Part 5

Treatment of inflammation.—The study of the causes and pathological alterations of inflammation has shown the process to be one of hypernutrition, attended by excessive blood supply, so this study will indicate the primary factor to be employed in the treatment of it. Any agent which will reduce the blood supply and prevent the excessive nutrition of the elements of the part will serve as a remedy. The means employed may be used locally to the part, or they may be constitutional remedies, which act indirectly.

Local treatment.—Removal of the cause will frequently allow the part to heal at once. Among causes of inflammation may be mentioned a stone in the frog, causing a traumatic thrush; a badly fitting harness or saddle, causing ulcers of the skin; decomposing manure and urine in a stable, which, by their vapors, irritate the air tubes and lungs and cause a cough.

Motion stimulates the action of the blood, and thus feeds an inflamed tissue. This is alike applicable to a diseased point irritated by movement to an inflamed pair of lungs surcharged with blood by the use demanded of them in a working animal, or to an inflamed eye exposed to light, or an inflamed stomach and intestines still further fatigued by feed. Rest, absolute quiet, a dark stable, and small quantities of easily digested feed will often cure serious inflammatory troubles without further treatment.

The application of ice bags or cold water by bandages, douching with a hose, or irrigation with dripping water, contracts the blood vessels, acts as a sedative to the nerves, and lessens the vitality of a part; it consequently prevents the tissue change which inflammation produces.

Either dry or moist heat acts as a derivative. It quickens the circulation and renders the chemical changes more active in the surrounding parts; it softens the tissues and attracts the current of blood from the inflamed organ; it also promotes the absorption of the effusion and hastens the elimination of the waste products in the part. Heat may be applied by hand rubbing or active friction and the application of warm coverings (bandages) or by cloths wrung out of warm water; or steaming with warm, moist vapor, medicated or not, will answer the same purpose. The latter is especially applicable to inflammatory troubles in the air passages.

Local bleeding frequently affords immediate relief by carrying off the excessive blood and draining the effusion which has already occurred. It affords direct mechanical relief, and, by a stimulation of the part, promotes the chemical changes necessary for bringing the diseased tissues to a healthy condition. Local blood-letting can be done by scarifying, or making small punctures into the inflamed part, as in the eyelid of an inflamed eye, or into the sheath of the penis, or into the skin of the latter organ when congested, or the leg when acutely swelled.

Counterirritants are used for deep inflammations. They act by bringing the blood to the surface and consequently lessening the blood pressure within. The derivation of the blood to the exterior diminishes the amount in the internal organs and is often very rapid in its action in relieving a congested lung or liver. The most common counterirritant is mustard flour. It is applied as a soft paste mixed with warm water to the under surface of the belly and to the sides, where the skin is comparatively soft and vascular. Colds in the throat or inflammations at any point demand the treatment applied in the same manner to the belly and sides and not to the throat or on the legs, as so often used. Blisters, iodin, and many other irritants are used in a similar way.

Constitutional treatment in inflammation is designed to reduce the current of blood, which is the fuel for the inflammation in the diseased part, to quiet the patient, and to combat the fever or general effects of the trouble in the system, and to favor the neutralization or elimination of the products of the inflammation.

Reduction of blood is obtained in various ways. The diminution of the quantity of the blood lessens the amount of pressure on the vessels, and, as a sequel, the volume of it which is carried to the point of inflammation; it diminishes the body temperature or fever; it numbs the nervous system, which plays an important part as a conductor of irritation in diseases.

Blood-letting is the most rapid means, and frequently acts like a charm in relieving a commencing inflammatory trouble. One must remember, however, that the strength of the body and repair depend on the blood; hence blood-letting should be practiced only in full-blooded, well-nourished animals and in the early stages of the disease.

Cathartics act by drawing off a large quantity of fluid from the blood through the intestines, and have the advantage over the last remedy of removing only the watery and not the formed elements from the circulation. The blood cells remain, leaving the blood as rich as it was before. Again, the glands of the intestines are stimulated to excrete much waste matter and other deleterious material which may be acting as a poison in the blood.

Diuretics operate through the kidneys in the same way.

Diaphoretics aid depletion of the blood by pouring water in the form of sweat from the surface of the skin and stimulating the discharge of waste material out of its glands, which has the same effect on the blood pressure.

Antipyretics are remedies to reduce the temperature. This may be accomplished by depressing the center in the brain that controls heat production. Some coal-tar products are very effective in this way, but they have the disadvantage of depressing the heart, which should always be kept as strong as possible. If they are used it must be with knowledge of this fact, and it is well to give heart tonics or stimulants with them. The temperature of the body may be lowered by cold packs or by showering with cold water. This is a most useful procedure in many diseases.

Depressants are drugs which act on the heart. They slow or weaken the action of this organ and reduce the quantity and force of the current of the blood which is carried to the point of local disease; they lessen the vitality of the animal, and for this reason are now used much less than formerly.

Anodynes quiet the nervous system. Pain in the horse, as in the man, is one of the important factors in the production of fever, and the dulling of the former often prevents, or at least reduces, the latter. Anodynes produce sleep, so as to rest the patient and allow recuperation for the succeeding struggle of the vitality of the animal against the exhausting drain of the disease.

The diet of an animal suffering from acute inflammation is a factor of the greatest importance. An overloaded circulation can be starved to a reduced quantity and to a less rich quality of blood by reducing the quantity of feed given to the patient. Feeds of easy digestion do not tire the already fatigued organs of an animal with a torpid digestive system. Nourishment will be taken by a suffering brute in the form of slops and cooling drinks when it would be totally refused if offered in its ordinary form, as hard oats or dry hay, requiring the labor of grinding between the teeth and swallowing by the weakened muscles of the jaws and throat.

Tonics and stimulants are remedies which are used to meet special indications, as in the case of a feeble heart, and which enter into the after treatment of inflammatory troubles as well as into the acute stages of them. They brace up weakened and torpid glands; they stimulate the secretion of the necessary fluids of the body, and hasten the excretion of the waste material produced by the inflammatory process; they regulate the action of a weakened heart; they promote healthy vitality of diseased parts, and aid the chemical changes needed for returning the altered tissues to their normal condition.

FEVERS.

Fever is a general condition of the animal body in which there is an elevation of the animal body temperature, which may be only a degree or two or may be 10 deg. F. The elevation of the body temperature, which represents tissue change or combustion, is accompanied with an acceleration of the heart's action, a quickening of the respiration, and an aberration in the functional activity of the various organs of the body. These organs may be stimulated to the performance of excessive work, or they may be incapacitated from carrying out their allotted tasks, or, in the course of a fever, the two conditions may both exist, the one succeeding the other. Fever as a disease is usually preceded by chills as an essential symptom.

Fevers are divided into essential fevers and symptomatic fevers. In symptomatic fever some local disease, usually of an inflammatory character, develops first, and the constitutional febrile phenomena are the result of the primary point of combustion irritating the whole body, either through the nervous system or directly by means of the waste material which is carried into the circulation and through the blood vessels, and is distributed to distal parts. Essential fevers are those in which there is from the outset a general disturbance of the whole economy. This may consist of an elementary alteration in the blood or a general change in the constitution of the tissues. Fevers of the latter class are usually due to some infecting agent and belong, therefore, to the class of infectious diseases.

Essential fevers are subdivided into ephemeral fevers, which last but a short time and terminate by critical phenomena; intermittent fevers, in which there are alterations of exacerbations of the febrile symptoms and remissions, in which the body returns to its normal condition or sometimes to a depressed condition, in which the functions of life are but badly performed; and continued fevers, which include contagious diseases, such as glanders, influenza, etc., the septic diseases, such as pyemia, septicemia, etc., and the eruptive fevers, such as variola, etc.

Whether the cause of the fever has been an injury to the tissues, such as a severe bruise, a broken bone, an inflamed lung, or excessive work, which has surcharged the blood with the waste products of the combustion of the tissues, which were destroyed to produce force, or the toxins of influenza in the blood, or the presence of irritating material, either in the form of living organisms or of their products, as in glanders or tuberculosis—the general train of symptoms are much the same, varying as the amount of the irritant differs in quantity, or when some special quality in them has a specific action on one or another tissue.

There is in fever at first a relaxation of the small blood vessels, which may have been preceded by a contraction of the same if there was a chill, and as a consequence there is an acceleration of the current of the blood. There is, then, an elevation of the peripheral temperature, followed by a lowering of tension in the arteries and an acceleration in the movement of the heart. These conditions may be produced by a primary irritation of the nerve centers of the brain from the effects of heat, as is seen in thermic fever, or sunstroke, or by the entrance into the blood stream of disease-producing organisms or their chemical products, as in anthrax, rinderpest, influenza, etc.

There are times when it is difficult to distinguish between the existence of fever as a disease and a temporary feverish condition which is the result of excessive work. Like the condition of congestion of the lungs, which is normal up to a certain degree in the lungs of a race horse after a severe race, and morbid when it produces more than temporary phenomena or when it causes distinct lesions, the temperature may rise from physiological causes as much as four degrees, so fever, or, as it is better termed, a feverish condition, may follow any work or other employment of energy in which excessive tissue change has taken place; but if the consequences are ephemeral, and no recognizable lesion is apparent, it is not considered morbid. This condition, however, may predispose to severe organic disturbance and local inflammations which will cause disease, as an animal in this condition is liable to take cold and develop lung fever or a severe enteritis, if chilled or otherwise exposed.

Fever in all animals is characterized by the same general phenomena, but we find the intensity of the symptoms modified by the species of animals affected, by the races which subdivide the species, by the families which form groups of the races, and by certain conditions in individuals themselves. For example, a pricked foot in a Thoroughbred may cause intense fever, while the same injury in the foot of a Clydesdale may scarcely cause a visible general symptom. In the horse, fever produces the following symptoms:

The normal body temperature, which varies from 99 deg. to 100 deg. F., is elevated from 1 deg. to 9 deg.. A temperature of 102 deg. or 103 deg. F. is moderate fever, 104 deg. to 105 deg. F. is high, and 106 deg. F. and over is excessive. The temperature is accurately measured by means of a clinical thermometer inserted in the rectum.

This elevation of temperature can readily be felt by the hand placed in the mouth of the animal, or in the rectum, and in the cleft between the hind legs. It is usually appreciable at any point over the surface of the body and in the expired air emitted from the nostrils. The ears and cannons are often as hot as the rest of the body, but are sometimes cold, which denotes a debility in the circulation and irregular distribution of the blood. The pulse, which in a healthy horse is felt beating about 42 to 48 times in the minute, is increased to 60, 70, 90, or even 100. The respirations are increased from 14 or 16 to 24, 30, 36, or even more. With the commencement of a fever the horse usually has diminished appetite, or it may have total loss of appetite if the fever is excessive. There is, however, a vast difference among horses in this regard. With the same degree of elevation of temperature one horse may lose its appetite entirely, while another, usually of the more common sort, will eat at hay throughout the course of the fever, and will even continue to eat oats or other grains. Thirst is usually increased, but the animal desires only a small quantity of water at a time, and in most cases of fever a bucket of water should be kept standing before the patient, which may be allowed to drink ad libitum. The skin becomes dry and the hairs stand on end. Sweating is almost unknown in the early stage of fevers, but frequently occurs later in their course, when an outbreak of warm sweat is often a most favorable symptom. The mucous membranes, which are most easily examined in the conjunctivae of the eyes and inside of the mouth, change color if the fever is an acute one; without alteration of blood the mucous membranes become of a rosy or deep-red color at the outset; if the fever is attended with distinct alteration of the blood, as in influenza, and at the end of two or three days in severe cases of pneumonia or other extensive inflammatory troubles the mucous membranes are tinged with yellow, which may even become a deep ocher in color, the result of the decomposition of the blood corpuscles and the freeing of their coloring matter, which acts as a stain. At the outset of a fever the various glands are checked in their secretions, the salivary glands fail to secrete the saliva, and we find the surface of the tongue and inside of the cheeks dry and covered with a brownish, bad-smelling deposit. The excretion from the liver and intestinal glands is diminished and produces an inactivity of the digestive organs which causes a constipation. If this is not remedied at an early period, the undigested material acts as an irritant, and later we may have it followed by an inflammatory process, producing a severe diarrhea.

The excretion from the kidneys is sometimes at first entirely suppressed. It is always considerably diminished, and what urine is passed is dark in color, undergoes ammoniacal change rapidly, and deposits quantities of salts. At a later period the diminished excretion may be replaced by an excessive excretion, which aids in carrying off waste products and usually indicates an amelioration of the fever.

While the ears, cannons, and hoofs of a horse suffering from fever are usually found hot, they may frequently alternate from hot to cold, or be much cooler than they normally are. This latter condition usually indicates great weakness on the part of the circulatory system.

It is of the greatest importance, as an aid in diagnosing the gravity of an attack of fever and as an indication in the selection of its mode of treatment, to recognize the exact cause of a febrile condition in the horse. In certain cases, in very nervous animals, in which fever is the result of nerve influence, a simple anodyne, or even only quiet with continued care and nursing, will sometimes be sufficient to diminish it. When fever is the result of local injury, the cure of the cause produces a cessation in the constitutional symptoms. When it is the result of a pneumonia or other severe parenchymatous inflammation, it usually lasts for a definite time, and subsides with the first improvement of the local trouble, but in these cases we constantly have exacerbations of fever due to secondary inflammatory processes, such as the formation of small abscesses, the development of secondary bronchitis, or the death of a limited quantity of tissue (gangrene).

In specific cases, such as influenza, strangles, and septicemia, there is a definite poison in the blood-vessel system and carried to the heart and to the nervous system, which produces a peculiar irritation, usually lasting for a specific period, during which the temperature can be but slightly diminished by any remedy.

In cases attended with complications, the diagnosis at times becomes still more difficult, as at the end of a case of influenza which becomes complicated with pneumonia. The high temperature of the simple inflammatory disease may be grafted on that of the specific trouble, and the determination of the cause of the fever, as between the two, is therefore frequently a difficult matter but an important one, as upon it depends the mode of treatment.

Any animal suffering from fever, whatever the cause, is much more susceptible to attacks of local inflammation, which become complications of the original disease, than are animals in sound health. In fever we have the tissues and the walls of the blood vessels weakened, we have an increased current of more or less altered blood flowing through the vessels and stagnating in the capillaries, which need but an exciting cause to transform the passive congestion of fever into an active congestion and acute inflammation. These conditions become still more distinct when the fever is accompanied with a decided deterioration in the blood itself, as is seen in influenza, septicemia, and at the termination of severe pneumonias.

Fever, with its symptoms of increased temperature, acceleration of the pulse, acceleration of respiration, dry skin, diminished secretions, etc., must be considered as an indication of organic disturbance. This organic disturbance may be the result of local inflammation or other irritants acting through the nerves on nerve centers, alterations of the blood, in which a poison is carried to the nerve centers, or direct irritants to the nerve centers themselves, as in cases of heat stroke, injury to the brain, etc.

The treatment of fever depends upon its cause. One of the important factors in treatment is absolute quiet. This may be obtained by placing a sick horse in a box stall, away from other animals and extraneous noises and sheltered from excessive light and drafts of air. Anodynes, belladonna, hyoscyamus, and opium act as antipyretics simply by quieting the nervous system. As an irritant exists in the blood in most cases of fever, any remedy which will favor the excretion of foreign elements from it will diminish this cause. We therefore use diaphoretics to stimulate the sweat and excretions from the skin; diuretics to favor the elimination of matter by the kidneys; cholagogues and laxatives to increase the action of the liver and intestines, and to drain from these important organs all the waste material which is aiding to choke up and congest their rich plexuses of blood vessels. The heart becomes stimulated to increased action at the outset of a fever, but this does not indicate increased strength; on the contrary, it indicates the action of an irritant to the heart that will soon weaken it. It is, therefore, irrational further to depress the heart by the use of such drugs as aconite. It is better to strengthen it and to favor the elimination of the substance that is irritating it. The increased blood pressure throughout the body may be diminished by lessening the quantity of blood. This is obtained in some cases with advantage when the disease is but starting and the animal is plethoric by direct abstraction of blood, as in bleeding from the jugular or other veins; or by derivatives, such as mustard, turpentine, or blisters applied to the skin; or by setons, which draw to the surface the fluid of the blood, thereby lessening its volume without having the disadvantage of impoverishing the elements of the blood found in bleeding. In many cases antipyretics given by the mouth and cold applied to the skin are most useful.