CAPPED ELBOW. 355 



Various changes will follow the opening of .the tumor and the 

 escape of its contents. In a majority of cases the process of cica- 

 trization will take place, and the cavity fill up by granulation, the 

 discharge, at first abundant, gradually diminishing and the wound 

 closing, usually without leaving any mark. At times, however, and 

 especially if the disease has several times repeated its course, there 

 may remain a pendulous sac, partly obliterated, which a sufficient 

 amount of excitement or irritation may soon restore to its previous 

 dimensions and condition. 



In other cases an entirely different process takes place. The walls 

 of the cavity, cyst, or abscess become ulcerated and thickened, the 

 granulations of the sac become fibrous in their structure and fill up 

 the cavity, and it assumes the character of a hard tumor on the back 

 of the elbow, sometimes partly and sometimes entirely covered by the 

 skin. It is fibrous in its nature, painless to the touch, well defined 

 in its contour, and may vary in size from that of a small apple to 

 that of a child's head. 



This last form of capped elbow is the most serious of any, resisting 

 all known forms of mild treatment, and removable by the knife only. 

 The other forms, even that with the inflammatory aspect and its large 

 edematous swelling which interferes with the work of the animal, 

 may justify a much milder prognosis, and, aside from their liability 

 to recur, may be ranked with the comparatively harmless affections. 



Treatment. — So long as the danger of recurrence is the principal 

 bad feature of capped elbow the most important consideration is that 

 of devising a means for its prevention. To prevent the animal from 

 lying down is evidently the simplest method of keeping the heels and 

 the elbow apart; but the impracticability of this prescription is 

 apparent, since a majority of animals are obliged to lie down when 

 they sleep, though it is true that a few take their sleep on their feet. 

 The question of shoeing here enters into the discussion. The shorten- 

 ing of the inside branch of the shoe, which is the one with which the 

 pressure is made, may be of advantage, and especially if the truncated 

 end of the shoe is smooth and filed over to remove all possibility of 

 pressure and contusion upon the skin. The protection of the skin of 

 the elbow by interposing soft tissues between that and the shoe, or by 

 banda^ng the heel with bags or covering it with boots, is considered 

 by many the best of the preventive methods, and the advantage to be 

 secured by resorting to it can not be overlooked when the number of 

 horses which develop shoe boil whenever the use of the boot is inter- 

 mitted is considered. In order to prevent the animal from assuming 

 the sternal decubitus, many give preference to the plan of fastening 

 a piece of wood across the stall at some distance from the front wall 

 or manger. It is a simple expedient, primitive, perhaps, but never- 

 theless practical and followed by good results. 



