Part 13

Symptoms. The nasal discharge is intermittent or irregular, being often partially or wholly suppressed by keeping the head elevated, and reappearing or becoming profuse when it is lowered. Feeding from the ground, nibbling roots, or pasturing increases the discharge, as the dependent position of the outlet, the jerking and shaking of the head and the movements of deglutition all favor its exit. Swelling of the parotidean region, a flatness instead of resonance on percussion, and the flattening and discharge and sometimes gurgling by manipulation are characteristic. There is cough, roaring during active exertion, sometimes dyspnœa, and, in bad cases, food may be drawn into the bronchia with serious and even fatal results. When the orifice is blocked and the pouch filled with gas the elastic swelling and resilience are characteristic, and pressure may flatten it with a gurgling sound. These symptoms serve to differentiate it from peripharyngeal abscess. The submaxillary lymphatic glands are usually swollen but less than in glanders and not so hard.

Treatment. In mild and recent cases in which the contents of the pouch have not yet become thick and dry, a cure may be effected; in winter by feeding the animal from the ground and largely with roots; and in summer, by turning out to grass. In either case the matter is allowed to escape almost as soon as formed and the irritated membrane tends to resume its healthy functions. This result will be favored by giving a course of tonics as recommended in simple ozœna, and the application of a mild blister to the throat.

Should this fail an operation must be resorted to. Günther, of Hanover, uses an instrument in the form of a tube a yard long, half an inch in diameter, slightly curved for two inches at one end which is blind, and having an orifice on one side close to this extremity. This tube having been introduced through the chamber of the nose on the affected side and its curved end having been carried into the narrow opening of the Eustachian pouch, tepid water is pumped in and the pouch thoroughly cleaned out. Astringent solutions are then employed. The introduction of the tube is, however, a very difficult operation and one quite impossible to any one who has not the most accurate knowledge of the parts in question.

A second mode of operating is by external incision. For this purpose are wanted scissors, knife, artery forceps, iron probe bent in the form of the letter S, and a tape. The horse having been thrown and fastened and the head extended, the hair is removed from a surface in front of the prominent border of the first bone of the neck, and an incision made between this border and the parotid gland. The incision is made immediately beneath a tendon which may be felt as a flattened cord crossing the border of the bone in its upper third, and it should be carried downward one and a half inches parallel to the margin of the bone. In this preliminary stage the operator has to carefully avoid injury to the parotid gland and the posterior auricular artery and vein. The skin and fascia having been divided the index finger of the left hand is pushed inward and forward until the prominent angle of the large cornu of the hyoid bone is felt, together with the muscle (stylo-hyoid) inserted into this bone above the angle referred to. The next step is important since crossing on the inner side of this muscle and bone at their point of union is the (internal carotid) artery which becomes subsequently enveloped in a fold of the membranous wall of the guttural pouch. The slightest variation in the position of the artery may here prove fatal unless the greatest caution is used. With the knife guarded by the index finger of the right hand the muscle is cut through from behind forward and the pulsation of the artery felt for beneath. Avoiding its position the knife, with its cutting edge turned forward and its point directed toward the horse’s nose, is pushed through the walls of the sac. The curved prob is now introduced and carried downward until it is felt beneath the skin just behind the angle of the lower jaw. This may be safely cut down upon with the knife as important parts (vessels and nerves) have been turned aside by its pressure. A tape attached to the prob is now drawn through the pouch and retained by a knot on each end. Tepid water must be injected through the lower orifice daily for three weeks, astringent antiseptic injections thrown in occasionally and the horse fed from the ground. At the end of this period the tape may be removed, and the wounds allowed to heal. During the course of treatment it is always advisable to change the tape several times by cutting the knot off one end of the old one, stitching the new one to it and drawing it through.

Puncture of the pouch at its lower part is a very simple operation when the accumulation of pus is abundant and chronic. The distended pouch gravitates downward largely separating the parotid from the deeper vessels and nerves, and finally fluctuates toward the lower end of the gland. In extreme cases it even opens and discharges. When fluctuation can be felt the sac may be incised with a bistoury or abscess knife and treated like a common sore. Opening with a pointed or olive-shaped cautery has the advantage of checking hæmorrhage and securing more perfect drainage. When there is no fluctuation the incision must be made just beneath the lower border of the parotid, the parotidoauricularis being first cut through, then the gland dissected from the deeper parts when the distended sac can usually be felt and opened. If not felt at once it can easily be reached by a careful dissection upward through the loose subparotidean connective tissue, with the finger nail or handle of the scalpel. A free opening may be made and the wound injected daily with a weak antiseptic solution.

ABSCESS OF THE FALSE NOSTRIL.

In young horses as the result of injury from the bridle or severe coryza, a circumscribed swelling sometimes appears on the outer flap of the nostril, at first firm, hot and tender, with a surrounding pasty infiltration, then forming into a tense elastic ovoid mass, the size of a pigeon’s or chicken’s egg. It may become chronic and remain for an indefinite period comparatively insensible to touch and only slightly interfering with the movements of the nostrils. As soon as the elastic tension betrays the presence of pus it should be evacuated by a free incision made from inside the nostrils and the wound plugged with medicated tow and allowed to heal by granulation.

NEOPLASMS IN THE HORSE’S NOSE.

Nasal fibrous polypus, connection, form, size, bony distortion, obstructed breathing, abrasion, ulceration, sloughing, submucous polypus, structure, degeneration. Symptoms, sneezing, snuffling, discharge, palpation, bony swelling, tenderness. Treatment, forceps, hook, ecraseur, knife, saw. Actinomycosis. Sarcoma, Carcinoma. Consistency, structure, fœtor, glandular swelling. Treatment. Recurrence. Fatty tumors. Bony tumors: cancellated or compact tissue, localized or extended. Cysts. Strongyli. Angioma. Varicosity. Color, obstruction to breathing, hæmorrhage, cicatrization.

These are essentially surgical diseases yet as they induce Chronic Catarrh they may be profitably noticed here.

I. =Fibrous Nasal Polypus.= These are connected to the mucosa by a pedicle or broad base, and vary in size from a pea to a mass which fills the entire nasal chamber, projects from the nostrils and presses outward the septum and facial bones. At times they weigh one or more pounds. They may cause whistling or rattling in breathing, or may completely obstruct the passage of air on the affected side. In time they may cause bulging or even attenuation and perforation of the bony walls, projecting through the hard palate or on the face. Sometimes the surface becomes the seat of granulation, ulceration, or sloughing, causing more or less fœtor. The large polypi make their main growth forward and backward, moulding themselves to the form of the chamber, and displacing the turbinated bones. They commence to grow under the mucous membrane and as they grow and become more loosely attached they carry this as an outer covering and pedicle. When incised they show a structure of interlacing bundles of fibres, with cell elements more or less abundant, according to the rapidity of growth. Gravitz found amyloid degeneration of the walls of the blood vessels and mucous follicles and of the fibres.

Symptoms are difficult breathing, snuffling, a smaller current of air on the affected side, or none, sneezing, a watery, purulent, bloody, or fœtid discharge, and the appearance of the polypus when the nasal chamber is examined in a good light. If beyond reach of vision the polypus may often be felt by the finger. Care must be taken not to mistake the red, angry surface of the turbinated bones in Catarrh for a polypus. If beyond the reach of the finger, the flat sound on percussion of the nasal and frontal bones on the affected side, and the persistently diminished flow of air may serve for diagnosis. Tenderness shown on percussion is common to this and abscess of the sinuses.

Treatment. The horse having been cast with the diseased side uppermost and the head turned to the light, the tumor is seized with the fingers, the forceps, or hook, and drawn gently outward. The chain of the ecraseur may be passed over it and slowly tightened upon the pedicle until it is cut through. This will usually obviate any laceration of the turbinated bones and consequent bleeding. In case of serious hæmorrhage check by cold water, ice, the actual cautery, or by plugging. Polypi with a broad base may be removed with a prob-pointed knife, curved on the flat, and furnished with a long handle. The mass is seized with a vulsella and detachment made by passing the knife with the concave side toward the tumor. In cases where the tumor cannot be seen or reached some have resorted to slitting up the outer wall of the nostril as far as the angle of union of the nasal and maxillary bones, care being taken to make the incision outside the upper end of the cartilage of the ala nasi. If too high to be satisfactorily reached in this way the nasal or frontal bone may be trephined over the body of the tumor as indicated by the flatness on percussion, and the operation performed through the opening thus made.

II. =Actinomycosis.= Though much more common in cattle than horses, yet the occasional occurrence of this in the face of the solipede must not pass unnoticed.

III. =Sarcoma= and =Carcinoma.= These are found growing from the periosteum, or even starting in the cancellated tissue and projecting into the nose, where they give rise to symptoms like those of fibrous polypi. Being much softer in texture and more liable to ulceration and degeneration they are likely to cause a much more offensive discharge. There is also more tendency to the implication of the submaxillary lymphatic glands. The only treatment is surgical and recurrence is always to be feared. (See Diseases of the Orbit.)

IV. =Fatty Tumors= of the nose are described by Röll and Gurlt as existing on the septum and in the sinuses. Being simple, they can be removed with great confidence as to nonrecurrence.

V. =Osseous Tumors of the Nasal walls.= These are described by Röll as osteophytes in the maxillary sinus in chronic catarrh, and by Gamgee as osteomata attached to the outer wall of the nasal chamber, which had to be detached by saw and bone forceps. I have found these latter of a soft porous structure easily detached by the knife, and in other cases dense and requiring, chisel, saw and forceps. In one instance the tumor grew from a dense hypertrophy of the maxillary bone which could not be entirely removed because the molar alveoli were implicated.

VI. =Cysts= named by Röll and others as present in the mucosa of the ethmoid cells in solipedes often contain larva of the strongylus armatus.

VII. =Angioma= may be but an exaggerated development of the abundant venous plexus and erectile tissue on the surface of the turbinated bones. There appears to be at other times an actual increase of the vascular tissue. As might be expected it has no abrupt margin, but gradually shades off into the healthy tissue. The prominent centre has a bluish red or brownish hue. It obstructs breathing, is apt to bleed under violent exertions in draught, or in contested races, and readily ulcerates with a bloody discharge. If it subsides and heals, it is followed by a whitish puckering like the so-called cicatrix of glanders.

CATARRH OF THE FRONTAL SINUSES IN CATTLE. CATARRH FROM TRAUMATISM.

Extent of sinuses in cattle. Causes, blows, unequal teams, locking horns, fracture. Pathology. Congestion, exudation, suppuration, swelling and closure of outlet, prostration, fever, agalactia, septic infection, ulceration, exclusion of oxygen. Symptoms. Crimson hæmorrhage, disturbed breathing, appetite, rumination, position of head and eyelids, percussion and temperature of forehead, fever. Chronic form. Slow progress, emaciation, anorexia, facial expression, hide, discharge, breath heavy or fœtid. Duration. Prognosis. Lesions in sinuses and glands. Treatment. Cold irrigation, icebags, elevation of head, laxatives, diuretics, dehorning, trephining, injections, astringent, antiseptic, blister, tonics.

The gravity of this affection is a consequence of the great extent of the delicate mucous membrane which lines the frontal sinus. This cavity not only occupies the whole forehead from beneath the eyes up to the frontal crest, but extends, in the mature horned animal, into the tapering bony process which forms the basis of support for the horn. The mucosa is rendered all the more extensive by the numerous pillars and septa that pass from the outer bony plate to the inner, giving great strength to the part for purposes of offense and defence. Inflammation of this membrane is usually the result of blows on the horns, and these are much more common among working oxen than dairy cows. The immediate cause is violent contact with the yoke when the head is lowered at pasture, and from blows of a club in the hands of the driver. In countries where the yoke is a broad padded board hung from the horns and resting on the forehead traumatic injuries are much more common. The active and vigorous animal gets the greater part of the work, and the wrench and jar may induce hæmorrhage and catarrh. If the yoke is ill-made or badly fitted the case is worse. The blows sustained by horn or forehead in an ordinary fight, may also be the cause, and a partial or complete fracture of the bony support is especially hurtful when the detached horn is replaced so as to close in the cavity. Blows on the frontal crest are also dangerous.

The pathology of the disease consists in an inflammation of the mucosa of the sinus, and the filling of that cavity with blood or, later, with a muco-purulent fluid, the escape of which is prevented by the closure of the nasal outlet by swelling. This of itself produces violent headache and much nervous disorder as witnessed by the drooping head, closed eyelids, prostration, high fever, anorexia, and in cows suppression of the milk secretion. But there is reason to believe that this is aggravated by the septic germs, which inspired with the air, were already present in the sinus, and which in the comparative absence of oxygen, in a rich culture medium and in contact with injured and debilitated tissues, assume an enhanced pathogenic rôle. This may serve to explain the ulceration of the mucosa of the sinus found in subjects that have suffered for some time. It further explains the notorious fact that the free access of air (oxygen) to the inflamed sinus is one of the most helpful therapeutic measures.

Symptoms of the Acute Form. When the disease is traumatic the first symptom is usually a hæmorrhage from the nose, the blood being of a bright crimson. Respiration is hurried, and appetite diminished, yet rumination may be imperfectly performed. The bleeding may be repeated for days in succession, but the ox is still capable of work. On the fifth or sixth day there is complete anorexia, rumination ceases, the head sinks resting on the manger or soil, the ears droop forward and downward, and may be swollen. The head inclines to the affected side, the corresponding horn is intensely hot, and the eyes are closed. Light percussion of the forehead on the affected side gives pain, and the sound elicited is flat and dull as compared with that from the opposite side. The temperature of the body rises 2° or more, the pulse becomes frequent, full and hard and the impulse of the heart abnormally strong. Costiveness, partially suppressed and high colored urine, and dry hot muzzle betray the fever. Unless relieved the chronic form may supervene.

SYMPTOMS OF THE CHRONIC FORM. When this comes on slowly, working oxen get emaciated, lose appetite, have the eyes dull and sunken, and the lids drooping, the coat rough and staring and the skin harsh, dry, and lacking in pliancy, the head is carried low when out of the yoke and, after shaking the head and sneezing, a glairy, slightly fœtid matter escapes from the nostril. The breath is fœtid and appears to be offensive to adjacent cattle.

This may continue for months with no other change than a more constant nasal discharge, and increasing emaciation and weakness.

Prognosis. This is favorable for the acute disease at the outset. But if no relief is furnished it is liable to go on to a fatal issue. Even the chronic form is curable unless the subject has already become hopelessly weak and debilitated.

In fatal cases the sinuses are found to be filled with a glairy fluid and the mucosa thickened and raw or ulcerated. There may be enlargement of the pharyngeal lymphatic glands, and there may be attendant pharyngitis.