BROKEN KNEES. 219 Three days afterwards there was little or no consequent swelling: healthy suppuration had taken place at the wound, and all was going on well. On the seventh day the wound was granulating, the ligature remaining. On the nineteenth day the wound had nearly healed; but the ligature had not separated. On the twenty-sixth day the ligature separated; and soon afterwards the wound healed up. Three months from this a nice observer could hardly detect any difference in the two sides of the neck.—Veterinarian, vol. ii, p. 176. BROKEN KNEES. Among the various causes that might be enumerated for horses falling down and breaking their knees, may be mentioned as the most common, tenderness before and other descriptions of lameness of the fore limbs; near or tripping action, cutting, inequality or discordance in action between the fore and hind legs; slippery, or rutty, or rugged roads, loose or rolling stones, pavements, &c. &c. Receiving, as the fore legs do in progression, a very large proportion of the weight of the whole body, nay, at times, the entire of the burthen, surmounted, probably, by the rider, and taking into account the hard and stony surfaces of our roads, it is not surprising that these falls upon the knees should so often be attended with serious consequences. Nor, indeed, will the disrepute in which horses are held who break their knees, and retain the marks thereof, be found so void of reason as it may at first appear, when we consider that lameness and faulty action form two of the leading causes of the accident. The fore legs have but little to do with progression; their principal office is to prop the burthen, step after step, as it is propelled onwards by the hind limbs: so that, should they (one or both), from any cause or accident whatever, miss or shorten or retard their step, so as to fail to be in readiness to catch the weight the moment it is driven forward, the equipoise is lost, and precipitation is the consequence. NATURE OF BROKEN KNEES.-To a medical man there are few more indefinite phrases than that of "broken knee:" to his mind it conveys no precise idea of the nature of the accident. Should the injury amount to nothing beyond contusion and consequent swelling, there being no skin cut or divided, I should imagine it would not constitute a broken knee; although this is but a form of the same injury. A case of this kind would require, by way of treatment, nothing beyond fomentation or evaporating washes, a dose of physic, and a loose box. Should the skin, however, be broken, and thus far the nature of the injury be established, then it becomes a question, and one of great moment, what else is broken or divided. Is it simply the skin? or is it the sheath of the tendon immediately beneath it? or is the tendon itself, together with the adherent capsular ligament, ruptured, and the cavity of the knee-joint opened? It must be obvious that these are considerations of the utmost importance to the medical practitioner, and points that must, more or less satisfactorily, be ascertained before he can pretend to set about the treatment of the case. SIMPLE BROKEN KNEE.-Contusion and more or less laceration of the skin is an accident needing but little medical assistance, although it be one that often turns out a source of much vexation to the owner of the horse, no less on account of the time it requires to get well, than the prospective it affords of leaving behind it a mark for life. However, our business in the affair is of a very summary and simple description. In the first place, the wounded parts must be thoroughly cleansed with warm water, and special care taken to eradicate every bit of dirt or grit that may be discoverable. This done, it will become a question how far it is practicable and advisable to draw the divided integument, or any loose flap of skin there may be, together by means of suture. For my own part, for all I mention this, I must say it is a practice I hardly ever resort to: I find, in almost every case, that the wound, after all, must granulate; and so for granulation I generally from the first-prepare it. Any consequent inflammation and swelling that may arise must be met by fomentation, evaporating lotions, and purgative medicine. The horse should be turned into a loose box; and for the first two or three days wear a cradle, to prevent him from gnawing or disturbing the wounds. As for dressings, should the wound not kindly digest or produce healthy-looking pus, use the black oil with a feather once a-day until it does; and then have recourse to tincture of benzoin, or the compound tincture of myrrh. Towards the end of the granulating process, slight escharotic dressings may be required, solutions of blue and white vitriol, &c. to repress the granulations, or destroy such as look weakly or unhealthy, and produce a better crop. CICATRIZATION*, ever a tedious affair, is rendered yet more so in the case of the knee, in consequence of its being a joint admitting of much motion; one that is used more than any other in the fore limb, and whose motion consists in flexion backward, whereby the skin upon its fore part is stretched (and any wound in it more or less opened) every step the animal takes. There is no avoiding or counteracting this without (in attempts to confine the limb by splints and bandages) doing more harm than good; and therefore it is that a loose box, where a horse moves but seldom, is, under all the circumstances of the case, the best situation for our patient. In respect to any scar, blemish, or MARK remaining, that must depend on the degree and extent of the injury the true skin (in which the roots or bulbs of the hair are set) has sustainedt. Unless the mischief has been very extensive, it commonly happens that the disunited parts of the skin stretch towards each other, and contract fresh union; in which case only a sort of seam is left, which, in time, the hair grows over and conceals. Supposing the old skin, however, to be so much bruised that the bulbs of the hair become disorganized, or supposing the vacuity, to be filled up by cicatrization after the granulation of the wound, be so large that new skin * Turn to cicatrization, under the head of Terminations of Inflammation. + Various nostrums are recommended by farriers and grooms in particular, for "making the hair grow" upon these scars or bare places. For my own part, I regard them as entitled to much the same degree of credit as bears' grease, or Macassar oil, or any other of those multifarious delusions. I beg to present my readers with one of singular efficacy! Take of Spermaceti ointment.. 3j zij 3j Mix together for an ointment; which, for a bay horse, is to be coloured with bole Armenian; for a black, with gunpowder or charcoal. This is the reason why so close and minute an examination is often requisite for the detection of blemish; a research, dealers are often in the habit of rendering still more difficult by blackening the part. must inevitably be produced, in either of these cases the scar left will be a bare or hairless one; or, in other words, amount to a blemish a circumstance in horses of much value, oftentimes of the utmost consequence. Grievous as this sequel ever has been considered, however, nothing worthy of notice lay before us in the shape of remedy, until Mr. Cherry, V.S., 2d Life Guards, conceived the possibility of obliterating or eradicating the scar on true and obvious surgical principles. "The numerous cases that occur, induced me," says Mr. Cherry, Mr. Cherry, "some years ago to direct my attention to the devising of some means whereby the appearance of a broken knee might be got rid of, when the injury done amounted to appearance only. Cutting round the edge, and dissecting out the blemished portion of skin, has been tried and has failed, because there would still be a large cicatrix left on the wound filling up; and when the edges of the skin have been brought together by suture, no better success has followed; because the skin being on the stretch, the sutures have given way, either from the swelling which always takes place, or from ordinary flexure of the knee in walking, or still more especially in lying down. Indeed, these means have rather increased the evil, than diminished it. It is well known that a long narrow wound cicatrizes much quicker and more completely than a circular; it therefore occurred to me that this kind of wound might be produced by dissecting out a portion of skin that should be included between two curvilinear incisions, both commencing at a point some distance, and extending to a point some distance below it. This would leave a wound in the shape of an elongated ellipsis, the edges of which being brought together, would form nearly a straight line. By making two other incisions, equidistant, one on each side, and corresponding in length with the two first made incisions, the effect of tension of the skin, on the sutures used to bring together the two edges formed in the first instance, would be taken off. I accordingly proceeded to try the experiment, and took from the knee of an ass an elliptical portion of skin, about four inches in length and about one inch in breadth, across the broadest part of it, leaving a gaping wound of corresponding dimensions. Having made the lateral incisions, the edges of the gaping wound were brought to OPENED KNEE AND OTHER JOINTS. 223 gether, and held nearly in contact by sutures. Then there were two wounds to fill up, but each was of only half the extent of the former, and there were four healthy edges from whence granulation could go on instead of two. As to the linear wound in the centre, it might be expected to unite partly by the first intention, which it did, and partly to fill up by granulating. The wounds granulated in the most favourable manner; the sutures were taken out in due time, and very soon the knee had the appearance of three straight lines similar to those produced by the firing-iron. These scars continued gradually to diminish; and in the course of a twelvemonth, when I shewed the subject of experiment to my friends, Mr. Goodwin and Mr. Percivall, we could only discover the lines by separating the hair and seeking for them."-The Hippiatrist. OPENED KNEE AND OTHER JOINTS. A wound penetrating into the cavity of a joint is at all times an affair of serious moment, and becomes eminently so in the case of the knee, an articulation of much complexity of structure, and one whose operations are mainly concerned in the motions of the fore extremity; and yet, unfortunately, it is the joint of all others likely to meet with this accident. Though, for these reasons, the knee demands our especial consideration, yet, almost all that is said in relation to it will equally apply to other joints suffering under similar injury. CAUSES. The ordinary cause or forerunner of an open kneejoint is "falling down upon the knees;" an accident that happens at the very time that the skin, and tendon, and capsular ligament in front of the joint, are all put on their extremest stretch, and consequently are so much the more likely to be broken or torn asunder. There are other ways, however, in which the joint may be penetrated. It may be pierced by a thorn or stub, as happens at times in hunting; or a nail, or a pitchfork, or any sharp-pointed instrument, may puncture it. When a horse falls, the nature of the wound that may be inflicted in course will very much depend upon the surface the knee strikes against. In some cases it happens that the joint, though not |