Part 12

Local Applications. These are the most important remedial measures and usually of themselves succeed in reestablishing a healthy condition.

The agents proving most useful are of an astringent nature and in obstinate cases one may be substituted for another as the last appears to lose its effect. Sulphate of Zinc or Sulphate of Copper in the proportion of half a drachm of either to a quart of water, may be used, or if there is much fœtor, a solution containing a drachm each of carbolic acid and carbonate of potash in a quart of water is to be preferred. In either case the addition of an ounce of pure glycerine renders the lotion at once more soothing and more efficient. The solution must be rendered tepid before injecting it, to obviate the irritation attending on the contact of a cold fluid with the delicate membrane of the nose. Among other agents may be named creolin, creosol, creosote, acetate of lead, potassium permanganate, and silver nitrate. Peroxide of hydrogen may be used either as injection or in spray.

The mode of injection is a matter of no small moment. It has been done in some instances by means of a large syringe but the irritation attendant on such a process is an insuperable objection to its use. A better instrument is that introduced by Professor Rey of Lyons. It consists in a tube bent on itself at an angle of 35° so as to form two arms of unequal lengths. The longer fifteen inches in length, one and a half in diameter and widening into a funnel at its free end;—the shorter about five inches long and tapering towards its free end where its aperture is only two-thirds of an inch across. The instrument is made of block tin or extemporaneously of gutta percha. Over the shorter arm is placed a tightly fitting leather ring four and a half inches in diameter on which is applied some wet tow to adapt it to the nostril and effectually close it. The nose having been drawn in so as to place the head in a vertical position, the short arm of the instrument is introduced into the affected nostril, and the liquid being gently poured into the long arm rises slowly in the nose until it is filled and the liquid flows from the nostril on the opposite side. In introducing the tube care must be taken that it may not irritate the inner wall of the nose on the one hand, nor pass into the blind pouch, known as the false nostril, on the other.

The greatest gentleness and tact are requisite in thus injecting the nostrils, though in troublesome animals it is sometimes necessary to resort to blindfolding or even to the application of a twitch on the ear, or finally to strapping the animal (head included) to a smooth firm vertical surface (operating table).

COLLECTION OF PUS IN THE NASAL SINUSES.

Nasal Sinuses, position, orifice, suppuration, symptoms, treatment, tonics, astringents, antiseptics, trephining, significance of the fœtor, mode of recovery.

In severe coryza the nasal sinuses become implicated as shown by the intensity of the symptoms, the prostration, the hanging head, and the heat and sometimes tenderness between the eyes and immediately beneath them on the side of the upper jaw. These sinuses are large spaces filled with air, situated between the superficial and deep plates of the bones of the face and opening into the nostrils by a narrow orifice in the upper part of the nasal chambers. When pus is largely formed in these it fails to flow out as rapidly as produced, parts with a portion of its liquid elements, increases in consistency and sometimes even undergoes decomposition, so that the discharge from the nostril has a putrid odor.

The most distinctive symptoms of this form of nasal gleet are obtained by percussing the sinuses, and in those cases in particular in which the accumulation is confined to one side of the head, the contrast between the two sides is unmistakable. By gently tapping the forehead with the middle finger from one eye to the other the flat solid sound on the diseased side is easily distinguished from the clear drum-like resonance on the healthy one. By tapping on the bone beneath each eye and just above the ridge on the side of the upper jaw, the difference between the two sides will be recognized in the same way. In some old standing cases increased tenderness and slight bulging of the bones over the affected sinuses are often superadded to the other symptoms. The eye on the affected side is usually retracted so as to seem smaller.

Treatment. In some cases the use of tonics and astringent injections as recommended for the treatment of ozœna will prove successful, but more usually it is needful to open and inject the sinuses.

For this the following articles are required: scissors, a knife, forceps, a trephine or circular saw from half to three-fourths of an inch in diameter and a whalebone or metallic prob.

The horse is thrown and made fast with the diseased side of the head uppermost. A point is then selected on a line drawn between the centres of the two eyeballs and an inch to one side the median line of the forehead; the hair is closely removed with the scissors, and a semi-circular flap of skin over an inch in diameter is dissected from the bone and turned back toward the poll. The trephine is next applied on the bone and a circular portion, having been cut through, is pulled out by the forceps, when the imprisoned pus will commonly ooze from the opening. A second point is chosen just above the lower end of the bony ridge of the upper jaw already referred to and opposite the third molar tooth, counting from before; the hair is removed as before, a flap of the skin raised upward and backward and the bone trephined to open the second sinuse. The point of election for this orifice is more important than that of the first. If it is too near the eye the lower part of the sinus, which is separated from the upper by an imperforate bony plate, is not opened and may continue to keep up the discharge from the nose. If on the contrary it is made too low down, the lower sinuse only is opened and the upper being imperfectly washed out from the wound in the forehead will keep up the discharge. Either then this plate must be struck with the trephine or it must be afterward perforated to secure a favorable result. The prob introduced by the wound in the forehead should further appear at the lower orifice.

The cavities are to be washed out first with clear tepid water, and thereafter daily with an astringent solution such as that used for injecting the nose. If the discharge does not escape freely by the lower orifice its exit may be facilitated by drawing a tape through the sinuses, from the upper to the lower, and retaining it there by a knot on each end.

Marked fœtor of the wound will usually indicate necrosis at the edge of the wound, and demands the use of bone forceps or chisel to remove the offending bone.

A cure is affected by the restoration of the membrane to its natural state, or in other cases by the filling up and obliteration of the cavity by granulation.

ABSCESS OF THE FALSE NOSTRIL OR TURBINATED BONES.

Structure of turbinated bones: suppuration or abscess, obstructed breathing, treatment, puncture, plugging, injection, trephining.

The turbinated bones are two fragile bony structures attached to the outer wall of each nasal chamber. The posterior half of each bone closes the corresponding nasal sinuse; the anterior half is rolled upon itself as a sheet of paper might be, and is accordingly open along one side. In this latter a collection of pus may result from severe inflammatory action and the resulting discharge may become somewhat chronic. The flow is greatest after the nose has been raised, from the pus having previously gravitated into a sac in the lower end of the bone. The pus may moreover pass backward into the larnyx from the raising of the head and induce a violent fit of coughing. Sometimes the inflammation has extended to the bones covering the nose which are bulging and tender. The thin turbinated bone gives way under the distension, bulges into the nose, and often stops the passage of air through that side. This symptom and the appearance of the swelling cause a close approximation in symptoms to nasal polypus. The facts that it supervened on a severe coryza, that it fluctuates on pressure if within reach of the finger, and that pus escapes when it is punctured, exclude the idea of polypus.

Treatment. Puncture of the abscess inside the nose, plugging and daily astringent injections will usually rapidly cure. Gamgee, Jessen and others, recommend trephining of the bone above the nose and washing it out daily, adding that an extensive removal of the bone will correct any existing bulging and deformity.

NASAL DISCHARGE FROM CARIOUS TEETH, ETC.

Ulceration into sinus from caries, loss of molar, overgrown molar. Fœtor, tenderness. Foreign body in the nose.

In cases of a diseased molar tooth in the upper jaw, food getting firmly impacted in the hollow space, irritates the pulp in the fang and the adjacent bone until the progress in ulceration reaches the nasal chamber or sinuse and a nasal discharge is established. If an upper molar tooth is lost the molar formerly opposed to it in the lower jaw grows out and sets up the same train of symptoms. In all cases then in which nasal gleet is associated with much fœtor and with difficulty in eating, a careful examination of the teeth should be made. (See Diseases of the Teeth).

FOREIGN BODY IN THE NOSE.

Professor Gamgee records the destruction of an animal for glanders in which the cause of the discharge was afterwards found to be a physic ball coughed up into the posterior part of the nose and firmly impacted there.

COLLECTIONS OF PUS IN THE GUTTURAL POUCHES.

Structure, position and opening of pouches, inflamed by extension. Symptoms, discharge intermittent with pendent head, swallowing, pasturing, cough, roaring, dyspnœa, inhalation of food, parotid swelling, glandular enlargement. Nature of contents. Treatment, pasturage, blister, tonics, irrigation, puncture, injection.

Though this is commonly a result of severe sore throat or strangles, yet as it causes a chronic discharge from the nose liable to be confounded with those properly due to diseases of the nasal chamber, it is noticed in this place.

The guttural pouches are two mucous sacs peculiar to solid footed animals. They lie side by side above the throat, and in direct contact with the lower surface of the superior bones of the head and the first bone of the neck. They are properly speaking dilatations of the Eustachian tubes which in all animals establish a communication between the pharynx and the middle ear. The opening into the pharynx is at the anterior extremity of the pouch and close to the posterior opening of the nostril, hence the discharge takes place chiefly or exclusively when the head is lowered, since gravitation then favors the escape of the fluid.

Frequently implicated in severe sore-throat the walls of the guttural pouches pour out pus as readily as other mucous membranes in a state of inflammation. As the escape of this product is hindered alike by the narrowness of the orifice and, in the elevated position of the head, by gravitation, it frequently becomes imprisoned and inspissated and proves a permanent source of irritation and discharge. In the early stages the contents are glairy with whitish or yellowish clots; later they are creamy, caseous or even cretaceous. The mucosa, at first red, congested and tumefied, becomes in chronic cases, hard, thick, puckered and adherent to adjacent structures. It sometimes ulcerates and the contents escape in mass, through the pharynx and nose, or externally behind the angle of the lower jaw. In the last case water swallowed may escape through the opening. More commonly the pus remains pent up, and thickens, and may dry and roll into round or oval pellets from the movements of deglutition. The discharge may be arrested for weeks or months when such masses block the outlet.