CAPPED ELBOW IN THE HORSE AND DOG. 799 



of mercury solution, and powders it with iodoform, leaving the flaps 

 open for six to twelve hours. When all bleeding has ceased and the 

 surfaces are covered with a serous discharge, he unites the flaps with 

 two series of sterilised silk sutures ; one set being used to bring together 

 the edges of the skin, and the second set, consisting of two or three 

 sutures only, being passed further from the edges and used to obliterate 

 any "dead space." If thought necessary, a drainage-tube is inserted. 

 Others, after dissecting out the growth, treat the wound by continuous 

 irrigation with cold water, which usually results in complete closure 

 in about three weeks. The horse should be kept in slings until the 

 wound has cicatrised, and afterwards the horse, when in the stable, 

 should wear some form of preventive pad. 



A similar disease occurs in large, heavy dogs, which, when lying 

 on hard ground, support themselves on the sternum and elbows. 

 The skin alone may be injured and thickened, or callosities form at 

 the affected spot, but occasionally the bursa olecrani becomes inflamed. 

 The disease is nearly always confined to chronic inflammation of the' 

 bursa, parabursitis occurring very rarely, and the swelling is soft 

 and fluctuating. Symptoms of acute inflammation (warmth and 

 pain) are in rare cases present ; but, as a rule, there is only a 

 fluctuating swelling of an oval or round form, varying from the size 

 of a hazel-nut to that of a hen's egg. 



The swelling is produced by distension of the bursa olecrani with 

 fluid, which sometimes contains fibrin (bursitis sero-fibrinosa) ; blood 

 is rarely met with. It never interferes with movement, but is a 

 blemish which is difficult to remove, the cause being always at work. 

 Animals accustomed to lie in the position described cannot be broken 

 of the habit, especially as the swelling is painless. Simple puncture 

 and removal of contents are therefore not sufficient, and, owing to 

 the flatness of the swelling, a ligature cannot be applied. If necessary, 

 the enlarged bursa must be surgically removed, though operation is 

 difficult, and, as a rule, cicatricial thickening remains. Before 

 operating, it is best to give a dose of morphine. The hair is removed 

 and an incision made over the swelling in the long axis of the limb. 

 The bursa is then separated from neighbouring parts, care being 

 taken not to incise it, which would greatly increase the difficulty 

 of the operation. The greatest precaution is required in separating 

 the bursa from the elbow, with which it is firmly united, and the 

 bone must not be exposed, as this would delay healing, and prevent 

 the formation of a cicatrix. When excision has been successful, 

 it is sometimes possible, by observing antisepsis, to produce healing 

 by first intention. The operation wound is carefully dressed and 



