Part 22

The cases that do not require a surgical operation must, as a rule, have persistent medical treatment. Mineral tonics and local medication are of the most value. For eight days give the following mixture: Reduced iron, 3 ounces; powdered nux vomica, 1 ounce. Mix and make into 16 powders; one powder should be mixed with the feed twice a day. Arsenious acid (white arsenic) in doses of from 3 to 6 grains three times daily is a good tonic for such cases. Sulphur burnt in the stable while the animal is there to inhale its fumes is also a valuable adjunct. Care should be taken that the fumes of the burning sulphur are sufficiently diluted with air so as not to suffocate the horse. Chlorid of lime sprinkled around the stall is good. Also keep a quantity of it under the hay in the manger so that the gases will be inhaled as the horse holds his head over the hay while eating. Keep the nostrils washed and the discharge cleaned away from the manger and stall. The horse may be caused to inhale the vapor of compound tincture of benzoin by pouring 2 ounces of this drug into hot water and fumigating in the usual way.

If the nasal gleet is the result of a diseased tooth, the latter must be removed. Trephining is the best possible way to remove it in such cases, as the operation immediately opens the cavity, which can be attended to direct. In all those cases of nasal gleet in which sinuses contain either tumors or collections of pus the only relief is by the trephine; and, no matter how thoroughly described, this is an operation that will be seldom attempted by the nonprofessional. It would therefore be a waste of time to give the modus operandi.

An abscess involving the turbinated bones is similar to the collection of pus in the sinuses and must be relieved by trephining.

THICKENING OF THE NASAL MEMBRANE.

This is sometimes denoted by a chronic discharge, a snuffling in the breathing, and a contraction of the nostril. It is a result of common cold and requires the same treatment as prescribed for nasal gleet, namely, the sulphate of iron, sulphate of copper, iodid of potassium, etc. The membranes of both sides may be affected, but one side only is the rule; the affected side may be easily detected by holding the hand tightly over one nostril at a time. When the healthy side is closed in this manner the breathing through the affected side will demonstrate a decreased caliber or an obstruction.

NASAL POLYPUS.

Tumors with narrow bases (somewhat pear-shaped) are occasionally found attached to the membrane of the nasal chambers, and are obstructions to breathing through the side in which they are located. They vary much in size; some are so small that their presence is not manifested, while others almost completely fill the chamber, thereby causing a serious obstruction to the passage of air. The stem, or base, of the tumor is generally attached high in the chamber, and usually the tumor can not be seen, but occasionally it increases in size until it can be observed within the nostril. Sometimes, instead of hanging down toward the nasal opening, it falls back into the pharynx. It causes a discharge from the nostril, a more or less noisy snuffling sound in breathing, according to its size, a discharge of blood (if it is injured), and sneezing. The side that it occupies can be detected in the same way as described for the detection of the affected side when the breathing is obstructed by a thickened membrane.

The only relief is removal of the polypus, which, like all other operations, should be done by an expert when it is possible to obtain one. The operation is performed by grasping the base of the tumor with suitable forceps and twisting it round and round until it is torn from its attachment, or by cutting it off with a noose of wire. The resulting hemorrhage is checked by the use of an astringent lotion, such as a solution of the tincture of iron, or by packing the nostrils with surgeon's gauze.

PHARYNGEAL POLYPUS.

This is exactly the same kind of tumor described as nasal polypus, the only difference being in the situation. Indeed, the stem of the tumor may be attached to the membrane of the nasal chamber, as before explained, or it may be attached in the fauces (opening of the back part of the mouth), and the body of the tumor then falls into the pharynx. In this situation it may seriously interfere with breathing. Sometimes it drops into the larynx, causing the most alarming symptoms. The animal coughs, or tries to cough, saliva flows from the mouth, the breathing is performed with the greatest difficulty and accompanied with a loud noise; the animal appears as if strangled and often falls exhausted. When the tumor is coughed out of the larynx the animal regains quickly and soon appears as if nothing were ailing. These sudden attacks and quick recoveries point to the nature of the trouble. The examination must be made by holding the animal's mouth open with a balling iron or speculum and running the hand back into the mouth. If the tumor is within reach, it must be removed in the same manner as though it were in the nose.

BLEEDING FROM THE NOSE.

This often occurs during the course of certain diseases, namely, influenza, bronchitis, purpura hemorrhagica, glanders, etc. But it also occurs independently of other affections and, as before mentioned, is a symptom of polypus, or tumor, in the nose.

Injuries to the head, exertion, violent sneezing--causing a rupture of a small blood vessel--also induce it. The bleeding is almost invariably from one nostril only, and is never very serious. The blood escapes in drops (seldom in a stream) and is not frothy, as when the hemorrhage is from the lungs. (See Bleeding from the lungs, p. 127.) In most cases bathing the head and washing out the nostril with cold water are all that is necessary. If the cause is known, you will be guided according to circumstances. If the bleeding continues, pour ice-cold water over the face, between the eyes and down over the nasal chambers. A bag containing ice in small pieces applied to the head is often efficient. If in spite of these measures the hemorrhage continues, plugging the nostrils with cotton, tow, or oakum, should be tried. A string should be tied around the plug before it is pushed up into the nostril, so that it can be safely withdrawn after 4 or 5 hours. If both nostrils are bleeding, only one nostril at a time should be plugged. If the hemorrhage is profuse and persistent, a drench composed of 1 dram of acetate of lead dissolved in 1 pint of water, or ergot, 1 ounce, should be given.

INFLAMMATION OF THE PHARYNX.

As already stated, the pharynx is common to the functions of both respiration and alimentation. From this organ the air passes into the larynx and thence onward to the lungs. In the posterior part of the pharynx is the superior extremity of the gullet, the canal through which the feed and water pass to the stomach. Inflammation of the pharynx is a complication of other diseases--namely, influenza, strangles, etc.--and is probably always more or less complicated with inflammation of the larynx. That it may exist as an independent affection there is no reason to doubt, and it is discussed as such with the diseases of the digestive tract.

SORE THROAT, OR LARYNGITIS.

The larynx is situated in the space between the lower jawbones just back of the root of the tongue. It may be considered as a box (somewhat depressed on each side), composed principally of cartilages and small muscles, and lined on the inside with a continuation of the respiratory mucous membrane. Posteriorly it opens into and is continuous with the windpipe. It is the organ of the voice, the vocal cords being situated within it; but in the horse this function is of little consequence. It dilates and contracts to a certain extent, thus regulating the volume of air passing through it. The mucous membrane lining it internally is so highly sensitive that if the smallest particle of feed happens to drop into it from the pharynx violent coughing ensues instantly and is continued until the source of irritation is ejected. This is a provision of nature to prevent foreign substances gaining access to the lungs. That projection called Adam's apple in the neck of man is the prominent part of one of the cartilages forming the larynx.

Inflammation of the larynx is a serious and sometimes fatal disease, and, as before stated, is usually complicated with inflammation of the pharynx, constituting what is popularly known as "sore throat." The chief causes are chilling and exposure.

Symptoms.--About the first symptom noticed is cough, followed by difficulty in swallowing, which may be due to soreness of the membrane of the pharynx, over which the feed or water must pass, or from the pain caused by the contraction of the muscles necessary to impel the feed or water onward to the gullet; or this same contraction of the muscles may cause a pressure on the larynx and produce pain. In many instances the difficulty in swallowing is so great that water, and in some cases feed, is returned through the nose. This, however, does not occur in laryngitis alone, but only when the pharynx is involved in the inflammation. The glands between the lower jawbones and below the ears may be swollen. Pressure on the larynx induces coughing. The head is more or less "poked out," and has the appearance of being stiffly carried. The membrane in the nose becomes red. A discharge from the nostrils soon appears. As the disease advances, the breathing may assume a more or less noisy character; sometimes a harsh, rasping snore is emitted with every respiration, the breathing becomes hurried, and occasionally the animal seems threatened with suffocation.

Treatment.--In all cases steam the nostrils, as has been advised for cold in the head. In bad cases cause the steam to be inhaled continuously for hours--until relief is afforded. Have a bucketful of fresh boiling water every fifteen or twenty minutes. In each bucketful of water put a tablespoonful of oil of turpentine, or compound tincture of benzoin, the vapor of which will be carried along with the steam to the affected parts and have a beneficial effect. In mild cases steaming the nostrils five, six, or seven times a day will suffice.

The animal should be placed in a comfortable, dry stall (a box stall preferred), and should have pure air to breathe. The body should be blanketed, and bandages applied to the legs. The diet should consist of soft feed--bran mashes, scalded oats, linseed gruel, and, best of all, fresh grass, if in season. The manger, or trough, should neither be too high nor too low, but a temporary one should be constructed at about the height he carries his head. Having to reach too high or too low may cause so much pain that the animal would rather forego satisfying what little appetite he may have than inflict pain by craning his head for feed or water. A supply of fresh water should be before him all the time; he will not drink too much, nor will the cold water hurt him. Constipation (if present) must be relieved by enemas of warm water, administered three or four times during the twenty-four hours.

A liniment composed of 2 ounces of olive oil and 1 each of solution of ammonia and tincture of cantharides, well shaken together, may be thoroughly rubbed in about the throat from ear to ear, and about 6 inches down over the windpipe, and in the space between the lower jaws. This liniment should be applied once a day for two or three days.

If the animal is breathing with great difficulty, persevere in steaming the nostrils, and dissolve 2 drams of chlorate of potassium in every gallon of water he will drink; even if he can not swallow much of it, and even if it is returned through the nostrils, it will be of some benefit to the pharynx as a gargle.

An electuary of acetate of potash, 2 drams, honey, and licorice powder may be spread on the teeth with a paddle every few hours. If the pain of coughing is great, 2 or 3 grains of morphin may be added to the electuary.

When the breathing begins to be loud, relief is afforded in some cases by giving a drench composed of 2 drams of fluid extract of jaborandi in half a pint of water. If benefit is derived, this drench may be repeated four or five hours after the first dose is given. It will cause a free flow of saliva from the mouth.

In urgent cases, when suffocation seems inevitable, the operation of tracheotomy must be performed. To describe this operation in words that would make it comprehensible to the general reader is a more difficult task than performing the operation, which, in the hands of the expert, is simple and attended with little danger.

The operator should be provided with a tracheotomy tube (to be purchased from any veterinary instrument maker) and a sharp knife, a sponge, and a bucket of clean cold water. The place to be selected for opening the windpipe is that part which is found, upon examination, to be least covered with muscles, about 5 or 6 inches below the throat. Right here, then, is the place to cut through. Have an assistant hold the animal's head still. Grasp your knife firmly in the right hand, select the spot and make the cut from above to below directly on the median line on the anterior surface of the windpipe. Make the cut about 2 inches long in the windpipe; this necessitates cutting three or four rings. One bold stroke is usually sufficient, but if it is necessary to make several other cuts to finish the operation, do not hesitate. Your purpose is to make a hole in the windpipe sufficiently large to admit the tracheotomy tube. It is quickly manifested when the windpipe is severed; the hot air rushes out, and when air is taken in it is sucked in with a noise. A slight hemorrhage may result (it never amounts to much), which is easily controlled by washing the wound with a sponge and cold water, but use care not to get any water in the windpipe. Do not neglect to instruct your assistant to hold the head down immediately after the operation, so that the neck will be in a horizontal line. This will prevent the blood from getting into the windpipe and will allow it to drop directly on the ground. If you have the self-adjustable tube, it retains its place in the wound without further trouble after it is inserted. The other kind requires to be secured in position by means of two tapes or strings tied around the neck. After the hemorrhage is somewhat abated, sponge the blood away and see that the tube is thoroughly clean, then insert it, directing the tube downward toward the lungs.

The immediate relief this operation affords is gratifying to behold. The animal, a few minutes before on the verge of death from suffocation, emitting a loud wheezing sound with every breath, with haggard countenance, body swaying, pawing, gasping, fighting for breath, now breathes tranquilly, and may be in search of something to eat.