Part 98

As substitutes for the salicylates, salol, salophen, phenocoll, antipyrin and acetanilid have been largely resorted to. The first is safe and trustworthy and does not irritate the stomach nor interfere with digestion. It may be given to horse or ox in a dose of 3 drams, thrice a day, to the pig in 10 grain, and to the dog in 5 grain doses.

Hübner had good success with pilocarpine hydrochlorate hypodermically (4 grains for a 7 months colt,) but this was not equally successful in the hands of Siedamgrotzky. Other sudorifics like tartar emetic, Dover’s powder, ammonium acetate, hot or spiced drinks (chamomile, boneset,) hot baths, hot air baths, and wet packs have been used successfully and may still be employed in suitable cases. The opium is often very helpful in relieving intense suffering, and beside or in place of the Dover’s powder internally, morphia may be injected subcutem over the affected region. The main objection to its use is its tendency to lock up the liver and bowels. Liquor of the acetate of ammonia fills at once the rôle of a potent diaphoretic, an antacid, and an eliminant.

In the use of baths and packs it is well to consider the condition of the patient. If the surface is cold with little reaction, and if the attack has supervened on exposure, or chill, persistent hot applications are indicated. Dogs and other small animals should have full hot baths lasting for 15 or 20 minutes, and while in full glow may be quickly sponged with cold water and rubbed dry in blankets, great care being taken to avoid exposure or chill when damp. Or for these and the larger animals as well, a hot air or steam bath may be applied under similar precautions. A cold wet wrapping on the cranium will tend to relieve cerebral congestion during the administration of the hot bath. In horses and cattle surface heat and sudation may be secured by active rubbing with wisps of straw, of both body and limbs, or by covering the neck and trunk with large bags containing a small amount of chaff, sand or grain hot from an oven. Hot carminative or alcoholic drinks are excellent adjuvants, and even sedatives or nauseants (opium, veratrum, aconite, tobacco). Another resort is to pass a hot smoothing iron an indefinite number of times over the affected region. The part may be finally wrapped in cotton.

In cases where the temperature runs high, on the other hand, and when the surface glows, this dread of chill and reaction may be dismissed. For the small animal a bath starting at 70° F. may be gradually lowered to 60° or 50° F. Or a full pack may be employed, a sheet wrung out of cold water being closely wrapped around the body, and covered at all points with two or more dry woolen blankets, care being taken to avoid the entrance of air and the occurrence of evaporation from the inner, damp layer. This cools the surface and the blood returning inwards, and in fifteen or twenty minutes it should induce free perspiration. It may be kept up twenty to thirty minutes and may be repeated as often as there is a serious rise of temperature. A less energetic method is the mere sponging of the surface with cold water. In all such cases friction is a valuable accessory.

Anodynes and revulsives are often applied to the affected parts with good results. In very acute cases (especially articular), lotions and liniments of salicylic acid or salicylate of soda with laudanum, aconite, or chloral hydrate may be used. In the less violent cases camphorated spirit, soap liniment, or a combination of essential oils (gaultherium, turpentine, cajeput, origanum, peppermint) with aqua ammonia and sweet oil may secure great relief. Mustard or essential oil of mustard in vaseline is an excellent alternate. Finally active cantharidine blisters are usually most effective. These are applied over the affected joints or muscles and if the inflammation shifts to other parts it is followed up until it finally disappears. A concurrent alkaline treatment, and more important still, absolute rest, will serve to protect the heart to some extent, against a metastasis from the exterior. It has been supposed that the beneficial action of the blister is in ratio with the amount of exudate, and hence cantharides has been highly esteemed in this connection. Friedberger and Fröhner have used tincture of iodine and biniodide of mercury.

The local application of anti-rheumatic agents would embrace all the salicylates, oil of wintergreen and guaiacol, the latter mixed with an equal amount of glycerine. Methyl salicylate has been strongly recommended for external use.

Stengel covers the surface with lint smeared with salicylate of methyl ointment, and then applies a plaster bandage over all. This removes muscular spasm, pain and swelling and is rarely required for longer than a few days.

In cases in which salicylates fail, other agents have been resorted to in man and to a lesser extent in the lower animals. Greenhow strongly advocates a combination of quinine and potassium iodide internally, while Russell Reynolds has successfully employed tincture of muriate of iron in large doses repeated every three hours.

In chronic cases these would especially commend themselves as calculated to repair the general health and overcome the loss of hæmoglobin. In chronic rheumatism a course of tonics is often the best resort, and in dogs especially cod liver oil has benefited when all else had failed. Arsenic too (3 to 8 drops Fowler’s solution thrice daily) has been beneficial in both dogs and pigs. In other cases iodide of iron has been helpful. So also with gum guaiacum given in combination with potassium iodide. In such cases too, treatment by alkalies and salicylates may be called for, and close attention should always be given to secure a free action of the liver, bowels and kidneys. The local treatment recommended for acute rheumatism, (hot baths, frictions with essential oils and above all blisters of mustard or cantharides) is even more applicable to the chronic. A firm bandage over a covering of cotton wool, and a systematic application of electricity will often help. Warmth, a run at grass in a sheltered sunny paddock, moderate exercise and a nutritious and easily digestible diet are important conditions.

GOUT. PODAGRA. ARTHRITIS URICA.

Definition. Affects birds, dogs, perhaps pigs. Causes: excess of nitrogenous food, imperfect oxidation, impaired metabolism and elimination. Susceptibility of birds in confinement. Xanthin bases. Nuclein. Hepatic torpor. Contracted kidney. Affects tissues of little vascularity. Lesions: chalky deposits around joints, and in internal organs. Solubility of biurate of soda in synovia, serum, etc. Symptoms: arthritis, joint tenderness, resting on breast, hard or fluctuating swellings, desquamation, ulceration, chalky urates. Diagnosis: test for biurate. Treatment: less albuminoid diet, eliminating salts, colchicum, piperazin, surgical and antiseptic dressing.

Definition. An arthritis characterized by periodical exacerbations, by the deposit of sodium biurate in and around the joints and at times in other parts of the body, and by more or less constitutional febrile disturbance during the paroxysms.

Animals susceptible. Among the lower animals the disease has been noticed almost exclusively in birds, which even normally excrete so much uric acid that the liquid may be semi-solid as found in the cloaca or in the droppings. While this is a constitutional peculiarity in the bird yet it is enhanced in connection with an abundant diet of rich nitrogenous materials, as in forced feeding, and in old animals in which the eliminating action of the kidneys is more or less impaired. Ebstein has shown that gout can be produced in birds by tying the ureters. All domesticated birds, chickens, turkeys, pigeons, ostriches, geese, ducks, Guinea fowl, have been found to suffer. A case of gout has been reported in a =dog=, and Pradal has described it as existing in swine, but the symptoms given are more in accord with articular rheumatism.

Causes. The causes of gout are overfeeding especially on highly concentrated nitrogenous food, acid sweets, and in turn sweet and acid alcoholic drinks, an excess of uric acid in the blood and tissues, imperfect oxidation of albuminoids, impaired metabolism, imperfect elimination of uric acid, and impaired innervation. Probably no single morbid condition is in itself sufficient to induce the disease but a combination of several, unquestionably operate in many cases.

The uric acid theory is favored by the constant presence of this acid in considerable amount in the blood of birds, and by Ebstein’s experiment in tying the ureters, but it has to face the fact that young and active birds living in the open air, and hunting for their food do not suffer, that it is usually scanty in the blood of man just before an attack, that Gilman Thompson failed to produce any symptoms of gout by injecting into the blood of animals more uric acid than the amount which they normally excrete in twenty-four hours, that the familiar symptoms of uric acid poisoning are not at all those of gout, and that the excess of uric acid in leucæmia, anæmia and pneumonia produces no such symptoms. In addition to excess of uric acid some other factor is required.

Xanthin bases (Xanthin, hypoxanthin, etc.) found in the blood by various observers, are derived from albuminoids, especially nuclein and nuclein bases, including in man caffein and theine, and being closely allied to uric acid are believed to have a nearly similar action.

Various forms of abnormal metabolism are invoked as the cause of uric acid and gout, and Haig and Vaughan hazard the theory that the breaking down of the nuclein is an important factor. This and other metabolisms are attributed to the local action of the uric acid and urates, and again to a fault in innervation. The imperfect action of the liver where the uric acid should be largely resolved into the more soluble urea, and of the kidneys through which it should be promptly excreted must be attributed to a nervous source. Levison incriminates the granular, contracted, inactive kidneys.

Ebstein attaches great importance to impaired nutrition in the affected tissues which undergo necrotic changes that pave the way for the deposition of urates in their substance. This is somewhat sustained by the occurrence of the local deposits in tissues in which circulation and nutritive changes are slow, and in older animals in which not only are the osseous tissues more calcic and less vascular, but the articular lamella has been formed by cretefaction of the bone and cartilage. Haig suggests that in the old, the joints are less vascular and less alkaline, and more sensitive to cold. On the other hand those in the greatest vigor of life are more ravenous, digest more actively and are in this sense more subject to injury from excess of uric acid and allied products. Birds at this age, confined and in process of fattening are thereby exposed. Overfed, obese, lazy, old house dogs are under similar causative conditions.

Lesions. The most prominent lesions in birds are chalky concretions of urates on the articular ends of the bones and in the structures around the joints including even the tendons, with more or less inflammatory exudate and even necrosis, invading the bony tissue and articular cartilage. Abscesses may be present usually outside the bursa. Birds suffer especially in the tarsal, metatarsal and phlangeal joints, but often also in the corresponding joints of the wing, and less frequently in the joints of the trunk, and in the internal organs,—kidneys, liver, lungs, serosæ,—and skin. In these last, miliary chalky concretions and encrustations are found. In Brückmüller’s case in the dog the chalky deposits of urates were found mainly on the epiphyses of the ribs, but also on the joints of the limbs.

Uric acid is always abundant in the blood of birds, and Roberts has shown that biurate of soda (the usual form of precipitate) is insoluble in blood serum, synovia and other body fluids when in excess of 1:10,000.

Symptoms. In birds the febrile and constitutional symptoms have not been carefully observed so that the objective symptoms in the affected joints have been mainly relied on. There is extreme tenderness marked by standing on one limb, or resting on the breast, and hence moping apart from the flock. When made to rise, the affected limb may be used to steady the body, or even to walk, with a limp, though in bad cases the sound limb only may be used. The affected joints are swollen, soft, hot, extremely tender, pitting on pressure, and later the seat of nodular yellow masses, usually hard, but sometimes fluctuating and in size from a pea to a hazel nut. The superimposed epidermis is thick, dry and scaly, falling off in flakes. At a more advanced stage the concretions may burst through the skin, discharging a buffy, granular, debris containing crystals of urates of ammonium or calcium, or of uric acid. Later still are ulcerous sores, involving the disintegrating urate nodules and the necrotic bones and cartilages. The deposits deflect the bones from their normal direction, causing not only nodular swellings on the toes but much crookedness and distortion. As in man the disease is essentially chronic and advances slowly, with anæmia, emaciation, debility and at times diarrhœa.

Diagnosis depends largely on the recognition of the excess of urates in the deposits. These appear under the microscope as fine acicular crystals, which in the harder portions have a concentric arrangement. A portion of the concretion may be moistened with a few drops of nitric acid and evaporated to dryness. To one part of the residue is added, by means of a pipette, a drop of aqua ammonia, and to another caustic soda. The ammonia develops a beautiful purple red color, and the soda a blue or purplish blue ring (Murexide test). In tubercular joints, which are common in birds, the caseated nodule is made up of cells and granular debris, with tubercle bacilli, and though cretaceous particles may be present they fail to give the microscopic and color appearances of uric acid.

Treatment. This must be largely preventive. The rich albuminoid feeding and close confinement must be modified especially in the older birds, and eliminating agents must be given in the drinking water. The Carlsbad combination (sodium sulphate 22; potassium sulphate 1; sodium chloride 9; sodium bicarbonate 18) may be used. Powdered colchicum ¼ gr. once or twice daily during an attack, or piperazin ½ gr. twice a day. Locally, abscesses should be opened, and like any sores or ulcers, treated with antiseptics (Salicylate of sodium 75 grs., glycerine 2 ozs.; or piperazin solution 2:100).

SCURVY: SCORBUTUS.

Definition. Susceptible animals: pigs, dogs. Causes: unwholesome salt meat, lack of fresh food, vegetables, potassium, bad environment, unvarying diet, lack of free range, putrescent food, foul water, infection; non-recurrence. Lesions: blood black, diffluent, little rigor mortis, excess of sodium, petechiæ and extravasations, red marrow, softened, swollen, bleeding, ulcerating gums. Symptoms: Anorexia, prostration, debility, tardy movements, petechiæ, loss of bristles, ulcers, gum lesions, joint swellings, blood extravasations. Diarrhœa. Prognosis unfavorable. Treatment: correct unwholesome environment and food, wash, rich food partly green or animal, iron, bitters, arsenic, mouth wash (potassium chlorate), for suckling milk. Butcher.

Definition. Scurvy is a subacute or chronic trophic disorder characterized by debility, inanition, anæmia, swelling and bleeding of the gums, gingival ulceration, dropping of the teeth, and petechial or more extensive hæmorrhages and exudations in the skin, serosa, and solid tissues.

Animals susceptible. In past times man has suffered extensively in connection with unwholesome food and environment, on long sea voyages, on uninhabited islands, in military campaigns, in besieged cities, in famines, when restricted to one article of food, etc. Among the lower animals, =pigs= especially suffer, when kept in close, foul quarters and fed a monotonous and insufficient ration. =Dogs= suffer under similar conditions, and probably other animals would if equally badly used.

Causes. Formerly it was attributed to an exclusive diet of salt meat and bread; to excess of sodium, and deficiency of potassium salts; to the absence of fresh vegetables; to tainted food, etc. A broader generalization shows the Eskimo living on a pure meat diet, the Mongolian on rice alone, the Congoese on plantains, and without scurvy. Yet it cannot be denied that these various conditions undermine the general health, and prepare the system for those faulty states of nutrition which are seen in scurvy. In pigs the food and environment are usually chiefly at fault, the subjects have been kept closely confined in foul buildings, in a hot, moist atmosphere, and with an uniform diet of maize or other unvarying and insufficient ration. It does not appear when there is a free access to a spacious yard or open field, and when the monotonous diet can be varied by a variety of slugs and other invertebrates. Röll attaches great importance to a putrid condition of the aliments (putrescent swill). Benion has found it mainly in obese swine, the forced feeding and intestinal fermentations manifestly operating as factors. Corrupt drinking water has proved a manifest factor among men living in camps, and pigs above all other animals are subjected to this cause. Benion says it occurs in the advanced stages of measles (cysticercus cellulosa).