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LAMINITIS.

Its Nomenclature, Nature, Etiology, Symptoms, Course,
Complications and Treatment.

CONTRIBUTION

Veterinary Pathology,

A. A. HOLCOMBE, D.V.S,

Professor of Surgical Patliology and Obstetrics in the American
Veterinary College.

NEW YORK :

A. N. Davis' Job Printing House,

60 University Place,
1880.

NOTE FROM THE AUTHOR.

<UAi'. O :2<50 —

The researches which I have made during the past two
years, into the pathology of Laminitis, have brought me to
conclusions, in part so much at variance with those set forth
in the text-books which I have seen, that I am prompted to
give the profession my views on the subject in this monogram.

I have treated of the disease in exteiiso, in that the prophy-
lactic, as well as remedial, treatment might be fully under-
stood, hoping thereby to prevent avoidable suffering, too often
the result of mistaken kindness, and to relieve that already

induced.

A. A. HOLCOMBE,

141 W. 54th Street, N. Y., City.

LAMINITIS.

NOMENCLATURE.

By what term this disease was first known to man is a
question unanswerable. During many years in the recent past,
and before an approximate knowledge of its lesions was had,
it was usually designated as " Founder."

In country districts, and amongst the great majority of the
laity, this name is yet almost exclusively used, and, undoubt-
edly, it was first so employed because of its conveyed expres-
siveness of the physical inability, or disinclination, upon the
part of the patient to proceed in his gait, resembling thereby
a ship similarly disabled. That it could have been adopted
upon any other ground, hardly seems possible, for the etymol-
ogy of the term does not indicate that it was so used because
it contained even the most remote intimation, either as to the
seat of the disease, its nature, or its cause.

Webster, in his Dictionary, gives as one of the definitions
to the term : " To trip ; to fall ; to stumble and go lame." This
definition is very truly descriptive of the most notable symp-
toms of the disease, and particularly so of the chronic form ;
but it does not serve in the least to distinguish between any
of the many diseases which cause tripping, stumbling and lame-
ness— objections which are fatal to its employment in a scien-
tific sense.

Since the days of Youatt, when symptomatology exercised
so important an influence in the naming of all diseases, this
term has gradually given way to the more modern " Lamin-

4 LAMINITIS.

itis," Avhich now finds recognition in all the text-books on
veterinary surgery.

But while this last and generally accepted term is an ex-
pressive one, based on an anatomico-pathological knowledge
of the disease, it is not strictly correct ; for it leaves the im-
pression that eitJier or both sets of the laminae might be the
seat of inflammation — an impossibility upon the part of the
horny tissue. Furthermore, it conveys the idea that only the
laminae are affected, whereas in many instances the velvety tis-
sue is also implicated — not as a complication, but as a part of
the primary disease.

A better term would be found in Podophyllitis; for this
would designate the sensitive laminae, or podophyllous tissue,
as the seat of the disease. Yet the same objection is applicable
here as in the case of laminitis, regarding the exclusion of the
velvety tissue.

The name coming nearest perfection in its comprehensive-
ness, if our knowledge of the pathology of the disease is cor-
rect, would be " Keratitis;" for it could rightfully be employed
to designate inflammation of all, or any part of the keratogen-
ous membrane. But, laying aside our objections to the defects
in the adopted term of Laminitis, and accepting it broadly as
meaning inflammation of the sensitive lamina; and velvety tis-
sues of the foot, it is still very generally misused by the pro-
fession in describing simple congestion of the keratogenous
membrane.

So also does it seem to me an error to apply this term to
that occasional condition where Ostitis and Periostitis of the
pedal bone, are of far more importance than the accompanying
Laminitis. It is probably true that in nearly all these cases
inflammation of the laminae precedes that of the other tissues ;
for, because of their different anatomical structure, bone and
periosteum are much more slow to respond to irritation than
are the laminae ; yet, since the producing or exciting cause is
one and the same in all these complications, and since the dis-
ease of the bone and its covering, are much the more serious,
it would seem that we might do better did we accept Williams'
suggestion and call these mixed cases " Peditis."

LAMINITIS.

NATURE.

Of the nature of Laminitis but little is to be said ; it being-
a simple non-specific, non-contagious, and non-infectious in-
flammation, characterized by the general phenomena attending
inflammation of the skin and mucous membranes, producing no
constitutional disturbances, except those dependent upon the
local disease ; and having a strong tendency, in severe cases,
to destructive disorganization of the tissues affected.

ETIOLOGY.

The causes of Laminitis are as wide and variable as in any
of the local inflammations, and may be divided into two classes :
the predisposing and exciting.

Predisposing Causes.

From personal observations I do not know that any par-
ticular construction of foot, or any special breed of horses are
thereby predisposed to this disease ; neither can I find any-
thing to warrant the assumption that it is in any way heredi-
tary ; so that while we may easily cultivate a predisposition to
the disease upon the part of the tissues subject to become
affected, the disease itself does not originate without an excit-
ing cause. Like most other tissues, a predisposition to inflam-
mation ma}' be induced in the sensitive laminse by any cause
which lessens their power of withstanding the work imposed
on them. It exists, to an extent, in those animals unaccustomed
; to work, particularly if they are plethoric, and in all those that
, have been previous subjects of the disease — for the same rule
holds good here that we find in so many diseases — i. e., that
one attack impairs the functional activity of the affected tis-
sues, and thus renders them more easy of a subsequent inflam-
mation.

Unusual excitement, by determining an excessive blood
supply ; bad shoeing ; careless paring of the feet by removing
the sole support, as well as high calkings without correspond-
ing toe-pieces, inust be included under this head.

O LAMINITIS.

Exciting Causes.

The exciting causes of Laminitis are many and varied ;
the most common being concussion, over-exertion, exhaustion,
rapid changes of temperature, ingestion of various foods, pur-
gatives, and the oft-mentioned metastasis. In conjunction with
these WilHams would add : " Excitement, bad shoeing, paring
of the feet, tight nailing of the shoes, and high calkings." I
do not believe these influences can rightly be classed with
the exciting causes, but have placed them under the head of
predisposing causes.

I. Concussion acts as a producer of this disease by the
local over-stimulation which it occasions — the excessive ex-
citement being followed by an almost complete exhaustion of
the functional activity of the keraphyllous tissue ; the exhaus-
tion by congestion, and eventually by inflammation. But con-
gestion here, as in all other tissues, is not necessarily always
followed by inflammation ; for although the principal symp-
toms belonging to true Laminitis are present, the congestion
may be relieved before the processes of inflammation are fully
established.

This is the condition that obtains in the many so-called
cases of Laminitis which recover in from twenty-four to forty-
eight hours' time. These are the cases which should be called
Congestion of the Laminae, or Congestion of the Keratogenous
Membrane; for there is, in truth, no inflammation present, and
the profession seems to have forgotten, or overlooked, the fact
that simple congestion here was a possibility.

Laminitis from concussion, is common in track-horses trot-
ting races when not in condition, especially if they are carrying
the obnoxious toe-weights ; and in green horses put to work
on city pavements, to which they are unaccustomed. Concus-
sion from long drives on dirt-roads, is at times productive of
the same results ; notably when the weather is extremely warm,
or at least when the relative change of temperature is great.
But undoubtedly the exhaustion so apt to be produced under
these circumstances, must be considered as exerting almost as
great an influence as an exciting cause, as does the long-con-

LAMINITIS. 7

tinued concussion. This same combination of causes must
also be admitted as determining- the disease when seen at
times in hunters ; for the imposed weight of the rider increases
the demands made upon the function of these tissues, and
their powers of resisting congestion and its consequences, are
the sooner exhausted.

2. Over-exertion — as heavy pulling or rapid work, even
where there is no chance for immoderate concussion, occasion-
ally results in this disease; although in the majority of in-
stances exiiaustion is a conjunctive cause, for over-exertion
cannot be long continued without inducing this condition.

3. Exhaustion, in whatever manner produced, is nearly as
prolific a source of Laminitis as is concussion ; for when the
physical strength has been greatly impaired, even though but
temporarily, some part of the economy is rendered more vul-
nerable to disease than others, and it is not strange that, in
many instances, it should be those parts still called upon to
perform their function of maintaining the weight of the body
after their activity has been exhausted. It is to this cause we
must ascribe those many cases which we see following a hard
day's work, where at no time has there been over-exertion or
immoderate concussion.

In the same manner a strong tendency to Laminitis is in-
duced in horses on sea-voyages ; the exhaustion of the laminae
resulting- from the continual constrained position which the
animal is compelled to maintain on account of the rocking-
motion of the vessel.

The same cause exists where one foot has been blistered,
or where one limb is incapacitated from some other reason ;
lor the opposite member, being called on to do double duty,
soon becomes exhausted, and congestion, followed by inflam-
mation results as a matter of course. Where one foot only
becomes Lamanitic it is customary to find the other, or cor-
responding member, participating at a later date ; not always,
as we are told, because of sympathy, but because the transfer
of all tlie functional performance to the one foot, proves with-
in itself a sufficient exciting cause.

o LAMINITIS.

4. Rapid changes of temperature act as an exciting cause
of Laminitis, in precisely the same way as they act to produce
disease in other tissues — the result of these variations of tem-
perature showing itself upon those parts rendered particularly
susceptible to pathological changes from some impairment of
their natural disease-resisting powers.

This change of temperature may be induced by drinking
large quantities of cold water while in an over-heated condi-
tion. Here the internal heat is rapidly reduced, the neighbor-
ing tissues and blood-vessels constringed, and the blood supply
to these organs greatly diminished ; while the quantity sent
to the periphery is correspondingly increased. True, in many
of the cases which result from this cause, there has not been
sufficient labor performed to impair the powers of the laminae,
and I am inclined to the opinion that Laminitis is the more
readily induced, than congestion or inflammation of the skin or
other peripheral organs, because of the impossibility upon the
part ot the laminae to relieve themselves of the threatened
congestion by the general safety-valve of perspiration.

A cold wind, or relatively cold air allowed to play upon
the body when heated and wet with sweat, has virtually the
same result ; for it arrests evaporation, and rapidly cools the
external surface, thereby determining an afflux of blood to
such organs and tissues as are protected from this outside in-
fluence. In many instances this happens to be some of the
internal organs, as the lungs, where the previous work has
been rapid and their functional activity impaired ; but in nu-
merous other instances the determination is toward the feet, and
that it is so, depends upon two very palpable facts — first : that
these tissues have been greatly excited, and are already receiv-
ing as much blood as they can, consistently with health, ac-
commodate ; secondly : even though these tissues are classed
with the peripheral ones, their protection from atmospheric
influences by means of the thick box of horn encasing them,
renders them, in this respect, equivalent to internal organs.

Again : a still more limited local action of cold excites
this disease, as seen from driving through water, or washing the
feet or legs while the animal is warm, or just in from work ;

LAMINITIS. 9"'

here a very marked reaction takes place in the peripheral tis-
sues of the limbs, and passive congestion of the foot results
from the interference with the return flow of blood being sent
to the organs in excess. These are more apt to be simple
cases of congestion, soon to recover ; yet they may become
true cases of Laminitis. Youatt says : " The danger is not
confined to the change from heat to cold ; a sudden transition
from cold to heat is as injurious, and therefore it is that so
many horses after having been ridden far in frost and snow,
and placed immediately in a hot stable, and littered up to the
knees, are attacked by this complaint." I have never seen
the disease occur under exactly similar circumstances, but am
inclined to believe, that in these cases, the disease was attrib-
uted to the zvronp cause — the excitement, exhaustion, and con-
cussion of the long ride being, apparently, entirely overlooked.
Furthermore, if we consider the physical conditions which must
necessarily be present under the circumstances, it seems incon-
sistent with our knowledge of the effects of heat and cold, to
believe the very moderate temperature of stables, and the heat-
producing properties of bedding "up to the knees," could be
productive of Laminitis.

Rather should we say that such favorable circumstances
would be conducive to opposite results.

5. Why it is that certain kinds of grain will cause Laminitis,
does not seem to be clearly understood. Certainly they pos-
sess no specific action upon the laminae, for all animals are not
alike affected ; neither do they always produce these results in
the same animal. In the case of some of these aliments, where
their ingestion causes a strong tendency to indigeston, the
consequent irritation of the alimentary canal may be so great
as to warrant the belief that the laminae are affected through
sympathy. In other instances there is no apparent interfer-
ence with digestion, nor evidence of any irritations of the mu-
cous membranes ; yet the disease is, in some manner, depend-
ent upon the food in question for its inception. Barley, Wheat,
and sometimes Corn, are the grains most prolific in the produc-
tion of this disease. With some horses there appears to be a
particular susceptibility to this influence of Corn. In such in-

lO LAMINITIS.

stances the feeding of this grain for a few days will be followed
by inflammation of the feet lasting from a few days to two
weeks' time. In these animals, to all appearances healthy, the
corn neither induces colic, indigestion nor purging, and, appar-
ently, no irritation whatever of the alimentary canal.

6. Fortunately purgative medicines but rarely become the
exciting cause of inflammation of the laminae. That it is then
the result of a sympathetic action upon the part of the tis-
sues affected, is, no doubt, more than hypothetical ; for when
there is no derangement of the alimentary canal existing, a
dose of cathartic medicine will, at times, bring on severe Lam-
initis, and that too before purgation commences.

Williams very ingeniously explains this sympathy of action
by remarking that the skin, mucous structures and laminae are
continuous one with another, and secretory ; that their secre-
tions are similar ; that irritation of one tends to spread to the
others, and although so slight in the skin as hardly to be
noticed, it becomes the source of an acute inflammation in the
sensitive tissues of the laminae surrounded as they are by un-
yielding structures If this be the true explanation, it is re-
markable that diseases of the skin are not accompanied by
affections of the laminae; for they are more nearly related by
contiguity, than are the mucous membranes and the laminae.
At the same time I am inclined to doubt the presence of skin
disease as a cause for the slow healing of wounds during the
course of Laminitis, as is claimed by Williams ; but rather
would attribute such tendency to blood-changes.

7. Most, if not all, the older authorities were agreed that
Metastatic Laminitis is a reality. That such a condition ever
does exist outside the imagination certainly awaits the prov-
ing.

That Laminitis may and oftimes does exist as a concurrent
disease with numerous others, is unquestionably true ; but to
believe an inflammation can be almost momentarily transferred
from one organ to another, no matter how remote, is to de-
stroy all belief in our knowledge of the pathology of this com-
plicated process. We do not pretend to deny that the indue-

LAMINITIS. ri

tion of Laminitis during the course of some other disease, may
serve to arrest the further invasion of healthy tissue by the
primar}^ process, or that it may exert a remedial influence upon
the first disease ; but it cannot and does not at once remove
that inflammation and obliterate its lesions ; for the products
of any inflammation, be it never so simple, require a certain
time for their removal, and it is impossible that, for instance,
the products of inflamed lung tissue can be immediately re-
moved, and the inflammation in whole transferred to the lam-
inae. There is no manner of removing such inflammatory pro-
ducts, except by the natural means of the lymphatics and
blood vessels, and even these very efficient absorbents are
powerless to accomplish their functions until degenerative pro-
cesses have rendered the products fluid. This liquifaction can-
not be accomplished in the short time required for the develop-
ment of Laminitis in these so-called metastatic cases ; and just
so long as the products of the inflammation remain in the tis-
sues in an unchanged form, just so long will you have the usual
symptoms belonging to the disease. Furthermore, since no
inflammation can exist without characteristic lesions being
produced, neither can it be removed until the lesions have in'
some manner been repaired. Metastatic Laminitis then is
nothing more nor less than concurrent Laminitis, and as such,
presents little in anyway peculiar outside the imperfectly un-
derstood exciting cause ; and the practitioner who allows the
acute symptoms of the Laminitis to mislead him, simply be-
cause their severity has overshadowed those of the primary
disease, may lose his case through unguarded subsequent treat-
ment. This form of Laminitis is by no means commonly met
with, but when seen, will usually be found in conjunction with
Pneumonia ; according to Youatt, with inflammation of the
bowels and eyes, and according to Law and Williams, some-
times with Bronchitis.

SYMPTOMS.

Laminitis is characterized by a congregation of symptoms
so well-marked as scarcely to be misinterpreted by the most
casual observer. They are nearly constant. in their manifes-

12 LAMINITIS.

tations, modified by the number of feet affected, the cause
which has induced the disease, the previous condition of the
patient, and the various other influences which operate in all
diseases to some extent. They may be divided into general
symptoms — which are concomitants of all cases of the disease,
subject to variations in degree only ; and special symptoms, or
those which serve to determine the feet affected and the com-
plications which may arise.

General Symptoms .

Usually the first symptom that would indicate any definite
obstruction to functional performance, is the interference with
locomotion produced by congestion of the keratogenous mem-
brane. Occasionally, the other symptoms are presented first.
With the development of the lameness the pulse will be found
accelerated, full, hard and striking the finger strongly ; the
temperature soon rises several degrees above the normal reach-
ing, sometimes io6" F., although it generally ranges between
I02 \-2^ and 105"". The respirations are rapid and panting in
character, the nostrils being widely dilated, and the mucous
membranes highly injected. The facial expression is anxious
and indicative of the most acute suffering, while the body is
more or less bedewed with sweat. At first, there may be a
tendency to diarrhoea, or it may appear later, particularly, as
the result of medication. The urine is high colored, scant in
quantity and of increased specific gravity, owing to the water
from the system being eliminated by the skin instead of the
kidneys. The appetite is impaired and sometimes entirely
lost, while the thirst is greatly increased. The affected feet
are hot and dry to the touch ; they are relieved as much as
possible from bearing weight ; rapping them with a hammer,
or compelling the animal to stand upon one affected member,
causes intense pain, while the digital artery throbs beneath
the finger.

Special Symptoms.

Liability to affection varies in the different feet according
to the exciting cause. Any one, or more, of the feet may be-
come the subject of this disease, although it appears more

LAMINITIS. 13

often in the fore feet than in the hind ones, — a fact owing to
the difference of function, /. e., that the fore feet are the bases
of the columns of support, receiving nearly all the body's weight
during progression, and consequently most of the concussion ;
while the hind feet at such times become simply the fulcra of
the levers of progression, and are almost exempt from con-
cussion.

One Foot. — Injuries and excessive functional perform^ance
are the causes of the disease appearing in only one foot ; here
the general symptoms, as a rule, are not severe, there often
being no loss of appetite, and no unusual thirst, while the pulse
temperature, and respirations remain about normal. In these
instances the weight of the body is early thrown upon the op-
posite foot, and the diseased one is extended, repeatedly raised
from the floor, and then carefully replaced. When made to
move forward, the lame foot is either carried in the air while
progression is accomplished by hopping with the healthy one,
or else the heel of the first is placed on the ground and re-
ceives the little weight thrown upon it, while the sound limb
is quickly advanced. Progression in a straight line is much
more easily accomplished, than is turning toward the lame
side.

Both Fore Feet. — When both fore feet are affected, the
symptoms are well marked. The lameness is excessive, and
the animal almost'immovable. When standing, the head hangs
low down, or rests upon the manger as a means of support and
.to relieve the feet ; the fore feet are well extended so that the
weight is thrown upon the heels, where the tissues are least
sensitive, least inflamed, and most capable of. relief from free
effusion. The hind feet are brought forward beneath the body
to receive as much weight as possible, thereby relieving the dis-
eased ones. If progression is attempted, which rarely happens
voluntarily during the first three or four days, it is accomplished
with very great pain and lamtness at the starting, which usu-
ally subsides to an extent after a few minutes exercise. Dur-
ing this exercise, if the animal happens to step upon a small
stone, or other hard substance, he stumbles painfully onto the

14 LAMINITIS.

other foot, and is excessively lame in the offended member for
a number of steps, owing to the acute pain which pressure
upon the sole causes in the tissues beneath. The manner of
the progression is pathognovionic of the complaint. Some-
times the affected feet are simultaneously raised from the
ground, (the hind ones meanwhile sustaining the weight), then
advanced a short distance and carefully replaced, while at al-
most the same moment the hind ones are quickly shuffled for-
ward near to the centre of gravitation.

In other instances one foot at a time is advanced and
placed with the heel upon the ground in the same careful man-
ner; all causes of concussion being carefully avoided. In at-
tempting to back the animal, he is found to be almost station-
ary, simply swaying the body back on the haunches, and elevat-
ing the toes of the diseased feet, as they rest upon their heels.
In attempting to turn him either to the right or left, he allows
his head to be drawn to the one side to its full extent before
moving, then makes his hind feet the axis around which the
forward ones describe a shuffling circle.

In a majority of cases of Laminitis in the fore feet, the
animal persists in standing until he is nearly recovered. In
other cases he as persistently lies, standing only when neces-
sity seems to compel it, and then for as short a time as possible.
If the recumbent position is once assumed, the relief experi-
enced from a removal of the weight of the body off the in-
flamed tissues, tempts the patient to seek it again, and so we
often find him down a greater part o\ the time. But this is not
true of all cases, for sometimes he will make the experiment,
then cautiously guard against a repitition. Even in those cases
of enforced recumbency, he oftimes takes advantage of the
first opportunity and gets upon his feet, doggedly remaining
there until again laid upon his side by his attendants. How to
explain this diversity of action I do not know, for theoretically
the recumbent position is the only appropriate one, except
when complications exist, and the one which should give the
most comfort, yet it is rejected by very many patients, and no
doubt for some good reason. It has been suggested as an ex-
planation, that when the animal gets upon his feet after lying

LAMINITIS. 1 5

for a time, the suffering is so greatly augmented, that the mem-
ory of this experience deters him from an attempted repeti-
tion. If this were true, the horse with the first attack of this
disease, must necessarily make the experiment before knowing
the after effects of lying down, yet many remain standing
without even an attempt at gaining this experimental knowl-
edge.

The most favored position of the animal when down, is on
the broad-side, with the feet and legs extended. While in this
position the general symptoms greatly subside ; the respira-
tions an4 pulse become almost normal ; the temperature falls,
and the perspiration dries. It is mostly with difficulty that he
is made to rise, and when he attempts it, gets up rapidly and
" all in a heap" as it were, shifting quickly from one foot to the
other, until they become accustomed again to the weight
thrown upon them. Occasionally a patient will get up like a
cow, rising upon the hind feet first. Although enforced exer-
cise relieves, to some extent, the soreness, it is but temporary,
for, after a few minutes rest, it returns again with all its former
severity.

Both Hind Feet. — When only both hind feet are affected,
they are, while standing, maintained in the same position as
when only the fore ones are the subjects of the disease ; but
with an entirely different object in view. Instead of being here
to receive weight, they are so advanced in that the heels may
receive whatever weight is, from necessity, imposed on them ;
the fore feet being, at the same time, placed well back beneath
the body where they become the main supports ; the animal
standing, as Williams describes it, " all of a heap."

Progression is even more difficult now than when the dis-
ease is confined to the anterior extremities. The fore feet are
dubiously advanced a short distance, and the hind ones then
brought forward with a kind of a kangaroo-hop, which results
in an apparent loss of equilibrium, which the animal is a few
moments in regaining. The general symptoms — or in other
words, the degree of suffering — seem more severe in these
cases, than where the disease affects the fore feet alone. The
standing position is not often maintained, the patient seeking

1 6 LAMINITIS.

relief in recumbency. This fact is easily understood, when we
con:>ider how cramped and unnatural is the position he assumes
while standing; and if it were maintained for any considerable
length of time, would, no doubt, excite the disease in the fore-
feet as explained by D'Arboval.

All Four Feet. — Laminitis of all four feet is but un-
commonly met with. The author has seen but three such
cases. In all these, the position assumed was nearly normal,
all the feet being slightly advanced, and first one, then another,
momentarily raised from the ground and carefully replaced ;
tlMS action being kept up almost continually during »the time
the animal remained standing. The suffering in these cases is
most acute ; the appetite is lost, and although the patient lies
most of the time, the temperature remains too high, the pulse
and respirations are greatly accelerated, the body covered with
sweat, and bed-sores are unpleasant accompaniments.

COURSE.

The course which Laminitis takes, varies greatly in dif-
ferent cases, being influenced more or less by the exciting
cause, the animals previous condition, the acuteness of the
attack and the subsequent treatment. The first symptoms
rarely exhibit themselves while the animal is at his work, al-
though we will occasionally see the gait impaired by stumb-
ling, the body covered with a profuse sweat and the respiration
become blowing in character, as premonitions of the oncom-
ing disease.

But as a rule nothing is noted amiss with the animal un-
til he has stood for some time after coming in from work, when,
in attempting to move him, he is found very stiff. Like all
congestions the early symptoms usually develop rapidly ; yet
this is not always the case, for in some instances there appears
to be no well-defined period of congestion, the disease seem-
ingly commencing at ti pointy and gradually spreading until a
large territory is involved in the morbid process.
Simple Congestion.

Those cases of simple congestion of the laminae, which we
erroneously call Laminitis, are rapidly developed ; the symp-

LAMINITIS. 17

toms being but moderately severe, and from one to three days
required for recovery.

There are no structural changes here, and but a moderate
exudate which is rapidly reabsorbed, leaving the parts precisely
in the same condition as they were previous to the attack. If
the congestion has been excessive, a rupture of some of the
capillaries will be found ; a condition more apt to obtain where
the animal is made to continue work after a development of
symptoms has begun.

True the majority of these last described cases prove to be
Laminitis in fact, yet at times the congestion will pass away,
and the extravasated blood be absorbed without inflammation
supervening to an extent sufficient to warrant us calling it
Laminitis. The seat of greatest congestion will always be
found in the neighborhood of the toe, because of the increased
vascularity of' that part ; and although at times it is limited
to the podophyllous tissue alone, any or all parts of the kera-
togenous membrane may be affected by the congestion, and
followed finally by inflammation.

A cute.

In the acute form of Laminitis, the symptoms may all
develop rapidly, or it may commence by the appearance of a
little soreness of the feet during progression, which in twenty-
four or forty-eight hours' time has passed into a well-marked
case. This peculiarity of development is due to one of two
causes — either the congestion is general but takes place slowly,
or else it begins in one or more points and gradually spreads
throughout the laminae. These acute cases generally run their
course in from a few days to two weeks, or more time. Usu-
ally a culmination of the symptoms is reached, if the patient
is properly treated, in from three to five days ; then evidences
of recovery are discernible in favorable cases. The lameness
improves, the other symptoms gradually subside, and eventually
health is regained. It is in these cases that a strong tendency
to disorganization of a destructive character exists, and hence it
is we see so many recover imperfectly, with marked structural
changes permanently remaining. The inflammatory exudate

1 8 LAMINITIS.

is poured out into the keratogenous membrane, which we find
swollen to the greatest degree compatible with its restricted
capabilities. This exudate is rich in wandering cells, and ac-
cording to Fleming, " a large quantity of hard consistent horn ''
is deposited on the surface of the inflamed tissues. The exuda-
tion is seen in greatest quantity at the toe where the vessels are
most profuse, while ooccasinally extravasated blood is found
on the inner surface or plates of the keraphyllous tissue. Pur-
ulent infiltration sometimes exists to a limited degree without
any suppuration occurring. The rich plastic infiltration which
has taken place, ends either in reabsorption, or, as it is prone
to do, in the development of new connective tissue ; while the
serous exudate and extravasated blood are readily removed
by the absorbents, and the new horn-material becomes organ-
ized and eventually removed by the off-growing hoof.

Sub -A cute.

Sub- Acute Laminitis is most often seen as a termination
of the acute form, although at times it exists independent of
or precedes an acute attack. It is characterized by the mild-
ness of its symptoms, slow course, and moderate tissue changes.
It may be present for a long time before any pathological le-
sions result, other than those found in the acute form, and when
these changes do take place, they should rather be viewed as

complications.

Chronic.

Chronic Laminitis is a term used by many to designate
any of the sequelae of the acute and sub-acute forms of this
disease. Pure chronic inflammation of the laminae is not very
commonly met with, but is most frequent in horses that have
long done fast track work. They have " fever in the feet " at
all times and are continually sore, both conditions being aggra-
vated by work. Like chronic inflammation of other parts there
is a strong tendency here to the development of new connec-
tive tissue, which by its pressure upon the blood vessels inter-
feres with nutrition. Atrophy of the os pedis and periostitis
with caries is not unusual. The continued fever and impaired
function of secretion, results in the production of horn, defi-

LAMINITIS. 19

cient in elasticity, somewhat spongy in character and inclined
to crumble. In others of these cases of " soreness " in horses
used to hard work, there is evident weakness of the coats of
the vessels brought on by repeated functional exhaustion.
Here slight work acts as an exciting cause of congestion, which
results in serous effusion and temporary symptoms similar to
those of chronic Laminitis. Chronic inflammation of the
laminae is no doubt present in most of the sequelae of Lamini-
tis, but it is not the most important nor most interesting lesion,
and so should be considered only as an adjunct of the pro-
cesses it may accompany.

COMPLICATIONS.

Complications concurrent with or supervening upon Lam-
initis are frequent and varied, and are often dependent upon
causes not fully understood.

Super- Purgation .

Super-purgation is one of the simplest of these, and not
usually attended with dangerous consequences. It rarely occurs
unless induced by the exhibition of a purgative ; and the ex-
cessive action of the medicine is probably to be explained upon
the theory that the mucous membrane sympathizes with the
diseased laminae, is irritable, and readily becomes over-excited.
The discharges are thin and watery, sometimes offensively
odorous, and occasionally persist in spite of treatment. It may
prove disastrous' to the welfare of the patient, by the rapid ex-
haustion which it causes, preventing resolution of the Lamin-
itis, and may even cause death.

SepticcBinia and Pycemia.

Septicaemia or Pyaemia are unusual complications, and are
seen only in the most severe cases, where bed-sores are pres-
ent, or suppuration of the laminae results. They die, as a rule,
within three days after showing signs of the complication. A
further consideration of the condition is unnecessary in this
connection.

20 LAMINITIS.

Metastatic Pneumonia.

Pneumonia — the so-called Metastatic — needs no especial
consideration, for in its lesions and symptoms it does not differ
from ordinary pneumonia, although it may be over-looked en-
tirely by the practitioner. Examinations of the chest in Lam-
initis should be made every day, so as to detect the disease at
its onset, and render proper aid.

Side-Bones.

A rapid development of side-bones, is one of the complica-
tions, or perhaps better, a sequel of Laminitis, not often met
with in practice. Here the inflammatory process extends to
the lateral cartilages with a strong tendency to calcification.
The deposition of the lime-salts is sometimes most rapid, so that
the "bones" are developed in a few weeks' time ; in other in-
stances they are deposited slowly, and their growth is not
noted until long after the subsidence of the Laminitis, so that
the exciting cause is not suspected. This change in the cartil-
ages may commence as early as the first week of the Laminitis,
and although the trouble in the laminae is removed in the course
of a fortnight, the symptoms do not entirely Subside, the ani-
mal still retaining the shuffling gait, while the side bones con-
tinue to grow, and the patient usually remains quite lame.
This alteration of the cartilages generally prevents the patient
recovering his natural gait, because of the permanent impair-
ment of function induced, and the practitioner- receives unjust
censure for a condition of affairs he could neither fore-see nor
prevent.

The lamanitic process also occasionally extends to the
periosteum of the os coronae ; or at least, concurrent with and
subsequent to Laminitis the development of " low ring-bone "
is seen, and it is apparently dependent upon the disease of the
laminae for its exciting cause. The impairment of function and
consequent symptoms are much less marked here than in side-
bones. The coronet remains hot and sensitive, and somewhat
thickened after the Laminitis subsides, and a little lameness is
present. This lameness persists and the deposits of new bone
may readily be detected.

LAMINITIS. 21

Suppuration.

Suppuration of the keratogenous membrane is a somewhat
common compHcation, and even when present in its most
limited form is always a serious matter ; but when it becomes
extensive, and especially where the suppurative process extends
to the periosteum, the results are apt to be fatal. When sup-
puration occurs the exudation does not appear to be excessive,
but is rich in leucocytes, and seems to have caused a detach-
ment of the sensitive tissues from the horn, prior to the forma-
tion of pus in some instances, while in others the tissues are
still attached to the horn, and the suppuration takes place in
the deeper tissues.

Limited suppurations may take place in any part of the
sensitive tissues of the foot during Laminitis, and may ulti-
mately be reabsorbed instead of being discharged upon the sur-
face ; but generally the process begins in the neighborhood of
the toe, and spreads backwards and upwards towards the coro-
net, where it is seen separating the horn from the coronary
band at the quarters. At the same time it is spreading over
the sole, and eventually the entire hoof is loosened, and finally
sloughs away, leaving the tissues beneath entirely unprotected.
If an examination of the keratogenous membrane is now care-
fully made, it will be found covered in greater part by pus and
coagulated exudate; at some points newly-organized horn may
be seen, while in others, and especially in the recently separated
portions, extravasated blood intermingles with the pus.

In other instances, and these are generally the cases not
considered unusually severe, the suppuration begins at the cor-
onary band which we find greatly effused, and crowded with
wandering cells and leucocytes. The suppuration extends but
a short distance in the podophyllous tissue, yet serves to de-
stroy the patient by separating the hcof from the coronary band
upon which it depends for support and growth. In this form
of the suppurative process, it is usually seen beginning in front ;
for it is this part of the coronary band that is always most ac-
tively affected with inflammation, and consequently it is here
that impairments first occur. Suppuration of the sensitive

22 LAMINITIS.

sole, is more common than of the sensitive laminae and coron-
ary band. It is present, in the majority of cases, where there is
a dropping of the os pedis, and in other instances where the
effusion at this point is so great as to arrest the production of
horn and uncover the sensitive tissues. Except when the result
of injury, it begins at the toe and spreads backward, and if not
relieved by opening the sole, escapes at the heel. Suppuration
of the sole is much less serious than where present in other
parts of the foot.

If the acute constitutional symptoms developed from this
sloughing of the foot do not result in death, a new hoof of very
imperfect horn may be developed after a time, but unless the
animal is to be kept for breeding purposes alone, the foot will
ever be useless for work, and death should relieve the suffering.
When only the sole sloughs, recovery takes place with proper

treatment.

Peditis.

This is the term which Williams applies to that serious
complication of Laminitis where not only the laminae, but
the periosteum and the pedal bone are also the subjects of
the inflammatory process. Neither is this all, for in some of
these cases of peditis acute serous synovitis of the " coffin
joint," is present, and where the tendency is to suppuration em-
pyema of the joint. Where periostitis and ostitis complicate
Laminitis, the exudation takes place in the keratogenous mem-
brane in and beneath the periosteum, and in the bone tissue. A
mild form of periostitis, in which the exudation is in the outer
or looser layer of the periosteum only, is a more common con-
dition than is recognized by practitioners generally ; and the
intimate contiquity of structures is the predisposing cause, the
disease either spreading from the original seat, or the compli-
cation occurs as one of the primary results of the exciting cause.
In the severer cases where the exudate separates the perios-
teum from the bone, suppuration, gangrene, and superficial
caries are common results. Where the plastic infiltration of
the bone tissue is rapid, the blood supply is cut off by the con-
sequent pressure upon the vessels in the Haversian canals, and
necrosis of the os pedis ensues. Grave constitutional symptoms

LAMINITIS. 23

mark these changes, and soon prove fatally exhaustive to the
patient.

In the mild cases of Periostitis it is by no means easy to
determine its presence positively, for there are no special symp-
toms by which it may be distinguished from pure Laminitis.
In the majority of the acute cases, though, that show no signs
of improvement by the fifth to seventh day, it is safe to sus-
pect periostitis is present, particularly if the coronets are very
hot, the pulse remaining full and hard, and the lameness acute.
In the fortunately rare cases where the bone is affected with
inflammation and suppuration, the agony of the patient is in-
tense, he occupies the recumbent position almost continually,
never standing for more than a few minutes at a time, suffers
from the most careful handling of the affected feet, maintains
a rapid pulse and respirations, high temperature, loss of appe-
tite and great thirst. It is in these cases the patient continu-
ally grows worse, and the appearance of suppuration at the
top of the hoof in about two weeks after the inception of the
disease, proves the inefficiency of any treatment that may have
been adopted, and the hopelessness of the case. These pa-
tients die usually between the tenth and twentieth days,
either from exhaustion or pyaemic infection. In making post-
mortem examinations of this condition, the os pedis will be
found blocked in parts with the exudate thrown out from its
numerous blood vessels. There is atrophy of the bony tissue
surrounding the Haversian canals, and a development of con-
nective tissue within, or else the enlarged canal is filled with
suppuration. The contiguous surface is denuded of its perios-
teum, which has been detached by the free exudation, is darker
In color than the healthy bone and generally roughened.

Caries.

Superficial caries may be present in, or follow, any case
of Laminitis, and its most common seats are directly at the
toe, particularly at the anterior surface, upon the anterior
face just beneath the pyramidal process, and on the plan-
tar surface of the relrossal processes. In this last-named
position it occasionally becomes more than superficial, extend"

24 LAMINITIS.

ing deep into the bone which it honey-combs completely in
the adjacent parts, and finally destroys, so that this part
of the bone may be found crumbling to pieces on attempting
to remove it.

Gangrene,

Occurs in the periosteum as the result of excessive detach-
ment from the bone, combined with compression from an over-
profuse exudate. Other parts of the sensitive tissues are sub-
ject to the same fate occasionally, from this last-named cause,
and at times large territories will be found dead.

Fuiniced Sole,

Is that condition in which the horny sole in the neighbor-
hood of the toe readily crumbles away and leaves the sensitive
tissues more or less exposed. It is not confined to being a
complication of Laminitis, but may be seen whenever the ne-
cessary conditions for inducing it are present. Williams has
described the horny tissue under these circumstances as being :
" weak, cheesy, ar spongy, like macerated horn, or even grum-
ous," and this certainly conveys a good idea of its appearance
and general characteristics. This crumbling horn when critic-
ally examined, shows almost an entire absence of the cohesive
matter which unites the healthy horn fibres, while the fibres
themselves are irregular and granular in appearance. Pumiced
sole depends upon an impairment of the horn-secreting powers
of the sensitive sole, or upon a separation occurring between
the horny and soft tissues which maintain its vitality. The
normal sole physiologically maintains a proper thinness, by
crumbling off in scales as it passes beyound the. life-mataining
influence of the producing tissues, and anything which perverts,
suspends, or destioys this inflluence, causes the crumbling pro-
cess to become excessive.

Punctured wounds of the feet, where accompanied by any
considerable destruction of the soft or horn-secreting tissues,
present the same peculiarities in this respect, in the immediate
neighborhood of the injury. Bruises of the sole are occasion-
ally followed by this change in the horn, where the exudation
has been excessive and separated it from the living tissues.

LAMINITIS. 25

True in these cases we rarely see the soft tissues laid bare for
the reason that new horn is constantly secreted and replaces
that undergoing the process of disintegration.

Laminitis presents three different conditions under which
pumiced sole may appear. First : where free exudation separ-
ates the horn from the other tissues, or where the process of
inflammation arrests the production of horn, by impairing or
destroying the horn-secreting membrane. Secondly : where
depression of the os pedis causes pressure upon, and arrests the
formation of horn ; and, Thirdly ; where the elevation of the
sole compresses the soft tissues against the pedal bone and in-
duces the same condition. Pumiced sole as it results from
simple exudation and separation of tissues is of no importance,
for the reason given above in connection with bruises ; but
where suppuration occurs in restricted portions of the foot in
conjunction with Laminitis, it always lays bare the tissues be-
neath and impairs the animal's value temporarily. In these
cases recovery takes place after a few weeks time by the tis-
sues horning over, as in injuries which have been attended with
the same process. Depression of the os pedis is not a sufficient
cause within itself to cause pumiced sole ; for, if the relative
change in the bone takes place slowly, or if the horn is thin,
the sole becomes convex from the gradual pressure, and the soft
tissues adapt themselves to the change without having their
function materially impaired. But when the dropping is sud-
den and the soft tissues entirely destroyed, the horn rapidly
crumbles away and the toe of the bone comes through. In
many of these cases the soft tissues remain uncovered for
months, and when they eventually become covered, it is with
a thin slightly adherent horn that bears but little or no wear.
The sole being now convex, the diseased tissues are compelled
to bear unusual weight by coming in contact with the ground,
and hence it is these animals are generally incurable cripples.
In the majority of cases where the sole is raised to meet the
pedal bone, and pumiced sole occurs, it is due, not to pressure
of the bone from within, (for the tissues are capable of adapt-
ing themselves to the gradual change) but to impaired vitality
of the sensitive tissues from the inflammation, and the constant

26 LAMINITIS.

concussion and pressure applied from without during progres-
sion. Added to this is to be considered the paring away of the
horn by the smith when applying the shoe, thereby keeping
the sole at this point too thin.

Turning Up of The Toe.

The results of my investigation into the cause and pathol-
ogy of this, too frequent, and most interesting sequel of Lam-
initis are somewhat at variance with the explanations given by
previous writers on the subject. For instance, Prof Williams
in his " Surgery" says : '' In some cases the removal of the ex-
udate leaves a space between the sensitive and horny laminae,
which has led some observers to think that the disease consists
essentially of absorption of the bond of union between the two
sets of laminae, the formation of a cavity and the subsequent
filling up of it with imperfect cheesy or seedy horn constituting
what is termed seedy-toe. Should the inflammation persist,
the exudate accumulates at the toe, increases in thickness,
presses upon the toe of the os pedis in the one direction, and
upon the crust in the other, separating the two, forcing the
toe of the bone downwards, and the toe of the crust upwards.
The effect of this change in the position of the bone is the
formation of a convex sole." Prof Law in his "Adviser''
makes the following remarks in relation to this condition : " If
the inflammation persists in a slight form, an excessive growth
of soft spongy horn takes place in front of the laminae at the
toe, separating the coffin bone from the hoof-wall, and allow-
ing its anterior border to press upon the sole, or even to per-
forate it." That "the removal of the exudate leaves a space
between the sensitive and horny laminae " is not clear to me,
for I have never been able to find an empty space between the
laminae, no matter how far apart they may have been forced.
It does not seem possible that such a condition could in any
way be produced by resorption, for the opposition to be over-
come in order to produce an empty space, a vacuum — is much
greater than can be accomplished by the absorbents.

All reabsorption of effused material must be followed in
subcutaneous parts, by one or more of four conditions : con-

LAMINITIS. 27

traction of tissue, renewed effusion, replacement of displaced
parts, or the production of ne^v tissue.

So far as my observations have gone, I find the effusion
under all circumstances in Laminitis comparatively limited,
and, that as the effused material is absorbed, the parts regain
their normal position and condition, or else the exudate is re-
placed by, or converted into , new tissue — so that at no time
is there an empty space created in the structures of the foot.
No matter how severe the inflammatory action may be, nor
how profuse the exudation, unless suppuration occurs, the soft
tissues are not destroyed to any considerable extent.

It is claimed by some writers that the soft tissues, having
been separated by the exudate from the horn, have lost their
function ; and that new horn, formed so plenteously under cer-
tain conditions, is produced alone by the coronary band. We
deny that this is true ; for we nnd in all of these cases, where
there is turning up of the toe, that the horn-producing lunction
of the coronary band is greatly impaired — in some cases almost
entirely suspended, upon the anterior part of the foot, and that
the greater this impairment on the part of the coronary band
the richer is the production of new horn at the toe. Further-
more, the new horn is always intimately attached to the podo-
phyllous tissue beneath, by which it has unquestionably been
produced; for if the coronary band is producing but little, and
the old horn is but slowly growing off, whence comes this new
horn } It cannot come from a tissue which can only replace
old horn with new, the said tissue being at least two inches
away from the point of production. Another evidence that
the new horn comes from the podophyllous tissue, is, that when
the function of the coronary band is regained, (as it oftimes is),
this new horn grows off with the wall and is replaced by new
horn from above, or from the coronary band.

Furthermore, this new horn is arranged between the sen-
sitive laminae in plates similar co the arrangement of the horny
laminae in the normal foot, with the exception that they are
not quite so regular and perfect in outline, and are covered
with more of the free cells spoken of by Fleming. Regarding
the direction of the horny fibres in this new horn, they will be

28 LAMINITIS.

found more oblique than the fibres in the healthy wall, the pro-
ducing tissue seeming to endeavor to throw these fibres off at
somewhat an approach to a right angle, as seen in the sensitive
sole and coronary band. Lastly these fibres are somewhat
flexuous, as in the healthy frog.

At whatever time, during the progress of the disease, the
separation of the sensitive and horny tissues is effected, the os
pedis thereafter tends to alter its relative position by reason of
the weight which it receives, and the position the animal as-
sumes throwing all the strain on the flexors.

But this tendency amounts to nothing of importance, unless
there is extensive separation of the bonds of union, when the
consequent pressure upon the soft tisses of the sole, already
impaired by disease, proves disastrous to their horn-producing
function, and ultimately destroys their structure. As seen in
plate No. 2, this deviation of the os pedis amounts to about five
lines, the convexity of the sole, reaching four and a half lines.
Here the change has been so gradual that but little impairment
of the function of the sensitive sole has resulted ; and the thin-
ness of the horny sole in front of the frog, is due to the interfer-
ence of the shoeing-smith. The space between the toe of the os
pedis and the original horn-wall, has been filled in with new horn,
as the bone receded from its original position. If this change in
the relation of the bone to the other tissues, was due, as Wil-
liams claims, to pressure of the exudate, this pressure, to over-
come the opposition of the sole, etc., would be so powerful as to
impair the horn-secreting function of the podophyllous tissue
on the anterior toe of the os pedis ; and hence, we would find
but little horn secreted, and that of a very inferior quality.
The opposite are the facts — plenty of horn of a good quality.
That replacement, complete or in part, takes place in many of
these cases, cannot be denied, for, as the superfluous horn at the
toe grows off with the wall, the bone tends to resume its old
position.

The exudate plays no part whatsoever \w forcing the toe of
the OS pedis downward, and the toe of the hoof upward, as
claimed by Williams and Law.

It does not always even so much as cause the separation be-

LAMINITIS. 29

tween the sensitive and horny tissues ; for at times this so-
lution of continuity is dependent upon other causes which have
no connexion with exudation. The turning up of the toe, as
seen in plate No. 3, is only the result of a simple mechanical
principle brought into operation by means of the altered rela-
tive growth of the horny fibres in different parts of the foot.

In every one of these cases there is a very decided impair-
ment of horn production upon the part of the coronary band
in its anterior part, while at the heel the production is as rapid,
or even takes place more rapidly, than normal, and the inevit-
able result is the formation of an angle upon the anterior wall ;
for the gro-A'ing heel tends to revolve, in its growth, around the
fixed point near the cornary band. As the angle forms at the
point where the impairment of function exists, /. e., near the
coronary band, the horn-fibres are deflected forwards, and con-
sequently upwards, so that the toe is brought nearer the horizon-
tal line, and the angle formed by the bones of the leg with
the anterior wall of the foot is diminished. This turning up of
the toe does not take place suddenly, as it might if dependent
upon the pressure of exudation, but the change is effected slow-
ly, and is commensurate only with the proportionate impair-
ment of horn secretion in front, and normal or increased produc-
tion at the heel. If the secretion of horn is nowhere impaired,
or if the interference with this function is equally distributed
throughout the entire coronary band, then it matters not what
amount of exudation may take place over the toe of the os
pedis, tlie toe of horn does not and cannot turn up.

But when the necessary causes are in operation, and the
angle begins to form on the anterior wall, the toe of the os
pedis, with its soft tissues attached, is separated from the horny
laminae, and becomes pressed upon by the upraising sole. This
separation of the tissues is due to the fact that the action of the
flexor pedis perforans and the ligaments of the " coffin joint "
tend strongly to hold the os pedis in its normal position, in re-
lation to the other bones of the leg ; while the strongest oppo-
sition is offered to the toe accompanying the horn, by the artic-
ular base of the coffin bone, and especially the pyramidal em-
inence, being situated above the point of the new angle, there-

30 LAMINITIS.

b}' necessitating the downward movement of all this part of the
bone so that the toe might conform to the new line of angular-
ity assumed by the lower anterior wall of the hoof* The exu-
dation which is now found taking place at the toe is the result,
not the cause, of the separation of the sensitive from the non-
sensitive tissues, and the new horn, which forms here, is the pro-
duct of the neighboring podophyllous tissue.

As the toe of the horny box proceeds in its change of re-
lative position, the sole rises to the os pedis, which eventually,
by its pressure, causes convexit}^ of the horny sole.

Animals affected with pumiced foot, and turning up of the
toe, during progression, always place the abnormally-long heel
first upon the ground, not because the heel is too long nor, as
in acute or sub-acute Laminitis, to relieve the pain, but for the
simple reason that the animal carries the leg forward with the
column of bones in the normal position, and attempting to keep
them so, the heel first comes in contact with the ground, and
he then knuckles over at the fetlock, in proportion to the a-
mount of foot deformity present, as he brings the toe to the sur-
face.

The pain and impairment of function in these cases always
results in marked atrophy of the muscles of the fore-arm, shoul-
der, and to some extent of the pectorals, while the position of
the fore feet advances the scapulo-humeral joints so well for-
ward as to cause a somewhat sunken appearance of the chest
in front, which the laity recognize as a peculiar form of the dis-
ease which they have designated as "Chest Founder."

Regarding the presence of inflammation during this process,
there is no doubt a chronic form is in existence a long time after
these lesions commence, yet it may in time subside and leave
the feet free from fever while the other changes still go on.

The lesions of turning up of the toe are permanent, and are
withal, the most interesting, pathologically, of all the compli-
cations of Laminitis.

* Since writing the above, I have seen a case in whicli the angle formed directly
at the coronary band, the os pedis being carried up, at the toe, with the horn, \\hile
the articular base was correspondingly depressed. The sole was of the normal thick-
ness, and not in the least convex.

LAMTNITIS.

Erosions of Encrusting Cartilage.

The altered position of the os pedis, as related tolffe-^eight-
bearing- surface, is such that in time, the flexors are shdH,erie<3,
and the joints become permarently sub-luxated with accofit- ■
panying degenerative process of the articular surfaces which
end in large ulcers at the fetlock, the second, and sometimes
the third, phalangeal articulations. These diseased conditions
of the joints, add to the suffering of the animal and increase his
difficulty of locomotion.

TREATMENT.

The treatment of Laminitis is probably more varied than
in any other disease, and yet in spite of it a large number of
cases recover for even the poorest practitioner. Since there
are two objects to be attained in treatment — prevention and
remedy — the matter will be considered under the head of pro-
phylaxis and remedial medication.

Prophylaxis.

To guard against and prevent disease, or to render an un-
preventable attack less serious than it otherwise would be, is
the highest practice of the healing art. In a disease so prone
to result from the simplest causes, as seen in Laminitis, and
especially when the soundest judgment may not be able to
determine the extent of the disease-resisting powers of the
tissues which are liable to be affected, or of what shall in every
instance constitute an over-excitement, it is not strange that
authors have avoided this field of instruction, and that horse-
owners find themselves in trouble from unintentional transgres-
sion. If the disease was dependent upon specific causes, or if
the stability of the tissues was of a fixed or more nearly deter-
minate quality, some measures might be instituted that would
prove generally preventive. But when we recall the fact that
predisposing causes are so prevalent, and often cannot be rem-
edied ; that what is but gentle work in one instance may incite
disease in another ; that what is food to-day may to-morrow
prove disastrous to health, and that necessary medical inter-

32 LAMINITIS.

ference, no matter how judicious, may cause a more serious
complaint than that which was being treated, the obstacles to
contend with become plain. Notwithstanding the difficulties
besetting effective prophylaxis of this disease, there are some
general rules to be observed that will in part serve to prevent
the dev^elopment of an unusual number of cases. In the first
place, all the predisposing causes named, must be removed
where possible, and when this is impossible, unusual care must
be taken not to bring into operation an exciting cause. Fat
animals should under no circumstances have hard work, and if
the weather is warm, or the variation of temperature great,
they should have but slozv, gentle labor, until they become in-
ured to it, the tissues hardened, and their excitability reduced
to a minimum.

Green horses should always have moderate work for the
same reason, and particularly when changed from the farm and
dirt-roads to city pavements. The increased concussion, changed
hygienic conditions and artificial living readily become active
causes of the disease under these circumstances.

Army horses just out of winter-quarters, track-horses with
insufficient preparation, and farmer's horses put to work in the
Spring, are among the most susceptible classes, and must be
protected by work that is easy and gradual. If long marches
or drives are imperative, then the incumbrances must be as
light as possible, and the journey interspersed with frequent
rests ; for this allows the laminae to regain their impaired func-
tional activity, and thereby to withstand much more work
without danger. And, furthermore, it permits an early detec-
tion of an oncoming attack m any case, prevents working after
the disease begins and renders subsequent medication much
more effective by cutting the process siiort at the stage of con-
gestion.

All animals when resting immediately after work, should
be protected from cold air or draughts. If placed in a stable
that is warm and without draught, no covering is necessary —
under opposite conditions blankets should be used until the
excitement and exhaustion of the labor performed have entirely
passed away. It is still better that all animals coming in warm

LAMINITIS. 3"3

from work, be "cooled out" by slow walking until the perspir-
ation has dried, and the circulation and respiration returned to
the normal. Animals stopped on the road, even for a few
moments' time, should always be protected from rapid change
of temperature by appropriate clothing. If it can be avoided,
horses that are working should never be driven or ridden
through a stream or pool of water. Where necessary, they
should be cooled off before passing through, and then kept ex-
ercising until completely dried. The same rule is to be ob-
served with regards washing the legs in cold water, when the
animal is just in from work ; for although it is practiced exten-
sively and usually with impunity, occasionally it proves the
cause of a most acute attack of this disease. Regarding shoe-
ing, as a predisposing cause, unusual changes in the manner
of applying the shoe should not be hastily made.

If a plain shoe has been worn, high heels or toes must not
be substituted at once, but the change, if necessary, gradually
made, so that the different tissues may adapt themselves to
the change of functional performance they are called upon to
bear. If on the other hand such changes are imperative, as is
sometimes the case, then the work must be so reduced in quan-
tity and quality that it cannot prove excitant of the disease.
Laminitis from the effects of purgative medicines is a condition
which can scarce be effectively guarded against, unless we dis-
card entirely this useful class of medicines. I cannot deter-
mine from the few cases in which I have seen this unhappy re-
sult of a purgative, that there are any conditions of the system
present that would warn us of danger in this direction. The
disease does not seem to have any dependence, for inception, in
such cases upon the size of the purgative, the length of time
before purgation begins, or the activity and severity with which
the remedy acts. The extent of prophylaxis in this regard,
must be confined to the exhibition of moderate doses of medi-
cines known to have .unusual irritating effects on the alimen-
tary canal. They should be used only when necessity de-
mands it.

Experience alone will determine what animals are liable
to suffer from this disease tln-ousfh tne influence of the different

34 LAMINITIS.

aliments. When an attack can with any certainty be ascribed
to any particular food, it should ever be withheld unless in the
smallest quantities. Horses that have never been fed upon
Indian Corn, should receive but a little at a time at first,
and always mixed with bran, oats or other food, until it has
been determined that no danger exists. Corn is much more
liable to cause Laminitis in warm than in cold weather, and for
this reason it should always be fed with care during Spring
and Summer months. Against Metastatic Laminitis there are
no measures which can in any way prove- preventive, the im-
portant consideration being its early recognition, which is more
readily accomplished than in Metastatic Pneumonia concurrent
with Laminitis.*

When an animal is excessively lame in one foot, the other
or opposite member should have the shoe early removed, and
cold water frequently applied. At the same time the slings
should be used if the subject remains standing. Horses should
under no circumstances be over-worked : to guard against this
previous work, nature of roads, state of weather, and various
other influences must be carefully noted. Watering while
warm, is a pernicious habit, and unless the animal is accus-
tomed to it, is apt to result in some disorder — oftimes in
Laminitis.

Remedial Medication.

In those .cases of simple passive congestion of the laminae
the body should be warmly clothed, and warm drinks given to
draw the blood in increased quantity to these parts, -so as
to direct it from the feet ; at the same time the feet should be
placed in warm water so as to increase the return flow of blood.
In the course of half an hour the feet may be changed to cold
water, which serves as a tonic to all the tissues, and kept there
until recovery is completed. If the constitutional symptoms
demand it diuretics should be given. Half-ounce doses of nitre
three times a day in the water answers the purpose. In cases
of active congestion the warm foot-baths should be omitted, and

* I have omitted speaking of Parturient Laminitis, never having seen a case,
and am unacquainted witli appropriate prophylaxis.

LAMTNITIS. 35

cold ones substituted from the commencement. Sub-acute
Laminitis demands the same treatment, with laxatives if there
is constipation, and the addition of low-heeled shoes. The
diuretics may need to be continued for some tim'e, and their
frequency increased. Regarding Acute Laminitis, what has
been called the " American Treatment " is so simple, and withal
so efficient that it is to be remarked other countries have never
adopted it. Since the disease is a local one, unquestionably the
remedies used should be applied in the immediate neighborhood
of the affected parts, or. if drugs are administered internally,
they should have some specific localized action.

And such are the claims made for the above-named meth-
od of treatment. It consists solely in the exhibition of large
doses of Nitrate of Potash and the continued application to the
feet and ankles, of cold water. We have never been able to
determine that nitre had any action on the keratogenous mem-
brane in particular, either in health or in disease, and if it is to
be called a specific, the claim must, as yet, rest upon the fact
that it nearly always cures. One noted American veterinary
surgeon attributes its good results, in this disease, to its con-
ceded power of defibrinizing the blood ; yet if this were its only
action, an}^ remedy producing the same effect in the same de-
gree, should prove just as effectual as a remedy ; a conclusion
which practice does not sustain. On the other hand, if Nitre
has but the one action as claimed, the remedies inducing the
opposite condition would be contra-indicated; yet phlebotomy,
which is known to favor hyperinosis, is practiced by some good
practitioners in Laminitis, and as they claim, with the best of
results. But be its action what it may, the fact remains that
three to fo7ir-ounce doses of Nitre repeated every six hours
is attended with the happiest effects ; the Laminitis frequently
subsiding inside of a week's time. , These large doses may be
continued for a week or ten days' time without danger ; never
under any circumstances have I seen the kidneys irritated to
excess, or other unfavorable effects produced.

The feet should either be kept in a tub of water at a tem-
perature of 45'^ to 50^ F.; (it may be lowered if desired), or if
the animal is lying down, swabs should be used and wet every

36 LAMINITTS.

half hour with the cold water. The water not only keeps the
horn soft and moist, but acts directly upon the inflamed tissues
by reducing their temperature, thereby increasing their vitality
and disease-resisting qualities, and at the same time, by toning
up the coats of the blood vessels, diminishes the supply of blood
and limits the exudation. Furthei^nore, cold has also an an-
set^thetic effect upon the diseased tissues, and relieves the pain.

Aconite maybe given in conjunction with Nitre where the
heart is greatly excited, and is beating strongly. Ten-drop doses
repeated every two hours for twenty-four hours, is usually suf-
ficient. The practice of giving cathartics is dangerous, for it
may excite super-purgation. Usually the Nitre has sufficient
effect upon the constipation to relieve it, yet if it should prove
obstinate, laxatives may be carefully given. Bleeding, both gen-
eral and local, should be guarded against ; the first because of
unfavorable hyperinosis, the latter from the danger of suppur-
ation and the difficulty in securing healing in some cases. The
shoes should always be early removed, and the soles left un-
parcd.

Paring of the soles presents two objections — first, while it
may temporarily relieve the pain by relieving pressure, it at
the same time allows of greater exudation which may more
than counter-balance the good effects : secondly, it makes the
feet tender and subject to bruises when the animal again goes
to work. The shoes should be replaced when convalescence
sets in, and the animal ready to take exercise. Exercise should
never be enforced until the inflammation has subsided, for al-
though it temporarily relieves the pain and soreness, it serves
to maintain the tissues in a state of continued irritation, in-
creases the exudation, and prolongs the recovery.

If, at the end of the fifth or sixth day, prominent symp-
toms of recovery are not apparent, apply a stiff" blister of can-
tharides around the coronet and omit the nitre for about forty-
eight hours. As soon as the blister has drawn well, the feet
may again receive wet swabs. If one blister does not sufifice
to remove the soreness, as is the case sometimes, especially
where periostitis is present, it may be repeated, or the actual
cautery applied. The same treatment should be adopted

LAMINITIS. 37

where side-bones form or periostitis of the os coronae ensues.
When the sole breaks through and exposes the os pedis and
soft tissues, the feet must be carefully shod — with thin heels
and thick toe where there is any tendency to walking- on the
heels — and the sole well protected with appropriate dressing
and pressure over the exposed parts. When there is turning
up of the toe, blistering of the coronet in front, carefully avoid-
ing the quarters and heels, sometimes stimulates the growth
of horn, but as a rule judicious shoeing is the only treatment
that will keep the animal in a condition to do moderate slow
work.

Where suppuration of the laminae is profuse, it is better to
destroy your patient at once and relieve his suffering ; but if
the suppuration is limited to a small extent of tissue, especially
of the sole, treatment as in acute cases may induce recovery,
and should always be tried. If from bed-sores or other causes
Septicaemia or Pyaemia is feared, the Bisulphite of Soda in
half-ounce doses may be given in conjunction with tonics and
other treatment indicated in these diseases. Regarding en-
forced recumbency, I doubt the propriety of insisting on it in
the majority of cases, for I think, as a rule, the animal assumes
whatever position gives most comfort. There can be no doubt
that recumbency diminishes the amount of blood sent to the
feet, and that the suffering is greatly relieved while in this
position, so that the experiment of enforcing recumbency may
be tried, yet should not be renewed if the patient thereafter
persists in standing.

Where the animal stands, or where constant lying indi-
cates it to prevent extensive sores, the patient should be
placed in slings, and the weight supported in this manner to
the relief of the feet. When all four feet are affected, it may
be impossible to use slings, for the reason that the patient re-
fuses to support any of his weight on his feet, and simply hangs
in the slings. Lastly, convalescent cases must not be returned
to work too early, else permanent recovery may never be ef-
fected.

Fig. 1.

Fig. 2.

Fig. I shows the healthy fcjot, with all the tissues in normal relative position,
as found in an eight-year-old gelding destroyed for dissection. The other cuts are
in outline only.

Fig, 2 shows the changed position of the os pedis, as seen in a laminitic-foot in
the Museum of the American Veterinary College. Downwaid deflection of the
bone at the toe, 5 lines. Convexity of the sole, 4!^ lines. New horn formed on
the anterior wall, as the bone receded, and hlls the space between the present jd'M.f?-
/^■^'^ and original /z^ir/zy laminae. Sole greatly thinned from paring. No turning up
of the toe.

Fig. 3.

Fig. 4,

Fig. 3. — Chronic Laminitis, with turning up of the toe, from a specimen in
American Veterinary College Museum, Deflection downward, 4 lines. Elevation
of horny toe from original position, 7 lines. Development of sole beneath the na-
vicular, from 7 lines (normal average thickness at this point) to 14 lines. Thickness
of sole over toe of ospedis, 4^^ lines, (normal about 6 lines). Thickness of new
horn over the anterior surface of the os pedis, 11 lines. Horn-producing function of
the coronary band greatly impaired in front — heel too long.

Fig. 4. — External appearance of the same foot as Fig, 3, showing the irregu-
larity of the lines produced by the alteration in relative horn growth at different
points, and showing the angle on the anterior wall.

r y