penetrated in the first instance, becomes opened afterwards, in consequence of the subsequent sloughing of parts from the violent contusion they have suffered. us. RECENT APPEARANCES AND EXAMINATION.-When the fall has been recent, and nothing done, the animal comes to us with his knees (one or both) covered with mud or dust, through which is oozing fluid blood, or, at a later period, with which is mingled blood in a dark and clotted condition. The first step to be taken is with warm water and a sponge to cleanse the wounded parts doing this with a light hand and a prying eye, in order that no risk may be run of adding to the mischief already before And while we are performing this preliminary and indispensable duty, is the time for observing and ascertaining the precise nature and extent of the injury. In some cases, 66 the tale is too soon told :" the bones of the joint lie open to view; or else the issue of synovia or joint-oil is such as to leave no doubt in our mind that the joint is penetrated. We must be careful, however, in not too hastily pronouncing that the joint is opened, simply from the appearance of synovia: a fluid similar to it (if not of the same nature) is contained within the sheath of the extensor tendon; and the penetration of that alone, without any injury to the joint, will give rise to precisely such a glairy whiteof-egg sort of discharge as true joint-oil itself*. The probe will determine this, and there is no great objection to its use for this purpose, providing it be handled with care and judgment : but there is always a great objection to a meddling prying search, and, where any force is used, the probe will assuredly prove an instrument of fresh mischief. SYMPTOMS.-The emission of synovia is that upon which most reliance must be placed, when any doubt impends; coupled with the result of cautious probe-examination. The poor animal halts with the wounded limb; though not near so much recently after the accident as on the accession of inflammation. He stands with it semi-flexed, resting it upon the toe, and taking special care to impose no weight upon it. From the moment * We are more likely to mistake this kind of accident for open joint in the case of the shoulder than any other articulation; though, after swelling is come on, we may do so in many cases. -- OPENED KNEE JOINT. 225 the accident has taken place we must be prepared for the consequences, the supervention of inflammation, violent according to the extent of the local mischief, as well as, in some measure, in ratio with the constitutional irritability of our patient. Above all to be apprehended, is inflammation of the synovial membrane, the lining of the joint. The day after the accident, the parts in the more immediate vicinity of the wound evince some unusual heat, fulness, and tenderness, and the inflammation from day to day augments and spreads, until the entire limb more or less participates in it. About this time also the constitution sympathizes -sympathetic fever comes on. The pulse rises; the animal loses his spirits and appetite; his mouth becomes dry; his eyes injected; and his skin and extremities feel warm. With the increase of pain, the pulse rises higher and higher; the breathing becomes disturbed; the animal relapses from his dull mood into one of watching and irritability: in short, from this period, the fever from pain and irritation, unless some check be given to it, is likely to run to such a height as to exhaust the vital energies of our poor sufferer even before time has been given for the local inflammation to have taken any turn towards restoration of the wounded parts. LOCKED JAW has been known to follow an opened joint: the circumstance has never happened in my own practice; but cases of it are on record*. ANCHYLOSIS or stiff joint is what however is to be most dreaded, it being the more common sequel of this accident. The synovial membrane, from exposure and the irritation consequent on the escape of its sheathing and protecting secretion, is, in some part, seized with inflammation, which rapidly spreads over the entire capsule of the joint, involving both it and the ligaments around in one mass of disease. My own pathological observations here tally with those presented to us in Mr. Brodie's admirable work on the subject†, viz. 1st, a preternatural secretion of synovia; 2dly, an effusion of adhesive matter into the * For further particulars, and how to prevent this, see Locked Jaw. + Pathological Observations on Diseases of the Joints, by B. C. Brodie, F.R.S. Q cavity of the joint; 3dly, a thickening of the synovial membrane, and subsequent conversion of it into a substance resembling gristle; accompanied by interstitial effusion into the cellular textures around the joint, cementing them together in one general mass: 4thly, suppuration of the cavity of the joint, and abscess in case it should be closed, which will distend and burst the capsule again, and, perhaps, in a fresh place: 5thly, ulceration of the synovial membrane, and consequent caries or erosion of the articular cartilaginous ends of the bones: 6thly, anchylosis, which is not only a consequence of the foregoing changes, but a result ever to be apprehended from a long motionless condition of a joint. The capsular and other external ligaments become converted into a spongy osseous mass; and, after a time, even the heads of the bones themselves, possessing no motion within their osseous case, contract bony adhesion: so that, in the end, the anchylosis becomes most complete and totally irremediable. Anchylosis may be said to constitute one of Nature's modes of cure, since the disease in the joint will be found to terminate when it occurs; thereby at once removing every apprehension we may retain for the animal's life. Unfortunately, both for our patient and ourselves, however, life may as well be lost as any important joint be rendered motionless. Though a man with a stiff leg or arm may still continue a useful member of society, no one would accept of the services of a horse with a stiff leg. TREATMENT. That excellent surgeon, the late Mr. Hey, of Leeds, always laid great stress on the practical importance of preventing inflammation in the joint. His words are-“ Upon this circumstance chiefly depends a successful termination*." Now, the way to accomplish this, is with the utmost expedition to remove the cause from which the inflammation takes its rise. This we believe to be, exposure of the cavity of the joint: it therefore becomes our earliest and most anxious duty to close this cavity. How is this to be effected? The surgeon's practice is to produce union by the first intention by adhesive plaster and bandages, or else by suture; and at the commencement of my professional career, in cases of punctured wounds, I pursued this plan myself, and not without success: I soon, however, discovered its general inaptitude for veterinary purposes; and found Hey's Practical Observations on Surgery. OPENED KNEE JOINT. 227 myself compelled to resort, in most cases, to more efficient though much more formidable measures. The actual cautery is, I believe, now, by a sort of general consent amongst veterinarians, admitted to be the most ready and efficient agent we possess for the closure of a wounded joint; and to it we had better at once have recourse than dally with the case, and run farther risk of inflammation being set up in the interior. A budding-iron, fitted in size to the aperture to be cauterized, is to be applied at a dull red heat, and with it the sides of the opening, as far inwards as the capsule of the joint, are to be thoroughly seared, so that a kind of coagulation of the juices-the secretions of the parts-may be produced, and thus a temporary sort of plug formed which will serve to seal the cavity, while the inflammation consequent on the burning is preparing by adhesive effusion a permanent one. After the application of the cautery, the wound may be sprinkled over with some absorbent powder-common flour, or charcoal, or bole. The continual extension and quietude of the limb are doubtlessly both very desirable objects; but when they cannot be accomplished but at the hazard of constant annoyance to the animal, probably they had better be dispensed with. I have found splints and bandages, on this account, often productive of more harm than good; and unless our conveniences and apparatus be of the best description, and our subject be a tolerably peaceable one, even slinging (at least in cases where the opening into the joint is not of formidable dimensions) is not, on the same account, to be recommended. Such cases will, generally, do very well confined in a box, where the animal cannot move about a great deal, even if he felt any disposition, which, under such circumstances, he seldom, I may say hardly ever, does. He should be turned loose, and wear a cradle. A case of recent occurrence will require no other local treatment than this; though one in which inflammation has become established may, from frequent eruptions, become very difficult to manage in so simple a manner. In this latter case I have repeatedly witnessed the best effects from a blister applied all round the joint, immediately after the introduction of the cautery. To poultices and fomentations I am decidedly hostile: they rather tend to promote the suppurative process, while it is the adhesive for which we are so desirous. The astringent powder forms the best covering for the sore. The cautery must be repeated after every fresh eruption of synovia; but I would not delay the blister beyond the second application: indeed, when the wound is at all formidable, I should apply it on the first. Independently of its medical operation, a blister, by the stiffness and soreness it creates in the skin, totally indisposes the animal to flex the joint. SUSPENSION. In cases in which the wound into the joint is extensive, and the injury altogether such as is likely to be followed by much local inflammation and sympathetic irritation and fever, it becomes advisable from the first to place the animal in slings-by which we mean a state of suspension, wherein the weight of his body, instead of being borne by his three sound limbs, is supported by artificial means. The simplest mode of slinging a horse, and that which annoys him the least, at the same time that it affords him every opportunity of reposing himself that such a situation can, is to suspend him from a cross beam by means of ropes, and pulleys, connected with a very broad piece of sailcloth spread underneath the animal's belly; which should be furnished with two breechings and two breastgirths (all broad and padded) in order to keep him from slipping out, either backwards or forwards. The ropes and pulleys (being a similar sort of apparatus to what sailors use for raising weights on board of ship) enable us to elevate or lower the animal at pleasure. In general, it is not advisable to lift him quite off the ground: I have usually found my patient quietest and most at his ease when his feet have been suffered to touch the surface. At the same time, his head should be confined with two collarreins or ropes of considerable strength, and the headstall itself should be well padded. Though horses in such strange situations may kick and plunge about a good deal at first, in general they are not long in becoming resigned to their trammels, and then turn altogether as quiet. The Frontispiece will serve to convey sufficient notion of what this slinging or suspensory apparatus should consist as well as of its mode of application, to enable any person to fit up tackle of the kind. The addi |