Treatment will be guided very largely by the type of the attendant
fever. If that is of a high type, with a hard, full, rapid pulse, bright
red mucous membranes, a clear eye, and well sustained strength in a
strong, vigorous animal, what is known as antiphlogistic (depleting,
depressing) treatment is admissible at the outset. But in many cases
with a low type of fever, a weak, rapid pulse, pallid, yellow, or livid
mucous membranes, a coated tongue, a dull or sunken eye, much depression
and prostration, swaying on the limbs in walking, pendant head, ears,
eyelids and lips, and varying and irregular temperature of the limbs,
etc., such measures are forbidden from the first, and tonics and
stimulants are demanded from the outset. Between the two extremes there
are many grades, which demand a judiciously adjusted intermediate
treatment. The general principles only of each characteristic form of
treatment can be here formulated, it being understood that no two cases
can be most advantageously treated in precisely the same way, but that
according to its special grade each case will demand its own specific
management applied according to the skill of the physician.
_Regimen._ An antiphlogistic diet will consist in a moderate or very
sparing amount of non-stimulating food of easy digestion (wheat bran or
oil meal in warm, sloppy mash, carrots, turnips, beets, potatoes,
apples, pumpkins; fresh, tender, green grass or in winter a little
scalded hay, may be taken as examples). _Ruminants_ should have no food
necessitating chewing of the cud; thus the roots, etc., should be pulped
or boiled, and hay and even grass must be interdicted until rumination
is re-established. When food is absolutely refused for days in
succession well-boiled gruels of oatmeal, barley-meal, linseed meal,
bran, etc., may be given from a bottle or by injection. _Dogs_ and
_cats_ should have only vegetable mush (unbolted flour, barley, or
oatmeal) with just enough beef-juice to tempt the animal to eat a
little. Milk with an admixture of oxide of magnesia, or even lime water
is often at once palatable and cooling. _Drink_ should be pure water,
cool, if kept constantly fresh before the animal, but warmed to
something less than tepid if supplied only at long intervals, so that
the thirsty patient is not tempted to drink to excess and chill himself.
_Rest_ in a clean, well-aired building, free from draughts of cold air
and with a southern exposure, is desirable, especially in winter. The
best temperature is usually sixty degrees to seventy degrees, especially
in inflammations in the chest, and extremes of temperature are to be
avoided. _Clothing_ will depend on the weather. In warm weather it may
be often discarded, while in winter it should always be sufficient to
obviate the access of _chill_ and consequent aggravation of the disease.
Whenever the atmosphere can be kept warm only at the expense of impurity
it is better to secure the comfort of the patient by the requisite
clothing than to subject him to impure air. As the extremities are the
first to suffer from cold, loose flannel bandages to the limbs are often
imperative.
_Remedies._ _General bleeding_, a great resort of our fore-fathers, has
been long all but discarded from modern practice. Today it is rarely
resorted to, except to save from an urgent and extreme danger, as in the
plethoric cow merging into parturient apoplexy, or the fat and
overdriven horse, gasping for breath and life, in general acute
congestion of the lungs. There are other cases of extensive acute and
dangerous congestions, especially in a strong, vigorous, and plethoric
patient, in which general bleeding in beneficial in warding off
threatened death; but sound, discriminating judgment is necessary to its
safe employment. When resorted to at all, the blood should be drawn from
a large orifice, in a full stream, to secure the desired depressant
effect with the smallest loss of blood, and the patient should be kept
especially quiet and apart from all excitement which would tend to
counteract the sedative action.
_Local bleeding_ is more extensively applicable than _general_, as it
usually effects the same purpose without the permanently weakening
effect. It acts in two ways, first, by emptying and contracting the
vessels in the skin over the inflamed organ, it solicits a sympathetic
contraction of the capillary vessels in that organ itself, and thus
inaugurates a progress toward recovery; and second, by so much as it
draws blood to the surface it diminishes the blood pressure on the
deeper inflamed organ, and affords a better opportunity for the
restoration of the healthy circulation and function. Local bleeding may
be practiced by simple scarification or leeches, or better, by cupping
with or without scarification. To apply leeches, the skin must first be
shaved. To cup, it must at least be greased. As a cup, an ordinary large
drinking-glass may be used, the air contained in it being driven out by
a lighted taper, and then the taper being withdrawn, the mouth of the
cup is instantly and accurately applied on the skin and held there,
until, as it cools, it draws up the skin within it and clings like a
sucker. A number of these may be applied according to the extent of the
inflammation, and, if desired, they may be removed, the part scarified,
and the cup reapplied. The cupping usually effects more than a mere
local attraction of blood; it very commonly causes a free circulation in
the whole skin, a generally diffused warmth, and even perspiration. Thus
we may secure the derivation of blood from the inflamed part, the
cooling of a large mass of blood in the extensive cutaneous circulation,
the cooling of the entire system by the return of this blood internally,
the elimination of injurious waste matters through the skin, the
lowering of the febrile heat and tension, and a better functional
activity of all the organs of the body.
Similar good results are obtained from all remedies that induce surface
warmth and vascularity and a free secretion from the skin.
_Warm baths_, for animals to which they can be applied, abstract blood
temporarily from the inflamed internal organs, diminish the blood
pressure, and really cool the system, beside securing elimination from
the skin and other secreting surfaces. They may be commenced warm (80°
F.) and gradually cooled down to 65° F. after the skin has become freely
active. In the larger quadrupeds, in which the warm bath is too often
practically impossible, the same revulsion of blood and warmth to the
skin may be secured by _rags wrung out of hot_ (_almost scalding_)
_water_, wrapped tightly round the body, covered with two or more dry
blankets, and kept tightly applied against the surface by elastic
circingles. The legs may be rubbed with straw wisps till warm, and then
loosely bandaged, or applications of red pepper, ammonia, or mustard,
may be made prior to bandaging. In place of hot water rugs, bags loosely
filled with bran, chaff, or other light agent, heated to 110° F., may be
applied round the body, or, where it is available, a Turkish or steam
bath may be resorted to. These hot cutaneous applications, to produce
glow and perspiration, are especially valuable in the chill that heralds
a violent inflammation, and if that can be suddenly checked by this
means the inflammation will often be warded off, or at least rendered
slight and easily controllable. After perspiring for half an hour the
patient may be gradually uncovered, rubbed dry, and covered with a dry,
warm blanket. If the skin is still glowing, a slight sponging with cool
or cold water may beneficially precede the rubbing and drying.
_Cold Baths._ In cases of very high fever a full cold bath (68° F.) may
be employed for fifteen minutes, and repeated as often as the
temperature rises. In many cases of parturition fever in cows great
benefit accrues from sponging the body with cold water and allowing it
to evaporate from the burning skin. In the extreme fever of heat
apoplexy (sunstroke), with a temperature of 110° F. and upward, a strong
current of cold water from a hose directed on the head and body often
gives the best results. In ordinary fevers in large animals the _cold
pack_ will often serve a good purpose. Wring a blanket out of water
(cold or tepid, according to the height of the fever and the strength
and power of reaction of the patient), wrap it round the body, cover it
with several dry blankets so that no part is exposed, and keep the whole
in close contact with the skin by elastic circingles. In fifteen minutes
the skin should be glowing and perspiring, and in half an hour the
wrappings should be removed, a little at a time, the parts rubbed dry
and covered with a dry woolen blanket. It may be repeated as often as
the fever rises.
_Diaphoretics._ Besides these remedial methods of inducing a revulsion
and glow in the skin with perspiration, _medicinal diaphoretics_ may be
resorted to. Among these may be included _copious drinks and injections
of warm water_, _acetate of ammonia_, _antimony_, _ipecacuan_, or
_pilocarpin_, or one of the sedatives, _aconite_, _veratrum_, or
_opium_, etc. Many a threatened acute inflammation has been to a great
extent cut short and nipped in the bud—the stage of chill—by warm
clothing, active hand rubbing, and such an apparently unscientific
nauseant as tobacco.
When the preliminary stage has passed and the hot stage of the fever has
set in, cooling and eliminating agents are especially called for.
_Laxatives._ In many cases, and especially in those with marked
constipation or bowels loaded with indigestible materials, a laxative is
beneficial. For the horse, aloes, or, often better, sulphate of soda,
and for cattle or sheep, the latter, or Epsom salts, will at once remove
an irritant, cool the general system, draw off much blood and nervous
energy to the bowels, and secure a considerable depletion and
elimination from the intestines. For swine, dogs, and cats castor oil or
salts may be used, and for fowls castor oil. If the mucous membranes are
yellow, the tongue furred, and feces scanty, hard, and fœtid, a dose of
calomel (horse or ox, one drachm; sheep or pig, one scruple; dog, three
grains; chicken, one-half grain) with tartar emetic (horse or ox, two
drachms; sheep, twenty grains; swine, one-half grain; dog, one-fourth
grain; chicken, one-eighth grain) may be given and followed in ten hours
by one of the laxatives named above.
_Diuretics._ In the absence of any manifest disorder of the digestive
organs, the laxative may be omitted and refrigerant diuretics resorted
to. Acetate of ammonia or potassa, nitre, tartrate of potassa,
carbonates of potassa or soda, may be used along with sedatives.
In cases of infectious disease with poisoning by ptomaines and toxins
the elimination of these by the bowels and kidneys is of the greatest
importance.
_Sedatives._ Of the sedatives, aconite, bromide of potassium, veratrum,
hyoscyamus, or chloral hydrate may be used according to the special
indications.
_Alkalies._ _Resolvents._ When the organ inflamed is a serous membrane
in which dangerous adhesions or other functional disorders are likely to
occur from newly formed false membranes, their formation should be
counteracted as far as possible by the free use of alkalies (carbonates
of soda, potash, or ammonia, nitre, iodide of potassium, muriate of
ammonia, etc.), and in the same conditions excessive effusion should be
controlled by free action on the kidneys.
_Antipyretics._ To reduce the febrile temperature and especially, when
caused by the ptomaines and toxins of bacterial infection, agents like
acetanilid, antipyrin, exalgin, analgene, benzanilide, salicylate of
soda, and quinine have been largely employed and will usually lower the
temperature several degrees in a few hours. They nearly all depress the
vital forces, or hinder reparatory processes, so that their use is to be
carefully guarded. Quinine which is less depressing than the others
hinders migration of the leucocytes and thus stands in the way of
successful phagocytosis. With a dangerously high temperature they may be
temporarily admissible, but they should be suspended as soon as
possible. In all ordinary cases they are probably better avoided. A
judicious use of the cold or tepid bath, or of wet compresses is
incomparably safer and more generally applicable.
_Stimulants._ When the disease results in great prostration or when
symptoms of septic or ptomaine poisoning set in stimulants are often
required to sustain the flagging heart and circulation. These may be
alcoholic, ammoniacal, etherial, camphor, digitalis, etc.
_Tonic Refrigerants._ Later, when both inflammation and fever have been
somewhat reduced, temperature, breathing, and pulse rendered more
moderate, eye clearer, and even appetite perhaps slightly improved, the
sedatives may give place to refrigerating tonics, such as mineral acids
(nitric, muriatic, sulphuric, or phosphoric), in combination with
bitters (quassia, cascarilla, calumba, gentian, salicin), without as yet
the suspension of refrigerant diuretics. Thus for the horse the
following Recipe: Pharmaceutical nitric acid, two drams; infusion of
gentian, ten ounces; nitrate of potassa, two ounces. Dissolve. Give one
ounce every six hours.
_In Convalescence._ When convalescence has fairly set in, the fever has
subsided, and there remains merely some debility with a remnant of the
inflammatory exudation to be removed or organized into tissue, or when
an abscess has developed and burst, the tonics must be even more freely
given, the mineral acids may even give place to preparations of iron or
cod-liver oil, and the diet must be made increasingly liberal. But
throughout the whole progress of the disease the bowels should be
carefully watched. Costiveness may quickly undo all that has been
gained, hence any indication of this should be met by laxative food
(boiled flaxseed, etc.), or, this failing, by injections or laxatives.
Similarly, if a freer action of the kidneys seems to be necessary for
elimination of waste matters or to reduce fever, diuretics should be
continuously kept up.
TREATMENT OF ADYNAMIC INFLAMMATION AND FEVER. In treating _low asthenic_
or _adynamic inflammation_ all depression and depletion is to be
carefully avoided. Even _laxatives_ must be employed with extreme
caution. If absolutely necessary it is best to give them in small (half)
doses and supplement their action by liberal injections of hot water.
Elimination of waste matter from the blood and system is still to be
sought, but it must be by _stimulating diuretics_ (sweet spirits of
nitre, carbonate, acetate, or muriate of ammonia, digitalis), and direct
_stimulants_ and _tonics_ must be given from the first (ammonia, wine,
strong ale, whisky, brandy, ether, gentian, calumba, nux vomica). For
the horse the following may serve as an example: Recipe: Sweet spirits
of nitre, four ounces; sulphuric ether, two ounces; tincture of gentian,
ten ounces; digitalis, one dram. Mix. Dose, two ounces in a pint of cool
water four times a day. When there is great debility and prostration
ammoniacal and alcoholic stimulants must be given freely, while if the
fever heat rises very unduly the cooling diuretics (citrate, tartrate,
or acetate of potassa, or nitre, etc.), and even sedatives (bromide of
potassium, hydrobromic acid, chloral hydrate, salicin, salicylate of
soda), must be resorted to. If there is any indication of a special
depressing poison in the system, or of the absorption of septic or other
noxious matter from a wound, antiseptics (hydrochloric acid, or
salicylic acid, sulphite of soda, quinia, or chlorate of potassa) may be
advantageously added to the prescription.
In these cases of asthenic inflammation, as in the advanced and
debilitated stages of sthenic inflammation, the diet should be as good
as the patient can digest. Boiled oats, barley, or flaxseed, rich,
well-boiled gruels, and beef-tea (even for herbivora,) may frequently be
resorted to with advantage.
_Local Treatment of Inflammation._ In all forms of superficial
inflammation the local treatment occupies an important place. The
persistent application of _cold_ (cold water in a stream, icebags,
freezing mixtures) will sometimes overcome the tendency to inflammation
or arrest it. This is especially sought when a violent inflammation (as
in a wounded joint) threatens to destroy an important organ. If adopted,
it must be persisted in, as if it is suspended too soon the reaction is
likely to make matters worse than ever. _Cold astringent applications_
have a similar tendency. Sugar-of-lead, one-half ounce; laudanum, one
ounce; water, one quart, may be kept applied by means of a linen
bandage. The water may often be advantageously replaced by extract of
witch-hazel. If the inflamed part is superficial the lotion may be made
_antiseptic_ (carbolic acid, one dram; or sulphurous acid solution, five
ounces; water, one quart). _Hot applications_, _fomentations_,
_poultices_ are nearly always appropriate but they should be made
antiseptic to prevent bacterial development. When adopted they should
like _cold_ ones be kept up as continuously as possible. These soothe
alike the superficial and deeper parts, the latter through sympathy,
producing first a relaxation of vessels and tissues, and later a
contraction of the former attended by pallor of the surface. They
greatly favor suppuration when that is already inevitable, though in
other cases they may obviate it by checking at an early stage the acute
inflammatory process on which it depends. Any bland agent that will
retain heat and moisture will make an excellent poultice, though
flaxseed-meal is the type of a soothing demulcent application. Very
slight inflammation may be successfully treated at the outset with a
_stimulating embrocation_ (alcohol or camphorated spirit), yet in the
more violent type of acute inflammation all local excitants tend to
aggravate the disease. In these violent forms the activity of the
disease should be first abated by local soothing and general sedative
measures, and then the part over the inflamed organ may be safely
treated with a stimulating liniment or even a blister. In such cases the
liniment first acts as a derivative of blood and nervous energy from the
inflamed part, and later and still more beneficially by securing in it a
sympathetic healing process, like that set up in the skin. It is further
probable that the absorbed albuminoids, which have been modified in the
congested part often exercise a decided effect on the inflamed tissue.
In raw sores where inflammation has been set up the granulations may
become dropsical or excessive, bulging beyond the adjacent skin as
_proud flesh_. This should be repressed by touching it gently with some
mild caustic (lunar caustic), so as to produce a thin, white film, and
the remote cause of the inflammation (often a local irritant) should be
sought and removed. In some unhealthy sores tending to excessive
granulation, the compound tincture of myrrh and aloes may be applied
daily with great benefit. When the granulations become excessive they
may be scraped down to the level of the skin and then treated with an
antiseptic (iodoform, boric acid, acetanilid, aristol).
_Blistering._ In subacute and chronic inflammations and in those acute
forms in which the violence of the inflammatory action has been already
subdued by soothing measures, blisters and other counterirritants may be
employed to counteract the remaining inflammatory action. These act
primarily by drawing off blood and nervous energy from the inflamed
organ to the skin, and secondarily, by establishing a sympathetic
healing process in the diseased part, simultaneously with the work of
recovery in the skin, when the blister has spent its action. But if
applied above a part which is still violently inflamed, there is apt to
be serious aggravation, through this same sympathy with the part
suffering under the rising of the blister. In this way great and
irreparable injury is often done through the laudations of particular
blisters for the cure of given diseases, without any reference to the
stage or grade of such disease. The value of a blister depends far more
on the time of its application than on the ingredients of which it may
be composed.
_Firing._ This acts in nearly the same manner as a blister, and demands
similar caution in its application. It is especially available in
subacute and chronic diseases of the joints, bones, and tendons, and may
be made more or less severe according to the nature and obstinacy of the
disease. It is applied in points or in lines at intervals of one-half to
one inch, and penetrating one-third, one-half, or entirely through the
skin. The hotter the iron the less the pain, but the greater the danger
of destruction of the intervening skin by the excess of radiating heat.
Hence the contact of the heated iron with any one part must be
judiciously graduated to the heat of the iron and the delicacy of the
skin, and should not exceed the fraction of a second.
_Massage, Rubbing._ In chronic inflammation and even in some acute
forms, with considerable exudation, rubbing or massage is of great
value. It hastens the progress of the blood through the veins, tends to
restore the normal circulation in the stagnant or partially obstructed
capillaries, moves on the exuded liquids in the lymphatic plexus,
rendering the absorption more active, and at once prevents the process
of disintegration of the tissues and obviates, the necessity for their
solution and removal. This may be largely accomplished by the use of the
brush or rubber, or by careful manipulation especially in the direction
of the veins. If the inflammation is near the surface the use of
antiseptic and deobstruent agents will heighten the good effect.
Iodoform, iodide of potassium, boric acid may serve as examples.
_Suppuration._ _Abscess._ The great variety of the causes and forms of
suppuration would forbid any extended notice of its treatment in this
place. It seems preferable to refer the reader to the subject of pyæmid
and the various surgical and medical diseases in which suppuration takes
place.