The production of waste matters in the system is necessarily proportionate to the amount of tissue destroyed. This appears in the blood mainly as urea, the organic acid of urine (hippuric in herbivora, uric in carnivora), together with phosphates, sulphates, and chlorides. These thrown off by the urine give it its high density. If not thus thrown off they remain as poisons in the circulation and bring about that prostrate, sunken, debilitated condition which characterizes the advanced stages of all severe and continued fevers—the typhoid condition. This is not to be confounded with the specific typhoid fever, in which a special fever germ expends itself, mainly on the bowels, and that runs through a regular course. The typhoid condition is that state in which an animal system, already greatly weakened by a severe disease, and perhaps further prostrated by a specific disease-poison, is subjected to a species of poisoning by the retained chemical products of the waste of the tissues.
Types of Fever. These are as characteristic as the types of inflammation, and of the same kind. The strong type of fever which attends on an acute inflammation in an otherwise healthy vigorous system, is spoken of as a high or inflammatory fever. The weak type which occurs in a broken down or debilitated system, or in connection with the action of a specific disease germ, or with the saturation of the system by waste chemical products is known as low, typhoid (better typhous), or adynamic fever. That form which persists in the utterly debilitated system, where the power of assimilation is practically lost, is known as hectic.
TREATMENT OF INFLAMMATION AND FEVER.
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.