Part 41

The pons Varolii is the transverse projection on the base of the brain, between the medulla oblongata and the peduncles of the cerebrum.

The cerebellum is lodged in the posterior part of the cranial cavity, immediately above the medulla oblongata; it is globular or elliptical in shape, the transverse diameter being greatest. The body of the cerebellum is composed of gray matter externally and of white matter in the center. The cerebellum has the function of co-ordinating movements; that is, of so associating them as to cause them to accomplish a definite purpose. Injuries to the cerebellum cause disturbances of the equilibrium but do not interfere with the will power or intelligence.

The cerebrum, or brain proper, occupies the anterior portion of the cranial cavity. It is ovoid in shape, with an irregular, flattened base, and consists of lateral halves or hemispheres. The greater part of the cerebrum is composed of white matter. The hemispheres of the cerebrum are usually said to be the seat of all psychical activities. Only when they are intact are the process of feeling, thinking, and willing possible. After they are destroyed the organism comes to be like a complicated machine, and its activity is only the expression of the internal and external stimuli which act upon it.

The spinal cord, or spinal marrow, is that part of the cerebrospinal system which is contained in the spinal canal of the backbone, and extends from the medulla oblongata to a short distance behind the loins. It is an irregularly cylindrical structure, divided into two lateral, symmetrical halves by fissures. The spinal cord terminates posteriorly in a pointed extremity, which is continued by a mass of nerve trunks--cauda equinae. A transverse section of the cord reveals that it is composed of white matter externally and of gray matter internally. The spinal cord does not fill the whole spinal canal. The latter contains, besides, a large venous sinus, fatty matter, the membranes of the cord, and the cerebrospinal fluid.

The spinal nerves, forty-two or forty-three in number, arise each by two roots, a superior or sensory, and an inferior or motor. The nerves originating from the brain are twenty-four in number, and arranged in pairs, which are named first, second, third, etc., counting from before backward. They also receive special names, according to their functions or the parts to which they are distributed, viz:

1. Olfactory. 2. Optic. 3. Oculo-motor. 4. Pathetic. 5. Trifacial. 6. Abducens. 7. Facial. 8. Auditory. 9. Glossopharyngeal. 10. Pneumogastric. 11. Spinal accessory. 12. Hypoglossal.

Inflammation of the Brain and its Membranes (Encephalitis, Meningitis, Cerebritis).

Inflammation may attack these membranes singly, or any one of the anatomical divisions of the nerve matter, or it may invade the whole at once. Practical experience, however, teaches us that primary inflammation of the dura mater is of rare occurrence, except in direct mechanical injuries to the head or diseases of the bones of the cranium. Neither is the arachnoid often affected with acute inflammation, except as a secondary result. The pia mater is most commonly the seat of inflammation, acute and subacute, but from its intimate relation with the surface of the brain the latter very soon becomes involved in the morbid changes. Practically, we can not separate inflammation of the pia mater from that of the brain proper. Inflammation may, however, exist in the center of the great nerve masses--the cerebrum, cerebellum, pons Varolii, or medulla at the base of the brain--without involving the surface. When, therefore, inflammation invades the brain and its enveloping membranes it is properly called encephalitis; when the membranes alone are affected it is called meningitis, or the brain substance alone cerebritis. Since all the conditions merge into one another and can scarcely be recognized separately during the life of the animal, they may here be considered together.

Causes.--Exposure to extreme heat or cold, sudden and extreme changes of temperature, excessive continued cerebral excitement, too much nitrogenous feed, direct injuries to the brain, such as concussion, or from fracture of the cranium, overexertion, sometimes as sequelae to influenza, pyemia, poisons having a direct influence upon the encephalic mass, extension of inflammation from neighboring structures, food poisoning, tumors, parasites, metastatic abscesses, etc.

Symptoms.--The diseases here grouped together are accompanied with a variety of symptoms, almost none of which, however, are associated so definitely with a special pathological process as to point unmistakably to a given lesion. Usually the first symptoms indicate mental excitement, and are followed by symptoms indicating depression. Acute encephalitis may be ushered in by an increased sensibility to noises, with more or less nervous excitability, contraction of the pupils of the eyes, and a quick, hard pulse. In very acute attacks these symptoms, however, are not always noted. This condition will soon be followed by muscular twitchings, convulsive or spasmodic movements, eyes wide open with shortness of sight. The animal becomes afraid to have his head handled. Convulsions and delirium will develop, with inability of muscular control, or stupor and coma may supervene. When the membranes are greatly implicated, convulsions and delirium with violence may be expected, but if the brain substances are principally affected stupor and coma will be the prominent symptoms. In the former condition the pulse will be quick and hard; in the latter, soft and depressed, with often a dilatation of the pupils, and deep, slow, stertorous breathing. The symptoms may follow one another in rapid succession, and the disease approach a fatal termination within 12 hours. In subacute attacks the symptoms are better defined, and the animal seldom dies before the third day. Within three or four days gradual improvement may become manifest, or cerebral softening with partial paralysis may occur. In all cases of encephalitis there is a marked rise in temperature from the very onset of the disease, with a tendency to increase until the most alarming symptoms develop, succeeded by a decrease when coma becomes manifest. The violence and character of the symptoms greatly depend upon the extent and location of the structures involved. Thus, in some cases there may be marked paralysis of certain muscles, while in others there may be spasmodic rigidity of muscles in a certain region. Very rarely the animal becomes extremely violent early in the attack, and by rearing up, striking with the fore feet, or falling over, may do himself great injury. Usually, however, the animal maintains the standing position, propping himself against the manger or wall, until he falls from inability of muscular control, or from unconsciousness. Occasionally, in his delirium, he may go through a series of automatic movements, such as trotting or walking, and, if loose in a stall, will move around persistently in a circle. Early and persistent constipation of the bowels is a marked symptom in nearly all acute affections of the brain; retention of the urine, also, is frequently observed.

Following these symptoms there are depression, loss of power and consciousness, lack of ability or desire to move, and usually fall of temperature. At this stage the horse stands with legs propped, the head hanging or resting on the manger, the eyes partly closed, and does not respond when spoken to or when struck with a whip.

Chronic encephalitis or meningitis may succeed the acute stage, or may be due to stable miasma, blood poison, narcotism, lead poisoning, etc. This form may not be characterized in its initial stages by excitability, quick and hard pulse, and high fever. The animal usually appears at first stupid; eats slowly; the pupil of the eye does not respond to light quickly; the animal often throws his head up or shakes it as if suffering sudden twinges of pain. He is slow and sluggish in his movements, or there may be partial paralysis of one limb, one side of the face, neck, or body. These symptoms, with some variations, may be present for several days and then subside, or the disease may pass into the acute stage and terminate fatally. Chronic encephalitis may effect an animal for ten days or two weeks without much variation in the symptoms before the crisis is reached. If improvement commences, the symptoms usually disappear in the reverse order to that in which they developed, with the exception of the paralytic effects, which remain intractable or permanent. Paralysis of certain sets of muscles is a very common result of chronic, subacute, and acute encephalitis, and is due to softening of the brain or to exudation into the cavities of the brain or arachnoid space.

Softening and abscess of the brain are terminations of cerebritis. It may also be due to an insufficient supply of blood as a result of diseased cerebral arteries and of apoplexy. The symptoms are drowsiness, vertigo, or attacks of giddiness, increased timidity, or fear of familiar objects, paralysis of one limb, hemiplegia, imperfect control of the limbs, and usually a weak, intermittent pulse. In some cases the symptoms are analogous to those of apoplexy. The character of the symptoms depends upon the seat of the softening or abscess within the brain.

Cerebral sclerosis sometimes follows inflammation in the structure of the brain affecting the connective tissues, which eventually become hypertrophied and press upon nerve cells and fibers, causing their ultimate disappearance, leaving the parts hard and indurated. This condition gives rise to a progressive paralysis and may extend along a certain bundle of fibers into the spinal cord. Complete paralysis almost invariably supervenes and causes death.

Lesions.--On making post-mortem examinations of horses which have died in the first stages of either of these diseases we find an excessive engorgement of the capillaries and small blood vessels, with correspondingly increased redness and changes in both the contents and the walls of the vessels. If death has occurred at a later period of the disease, it will be found that, in addition to the redness and engorgement, an exudation of the contents of the blood vessels into the tissues and upon the surfaces of the inflamed parts has supervened. If the case has been one of encephalitis, there will usually be found more or less watery fluid in the ventricles (natural cavities in the brain), in the subarachnoid space, and a serous exudation between the convolutions and interstitial spaces of the gray matter under the membranes of the brain. The quantity of fluid varies in different cases. Exudations of a membranous character may be present, and are found attached to the surfaces of the pia mater.

In meningitis, especially in chronic cases, in addition to the serous effusion, there are changes which may be regarded as characteristic in the formation of a delicate and highly vascular layer or layers of membrane or organized structure on the surface of the dura mater, and also indications of hemorrhages in connection with the membranous formations. Hematoma, or blood tumors, may be found embedded in this membrane. In some cases the hemorrhages are copious, causing paralysis or apoplexy, followed by speedy death. The meningitis may be suppurative. In this case a puslike exudate is found between the membranes covering the brain.

In cerebritis, or inflammation of the interior of the brain, there is a tendency to softening and suppuration and the formation of abscesses. In some cases the abscesses are small and numerous, surrounded with a softened condition of the brain matter, and sometimes we may find one large abscess. In cases of recent development the walls of the abscesses are fringed and ragged and have no lining membrane. In older or chronic cases the walls of the abscesses are generally lined with a strong membrane, often having the appearance of a sac or cyst, and the contents have a very offensive odor.

Treatment.--In all acute attacks of inflammation involving the membranes or cerebral masses, it is the pressure from the distended and engorged blood vessels and the rapid accumulation of inflammatory products that endangers the life of the animal in even the very early stage of the disease. The earlier the treatment is commenced to lessen the danger of fatal pressure from the engorged blood vessels, the less effusion and smaller number of inflammatory products we have to contend with later. The leading object, then, to be accomplished in the treatment of the first stage of encephalitis, meningitis, or cerebritis, and before a dangerous degree of effusion or exudation has taken place, is to relieve the engorgement of the blood vessels and thereby lessen the irritation or excitability of the affected structures. If the attempt to relieve the engorgement in the first stage has been only partially successful, and the second stage, with its inflammatory products and exudations, whether serous or plastic, has set in, then the main objects in further treatment are to keep up the strength of the animal and hasten the absorption of the exudative products as much as possible. To obtain these results, when the animal is found in the initial stage of the disease, if there is unnatural excitability or stupor with increase of temperature and quickened pulse, we should apply cold to the head in the form of cold water or ice. For this purpose cloths or bags may be used, and they should be renewed as often as necessary. If the disease is still in its early stages and the animal is strong, bleeding from the jugular vein may be beneficial. Good results are to be expected only during the stage of excitement, while there is a strong, full pulse and the mucous membranes of the head are red from a plentiful supply of blood. The finger should be kept on the pulse and the blood allowed to flow until there is distinct softening of the pulse. As soon as the animal recovers somewhat from the shock of the bleeding the following medicine should be made into a ball or dissolved in a pint of warm water and be given at one dose: Barbados aloes, 7 drams; calomel, 2 drams; powdered ginger, 1 dram; tincture of aconite, 20 drops.

The animal should be placed in a cool, dark place, as free from noise as possible. When the animal becomes thirsty half an ounce of bromid of potash may be dissolved in the drinking water every six hours. Injections of warm water into the rectum may facilitate the action of the purgative. Norwood's tincture of veratrum viride, in 20-drop doses, should be given every hour and 1 dram of solid extract of belladonna every four hours until the symptoms become modified and the pulse regular and full.

THE NERVOUS SYSTEM.]

If this treatment fails to give relief, the disease will pass into the advanced stages, or, if the animal has been neglected in the early stages, the treatment must be supplanted with the hypodermic injection of ergotin, in 5-grain doses, dissolved in 1 dram of water, every six hours. The limbs may be poulticed above the fetlocks with mustard. Warm blanketing, to promote perspiration, is to be observed always when there is no excessive perspiration.

If the disease becomes chronic (encephalitis or meningitis), we must place our reliance upon alteratives and tonics, with such incidental treatment as special symptoms may demand. Iodid of potassium in 2-dram doses should be given three times a day and 1 dram of calomel once a day to induce absorption of effusions or thickened membranes. Tonics, in the form of iodid of iron in 1-dram doses, to which is added 2 drams of powdered hydrastis, may also be given every six or eight hours, as soon as the active fever has abated. After the disappearance of the acute symptoms, blisters (cantharides ointment) may be applied behind the poll. When paralytic effects remain after the disappearance of all other symptoms, sulphate of strychnia in 2-grain doses, in combination with the other tonics, may be given twice a day and be continued until it produces muscular twitching. In some cases of paralysis, as of the lips or throat, benefit may be derived from the moderate use of the electric battery. Many of the recoveries will, however, under the most active and early treatment, be but partial, and in all cases the animals become predisposed to subsequent attacks. A long time should be allowed to pass before the animal is exposed to severe work or great heat. When the disease depends upon mechanical injuries, they have to be treated and all causes of irritation to the brain removed. If it is due to stable miasma, uremic poisoning, pyemia, influenza, rheumatism, toxic agents, etc., they should receive prompt attention for their removal or mitigation.

Cerebral softening, abscess, and sclerosis are practically inaccessible to treatment, otherwise than such relief as may be afforded by the administration of opiates and general tonics, and, in fact, the diagnosis is largely presumptive.

CONGESTION OF THE BRAIN, OR MEGRIMS.

Congestion of the brain consists in an accumulation of blood in the vessels, also called hyperemia, or engorgement. It may be active or passive--active when there is an undue accumulation of blood or diminished arterial resistance, and passive when it accumulates in the vessels of the brain, owing to some obstacle to its return by the veins.

Causes.--Active cerebral congestion may be from hypertrophy of the left ventricle of the heart, excessive exertion, the influence of extreme heat, sudden and great excitement, artificial stimulants, etc. Passive congestion may be produced by any mechanical obstruction which prevents the proper return of blood through the veins to the heart, such as a small or ill-fitting collar, which often impedes the blood current, tumors or abscesses pressing on the vein in its course, and organic lesions of the heart with regurgitation.

Extremely fat animals with short, thick necks are peculiarly subject to attacks of cerebral congestion. Simple congestion, however, is merely a functional affection, and in a slight or moderate degree involves no immediate danger. Extreme engorgement, on the contrary, may be followed by rupture of previously weakened arteries and capillaries and cause immediate death, designated then as a stroke of apoplexy.

Symptoms.--Congestion of the brain is usually sudden in its manifestation and of short duration. The animal may stop very suddenly and shake its head or stand quietly braced, then stagger, make a plunge, and fall. The eyes are staring, breathing hurried and stertorous, and the nostrils widely dilated. This may be followed by coma, violent convulsive movements, and death. Generally, however, the animal gains relief in a short time, but may remain weak and giddy for several days. If it is due to organic change of the heart or the disease of the blood vessels in the brain, then the symptoms may be of slow development, manifested by drowsiness, dimness or imperfect vision, difficulty in voluntary movements, diminished sensibility of the skin, loss of consciousness, delirium, and death. In milder cases effusion may take place in the arachnoid spaces and ventricles of the brain, followed by paralysis and other complications.