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.
DISEASES OF THE RESPIRATORY ORGANS.
Importance of diseases of the respiratory organs—in horses and dogs. Proclivity through over-exertion, through extent and delicacy of the mucosa, through changes of temperature, through weather, through air pollution, through kind of diet, through change of latitude, through nervous sympathy, through debilitation of the lung tissue, through suppression of perspiration, through a high dew point, through bacteria and other germs, through youth and change of habits.