges of the wound. This is closed
by sutures ; a drain is left at the lower commissure ; and the region
covered with an antiseptic bandage, and immobilized as much as pos-
sible. This is a delicate operation, which exposes to most severe com-
plications, if asepsy has failed. Gunther and MoUer have condemned
it. Notwithstanding some late success, their judgment needs no
revision. We can only repeat what we have said on tendinous dropsies
in general ; in the ordinary circumstances of our medicine, if one does
not wish to run big risks, let him continue and prefer the cautery to the
bistouri ; leave arthrotomy to the virtuoso and the lover of cutting.
Let us resume the therapeutics of hydarthrosis. At the beginning,
prescribe rest, douches, cold baths, astringents, compression, massage.
If these fail, use blistering and again hydrotherapy and massage.
When the dropsy is abundant or already old, and the peri-synovial tissues
indurated, resort to firing in lines, in fine points or in needles.
HYDARTHROSIS. $6t
Hydarthrosis of Extremities.
/. — Scapiilo- Humeral Joint.
Although very extensible, the synovial of the shoulder-joint does not
protrude externally when it is dropsical. This condition is accused by-
lameness and stiffness of the ex-
tremity, which is carried forward
with difficulty ; in some cases, the
point of the shoulder is deformed
by a diffuse swelling. The sheath
•of the coraco-radialis, which, in
solipeds, is independent of the
scapulo-humeral synovial, may be
the seat of a synovitis, sometimes
mistaken for the lesions of the
articulation.
Lines or deep points firing is
the only beneficial treatment.
" In tetradactyles, dropsy of
the articular capsula may be
manifested by a double soft
tumor, which appears on both
sides of the coraco-radialis mus-
cle, that is, at the antero-inferior
part of the point of the shoulder.
The reason is that the ca,psula