This is the term or terms applied when bronchitis, pleurisy, and pneumonia all exist at once. It is impossible for one who is not an expert to diagnose the state with certainty. The apparent symptoms are the same as when the animal is affected with pleuropneumonia.
This is the state in which an animal is affected with pleurisy and pneumonia combined, which is not infrequently the case. At the beginning of the attack only one of the affections may be present, but the other soon follows. It has already been stated that the pleura is closely adherent to the lung. The pleura on this account is frequently more or less affected by the spreading of the inflammation from the lung tissue. There is a combination of the symptoms of both diseases, but to the ordinary observer the symptoms of pleurisy are the most obvious. The course of treatment to be pursued differs in no manner from that given for the affections when they occur independently. The symptoms will be the guide as to the advisability of giving oil and laudanum for the pain if the pleurisy is very severe. It should not be resorted to unless it is necessary to allay the pain.
We have described here bronchitis, pneumonia, and pleurisy mainly as they occur as independent diseases, but it should be remembered that they merge into each other and may occur together at one time. While it is true that much more might have been said in regard to the different stages and types of the affections, and also in regard to the treatment of each stage and each particular type, the plan adopted of advising plain, conservative treatment is considered the wisest on account of simplifying as much as possible a subject of which the reader is supposed to know very little.
Hydrothorax is sometimes difficult to overcome by means of the use of medicines alone, when the operation of tapping the chest is performed to allow an escape for the accumulated fluid. The operation is performed with a combined instrument called the trocar and cannula. The puncture is made in the lower part of the chest, in the space between the eighth and ninth ribs. Wounding of the intercostal artery is avoided by inserting the instrument as near as possible to the anterior edge of the rib. If the operation is of benefit, it is only so when performed before the strength is lowered beyond recovery. The operation merely receives a passing notice here, as it is not presumed that the nonprofessional will attempt it, although in the hands of the expert it is attended with little danger or difficulty.
In the beginning of the attack, if the pain is severe, causing the animal to lie down or paw, morphin may be given by the mouth in 5-grain doses, or the fluid extract of Cannabis indica may be used in doses of 2 to 4 drams.
If the case is not progressing favorable in ten or twelve days after the beginning of the attack, convalescence is delayed by the fluid in the chest failing to be absorbed. The animal becomes dull and weak and evinces little or no desire for feed. The breathing becomes still more rapid and difficult. An effort must now be made to excite the absorption of the effusion. An application of liniment or mild blister should be rubbed over the lower part of both sides and the bottom of the chest. The following drench may be given three times a day, for seven or eight days, if it is necessary and appears to benefit: Tincture of the perchlorid of iron, 1 ounce; tincture of gentian, 2 ounces; water, 1 pint. Also give 1 dram of iodid of potassium, dissolved in the drinking water, an hour before feeding every night and morning for a week or two.
If the patient becomes debilitated, the stimulants as prescribed for pneumonia should be used according to the same directions. The same attention should be given to the diet. If the animal will partake of the bran mashes, scalded oats, and grass, it is the best; but if he refuses the laxative diet, then he should be tried with different kinds of feed and allowed whichever kind he desires.
During the first few days, when pain is manifested by restlessness, apply hot packs to the sides diligently. After four or five days, when the symptoms show that the acute stage has somewhat subsided, mustard may be applied as recommended for pneumonia. From the beginning the following drench may be given every six hours, if the horse takes it kindly: Solution of the acetate of ammonia, 3 ounces; spirits of nitrous ether, 1 ounce; bicarbonate of potassium, 3 drams; water, 1 pint.
Pleurisy may affect only a small area of one side or it may affect both sides. It is oftener confined to the right side.
Treatment. The instructions in regard to the general management of bronchitis and pneumonia must be adhered to in the treatment of pleurisy. Comfortable quarters, pure air, warm clothing to the body and bandages to the legs, a plentiful supply of pure cold water, the laxative feed, etc., in this case are equally necessary and efficacious. The hot applications applied to the chest, as directed in the treatment of pneumonia, are very beneficial in pleurisy, and should be kept up while the symptoms show the animal to be in pain.
Within two or three days the urgent symptoms may abate owing to the exudation of the fluid, and the subsidence of the pain. The fluid may now undergo absorption, and the case may terminate favorably within a week or 10 days.
If the quantity of the effusion is large its own volume retards the process of absorption to a great extent, and consequently convalescence is delayed. In severe cases the pulse becomes more frequent, the breathing more hurried and labored, the flanks work like bellows, the nostrils flap, the eyes stare wildly, the countenance expresses much anxiety, and general signs of dissolution are plain. After a time swellings appear under the chest and abdomen and down the legs. The accumulation in the chest is called hydrothorax, or dropsy of the chest. When this fluid contains pus the case usually proves fatal. The condition of pus within the cavity is called empyema.
Percussion is of valuable service in this affection. After effusion occurs the sound produced by percussing over the lower part of the chest is dull. By striking different parts one may come to a spot of greater or less extent where the blows cause much pain to be evinced. The animal may grunt or groan every time it is struck. Another method of detecting the affected part is to press the fingers between the ribs, each space in succession, beginning behind the elbow, until a place where the pressure causes more flinching than at any other part is reached. Auscultation is also useful. In the first stage, when the surfaces are dry and rough, one may hear, immediately under the ear, a distinct sound very much like that produced by rubbing two pieces of coarse paper together. No such friction sound occurs when the membrane is healthy, as the natural moisture, heretofore mentioned, prevents the friction. In many cases this friction is so pronounced that it may be felt by placing the hand over the affected part. When the dry stage is succeeded by the exudation of fluid this friction sound disappears. After the effusion into the cavity takes place sometimes there is heard a tinkling or metallic sound, due to dropping of the exudate from above into the collected fluid in the bottom of the cavity, as the collected fluid more of less separates the lung from the chest walls.
Symptoms. When the disease exists as an independent affection it is ushered in by a chill, but this is usually overlooked. About the first thing noticed is the disinclination of the animal to move or turn around. When made to do so he grunts or groans with pain. He stands stiff; the ribs are fixed that is, they move very little in the act of breathing but the abdomen works more than natural; both the fore feet and elbows may be turned out; during the onset of the attack the animal may be restless and act as if he had a slight colic; he may even lie down, but does not remain long down, for when he finds no relief he soon gets up. After effusion begins these signs of restlessness disappear. Every movement of the chest causes pain; therefore the cough is peculiar; it is short and suppressed and comes as near being no cough as the animal can make it in his desire to suppress it. The breathing is hurried, the mouth is hot, the temperature being elevated from 102° or 103° to 105° F. Symptoms that usually accompany fever are present, such as costiveness, scanty, dark-colored urine, etc. The pulse is frequent, perhaps 70 or more a minute, and is hard and wiry. The legs and ears are cold.
The first lesion of pleurisy is overfilling of the blood vessels that ramify in this membrane and dryness of the surface. This is followed by the formation of a coating of coagulated fibrin on the diseased pleura and the transudation of serum which collects in the chest. This serum may contain flakes of fibrin and it may be straw colored or red from an admixture of blood. The quantity of this accumulation may amount to several gallons.
Inflammation of this membrane is called pleurisy. Being so closely united with the lung, it can not always escape participation in the disease when the latter is inflamed. Pleurisy may be due to the same predisposing and exciting causes as mentioned in the beginning of this work as general causes for diseases of the organs of respiration, such as exposure to sudden changes of temperature, confinement in damp stables, etc. It may be caused also by wounds that penetrate the chest, for it must be remembered that such wounds must necessarily pierce the pleura. A fractured rib may involve the pleura. The inflammation following such wounds may be circumscribed; that is, confined to a small area surrounding the wound, or it may spread from the wound and involve a large portion of the pleura. The pleura may be involved secondarily when the heart or its membrane is the primary seat of the disease. It may occur in conjunction with bronchitis, influenza, and other diseases. Diseased growths that interfere with the pleura may induce pleurisy. The most frequent cause of pleurisy is an extension of inflammation from adjacent diseased lung. It is a common complication of pneumonia. Pleurisy will be described here as an independent affection, although it should be remembered that it is very often associated with the foregoing diseases.
The thoracic cavity is divided into two lateral compartments, each containing one lung and a part of the heart. Each lung has its separate pleural membrane, or covering. The pleura is the thin, glistening membrane that covers the lung and also completely covers the internal walls of the chest. It is very thin, and to the ordinary observer appears to be part of the lung, which, in fact, it is for all practical purposes. The smooth, shiny surface of the lung, as well as the smooth, shiny surface so familiar on the rib, is the pleura. In health this surface is always moist. A fluid is thrown off by the pleura, which causes the surface to be constantly moist. This is to prevent the effects of friction between the lungs and the walls of the chest and other contiguous parts which come in contact. It must be remembered that the lungs are dilating each time a breath is taken in, and contracting each time a breath of air is expelled. It may be readily seen that if it were not for the moistened state of the surface of the pleura the continual dilatation and contraction and the consequent rubbing of the parts against each other would cause serious friction.
When the symptoms have abated and nothing remains of the disease except the cough and a white discharge from the nostrils, all other medicines should be discontinued and a course of tonic treatment pursued. Give the following mixture: Reduced iron, 3 ounces; powdered gentian, 8 ounces; mix well together and divide into sixteen powders. Give a powder every night and morning mixed with bran and oats, if the animal will eat it, or shaken with about a pint of flaxseed tea and administered as a drench.
If the cough remains after the horse is apparently well, give 1 dram of iodid of potassium dissolved in a bucketful of drinking water one hour before each meal for two or three weeks if necessary. Do not put the animal to work too soon after recovery. Allow ample time to regain strength. This disease is prone to become chronic and may run into an incurable case of thick wind.
If the animal retains an appetite, a soft diet is preferable, such as scalded oats, bran mashes, and grass, if in season. If he refuses cooked feed, allow in small quantities anything he will eat. Hay, cob corn, oats, bread, apples, and carrots may be tried in turn. Some horses will drink sweet milk when they refuse all other kinds of feed, and especially is this the case if the drinking water is withheld for a while. One or 2 gallons at a time, four or five times a day, will support life. Bear in mind that when the disease is established recovery can not occur in less than two or three weeks, and more time may be necessary. Good nursing and patience are required.
Compel the animal to inhale steam from a bucketful of boiling water containing a tablespoonful of oil of turpentine and spirits of camphor, as advised for cold in the head. In serious cases the steam should be inhaled every hour, and in any case the oftener it is done the greater will be the beneficial results. Three times a day administer an electuary containing acetate of potash (2 drams), with licorice and molasses or honey. It is well to keep a bucketful of cold water before the animal all the time. If the horse is prostrated and has no appetite, give the following drench: Spirits of nitrous ether, 2 ounces; rectified spirits, 3 ounces; water, 1 pint. Repeat the dose every four or five hours if it appears to benefit. When the horse is hard to drench, give the following: Pulverized carbonate of ammonia, 3 drams; linseed meal and molasses sufficient to make the whole into a stiff mass; wrap it with a small piece of tissue paper and give as a ball. This ball may be repeated every four or five hours. When giving the ball care should be taken to prevent its breaking in the mouth, as in case of such accident it will make the mouth sore and prevent the animal from eating. If the bowels are constipated, give enemas of warm water. Do not give purgative medicines. Do not bleed the animal.
Treatment. The matter of first importance is to insure pure air to breathe, and next to make the patient's quarters as comfortable as possible. A well-ventilated box stall serves best for all purposes. Cover the body with a blanket, light or heavy, as the season of the year demands. Hand-rub the legs until they are warm, then wrap them in cotton and apply flannel or Derby bandages from the hoofs to the knees and hocks. If the legs can not be made warm with hand rubbing alone, apply dry mustard. Rub in thoroughly and then put the bandages on; also rub mustard paste well over the side of the chest, covering the space beginning immediately behind the shoulder blade and running back about eighteen inches, and from the median line beneath the breast to within ten inches of the ridge of the backbone. Repeat the application to the side of the chest about three days after the first one is applied.
Bronchitis, affecting the smaller tubes, is one of the most fatal diseases, while that of the larger tubes is never very serious. It must be stated, however, that it is an exceedingly difficult matter for a nonexpert to discriminate between the two forms, and, further, it may as well be said here that he will have difficulty in discriminating between bronchitis and pneumonia.
Symptoms. The animal appears dull; the appetite is partially or wholly lost; the head hangs; the breathing is quickened; the cough, at first dry, and having somewhat the character of a "barking cough," is succeeded in a few days by a moist, rattling cough; the mouth is hot; the visible membranes in the nose are red; the pulse is frequent, and during the first stage is hard and quick, but as the disease advances becomes smaller and more frequent. There is a discharge from the nostrils that is at first whitish, but later becomes creamy or frothy, still later it is sometimes tinged with blood, and occasionally it may be of a brownish or rusty color. By auscultation, or placing the ear to the sides of the chest, unnatural sounds can now be heard. The air passing through the diseased tubes causes a wheezing sound when the small tubes are affected, and a hoarse, cooing, or snoring sound when the larger tubes are involved. After one or two days the dry stage of the disease is succeeded by a moist state of the membrane. The ear now detects a different sounds caused by the bursting of the bubbles as the air passes through the fluid, which is the exudate of inflammation and the augmented mucous secretions of the membrane. The mucus may be secreted in great abundance, which, by blocking up the tubes, may cause a collapse of a large extent of breathing surface. Usually the mucus is expectorated; that is, discharged through the nose. The matter is coughed up, and when it reaches the larynx much of it may be swallowed, and some is discharged from the nostrils. The horse can not spit, like the human being, nor does the matter coughed up gain access to the mouth. If in serious cases all the symptoms become aggravated, the breathing is labored, short, and quick, it usually indicates that the inflammation has reached the breathing cells and that catarrhal pneumonia is established. In this case the ribs rise and fall much more than natural. This fact alone is enough to exclude the idea that the animal may be affected with pleurisy, because in that disease the ribs are as nearly fixed as it is in the power of the animal to do so, and the breathing is accomplished to a great extent by aid of the abdominal muscles. The horse persists in standing throughout the attack. He prefers to stand with head to a door or window to gain all the fresh air possible, but if not tied may occasionally wander listlessly about the stall. The bowels most likely are constipated; the dung is covered with slimy mucus. The urine is decreased in quantity and darker in color than usual. The animal shows more or less thirst; in some cases the mouth is full of saliva. The discharge from the nose increases in quantity as the disease advances and inflammation subsides. This is rather a good symptom, as it shows that one stage has passed. The discharge then gradually decreases, the cough becomes less rasping, but of more frequent occurrence, until it gradually disappears with the return of health.
Bronchitis is an inflammation of the bronchial tubes. When this inflammation extends to the air sacs at the termini of the smallest branches of the bronchial tubes, the disease is broncho-pneumonia. Bronchitis affecting the larger tubes is less serious than when the smaller are involved. The disease may be either acute or chronic. The causes are generally much the same as for other diseases of the respiratory organs, noticed in the beginning of this article. The special causes are these: The inhalation of irritating gases and smoke and fluids or solids gaining access to the parts. Bronchitis is occasionally associated with influenza and other specific fevers. It also supervenes on common cold or sore throat.
These two sacs are situated above the throat, and communicate with the pharynx, as well as with the cavity of the tympanum of the ear. They are peculiar to solipeds. Normally, they contain air. Their function is unknown.
One or both guttural pouches may contain pus. The symptoms are as follows: Swelling on the side below the ear and an intermittent discharge of matter from one or both nostrils, especially when the head is depressed.
The swelling is soft, and, if pressed upon, matter will escape from the nose if the head is depressed. As before mentioned, these pouches communicate with the pharynx, and through this small opening matter may escape. A recovery is probable if the animal is turned out to graze, or if he is fed from the ground, as the dependent position of the head favors the escape of matter from the pouches. In addition to this, give the tonics recommended for nasal gleet. If this treatment fails, an operation must be performed, which should not be attempted by any one unacquainted with the anatomy of the part.
The windpipe is not subject to any special disease, but is more or less affected during laryngitis (sore throat), influenza, bronchitis, etc., and requires no special treatment. The membrane may be left in a thickened condition after these attacks. One or more of the rings may be accidentally fractured, or the tube may be distorted or malformed as the result of violent injury. After the operation of tracheotomy it is not uncommon to find a tumor or malformation as a result, or sequel, of the operation. In passing over this section attention is merely called to these defects, as they require no particular attention in the way of treatment. It may be stated, however, that any one of the before-mentioned conditions may constitute one of the causes of noisy respiration described as "thick wind."
The windpipe, or trachea as it is technically called, is the flexible tube that extends from, the larynx, which it succeeds at the throat, to above the base of the heart in the chest, where it terminates by dividing into the right and left bronchi the tubes going to the right and left lung, respectively. The windpipe is composed of about fifty incomplete rings of cartilage united by ligaments. A muscular layer is situated on the superior surface of the rings. Internally the tube is lined with a continuation of the mucous membrane that lines the entire respiratory tract, which here has very little sensibility in contrast to that lining the larynx, which is endowed with exquisite sensitiveness.
If the horse becomes very much debilitated, stimulants of a more pronounced character are required. The following drench is useful: Rectified spirits, 3 ounces; spirits of nitrous ether, 2 ounces; water, 1 pint. This may be repeated every four or five hours if it seems to benefit; or 6 ounces of good whisky diluted with a pint of water may be given as often, instead of the foregoing.
During the period of convalescence good nutritive feed should be allowed in a moderate quantity. Tonic medicines should be substituted for those used during the fever. The same medicines advised for the convalescing period of bronchitis are equally efficient in this case, especially the iodid of potash; likewise, the same general instructions apply here.
The chief causes of death in pneumonia are heart failure from exhaustion, suffocation, or blood poisoning from death (gangrene) of lung tissue. The greater the area of lung tissue diseased the greater the danger; hence double pneumonia is more fatal than pneumonia of one lung.
There are many valuable medicines used for the different stages and different types of pneumonia, but in the opinion of the writer it is useless to refer to them here, as this work is intended for the use of those who are not sufficiently acquainted with the disease to recognize its various types and stages; therefore they would only confuse. If you can administer a ball or capsule, or have anyone at hand who is capable of doing it, a dram of sulphate of quinin in a capsule, or made into a ball, with sufficient linseed meal and molasses, given every three hours during the height of the fever, will do good in many cases. The ball of carbonate of ammonia, as advised in the treatment of bronchitis, may be tried if the animal is hard to drench. The heart should be kept strong by administering digitalis in doses of 2 drams of the tincture every three hours, or strychnia 1 grain, made into a pill with licorice powder, three times daily.
A diet consisting principally of bran mashes, scalded oats, and, when in season, grass or corn fodder is preferable if the animal retains an appetite; but if no desire is evinced for feed of this particular description, then the animal must be allowed to eat anything that will be taken spontaneously. Hay tea, made by pouring boiling water over good hay in a large bucket and allowing it to stand until cool, then straining off the liquid, will sometimes create a desire for feed. The animal may be allowed to drink as much of it as he desires. Corn on the cob is often eaten when everything else is refused. Bread may be tried; also apples or carrots. If the animal can be persuaded to drink milk, it may be supported by it for days. Three or four gallons of sweet milk may be given during the day, in which may be stirred three or four fresh eggs to each gallon. Some horses will drink milk, while others will refuse to touch it. It should be borne in mind that all feed must be taken by the horse as he desires it; none should be forced down him. If he will not eat, you will only have to wait until a desire is shown for feed. All kinds may be offered, first one thing and then another, but feed should not be allowed to remain long in trough or manger; the very fact of its constantly being before him will cause him to loathe it. When the animal has no appetite for anything the stomach is not in a proper state to digest food, and if it is poured or drenched into him it will only cause indigestion and aggravate the case. It is a good practice to do nothing when there is nothing to be done that will benefit. This refers to medicine as well as feed. Nothing is well done that is overdone.
Another and oftentimes fatal mistake made by the nonprofessional is the indiscriminate and reckless use of aconite. This drug is one of the most active poisons, and should not be handled by anyone who does not thoroughly understand its action and uses. It is only less active than prussic acid in its poisonous effects. It is a common opinion, often expressed by nonprofessionals, that aconite is a stimulant. Nothing could be more erroneous; in fact, it is just the reverse. It is one of the most powerful sedatives used in the practice of medicine. In fatal doses it kills by paralyzing the very muscles used in breathing; it weakens the action of the heart, and should not be used. Do not give purgative medicines. If constipation exists, overcome it by an allowance of laxative diet, such as scalded oats, bran, and linseed mashes; also, grass, if in season. If the costiveness is not relieved by the laxative diet, give an enema of about a quart of warm water three or four times a day.
