Text book of veterinary medicine, Volume 2 (of 5)

by James Law

After a first attack there is a strong predisposition to a second under similar exciting conditions.

Diagnosis. The peculiar symptoms of this disease and the circumstances attending its onset, are usually sufficient to distinguish it from all others. There may be danger of confounding certain cases with thrombosis of the posterior aorta, or of the iliac arteries or their branches, but the absence, in such cases, of the special history of the attack and of the morbid state of the urine, and the absence of pulsation in the arteries distal to the thrombosis will serve to prevent confusion. Spinal myelitis will be distinguished by the gradual nature of the onset, by the absence of the conditions attending on the attack of hæmoglobinæmia, and usually by the absence of hæmoglobin, urea and other nitrogenous products in excess in the urine.

Prevention. The hard worked or systematically exercised horse, which is at the same time heavily fed must not be left in a state of absolute rest in his stall for twenty-four hours. A fair amount of exercise must be given on every day in the week, and at the same time, the food should be restricted in ratio with the restriction of exercise. Turning for an hour or two daily into a yard may be a sufficient precaution. When from any cause, rest is imperative, the diet must be materially reduced and given in part in a laxative form (bran, roots), or a slight laxative (Glauber salts) or diuretic (saltpeter) may be added. Cleanliness and a free ventilation of the stable, are also of value in obviating at once auto-intoxication and the admission of poison through the lungs. In the same way a free allowance of drinking water is beneficial as favoring a general elimination from the various emunctories, and a dilution of the plethoric blood.

These precautionary measures are especially important in the case of horses which have passed through a first attack and which are in consequence strongly predisposed to a second. Horses fed liberally on highly nitrogenous food (oats, beans, peas, cotton seed meal), will also require specially careful oversight when at rest for a day or two only.

Treatment. The first and perhaps the most important consideration is absolute rest. If the subject is stopped instantly on the appearance of the first symptoms, the disease may be often aborted. It is better to avoid the exercise of walking to a stable until such time as the severity of the attack has somewhat moderated and then to move the subject only in the slowest and quietest possible way. If the patient is already down and unable to rise, he may be carried to the nearest stable in an ambulance or on a stone-boat, and there helped to his feet and supported in slings. Though he may be unable to continue in the standing position without the sling, yet if he can use his limbs at all for support, and is prevented from lying down, the breathing will be rendered so much more free and quiet, that it may greatly lessen the transfer of the poisonous elements into the general circulation and materially contribute to recovery. If, however, he cannot stand on his limbs at all, but must settle in the slings, the compression of the chest will so excite the breathing that it will induce dyspnœa, pulmonary congestion and a rapidly fatal result. In such a case a good bed must be provided and the patient made as comfortable as possible in the recumbent position.

In some cases in the earliest stages a full dose of sweet spirits of nitre or even half a pint of whiskey has seemed to assist in aborting the disease though the urine was already of a deep red color. It probably acted by supporting the already oppressed heart, and securing a prompt elimination by the kidneys.

Friedberger and Fröhner strongly recommend bleeding in all cases of dyspnœa and excited heart action, and considering the plethoric condition of the animal it would equally commend itself in other cases as well. This is the most prompt sedative of the nervous and vascular excitement, and the most speedy and certain means of removing much of the poisons accumulated in the blood, and of diluting what remains by reason of the absorption of liquids from every available source. This will more than counterbalance any temporary increase of poisons drawn from the portal system to fill up the vacuum in the systemic veins caused by the emission of blood. When the thick tarry condition of the blood seriously hinders a speedy abstraction both jugulars may be opened at once.

In some cases of great nervous excitement bromides may be useful in moderating circulatory and respiratory movement, but on the whole the advantage is greater from an immediate resort to eliminating agents.

One of the most effective agents is water. If the patient is thirsty he should have all he will drink, and if not, it may even be given from a bottle, or thrown into the rectum. A still more effective resort would be to introduce water intravenously in the form of a normal saline solution, or even to pass it into the trachea through a small cannula or large hypodermic needle. This serves to dilute the over dense blood, to stimulate the kidneys and other emunctories to active secretion, and to retain in solution the hæmoglobin, urea and other products which would otherwise cause greater irritation. This would be especially applicable after the blood tension had been diminished by phlebotomy.

Warm fomentations to the loins or croup are not without their influence. They tend to soothe the irritated parts and to solicit the action of the kidneys more particularly. The old resort of a fresh sheep skin, with the fleshy side in, may be used as a substitute.