Part 37

Some practitioners make local applications of hot water and of aqua ammonia (confined) but unless very closely watched these are liable to destroy the hair follicles and produce permanent blemish.

The hot air, steam bath, and hot compress have the advantage over the mere irritant derivatives that their action is from first to last soothing and free from all risk of inducing sympathetic irritation and yet as derivatives they are eminently efficient. Next to them in safety and efficacy comes dry cupping.

The irritant derivatives are often the most valuable, but must be used with great judgment. They are always dangerous when the pleural inflammation runs very high and when the local irritation and suffering are specially acute. Under such circumstances it is usually desirable to adopt other measures to moderate the severity of the inflammation, and to fall back on baths, compresses and cups until the irritation is alleviated before vegetable or animal vesicants are resorted to. In acute and severe attacks these latter are especially applicable to the early stages before the inflammation has been fully formed, or after the stage of free effusion has set in.

With high fever and no benefit from hot local applications, cold irrigation or refrigerant compresses to the walls of the chest, have proved useful, but considering the rôle filled by cold in causation and the suggested relation between pleurisy and rheumatism this is not to be followed as a general practice.

If the patient has been a hearty feeder and if there is evident costiveness a purgative (aloes or sulphate of soda) is often desirable at the outset, but if the disease is of a low type this is always dangerous, owing to susceptibility of the intestinal mucosa and it is safer to correct constipation by injections or at most by a pint of olive oil.

When the suffering is very acute and is aggravating the fever, a hypodermic injection of morphine will often greatly relieve and even favor a revulsion of blood toward the skin, but as it tends to suppress the action of both bowels and kidneys it should be avoided unless it seems absolutely necessary, and above all it should not be given by the stomach. Cocaine hypodermically may be used to relieve pain.

Both fever and suffering can sometimes be greatly relieved by large doses (2 drachms 3 or 4 times daily) of salicylate of soda, which again suggests a close relation of the disease to rheumatism. Acetanilid or phenacetin may be used to fill the same indication.

Next come the questions of alkaline and diuretic treatment. Some cases do well if given nitrate of potash freely in the drinking water. Some prefer the alkaline diuretics, such as acetate of potash or ammonia, bicarbonate of potash or soda, biborate of soda, or the vegetable diuretics such as colchicum, squills, etc. Fraënkel found that, while comparatively ineffective alone, these proved most efficient (in man) when combined with cinchona or other bitter. The hint should be useful to the veterinarian. Diuretics in the stage of effusion should be pushed as far as the strength of the patient will warrant.

Friedberger and Fröhner recommend pilocarpin, and no agent produces an equal secretion from the natural emunctories and an equal tendency to reabsorption. It is however so profoundly exhausting that it must be used with the greatest judgment and caution.

Digitalis has often an excellent effect. Though not primarily a diuretic, it is a powerful tonic of the heart and circulation, and by increasing the blood tension it usually produces a free flow of urine. In combination with the diuretic salts it may be used from the first but it is especially valuable, after effusion and when attention must be given mainly to securing reabsorption. Care is demanded that we avoid its cumulative action, and in place of continuous large doses, a strong infusion applied over the loins will sometimes have a good effect. It may also be combined with bitters and even with ferruginous tonics in the advanced stages.

In combination with neutral salts and digitalis, iodide of potassium would seem to be indicated. Results however do not show a great superiority to other diuretics in favoring absorption.

Tincture of iodine, painted upon the chest over the affected parts, and repeated until tender, acts more or less as both a derivative and deobstruent. A liniment of iodide of potassium and soap is a convenient form of application.

The inunction of the chest walls with mercurial ointment has strong advocates both among physicians and veterinarians, and is combined in such cases with the exhibition of calomel internally. Unless the good effects are shown in a day or two it may well be abandoned.

When effusion becomes dangerous through excess, and in advanced cases when it fails to yield to medicinal measures thoracentesis is called for. (See under hydrothorax.)

PLEURISY IN CATTLE.

Milch cows and work oxen most liable. Causes. Damp buildings and locations, sudden transitions from heat to cold, exposure when fatigued, etc. Symptoms, rigor, reaction, cold horns and limbs, later hot, excited pulse, catching breathing, hyperthermia, 104° to 105°, tender chine and intercostals, friction sound, later dulness, creaking, weaker murmur, subacute cases often tuberculous, effusion unilateral, chronic cases. Lesions, as in horse with superficial marbling of lung. Treatment, laxative, warm drink, compresses, derivatives, sedatives, diuretics, heart tonics, diuretics, thoracentesis.

This is not common in young growing cattle, but is more frequent in milch cows and work oxen. It is due to the same causes as in the horse, and especially to chills when heated, damp buildings and locations, cold draughts between open windows or doors, and cold storms. The greatest danger comes from hot, close stables, like many distillery stables, approximating to the temperature of the animal body and from which the stock are suddenly turned out of doors, or shipped by car or boat with a temperature near zero, and above all if furnished ice water to drink. Such animals taking no exercise to increase the circulation and heat, are especially liable to shiver and contract illness. Rigors too are easily induced in animals standing in hot buildings, when, in connection with the cleaning, an adjacent door is thrown wide open or two on opposite sides of the house. Working oxen heated with exercise and then exposed to extreme cold and compulsory inaction are endangered.

Symptoms. The attack is manifested by the same general symptoms as in the horse. The rigors are often very well marked, especially over the shoulder; the tenderness of the chine and intercostal spaces is striking; the breathing is catching but there is rarely the same restlessness as in the horse; the bowels are costive, appetite and rumination impaired or suspended, and the paunch is often distended with gas. The tenderness of the intercostal spaces, the friction sound of the pleura, and the maintenance of the respiratory murmur and the normal resonance of the lung, become the ultimate diagnostic symptoms. The pulse may be 70° and upward, the temperature above 104° to 105°. In some insidious cases indeed the fever is very slight and besides the general wasting of the animal, the indications obtained by physical examination alone enabled us to recognize the malady. Tuberculous pleurisy which is very common in cattle is to be suspected in such cases.

Effusion is recognized by the dulness of the lower part of the chest up to a certain line, and often unilateral, by the softer pulse, by the dilated nostrils, or open mouth, the contracted facial muscles, by the glazed eye, and anxious expression, by oppressed breathing and often by engorgement under the chest and in the limbs.

When the disease lasts over ten or twelve days it tends to pass into the chronic form. Or a chronic pleurisy of a subacute type may begin de novo and pursue an insidious and latent course.

If the disease commences as a subacute affection there may have been for a month, capricious appetite, general ill-health and falling away before any other symptom is noticed. Now the breathing is manifestly excited, a small, short cough is heard at intervals, the pulse is accelerated but weak, and pinching auscultation and percussion detect unequivocal signs of pleurisy. From this the symptoms become more decided though for a length of time they are very slight, the animal meanwhile becomes increasingly emaciated, and perishes ultimately in a state of great weakness. Such insidious cases are always to be suspected of tuberculosis.

The post mortem appearances resemble those of the horse. The surface of the lung beneath the diseased portions of pleura, however, often presents a marbled appearance from the infiltration of the areolar tissue between the adjacent pulmonary lobules. The organization of the false membranes begins on an average about the tenth day.

Treatment. The same general principles must be followed as in the horse. Bleeding can rarely be employed, partly because the disease so often assumes a subacute form, and partly because when first seen considerable effusion has often already taken place and severe depletive measures are thereby contraindicated.

A laxative dose (1 ℔.) of sulphate magnesia, may be given in warm gruel, and the same means by compresses, hot fomentations and counterirritation adopted, and the same sedative and diuretic medicines given as in the horse. In the advanced stages and in the low types of the disease the stimulating diuretics (sweet spirits of nitre, and liquor of the acetate of ammonia) and vegetable and mineral tonics are especially indicated. The diet in these last types must be nutritive, laxative and easily digested.

Tapping of the chest is equally applicable as in the horse, (see Hydrothorax.)

In the chronic forms everything is to be done to support the general health whether by food stimulants or tonics, and counterirritants may be applied several times.

PLEURISY IN SHEEP.

Causes, exposure, after clipping, washing in cold weather, alternations from hot buildings to cold fields, shedding of the wool. Symptoms, hyperthermia, troubled breathing and pulse with catching inspiration, tender intercostals, friction sound, and signs of effusion. Treatment, preventive, shelter, febrifuges in food or water, aqua ammonia to sides.