concerned first with a consideration of the correct treatment to be adopted
when we know the wound to have reached the articulation.
Only too frequently the treatment practised is that of poulticing. In other
portions of this work we have pointed out the advantages that a continued
antiseptic bathing has over the application of a poultice, the greater
readiness with which the solution comes into contact with the deeper parts
of the wound, and the far greater chance there is of maintaining water in
an antiseptic condition than there is of keeping a poultice in the same
state. There is no doubt, that in this case also, the cold or warm
antiseptic bath is to be preferred to the poultice. It is questionable,
however, whether even the bath is sufficient for our purpose here. We have
in this case a deep punctured wound, and a wound that in every probability
is infected with the organisms of pus or of putrefaction. It is a wound,
moreover, which is likely to impede the thorough access to it of the
solution in which the foot is fomented, on account of the flakes of
coagulated fibrin which fill it.
The most rational treatment, therefore, if we get to the case early enough,
is to irrigate the wound freely with a solution of carbolic acid in water
(1 in 20), or with a solution of perchloride of mercury (1 in 1,000),
injected by means of a glass syringe, or the pattern of syringe devised for
quittor. This injecting should be done thoroughly, and by that we mean that
several syringefuls of the solution should be injected, the joint after
each injection being manipulated so as to distribute the solution as far as
possible over it. When this is done the opening in the sole may be plugged
with a little perchloride of mercury, or, better still, with a little piece
of tow saturated with a concentrated solution of perchloride of mercury
or a solution of iodoform in alcohol and an antiseptic pad of tow or lint
placed over all. The foot should then be bandaged and encased in a boot or
sacking protective. The bandage should be removed daily and the antiseptic
pad changed. At each visit the animal's condition must be carefully
noted. So long as constitutional disturbance is slight, the foot appears
comfortable, is free from marked heat and tenderness, and pawing movements
are absent, and so long as the discharge on the pad appears non-purulent,
free from marked odour, and small in quantity, then this dressing may be
persisted in.
This treatment of open joint, preventive as it is of arthritis, is also
indicated in the case of open navicular bursa. In several instances we have
practised this treatment for the dressing of wounds implicating the bursae
of tendons and the capsules of joints. It is also spoken of favourably by
Mr. C.H. Flynn in the _American Veterinary Review_ for June, 1888, whose
treatment is as follows: 'Place the patient in a clean, well-ventilated,
and drained stable. Have all the litter removed, and insist on the stall
being kept clean. Either place the animal in slings, or tie the head so as
to prevent lying down. Clip the hair and cleanse the parts well. He prefers
the corrosive sublimate solution (1 in 1,000). Should the wound be of two
or more days' standing, inject the joint with the corrosive sublimate
solution. Now dry the parts with a clean towel and sprinkle the wound with
iodoform. Over this place a thick layer of absorbent cotton-wool, filled
with iodoform, bandage securely, and keep the patient on a moderate diet,
preserving the utmost quietude possible. Should the bandage remain in
position and the animal free from pain, leave the bandage and dressing in
place from five days to a week. Then change it, and should the discharge
be little, do not disturb it, but renew the iodoform and cotton dressing,
leaving it on for another week.'
Other treatments for the same condition are practised, in which the wound
is dusted with powdered iodoform, with potassium permanganate, or with
corrosive sublimate, or where the wound, instead of being dusted, has
the corrosive sublimate applied in the form of a plug. In each case the
preliminary irrigation with the corrosive sublimate solution is dispensed
with. This, however, should on no account be omitted. In our opinion it
constitutes the very essence of the rationality of the treatment.