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Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

1. Currently there are _____ levels of codes associated with HCPCS.
a. two
b. three
c. four
d. five
ANSWER: a
POINTS: 1
DIFFICULTY: Easy
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:01 AM
DATE MODIFIED: 8/2/2016 1:02 AM

2. Processing of DMEPOS claims for a specific geographic region is done by _____.

a. Medicaid
b. a DME Medicare administrative contractor
c. a hospital
d. a DMEPOS dealer
ANSWER: b
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:03 AM
DATE MODIFIED: 8/2/2016 1:04 AM

3. Coding questions asked by the DMEPOS dealer should be checked with the _____.
a. Medicaid office
b. Medicare office
c. DMEPOS dealer
d. PDAC
ANSWER: d
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:04 AM
DATE MODIFIED: 8/2/2016 1:05 AM

4. An HCPCS level II code begins with the letter “K.” This signifies that the Medicare administrative contractor
responsible for processing the claim is a _____.
a. primary MAC
b. DME MAC
Copyright Cengage Learning. Powered by Cognero. Page 1
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

c. primary MAC or DME MAC

d. CMS
ANSWER: b
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:27 AM
DATE MODIFIED: 8/2/2016 1:28 AM

5. HCPCS level II _____ are attached to any HCPCS level I or II code to provide additional information regarding the
product or service reported.
a. temporary codes
b. permanent codes
c. numbers
d. modifiers
ANSWER: d
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:28 AM
DATE MODIFIED: 8/2/2016 1:29 AM

6. Which of the following modifiers may be added to a code for CPT radiology services?
a. -59
b. -25
c. -53
d. -73
ANSWER: a
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:30 AM
DATE MODIFIED: 8/2/2016 1:31 AM

7. When assigning HCPCS level II codes, _____.

a. a service may not be reported by assigning both a CPT and HCPCS level II codes
b. qualifying terms such as dosage limits do not alter the quantity reported
c. most supplies are not included in the charge for the office visit or procedure
d. some HCPCS level I and II services are not payable by Medicare
ANSWER: d
Copyright Cengage Learning. Powered by Cognero. Page 2
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:31 AM
DATE MODIFIED: 8/2/2016 1:32 AM

8. The Administrative, Miscellaneous, and Investigational section of HCPCS level II includes codes for all of the
following EXCEPT _____.
a. exercise equipment
b. nonprescription drugs
c. ancillary transportation-related fees
d. noncovered items and services
ANSWER: c
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:32 AM
DATE MODIFIED: 8/2/2016 1:34 AM

9. Codes for outpatient PPS would include which of the following?

a. Durable medical equipment
b. Nonprescription drugs
c. Biologicals
d. Radiopharmaceutical agents
ANSWER: c
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:35 AM
DATE MODIFIED: 8/2/2016 1:35 AM

10. What are used to report product-specific HCPCS codes to obtain reimbursement for biologicals, devices, drugs, and
other items associated with implantable device technologies?
a. Modifiers
b. C codes
c. D codes
d. R codes
ANSWER: b
POINTS: 1
DIFFICULTY: Moderate
Copyright Cengage Learning. Powered by Cognero. Page 3
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

QUESTION TYPE: Multiple Choice

HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:36 AM
DATE MODIFIED: 8/2/2016 1:39 AM

11. A patient is prescribed orthopedic shoes. A code to reflect the shoes would be found under the _____ section.
a. Outpatient PPS
b. Medical and Surgical Supplies
c. Prosthetic Procedures
d. Orthotic
ANSWER: d
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:43 AM
DATE MODIFIED: 8/2/2016 1:44 AM

12. A patient who is severely diabetic received a below-knee test socket. The code assigned would be found under the
_____ section.
a. Orthotic
b. Medical and Surgical Supplies
c. Outpatient PPS
d. Prosthetic Procedure
ANSWER: d
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:45 AM
DATE MODIFIED: 8/2/2016 1:46 AM

13. A patient was supplied with a water pressure mattress. Report code _____.
a. E0181
b. E0186
c. E0187
d. E0194
ANSWER: c
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:47 AM
Copyright Cengage Learning. Powered by Cognero. Page 4
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

DATE MODIFIED: 8/2/2016 1:48 AM

14. A patient was assessed for a hearing aid. Report code _____.
a. V5008
b. V5010
c. V5266
d. V5241
ANSWER: b
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:48 AM
DATE MODIFIED: 8/2/2016 1:49 AM

15. A patient received an injection of morphine sulfate, 10 mg. Report code _____.
a. J2270
b. J2274
c. S0093
d. S0109
ANSWER: a
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:50 AM
DATE MODIFIED: 8/2/2016 1:51 AM

16. A 10-year-old patient required sign language services for 30 minutes. Report code(s) _____.
a. T1023
b. T1015
c. T1013
d. T1013, T1013
ANSWER: d
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:52 AM
DATE MODIFIED: 8/2/2016 1:52 AM

17. A patient was administered butorphanol tartrate (trade name Stadol NS), nasal spray, 25 mg. Report code _____.
a. J0595
Copyright Cengage Learning. Powered by Cognero. Page 5
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

b. J7631
c. J7506
d. S0012
ANSWER: d
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 1:56 AM
DATE MODIFIED: 8/2/2016 1:57 AM

18. The provider transported portable x-ray equipment to the nursing home for the purpose of testing several patients.
Report code _____.
a. R0070
b. R0075
c. R0076
d. Q0092
ANSWER: b
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 2:14 AM
DATE MODIFIED: 8/2/2016 2:15 AM

19. A patient was given a 30-day supply of prenatal vitamins. Report code _____.
a. S0197
b. J1410
c. A9153
d. A9152
ANSWER: a
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 2:15 AM
DATE MODIFIED: 8/2/2016 2:17 AM

20. An outpatient received a disposable topical hyperbaric oxygen chamber. Report code(s) _____.
a. A0422
b. A0422, A4575
c. A4575
d. A4616
Copyright Cengage Learning. Powered by Cognero. Page 6
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

ANSWER: c
POINTS: 1
DIFFICULTY: Difficult
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 8/2/2016 2:17 AM
DATE MODIFIED: 8/2/2016 2:18 AM

21. Adhesive remover, wipes, any type, each. Assign HCPCS code(s).
ANSWER: A4456
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:46 AM
DATE MODIFIED: 8/3/2016 8:46 AM

22. Detachable, adjustable height armrest, upper portion, each. Assign HCPCS code(s).
ANSWER: K0018
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:48 AM
DATE MODIFIED: 8/3/2016 8:48 AM

23. Stoma cap. Assign HCPCS code(s).

ANSWER: A5055
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:48 AM
DATE MODIFIED: 8/3/2016 8:48 AM

24. Enteral nutrition infusion pump, with alarm. Assign HCPCS code(s).
ANSWER: B9002
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:49 AM
DATE MODIFIED: 8/3/2016 8:49 AM

25. Radiopharmaceutical, diagnostic, not otherwise classified. Assign HCPCS code(s).

ANSWER: A4641
POINTS: 1

Copyright Cengage Learning. Powered by Cognero. Page 7

Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

QUESTION TYPE: Objective Short Answer

HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:49 AM
DATE MODIFIED: 8/3/2016 8:49 AM

26. Addition, endoskeletal system, below knee, alignable system. Assign HCPCS code(s).
ANSWER: L5910
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:50 AM
DATE MODIFIED: 8/3/2016 8:50 AM

27. Culture, bacterial, urine, quantitative, sensitivity study. Assign HCPCS code(s).
ANSWER: P7001
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:50 AM
DATE MODIFIED: 8/3/2016 8:50 AM

28. Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg. Assign HCPCS code(s).
ANSWER: J7674
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:51 AM
DATE MODIFIED: 8/3/2016 8:51 AM

29. Assistive listening device, alerting, any type. Assign HCPCS code(s).
ANSWER: V5269
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:51 AM
DATE MODIFIED: 8/3/2016 8:51 AM

30. Case management, per month. Assign HCPCS code(s).

ANSWER: T2022
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:51 AM

Copyright Cengage Learning. Powered by Cognero. Page 8

Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

DATE MODIFIED: 8/3/2016 8:52 AM

31. Sphere, single vision, plano to plus or minus 4.00, per lens. Assign HCPCS code(s).
ANSWER: V2100
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:52 AM
DATE MODIFIED: 8/3/2016 8:52 AM

32. Compression burn garment, bodysuit (head to foot), custom fabricated. Assign HCPCS code(s).
ANSWER: A6501
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:53 AM
DATE MODIFIED: 8/3/2016 8:53 AM

33. Neuromuscular stimulator, electric shock unit. Assign HCPCS code(s).

ANSWER: E0745
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:53 AM
DATE MODIFIED: 8/3/2016 8:53 AM

34. Contact lens, gas permeable, bifocal, one lens. Assign HCPCS code(s).
ANSWER: V2512
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:53 AM
DATE MODIFIED: 8/3/2016 8:53 AM

35. Additive for enteral formula (e.g., fiber). Assign HCPCS code(s).
ANSWER: B4104
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:54 AM
DATE MODIFIED: 8/3/2016 8:54 AM

36. Catheter, hemodialysis/peritoneal, long term. Assign HCPCS code(s).

ANSWER: C1750
Copyright Cengage Learning. Powered by Cognero. Page 9
Name: Class: Date:

Chapter 07 HCPCS Level II National Coding System

POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:54 AM
DATE MODIFIED: 8/3/2016 8:54 AM

37. Injection, ziprasidone mesylate, 20 mg. Assign HCPCS code(s).

ANSWER: J3486, J3486
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:54 AM
DATE MODIFIED: 8/3/2016 8:55 AM

38. Positioning seat for persons with special orthopedic needs. Assign HCPCS code(s).
ANSWER: T5001
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:55 AM
DATE MODIFIED: 8/3/2016 8:55 AM

39. Smoking cessation gum. Assign HCPCS code(s).

ANSWER: S4995
POINTS: 1
DIFFICULTY: Moderate
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:55 AM
DATE MODIFIED: 8/3/2016 8:56 AM

40. Diabetes outpatient self-management training services, group session (2 or more), per 90 minutes. Assign HCPCS
code(s).
ANSWER: G0109, G0109, G0109
POINTS: 1
QUESTION TYPE: Objective Short Answer
HAS VARIABLES: False
DATE CREATED: 8/3/2016 8:56 AM
DATE MODIFIED: 8/3/2016 8:57 AM

Copyright Cengage Learning. Powered by Cognero. Page 10

Random documents with unrelated
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 careful your knife is thoroughly
sharpened, and is of sufficient
size; mind, also, that all the
cuts run smoothly into one
another, so as to leave clean
surfaces for the healing process
to unite. Having reached the
heart of the disorder, proceed
to empty out all the concrete
matter. That done, wash out the
part with a syringe and the
coldest spring water. Afterward
POLL EVIL DURING THE FIRST examine the cavity. Excise any
STAGE. loose pieces of tendon or of
ligament, and cut until a
healthy aspect is everywhere presented. Then rub the sides of the
deep-seated wound with lunar caustic. Let the horse rise, giving
orders that the sore is to be thoroughly moistened thrice daily with
the solution of the chloride of zinc, one grain to the ounce of water,
and, placing a rag dipped in a solution of tar over the wound to keep
off the flies, return the horse to the stable.
If the disease be left to run its course, the swelling generally
increases, while numerous openings at last disfigure the
enlargement. From such drain a glairy discharge. This adheres to the
surrounding parts, and, joined to the miserable expression of the
countenance, gives to the horse a peculiarly unpleasant appearance.
The flesh wastes under the perpetual anguish, and the half-
conscious aspect of the creature justifies a suspicion that the brain is
affected.
In that case, proceed as before directed concerning casting the
horse and the knife with which you operate. Have the blade rather
too large than too small. Most veterinary instruments are mere
adaptations of those employed by the human surgeon. The author
never remembers to have seen anything approaching to the
magnitude of a proper horses operating knife in the hands of his
fellows. A small blade compels numerous small cuts. The part is
rather snipped asunder than divided by one clean incision. The
recovery is thereby materially delayed; and the lengthened operation
greatly deteriorates from its chances of success, not to dwell upon
the increased suffering occasioned to the quadruped.
The horse being down, do not attempt any display of your
proficiency. Look well and long at the part intended to be operated
upon. Decide in your own mind the course in which the knife is to
move. That course should be influenced by the direction in which
you may probably separate the greater number of sinuses. In the
engraving inserted below there are four holes, each indicating the
presence of a sinus. The supposed direction of the knife is laid down
by dotted lines. The primary and lower incision includes three of the
pipes. That made, another connects the other sinus with the longer
incision; the after-labor necessitates the cleaning of the central sac,
removing all the hanging pieces, also probing the sinuses, and
making sure all are fairly opened. If any are found unopened, a
director should be inserted, and the channel should be connected
with the chief wound by means of a smaller knife.
Two cautions are necessary
to be given with regard to the
treatment of poll evil: Never
permit the knife to be applied
upon the root of the mane.
Underneath the hair which
decorates the neck of the horse
lies an important ligament, by
means of which the head is
chiefly supported. All the evils
POLL EVIL IN ITS SECOND STAGE, which might be anticipated may
OR WHEN READY FOR OPERATION. not spring from the division of
that development; but it is well
to spare it, although the prostrate animal should have to be turned
over, and the operation have to be continued on the other side. Also,
when working the creature subsequent to its recovery, never use a
collar. Wounds, although perfectly healed, are apt to remain
morbidly sensitive; serious accidents, over which the reader would
deeply grieve, may occur from the harness touching the part which
once was diseased. A breast strap is, therefore, to be much
preferred.
There are several popular methods of treating this disease. All,
however, are cruel; one is barbarous; when properly conducted,
none are efficient under the direction of a person possessing the
smallest feeling. The injection of potent caustics in solution, or
violent compression upon an exquisitely tender swelling even until
the force employed amounts to that power which can bring the sides
of a distant internal cavity together, drive out the corruption, and
hold the part in that position while healing is established, have been
largely advocated. Whoever could increase the suffering of a mute
and patient life to that degree which the last method necessitates
would merit a much severer punishment than the writer can afford
space to detail. Of these modes of cure the author can profess no
experience. He has, however, seen injections used; in no instance
have they been successful. The time which they occupied was
enormous, and the expense with which they were attended by no
means small. The man who hopes to eradicate this disease should
never have recourse to them.
Another process, formerly very popular, consisted in slicing the
living flesh in a very coarse and vulgar manner; that, however, was
merely preparatory. The chief dependence was placed in boiling
liquor, which was inhumanly poured into the wounds. After such a
method were all sinuous sores treated by an ignorant and
uneducated quack, who especially delighted in eradicating such
forms of disease. The writer has heard terrible descriptions given of
the agony produced, and equally revolting has been the picture of
the filth employed by this unqualified horse doctor. While, however,
the course which has been mentioned is reprobated, our heaviest
condemnation should alight upon those persons who could so violate
the sacredness of their trusts as to surrender any creature to the
torments of so horrible a remedy.
 In poll evil, the only certainty reposes on the knife. When
properly employed, the operation is brief; the temporary agony
bears no proportion to the years of subsequent relief thereby
secured. To be properly employed, however, it should be used as
though the person invested with it was, for the time, divested of all
feeling. He who accepts it must think only upon what he is about to
perform, and must summon resolution to do it quickly. In surgery,
hesitation is positive cruelty; the knife, to be curative, should be
gracefully moved through the living flesh. All notching and hacking
are tortures, and worse than folly; the blade should sweep through
the substance; and, to prevent the struggles of the quadruped from
interfering with the intentions of the surgeon, all that will be
necessary is for some person to sit upon the cheek of the prostrated
animal.

FISTULOUS WITHERS.

This disease, in its chief characteristics, closely resembles poll

evil. It, however, differs from that disorder in one fortunate
particular; poll evil must come to maturity before its cure can be
attempted with any hope of success. Injury to the withers is easiest
eradicated when attacked upon its earliest appearance; both,
however, in their worst periods, proceed from pus being confined,
from it decomposing and its establishing numerous sinuses. When
disease has reached this stage, the only certain cure is the free but
skillful use of the knife.
Fistulous withers, in the first instance, is an injury to one of
the superficial burst which nature has provided to facilitate the
movement of the vertebral, points spinal under the skin. The hurt is
occasioned by badly-made saddles, but more especially by the
ladies' saddles. Some fair equestrians delight to feel their bodies
lifted into the air, and enjoy the trivial shock of the descent; such
movements, however, necessitate the weight should be leaned upon
the crutch and stirrup. This kind of exercise is never indulged in by
good female riders, as no saddle, however well constructed, can
resist the constant strain to one side. Friction is produced; a bursa is
irritated, and the animal will, under the best treatment, be rendered
useless for a fortnight. Rolling in the stalls is also reported to have
occasioned this affection; so likewise is the heavy hammer of the
shoeing smith, intemperately employed to chastise the transient
movement of an observant horse.
When first produced, the remedy is certain and easy. A swelling
about the size of an egg appears near the withers, upon the off side
of the body. Go up to the horse upon that side; have with you a
keen-edged and sharply-pointed knife of pocket dimensions. Stand
close to the animal; then impale the tumor, and, having the back of
the blade toward the quadruped, cut quickly upward and outward.
Mind, and stand very close to the center of the body, as the pain of
this trivial operation is apt to make the creature lash out and prance.
At the spot indicated a person is perfectly safe; neither hoof nor leg
will touch that particular place, or even come near it. Rest one hand
on the back, and by your voice reassure the startled creature.
The swelling being divided, exchange the knife for a lunar caustic
case; smear over the interior well with the cautery, and all the
business is over. Never, however, attempt to pass by the heels of a
steed which has been pained. The animal may suspect your motives,
and the hind feet of the horse are the most powerful weapons of
offense and of defense. Have the creature backed from the stall ere
you attempt to quit it. Subsequently keep the wound moist with the
lotion composed of chloride of zinc—one grain to the ounce of
water; also have the part covered with a rag, moistened with
solution of tar. In nine or ten days the incision will have healed, and
after the lapse of a fortnight the animal may return to its ordinary
employment.
Should this remedy be neglected, pus is soon formed within the
enlargement, and the formation is accompanied by swelling, heat,
and pain. The horse is useless, and continues thus till the affection is
 eradicated. The animal cannot
wear a collar; it cannot endure
a saddle; at length numerous
holes are formed upon the
enlargement. These are the
mouths of so many sinuses, and
from each exudes a foul
discharge. The poor quadruped
evidently suffers greatly; it will
almost stand still and starve
rather than brave agony by
violent motion.
The only remedy is by
operation; make an incision so
THE SLIGHT as to embrace the greatest
ENLARGEMENT number of holes. Then cut from
WHICH, the other openings into the
BADLY TREATED
main channel; this done, have
OR UNATTENDED
TO, the sides of the wound held
MAY END IN back, while the center of
FISTULOUS corruption is cleaned out. Such
WITHERS. is a very filthy and unpleasant
office; if the bones are affected,
all the diseased parts must be removed. When slight, the tainted
portions may be scraped away; when of long standing, the spines of
the vertebræ have been sundered with the saw and thus taken from
the body. At any risk, none but healthy bone must be suffered to
remain; all discolored or white portions of the bony structure must
be extirpated, and none but that which, is of a healthy pink color
suffered to continue. If a particle of unhealthy, osseous growth is left
behind, the wound may close, but it will break out again, and the
disease become as bad as ever.
The cleansing being accomplished, apply the cloth over the
wound, and keep wet with the lotion formerly directed to be used.
 Sometimes the sinuses will
take a dangerous direction,
and, favored by the action of
the shoulder, will burrow from
the withers to the chest or
elbow. Then the knife cannot be
employed. Should a pipe incline
to this course, but be of
comparatively short extent,
insert a little bichloride of
mercury down the channel. This
A HORSE WITH FISTULOUS
is best done by powdering WITHERS IN THE WORST STAGE.
some of the salt. Dip the elastic
probe, which has recently been
down the sinus, into the powder. Reinsert it, and continue to repeat
this action till all the bichloride is expended.
If the sinus should have run its entire course, but not have found
an exit below, then employ a long guarded seton needle, such as
can be purchased at all veterinary instrument makers. Insert this in
its guarded state, and, having pushed it as far as it will go, give,
upon the end of the handle, a moderately sharp blow; this will force
out the cutting edge and drive the point through the flesh. Pass a
long tape, with a knot at the further end of it, through the opening
near the point, and withdraw the instrument, leaving the tape in
after another knot has been tied at the other extremity.
Thus a seton is established, and a depending orifice is instituted.
The tape will act as a drain to the morbid secretion, while the
irritation produced by it will also remove the callous lining of the
pipe. A healthy action will thereby be established; and so soon as
the inferior wound discharges a full stream of thick, creamy pus, the
seton may be cut out, with a conviction that its office is fulfilled.
 A GUARDED SETON NEEDLE.

THE SETON NEEDLE PROTRUDED, AND SECURED WITHIN THE HANDLE

BY MEANS OF A SCREW.
The screw being loosened, the button is struck, and the sharp needle
shoots forward, cutting its way through any interposing obstacle.

However, never turn animals afflicted with fistulous withers or

with poll evil out to grass. In the last disease, the motion of the
head, the outstretching of the neck, and movement of the jaws
occasion agony; and in the first instance, the necessity for perpetual
action entails so much misery as soon renders the life worthless. The
horse which is not worth the best of food in the best of stables,
should not be doomed to a life of starvation and of torture. It is the
shame of society that rich men are tempted by a few pounds to
dispose of the creature which has been maimed in their service.
Wounds endured when obeying the wishes of the master should
endear the slave unto his lord. In the case of the willing steed, the
law is reversed. The owner blemishes; and instead of nursing the
wounded life, he disposes of it. The injured animal is sold to the first
purchaser for so much as the damaged article will fetch.

FISTULOUS PAROTID DUCT.

This is a most serious evil, rather than a quickly-killing disease.

The animal which is thus afflicted may endure for years; but each
meal consumed and each day survived rates as a period of misery.
When it is considered how much the happiness of the lower order of
beings depends on merely feeding and living, it will be at once
apparent how much the horse has lost when all enjoyment has
departed from eating; when mere existence is embittered by being a
prolongation of the suffering. The digestion becomes deranged,
because the saliva, or a valuable secretion imperative to the proper
performance of the function, is absent; while every movement is a
pain occasioned by the agony of a diseased stomach and the
anguish attendant upon a fistulous sore. The wretched creature, in
this condition, speedily becomes an object of disgust to the most
humane master; and, according to the convenient morality of
modern times, is therefore sold to the highest bidder. Purchased only
for the work which remains in the carcass, a fearful doom lies before
the sick and debilitated quadruped. It rapidly sinks lower and lower,
at each stage of its descent the food growing more scanty as the
labor becomes more exhausting.
The parotid duct is the tube by which the saliva secreted by the
gland is, during the act of mastication, conveyed into the mouth and
mingled with the food. The parotid gland lies at the spot where the
neck joins the jaw; within the interior of that body numerous fine
hollow vessels connect and unite. These at each junction become
larger and fewer in number, till at length they all terminate in one
channel, which is the duct immediately about to be considered. It
leaves the gland and travels for some space upon the inner side of
the jaw; after which it curls under the inferior border of the bone
and runs in front of the large masseter muscle of the horse's cheek.
Its injury is frequently occasioned by hay-seeds or particles of
food, during the process of comminution, entering the open mouth
of the duct; these, subsequently becoming swollen, prevent the free
egress of the saliva. The secretion, nevertheless, goes forward and
accumulates within the tube, which it greatly distends. A confined
secretion produces the most exquisite agony. The motion of the jaw
stimulates the gland to pour forth its fluid; thus every mouthful
which the animal is forced to eat not only is the cause of suffering,
but likewise occasions additional pressure to a channel already
enlarged to bursting, and which at length bursts.
 Another provocative is
calculus, or stone, which is
sometimes taken from the
cheeks of horses, they being of
enormous comparative
magnitude; the natural tube
would not admit a pea.
Concretions have been removed
from this narrow passage as
large as a pullet's egg. Such an
obstacle not only impedes the
flow of saliva, but produces
additional anguish by the
distention it occasions, and by
THE PAROTID DUCT DISTENDED BY
the hinderance so hard a A
substance offers to every SALIVARY CALCULUS.
motion of the animal jaw during
the necessary period of
mastication.
Every puncture made into the substance of the duct, and every
rupture of the canal, speedily becomes fistulous sores. The saliva
constantly pours through the opening thus instituted; the healing
process is thereby prevented, and the edges of the wound rapidly
become callous. It is, however, painful to be obliged to state that the
stable fork, in the hand of an intemperate groom, is the instrument
by which these punctures are too frequently occasioned.
Gentlemen when engaging people to attend upon their animals
should always be very particular concerning temper. An irritable
person, however smart he may appear, is obviously disqualified for
such an occupation. A man of an evil temper should never be
engaged. Still, the great majority of present grooms are rather
conspicuous for an exuberance of conceit, than remarkable for any
openness of countenance. Smartness may gratify the pride of the
master; but it is difficult to comprehend in what manner it possibly
can benefit his horse.
 There is an old proverb which, being "the condensed wisdom of
ages," teaches that "the master's eye fattens the steed." Most of
modern masters dislike nothing so much as trouble. The stable is
given over to the servant. No Eastern despot is so absolute as the
groom in his dominions: he kicks and abuses its inhabitants at his
pleasure. If the free exercise of his will occasions injury, a lie is
easily invented and readily believed by the lazy superior. All that
comes into or passes out of the building pays toll to the invested
ruler. Five per cent. is levied upon the hay and corn merchant; the
dung is sold as a legitimate perquisite; the bills of the harness and
the coach makers are taxed one shilling in the pound by the most
ignorant groom, and often much higher by the properly initiated.
Thus the idle man pays dearly for his ease. There is no luxury so
expensive as a want of wholesome energy.
The process of mastication
causes the saliva to be
secreted. At each motion of the
jaw it is squirted forth with
violence; every drop of the fluid
passes through the false
opening—no portion finds its
way into the mouth. The
running of the stream down the
cheek wears away the hair,
while the absence of a valuable
A HORSE, HAVING A FISTULOUS constituent toward perfect
PAROTID
DUCT, IN THE ACT OF EATING.
digestion occasions the diet not
to nourish the body. The animal
loses flesh, and quickly
assumes a miserable appearance, which makes the proprietor long
to rid his sight of so pitiable an object.
The cure for this disease was aptly illustrated by Mr. Gowing, the
excellent veterinary surgeon of Camden Town. That gentleman made
an adhesive fluid, by either saturating the strongest spirit of wine
with gum mastic, or dissolving India-rubber in sulphuric ether. Then,
when the horse was not eating, he pared off the hardened edges of
the wound till blood issued therefrom. He subsequently allowed the
bleeding to stop, and placed over the orifice a piece of strained
India-rubber. Over that he put a thin layer of cotton; fastened one
end of the cotton to the hair of the cheek by means of the adhesive
preparation. That being dry, he tightened the cotton and glued down
the opposite extremity. Next he attached another layer of cotton,
and subsequently another. Afterward he fastened more cotton, some
of it crossways; and, having added as many layers as would make a
good body, saturates the whole with the adhesive solution before
alluded to.
The hair affords a good ground to which any other substance can
be fastened; but it is rendered better by being thoroughly washed
with soft soap and warm water. The ablution deprives the skin of the
horse of its naturally unctuous secretion, and permits the adhesive
application a better chance.
The horse should be allowed no food which necessitates
mastication. The head should be fastened to the pillar-reins during
the process of cure. Thin gruel only should be presented while
treatment is progressing, and that should be continued until the
covering falls off. Should the wound not be healed, allow a couple of
days to elapse; but give no solid food. Permit the horse to rest on
refuse tan—not straw, which might be eaten—during all this time.
Afterward renew the attempt, and repeat it again if necessary—
though the first trial generally succeeds.
Before concluding, it may be well to arm the reader against those
practices generally adopted by horse doctors. These practices consist
in the use of the red-hot budding iron, which is among them a very
popular application to a fistulous parotid duct. The theory which
induces this resort is, a belief that the heated iron induces an eschar,
and the wound closes before the crust falls off. Red-hot iron is,
however, far more disposed to destroy substance than to favor
growth; and, probably, its curative properties could have gained faith
among no other class. Possibly there exists no other body which
would credit that, to burn a hole larger, was the best way to close it.
Another artifice is to inject caustic lotions up the duct, and thereby
occasion the gland to slough out. Against such cruelty the author is
pleased to think little need be said. The operation, when successful,
causes so much irritation as endangers the life; for the body of the
gland is permeated by so many and such important vessels as
render the termination always very dubious.

PHLEBITIS, OR INFLAMMATION OF THE VEIN.

Formerly it was the custom to bleed horses for everything and for
nothing. It was not even suspected that a creature which exists only
to labor unto the limit of possibility is far more likely to be the victim
of debility than of repletion. It never occurred to any master that his
wretched animal wanted blood putting into it rather than abstracting
the smallest quantity of blood from it. However, formerly bleeding
was a favorite resort with the apothecary, and the old veterinary
surgeon seems to have followed the bad example. Aged people have
informed the writer that they remember the time when, on a Sunday
morning, a long shed was filled with agricultural horses standing in a
row. These victims were all waiting to be bled. The veterinary
surgeon's assistant used to take the fleam, and to open a vein in the
first animal's neck. Then he would proceed to the second; and thus,
in turn, he would open the jugulars of the entire number. No account
was taken of the quantity of blood lost; that flowed forth till the last
had been operated upon, when all the creatures stood
simultaneously draining forth their lives.
The veterinary surgeon's assistant subsequently returned, and
pinned up the orifice of the first horse; then he went and performed
that office for the succeeding animal. Thus he, a second time,
progressed down the row, pinning up as he proceeded; and the poor
horses often tottered before he came. All this was done for a human
fancy: man thought the loss of blood, at spring and autumn,
beneficial to all kinds of life. The writer has heard of old ladies who
were very skillful in bleeding cats. Most cats, however, resist such an
application of medical talent; not so the horse: this animal submits
itself patiently to the master's will. The creature seems to recognize
that it has no right to exist except by the permission of its owner.
There is no living being which acknowledges so abject a
dependence.
In return it is made a sport of the idlest whims. Hence horses,
after bleeding, were all thought to be much benefited. They were
expected to perform greater labor and to continue in sounder health.
In vain did the disease visit the stable more frequently; to no
purpose was diminished capability displayed. The ungrateful bodies
of the "plaguy beasts" were blamed, which would go wrong even
after mortal science had expended its wealth upon them. Man never
doubted his own wisdom; he never questioned his own conduct; and
it is astonishing the quantity of prejudice which is from year to year
perpetuated for the want of a small amount of so cheap an article as
mental inquiry.
The worst of the evil still remains to be told. The creatures, being
bled, were esteemed so greatly benefited as to require no
subsequent attention. Phlebitis was consequently, in other days, a
rather common affection. If neglected, the disease may terminate in
death. In cases aggravated by mistaken measures, the disorder
mounts to the brain, and occasions awful agonies. Taken early and
properly administered to, this disposition is easily arrested. It was
formerly wrongly treated, and was traced to an erroneous origin.
Phlebitis was, to the perfect satisfaction of learned judges seated on
the bench, attributed to the surgeon's want of care. So serious an
evil was imagined to be caused by culpable neglect during a trivial
operation. It was thought to have been provoked by the use of a
foul instrument, or by employing anything else to strike a fleam than
a properly-made blood-stick.
Experiments, however, which were instituted at the Royal
Veterinary College, have proved that no want of care, during the
performance of bleeding, can provoke the disorder. Wretched horses,
in that establishment, have been punctured with dirty, rusty, blunt,
and jagged fleams; all manner of blood-sticks have been employed
in every description of way. These have been struck violently and
tapped in the gentlest fashion. Every possible sort of pinning up has
been adopted; but the utmost endeavor of intentional perversion
could not produce inflammation of the vein. There appears to be
only one ascertained cause: that is, bleed; do not tie up the head,
but turn it into a field, or present fodder to be eaten off the ground,
and the animal will have phlebitis. The pendulous position of the
head and the motion of the jaws alone seem capable of starting
inflammation in the jugular vein. Therefore, should the reader ever
permit a horse to be bled—which, save in extreme cases, is perfectly
unnecessary—let him remember to place the animal subsequently in
the stable, to tie the halter to the rack for twenty-four hours, and,
during the same space, to abstain from allowing any food. These
injunctions, however, do not refer to the bleedings sometimes
adopted to counteract acute disease.
There is one circumstance which should always be well
considered before any horse is bled: Certain animals have a
constitutional predisposition toward this peculiar form of disease.
The horse whose vein shall inflame no man can, by sign, mark, or
investigation, pick from a herd. It is, however, an ascertained fact
that particular animals, of no fixed breed, and apparently
characterized by no recognized state of body, have a mighty
tendency to exhibit this particular disorder. The horse may appear
unexceptionable as regards health; but, nevertheless, strike it with a
fleam or puncture it with a lancet, and phlebitis will undoubtedly be
generated; none of the usual precautions can always prevent the
misfortune. Such predisposition evidently depends on a determinate
condition of system which science has hitherto failed to recognize.
This fact, or eccentricity in the constitutions of isolated horses,
ought to be generally known. Men have recovered heavy damages in
courts of law, and blameless veterinary surgeons have been ruined,
by circumstances over which the utmost stretch of human
precaution could possibly exercise no control. However, a more
extended knowledge concerning the real origin of this disorder may
do some good, since it will guard juries from delivering wrongful
verdicts, and may tend to check that love of venous depletion which
is still too prevalent with ignorant horse owners.
There was formerly a great diversity of opinion concerning a
supposed eccentricity in the facts observed during this disease. If a
horse was bled in the neck, and subsequently exhibited phlebitis, the
brain became affected. If an animal was depleted from the fore leg,
and displayed the disease, the heart became involved. In one case,
the disorder proceeded from the center of circulation; and in the
other, it mounted directly toward the organ. A great many
hypotheses were published to explain or to account for this
imaginary peculiarity. Much nonsense was spoken, and more was
written, to point out the real cause of an imaginary difference. Yet,
calmly viewed, the seeming diversity appears to agree with the
commonest law of nature. Phlebitis always closes the vessel at the
seat of injury. The disease, therefore, in each case, is prevented
from descending, and consequently ascends above the orifice—the
only peculiarity being the relative situations of the structures
involved.
This affection is most common after blood has been taken from
the neck. That seeming preference for a particular part may,
however, be nothing more than a circumstance dependent upon the
greater number of animals which have their jugulars opened. Were
the brachial or the saphena veins punctured as frequently as the
vessel which carries the blood from the brain, the apparent
difference might appear in the opposite direction. However, from
whichever vessel the depletion is effected, always tie the
quadruped's head up, and present no food. A stall is to be preferred
to a loose box, as the confined space is more likely to prevent
action. Motion is the source of all danger. This fact was aptly
illustrated by an anecdote which used to be related by the late Mr.
Liston, the eminent surgeon. In his lecture, that gentleman surprised
his class by stating that the last person whom he bled perished of
phlebitis. Bleeding is the most simple operation in human surgery.
Most surgeons leave this office to the apothecary; consequently it
was rather a condescension in one who deservedly ranked so high in
his profession to stoop to such an act. What, therefore, could
possibly cause disease to follow the operation, when performed by
him who was accustomed to surgery upon its grandest scale?
The cause was soon explained. The person operated upon
chanced to be a lunatic. This insane individual embraced the notion
that the healing process was much favored by constant motion;
consequently he kept on flexing and extending his arm with all the
violence which is natural to the demented. In vain was every effort
made to persuade him from so mad an action. He clung with
extraordinary pertinacity to his unwholesome theory. On the
following day, Mr. Liston was surprised to find his patient in bed, but
still moving the arm in which disease had already declared itself.
Measures were taken to keep the limb quiet, but it was found
impossible to accomplish this in a satisfactory manner; and when Mr.
Liston again called, the patient was no more!
A vein being about to inflame, the earliest intimation of the fact
is given by the separation of the lips of the wound, while through
the opening drains a small quantity of a thin discharge. Should this
warning excite no attention, a round and hard swelling appears.
That may be like a hazel-nut in size, or it may resemble half a
chestnut in magnitude; and this is soon followed by a swollen state
of the vein superior to the orifice.
Then supervenes the second stage of the disorder. Unhealthy
abscesses are formed along the course of the vein. As these mature,
they burst, and send forth an unsightly and filthy liquid resembling
thin, contaminated pus. On examination, these tumors are found to
be united. They penetrate to the interior of the vessel, and are
joined together by numerous sinuses. They literally constitute so
many holes in the neck.
If no attention be now paid to the aggravated symptoms, worse
speedily ensues. In the direction formerly indicated the vessel feels
hard under the skin. Supposing
this sign to be neglected,
unhealthy pus issues in quantity
from the wounds and soils the
neck. This secretion is soon
converted into a dark, impure,
and fetid discharge resembling
decayed blood. The horse
grows dull and stupid; the
inflammation ultimately affects A HORSE WITH PHLEBITIS, OR
the brain, when the suffering INFLAMMATION OF THE VEIN,
IN THE SECOND STAGE.
and the life are extinguished in
the violent agonies of phrenitis.
The cure is easy, but
everything depends upon the
energy of him who undertakes
it. When the lips of the wound
which have been brought
together by means of the
twisted suture—as the "pin with
tow wrapped round it" is
THE THIRD STAGE OF PHLEBITIS.
professionally termed—display a
tendency to separate, and,
instead of being dry, appear moist, let no prejudice incline toward
the ancient practice of fomenting and poulticing the injury. Without
the loss of a moment in hesitation, withdraw the pin; remove the
substance which was twined round it, and apply a moderate-sized
blister immediately over and around the puncture. Should the
disease have ascended up the neck, still rub in a blister; only a
proportionate amount of surface must then be acted upon. If the
case be as bad as possible, and yet the animal is alive, still a blister
is indicated.
With the progress of the disease a larger space should always be
subjected to irritation, so as to cover every part the most active
imagination could suppose to be involved. One blister, moreover, will
 not suffice; another, and
another, and another must be
employed, till every sign of
disorder has vanished. They
must, however, be applied in
quicker succession as the
symptoms are more urgent,
while a greater interval may be
THE TWISTED SUTURE. allowed between each when the
A pin is first stuck affection is less serious. In the
through the lips worst stage of phlebitis,
of the wound; a another blister must be put over
portion of tow, the part upon which the
thread, or hair is irritation of the first has not
then wrapped
round the pin, entirely ceased to act. In the
and, to complete second stage, the surface must
all, the point of have been barely healed before
the pin is lastly another vesicatory is resorted
clipped off. to. During the primary
symptom, a single application
frequently is sufficient; or, at most, two blisters generally suffice.
When the vessel assumes the corded state, a blister can effect
no more than to check the progress of the disorder; no agency,
however, which science has placed at the disposal of man can
restore the uses of the vein. The vessel is lost, and lost forever. If a
foul and black discharge issue from the openings, insert a director
and enlarge the wounds, joining the holes by slitting up the sinuses
which unite them; but do not cut the entire extent of the hardened
vessel, as in that case you may be deluged in blood. The
employment of the knife and the free use of blisters constitute the
chief means toward the cure of phlebitis. The sinuses must be laid
open. The probe should then be most patiently employed, for every
sinus must be slit up. This may be done at once, when the hardness
indicates the vessel to be closed above the part which the incision
interferes with. To such an extent the knife may always be
employed, while blisters after blisters are used, regardless of the
severe wounds over which they are applied.
Much relief is afforded by the large and pendulous incision,
through which the corruption freely finds an exit. Some horses,
however, from the pain occasioned by the raw and inflamed
condition of the neck, will not allow the blister to be rubbed in after
the ordinary fashion, especially when the irritation caused by the
former application has not thoroughly subsided. In cases of this sort,
do not employ the twitch or resort to greater restraints. Exercise
your reason. Regard the painful aspect of the wounds. Ask yourself
how you should enjoy the hard hand of a groom violently scrubbed
over such a part, were the soreness upon your own body. Act upon
the response. Procure a long-haired brush, such as pastry-cooks use
to egg over their more delicate manufactures. Go then into the next
stall. Speak kindly to a sick inferior that is at your mercy. Have the
creature led forth, and, with the brush just described, smear the part
with oil of cantharides or liquid blister. The extract of the Spanish fly
does not occasion immediate agony, and the application of oil will
cool or soothe the anger of the wounds.
With the jugular vein inflamed, the horse, during the period of
treatment, should consume no solid food. Hay tea, sloppy mashes,
and well-made gruel should constitute its diet. However, the gruel
must not be given in such quantities or made so thick as the same
substance would be allowed to a healthy horse. Gruel may not be
very sustaining to the human being, but it is nothing more than the
oat divested of the shell or refuse part. To the equine species such
food, whether given dry or boiled in water, is highly stimulating; and,
as fever invariably accompanies inflammation, oats in any form
evidently are contraindicated. Should the animal, however, become
ravenous, a portion of potatoes, being first peeled, may be boiled to
a mash. Some water and a sufficiency of pollard ought to be added,
and the whole presented in such a state as requires no mastication,
but in a condition that will allow the mixture to be drawn between
the teeth. The same thing may be done with carrots and with
turnips, only all mashed roots, except potatoes, should be passed
through a colander, and moistened with some of the water in which
they are boiled.
Any animal, during treatment, should be placed in a loose box.
No creature should be turned into the field. It is cheaper to pasture
than to stable a horse; but the constant motion of the legs, as the
field is traversed, is injurious to the punctured vein of the limbs,
while the pendulous state of the head and the perpetual movement
of the jaws are most prejudicial when venesection has been
performed upon the neck. The stable is, in every point of view, the
cheapest and the best residence. The head of the animal must be
tied to the rack throughout the day; while, at night, the halter may
be lengthened, permitting the creature to lie down; but the floor
should be littered with tan, as straw might be eaten.
Let the horse remain thus for six weeks subsequent to the
completion of a cure. Then give gentle exercise to the extent which
it can be borne—the quantity being small, and the pace very slow at
first, but gradually augmented. This exercise should be maintained
for three months. The animal may afterward return to slow work;
but if the neck is the place affected, it must not wear a collar or be
harnessed to the shafts for the next six months. At the end of that
time the horse may return to its customary employment; but, if
ridden or driven, it is always well to bear in mind the late affliction,
and to grant more than the usual time for the performance of the
journey. At the expiration of the year, the smaller veins, having
become enlarged, have adapted themselves to the loss which the
circulation has sustained, and the horse may resume full work.
For the first year, gruel, crushed and scalded oats, with two
bundles of cut grass per day, should constitute the diet. The manger
should be heightened, and the halter be so arranged as to prevent
the head being much lowered. Do all in your power to render
useless violent mastication; and, as the horse never chews when the
operation is unnecessary, the animal will obviously second your
endeavors.
 At the expiration of twelve months the animal which has lost a
vein may be sold, and, in law, has been accounted sound. Such a
blemish, however, is far from a recommendation; in this case law
and common sense may be at variance. The reader, therefore, is
advised never to purchase a nag in such a condition without insisting
upon a special warranty, in which it is provided that the animal is to
be taken back should the loss of a vessel be productive of any evil
effects within the space of one twelvemonth.

BROKEN KNEES.

These accidents affect the exterior of the central joint of the fore
legs. They may be very trivial or very serious: they may simply ruffle
the hair or scratch the cuticle covering the integument; the same
cause may, however, remove the hair and lay bare the cutis.
Moreover, the wound is often aggravated by the nature of the road
on which the animal is traveling. A fall upon a very rough surface
might even destroy a portion of the skin, and deprive more or less of
the cellular tissue of vitality.

BROKEN KNEES OF VARIOUS DEGREES OF

INTENSITY.
The hair ruffled and the cuticle scratched. The hair removed and
the true skin exposed. The skin destroyed and the cellular tissue
injured.

Accompanying such accidents there is generally some amount of

contusion. When it falls, the horse is in motion, and the impetus
lends violence to the descent. Probably the animal is being ridden
when it comes to the ground. The weight of the blow is not only
then proportioned to the heavy body of the horse and the rate at
which it is progressing, but its effect is augmented by the load upon
its back. These considerations render broken knees the proper
dread of every horse proprietor. An animal may stumble and come
down which, prior to the mishap, would have been sold cheap for
several hundreds. It may be raised from the ground with almost all
its worth demolished. The nature of the hurt is not, however, always
shown at first. The chief danger, in broken knees, lies in the
accompanying contusion. The horse which rises without a hair
ruffled, but which fell with violence, is always, with informed
persons, a cause of considerable anxiety. Contusion is to be more
dreaded in its consequences than is the largest wound when devoid
of anything approaching to a bruise.
The reason why contusion is thus gravely regarded is because,
when that occurs in severity, the vitality of all the coverings to the
knee is destroyed, and, in very bad cases, even the bones are
materially injured. All dead parts must be cast from a living body;
and no man can predicate how deep may be the injury, or how
important may be the structures which shall be opened, when the
slough takes place.
Proprietors of horses thus injured are commonly very earnest in
their solicitations for a professional opinion as to the extent and
probable consequences of the accident. No certain judgment can,
however, be pronounced, nor should one be given. Any surgical
calculation, notwithstanding it may be most prudently qualified, is
apt to be misconstrued by the anxiety of distress. The most guarded
hint at a probability of recovery is too likely to be seized upon as a
positive guarantee of perfect restoration; and the possible evils
which may have been alluded to, confusion causes the individual not
to remember. Therefore silence is wisdom in these cases, however
slight the broken knee may appear in the first instance.
Broken knees are principally caused by the imprudence of him in
whom authority is invested. Certain people imagine the public
admire the man who chastises a horse. Such persons slash away for
every trivial error. Every imaginary fault is punished with the whip,
which too often curls around parts that should be respected. The
animal, pained and frightened, thinks only of the slasher behind it,
and entirely disregards the path upon which its eyes should be
directed. The cutting is incessant, and the horse's pace is
incautiously fast. An impediment is encountered; the animal trips; it
is cast to the ground with violence, while the man is probably
rendered fitter for a hospital than for the continuance of his travels.
Other riders and drivers always visit with severity the slightest
indication of weak limbs. A sudden drop or a false step is, to such
people, the signal for the reins to be jagged, the voice to be raised,
and the whip to be freely exercised upon all parts of the animal's
body, but mostly about the face and ears. The man likes to behold
the poor creature shake its head, and loves to imagine he is then
teaching the terrified quadruped to be careful. Equine pupils, no
more than human scholars, are to be tutored by barbarity, which
may slay the reason long before it can instruct the mind. Composure
is imperative to the acquirement of any knowledge. Thrashing calls
forth terror, and alarm is synonymous with confusion of mind. The
horse is susceptible of a fear which humanity, happily, finds it
difficult to conceive; and how far such a creature is calculated to be
educated by cruelty, the intelligent reader is left to infer.
Could the animal argue, it might plead that the weakness
objected to was caused by exertion made in man's service; that the
stumbling gait was consequent upon no negligence on its part; that
it afforded the beaten wretch no pleasure to have the knees broken,
but, if the quadruped might profess a choice, it would prefer not
falling down, etc. etc. If such pleas were properly considered, they
perhaps might still the turbulence of the punisher.
The great majority of these injuries are consequent upon the
prejudice or thoughtlessness of mankind. Popular admiration is, in
this country, much in favor of a good crest. Every animal, no matter
how nature may have formed the neck, must carry a good head. The
rider, therefore, drags upon the bridle, while the form of nearly every
gentleman's harness-horse is distorted by the bearing-rein. The
constraint thus enforced not only obliges additional muscular action,
but it disqualifies the animal to see the ground. In England there
should be no objection to a blind horse, since such of the species as
have eyes are, by the prejudices of society, seldom permitted to use
them. The horse, being urged on when virtually blindfold, must of
necessity stumble upon any unusual impediment being encountered.
Such an accident shows no fault in the quadruped; but the man is
truly responsible for those consequences which his folly has induced.
When a horse stumbles, never raise your voice—the creature
dreads its master's chiding; never jag the reins—the mouth of the
horse is far more sensitive than the human lips; never use the lash—
the horse is so timid that the slightest correction overpowers its
reasoning faculties. Speak to the creature; reassure the palpitating
frame; seek to restore those perceptions which will form the best
guard against any repetition of the faulty action. When the legs are
weak, the greater should be the care of him who holds the reins. No
cruelty can restore the lost tonicity of the limbs; therefore all
slashing is utterly thrown away. If the reader regard his own safety,
let him not, when riding, hold the head up, or, when driving,
sanction the employment of a bearing-rein. No inhumanity can
convert an animal with a ewe neck into the creature with a naturally
lofty crest. The disguise of such a defect as a head badly placed on
the neck is an impossibility. Therefore, if you are desirous of a well-
carried head, think of it when making the purchase. Pay something
more, and any kind of quadruped is obtainable; but be above the
meanness which purchases for a low figure, and then endeavors to
palm off its cheap article as a jewel procured at the highest price.
When a horse has been down, never judge of the injury by the
first appearance. While the animal stands in the yard, order the
groom to fetch a pail, with milk-warm water and a large sponge.
With these he is to clean the knees—not after the usual coarse and
filthy fashion now universal; not by first sopping the part, and then
squeezing the soiled sponge into the pail whence more fluid is to be
abstracted. The dabbing and smearing a wound simply irritates it;
and the dirt, having all entered into the pail, the fluid is rendered
unsuited to after cleanly purposes.
To perform the office properly, the
knee should not be touched. The
sponge should be saturated, then
squeezed dry above the seat of injury.
The water thus flows in a full stream
over the part, and, by the force of
gravity, carries away any loose dirt that
may be upon the surface. Sopping,
dabbing, wiping, and smearing occasion
pain, and can remove nothing which
may have entered the skin and which is
protected from the action of the sponge
by a covering of hair; whereas by the THE PROPER WAY TO WASH
A BROKEN KNEE.
plan recommended the dirt is removed,
the part is not debilitated, neither is its
natural energy destroyed. The last drop of water, moreover, is as
clean as was the first, and the animal is not irritated immediately
prior to a surgical examination.
The wound being cleansed, a certain time should be allowed to
elapse for the horse to recover its composure. It should return to the
stable, have a feed of corn, and be watered. Then the real business
commences. The animal should be gently approached; its condition
should be observed. If any nervousness is exhibited, the person
ought to retire, and a further pause should be allowed. If, on the
second visit, any unusual symptoms are displayed, have the
quadruped led into the yard and blindfolded. Let a man take up the
other fore leg, when the knee may be examined with safety.
Place the palm of the hand over the joint. Hold it there to
ascertain if any heat or swelling is to be detected. Should there be
swelling, make gradual and gentle pressure upon it with the thumb
or one finger. If, upon suddenly removing the hand, an indent is
conspicuous, it argues considerable effusion, and justifies fear as to
the result. Should neither heat nor swelling be remarked, further
pressure is to be made with the thumb upon the knee. The force
should be gentle at first and gradually increased. If the action is
sustained well, or even moderately endured, it allows of hope being
entertained. But should the horse attempt to rear upon the first
impress of the thumb, the result is very dubious. The absence of
agony is far from anything approaching to a positive proof, as bone
and synovial membrane, tendon and ligament, do not take on acute
inflammation when first injured; but, from the response thus elicited,
a fair inference as to the probability may be drawn.
Should the skin be lacerated, the probe must be employed. Such
injuries are very deceptive. They may be much more extensive than
the size of the wound would indicate. The probe being of metal,
ought not to be thrust violently against every exposed part. This
kind of proceeding can effect no good. The probe should be held
lightly between the thumb and fore finger; no pressure should be
made upon it—the instrument ought rather to fall of its own gravity
than be forced into the flesh. A thin piece of wire can be readily
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