If this treatment fails to give relief, the disease will pass into the advanced stages, or, if the animal has been neglected in the early stages, the treatment must be supplanted with the hypodermic injection of ergotin, in 5-grain doses, dissolved in 1 dram of water, every six hours. The limbs may be poulticed above the fetlocks with mustard. Warm blanketing, to promote perspiration, is to be observed always when there is no excessive perspiration.
If the disease becomes chronic (encephalitis or meningitis), we must place our reliance upon alteratives and tonics, with such incidental treatment as special symptoms may demand. Iodid of potassium in 2-dram doses should be given three times a day and 1 dram of calomel once a day to induce absorption of effusions or thickened membranes. Tonics, in the form of iodid of iron in 1-dram doses, to which is added 2 drams of powdered hydrastis, may also be given every six or eight hours, as soon as the active fever has abated. After the disappearance of the acute symptoms, blisters (cantharides ointment) may be applied behind the poll. When paralytic effects remain after the disappearance of all other symptoms, sulphate of strychnia in 2-grain doses, in combination with the other tonics, may be given twice a day and be continued until it produces muscular twitching. In some cases of paralysis, as of the lips or throat, benefit may be derived from the moderate use of the electric battery. Many of the recoveries will, however, under the most active and early treatment, be but partial, and in all cases the animals become predisposed to subsequent attacks. A long time should be allowed to pass before the animal is exposed to severe work or great heat. When the disease depends upon mechanical injuries, they have to be treated and all causes of irritation to the brain removed. If it is due to stable miasma, uremic poisoning, pyemia, influenza, rheumatism, toxic agents, etc., they should receive prompt attention for their removal or mitigation.
Cerebral softening, abscess, and sclerosis are practically inaccessible to treatment, otherwise than such relief as may be afforded by the administration of opiates and general tonics, and, in fact, the diagnosis is largely presumptive.
Congestion of the brain consists in an accumulation of blood in the vessels, also called hyperemia, or engorgement. It may be active or passive—active when there is an undue accumulation of blood or diminished arterial resistance, and passive when it accumulates in the vessels of the brain, owing to some obstacle to its return by the veins.
Causes.—Active cerebral congestion may be from hypertrophy of the left ventricle of the heart, excessive exertion, the influence of extreme heat, sudden and great excitement, artificial stimulants, etc. Passive congestion may be produced by any mechanical obstruction which prevents the proper return of blood through the veins to the heart, such as a small or ill-fitting collar, which often impedes the blood current, tumors or abscesses pressing on the vein in its course, and organic lesions of the heart with regurgitation.
Extremely fat animals with short, thick necks are peculiarly subject to attacks of cerebral congestion. Simple congestion, however, is merely a functional affection, and in a slight or moderate degree involves no immediate danger. Extreme engorgement, on the contrary, may be followed by rupture of previously weakened arteries and capillaries and cause immediate death, designated then as a stroke of apoplexy.
Symptoms.—Congestion of the brain is usually sudden in its manifestation and of short duration. The animal may stop very suddenly and shake its head or stand quietly braced, then stagger, make a plunge, and fall. The eyes are staring, breathing hurried and stertorous, and the nostrils widely dilated. This may be followed by coma, violent convulsive movements, and death. Generally, however, the animal gains relief in a short time, but may remain weak and giddy for several days. If it is due to organic change of the heart or the disease of the blood vessels in the brain, then the symptoms may be of slow development, manifested by drowsiness, dimness or imperfect vision, difficulty in voluntary movements, diminished sensibility of the skin, loss of consciousness, delirium, and death. In milder cases effusion may take place in the arachnoid spaces and ventricles of the brain, followed by paralysis and other complications.
Pathology.—In congestion of the brain the cerebral vessels are loaded with blood, the venous sinuses distended to an extreme degree, and the pressure exerted upon the brain constitutes actual compression, giving rise to the symptoms just mentioned. On post-mortem examinations this engorgement is found universal throughout the brain and its membranes, which serves to distinguish it from inflammations of these structures, in which the engorgements are confined more or less to circumscribed portions. A prolonged congestion may, however, lead to active inflammation, and in that case we find serous and plastic exudations in the cavities of the brain. In addition to the intensely engorged condition of the vessels we find the gray matter of the brain redder than natural. In cases in which several attacks have occurred the blood vessels are often found permanently dilated.
Treatment.—The animal should be taken out of harness at once, with prompt removal of all mechanical obstructions to the circulation. If it is caused by venous obstruction by too tight a collar, the loosening of the collar will give immediate relief. The horse should be bled freely from the jugular vein. If due to tumors or abscesses, a surgical operation becomes necessary to afford relief. To revive the animal if it becomes partially or totally unconscious, cold water should be dashed on the head. Give a purge of Glauber's salt. If the limbs are cold, tincture of capsicum or strong mustard water should be applied to them. If symptoms of paralysis remain after two or three days, an active cathartic and iodid of potassium will be indicated, to be given as prescribed for inflammation of the brain. In confirmed cases, treatment is not advisable, as there is considerable danger to the owner should an attack occur in a crowded street.
Prevention.—Well-adjusted collar, with strap running from the collar to the girth, to hold down the collar when pulling upgrade; regular feed and exercise, without allowing the animal to become excessively plethoric; moderate checking, allowing a free-and-easy movement of the head; well-ventilated stabling, proper cleanliness, pure water, etc.
The term sunstroke is applied to affections occasioned not exclusively by exposure to the sun's rays, as the word signifies, but by the action of great heat combined generally with humid atmosphere. Exhaustion produced by long-continued heat is often the essential factor, and is called heat exhaustion. Horses on the race track undergoing protracted and severe work in hot weather often succumb to heat exhaustion. Draft horses which do not receive proper care in watering, feeding, and rest in shady places and are exposed for many hours to the direct rays of the sun suffer very frequently from sunstroke.
Symptoms.—Sunstroke is manifested suddenly. The animal stops, drops his head, begins to stagger, and soon falls to the ground unconscious. The breathing is marked with great stertor, the pulse is very slow and irregular, cold sweats break out in patches on the surface of the body, and the animal often dies without having recovered consciousness.
The temperature becomes very high, reaching 105° to 109° F.
In heat exhaustion the animal usually requires urging for some time prior to the appearance of any other symptoms, generally perspiration is checked, and then the horse becomes weak in its gait, the breathing hurried or panting, eyes watery or bloodshot, nostrils dilated and highly reddened, assuming a dark, purple color; the pulse is rapid and weak, the heart bounding, followed by unconsciousness and death. If recovery takes place, convalescence extends over a long period of time, during which incoordination of movement may persist.
Pathology.—Sunstroke, virtually active congestion of the brain, often accompanied with effusion and blood extravasation, characterizes this condition, with often rapid and fatal lowering of all the vital functions. In many instances the death may be due to the complete stagnation in the circulation of the brain, inducing anemia, or want of nourishment of that organ. In other cases it may be directly due to the excessive compression of the nerve matter controlling the heart's action, and cause paralysis of that organ. There are also changes in the composition of the blood.
Treatment.—The animal should be placed in shaded surroundings. Under no circumstances is blood-letting permissible in sunstroke. Ice or very cold water should be applied to the head and along the spine, and half an ounce of carbonate of ammonia or 6 ounces of whisky should be given in 1 pint of water. Cold water may be used as an enema and should also be showered upon the body of the horse from the hose or otherwise. This should be continued until the temperature is down to 103° F. Brisk friction of the limbs and the application of spirits of camphor often yields good results. The administration of the stimulants should be repeated in one hour if the pulse has not become stronger and slower. In either case, when reaction has occurred, preparations of iron and general tonics may be given during convalescence: Sulphate of iron, 1 dram; gentian, 3 drams; red cinchona bark, 2 drams; mix and give in feed morning and evening.
Prevention.—In very hot weather horses should have wet sponges or light sunshades on the head when at work, or the head may be sponged with cold water as many times a day as possible. Proper attention should be given to feeding and watering, never in excess. During the warm months all stables should be cool and well ventilated, and if an animal is debilitated from exhaustive work or disease it should receive such treatment as will tend to build up the system. Horses should be permitted to drink as much water as they want while they are at work during hot weather.
An animal which has been affected with sunstroke is very liable to have subsequent attacks when exposed to the necessary exciting causes.
Apoplexy is often confounded with cerebral congestion, but true apoplexy always consists in rupture of cerebral blood vessels, with blood extravasation and formation of blood clot.
Causes.—Two causes are involved in the production of apoplexy, the predisposing and the exciting. The predisposing cause is degeneration, or disease which weakens the blood vessel; the exciting cause is any one which tends to induce cerebral congestion.
Symptoms.—Apoplexy is characterized by a sudden loss of sensation and motion, profound coma, and stertorous, difficult breathing. The action of the heart is little disturbed at first, but soon becomes slower, then quicker and feebler, and after a little time ceases. If the rupture is one of a small artery and the extravasation limited, sudden paralysis of some part of the body is the result. The extent and location of the paralysis depend upon the location within the brain which is functionally deranged by the pressure of the extravasated blood; hence these conditions are very variable.
In the absence of any premonitory symptoms or an increase of temperature in the early stage of the attack, we may be reasonably certain in making the distinction between this disease and congestion of the brain, or sunstroke.
Pathology.—In apoplexy there is generally found an atheromatous condition of the cerebral vessels, with weakening and degeneration of their walls. When a large artery has been ruptured it is usually followed by immediate death, and large rents may be found in the cerebrum, with great destruction of brain tissue, induced by the forcible pressure of the liberated blood. In small extravasations producing local paralysis without marked general disturbance the animal may recover after a time; in such cases gradual absorption of the clot takes place. In large clots atrophy of the brain substances may follow, or softening and abscess from want of nutrition may result, and render the animal worthless, ultimately resulting in death.
Treatment.—Place the animal in a quiet, cool place and avoid all stimulating feed. Administer, in the drinking water or feed, 2 drams of the iodid of potassium twice a day for several weeks if necessary. Medical interference with sedatives or stimulants is more liable to be harmful than of benefit, and blood-letting in an apoplectic fit is extremely hazardous. From the fact that cerebral apoplexy is due to diseased or weakened blood vessels, the animal remains subject to subsequent attacks. For this reason treatment is very unsatisfactory.
Causes.—In injuries from direct violence a piece of broken bone may press upon the brain, and, according to its size, the brain is robbed of its normal space within the cranium. It may also be due to an extravasation of blood or to exudation in the subdural or arachnoid spaces. Death from active cerebral congestion results through compression. The occurrence may sometimes be traced to the direct cause, which will give assurance for the correct diagnosis.
Symptoms.—Impairment of all the special senses and localized paralysis. All the symptoms of lessened functional activity of the brain are manifested to some degree. The paralysis remains to be our guide for the location of the cause, for it will be found that the paralysis occurs on the opposite side of the body from the location of the injury, and the parts suffering paralysis will denote, to an expert veterinarian or physician, the part of the brain which is suffering compression.
Treatment.—Trephining, by a skillful operator, for the removal of the cause when due to depressed bone or the presence of foreign bodies. When the symptoms of compression follow other acute diseases of the brain, apoplectic fits, etc., the treatment must be such as the exigencies of the case demands.
This is generally caused by falling over backward and striking the poll, or perhaps falling forward on the nose, by a blow on the head, etc. Train accidents during shipping often cause concussion of the brain.
Symptoms.—Concussion of the brain is characterized by giddiness, stupor, insensibility, or loss of muscular power, succeeding immediately upon a blow or severe injury involving the cranium. The animal may rally quickly or not for hours; death may occur on the spot or after a few days. When there is only slight concussion or stunning, the animal soon recovers from the shock. When more severe, insensibility may be complete and continue for a considerable time; the animal lies as if in a deep sleep; the pupils are insensible to light; the pulse fluttering or feeble; the surface of the body cold, muscles relaxed, and the breathing scarcely perceptible. After a variable interval partial recovery may take place, which is marked by paralysis of some parts of the body, often of a limb, the lips, ear, etc. Convalescence is usually tedious, and frequently permanent impairment of some organs remains.
Pathology.—Concussion produces laceration of the brain, or at least a jarring of the nervous elements, which, if not sufficiently severe to produce sudden death, may lead to softening or inflammation, with their respective symptoms of functional derangement.
Treatment.—The first object in treatment will be to establish reaction or to arouse the feeble and weakening heart. This can often be accomplished by dashing cold water on the head and body of the animal; frequent injections of weak ammonia water, ginger tea, or oil and turpentine should be given per rectum. In the majority of cases this will soon bring the horse to a state of consciousness. In more severe cases mustard poultices should be applied along the spine and above the fetlocks. As soon as the animal gains partial consciousness stimulants, in the form of whisky or capsicum tea, should be given. Owing to severity of the structural injury to the brain or the possible rupture of blood vessels and blood extravasation, the reaction may often be followed by encephalitis or cerebritis, and will then have to be treated accordingly. For this reason the stimulants should not be administered too freely, and they must be abandoned as soon as reaction is established. There is no need for further treatment unless complications develop as a secondary result. Bleeding, which is so often practiced, proves almost invariably fatal in this form of brain affection. We should also remember that it is never safe to drench a horse with large quantities of medicine when he is unconscious, for he is very liable to draw the medicine into the lungs in inspiration.
Prevention.—Young horses, when harnessed or bitted for the first few times, should not have their heads checked high, for it frequently causes them to rear up, and, being unable to control their balance, they are liable to fall over sideways or backwards, thus causing brain concussion when they strike the ground.
This is a physiological condition in sleep. It is considered a disease or may give rise to disease when the circulation and blood supply of the brain are interfered with. In some diseases of the heart the brain becomes anemic, and fainting fits occur, with temporary loss of consciousness. Tumors growing within the cranium may press upon one or more arteries and stop the supply of blood to certain parts of the brain, thus inducing anemia, ultimately atrophy, softening, or suppuration. Probably the most frequent cause is found in plugging, or occlusion, of the arteries by a blood clot.
Symptoms.—Imperfect vision, constantly dilated pupils, frequently a feeble and staggering gait, and occasionally cramps, convulsions, or epileptic fits occur.
Pathology.—The exact opposite of cerebral hyperemia. The blood vessels are found empty, the membranes blanched, and the brain substance softened.
Treatment.—Removal of the remote cause when possible. General tonics, nutritious feed, rest, and removal from all causes of nervous excitement.
This condition consists in an unnatural collection of fluid about or in the brain. Depending upon the location of the fluid, we speak of external and internal hydrocephalus.
External hydrocephalus is seen chiefly in young animals. It consists in a collection of fluid under the meninges, but outside the brain proper. This defect is usually congenital. It is accompanied with an enlargement of the skull, especially in the region of the forehead. The pressure of the fluid may cause the bones to soften. The disease is incurable and usually fatal.
Internal hydrocephalus is a disease of mature horses, and consists in the accumulation of an excessive quantity of fluid in the cavities or ventricles of the cerebrum. The cause of this accumulation may be a previous inflammation, a defect in the circulation of blood through the brain, heat stroke, overwork, excessive nutrition, or long-continued indigestion. Common, heavy-headed draft horses are predisposed to this condition.
Symptoms.—The symptoms are an expression of dullness and stupidity, and from their nature this disease is sometimes known as "dumminess" or "immobility." A horse so afflicted is called a "dummy." Among the symptoms are loss of intelligence, stupid expression, poor memory, etc. The appetite is irregular; the horse may stop chewing with a wisp of hay protruding from his lips; he seems to forget that it is there. Unnatural positions are sometimes assumed, the legs being placed in clumsy and unusual attitudes. Such horses are difficult to drive, as they do not respond readily to the word, to pressure of the bit, or to the whip. Gradually the pulse becomes weaker, respiration becomes faster, and the subject loses weight. Occasionally there are periods of great excitement due to temporary congestion of the brain. At such times the horse becomes quite uncontrollable. A horse so afflicted is said to have "staggers." The outlook for recovery is not good.
Treatment is merely palliative. Regular work or exercise and nutritious feed easy of digestion, with plenty of fresh water, are strongly indicated. Intensive feeding should not be practiced. The bowels should be kept open by the use of appropriate diet or by the use of small regular doses of Glauber's salt.
Tumors within the cranial cavity and the brain occur not infrequently, and give rise to a variety of symptoms, imperfect control of voluntary movement, local paralysis, epilepsy, etc. Among the more common tumors are the following:
Osseous tumors, growing from the walls of the cranium, are not very uncommon.
Dentigerous cysts, containing a formation identical to that of a tooth, growing from the temporal bone, sometimes are found lying loose within the cranium.
Tumors of the choroid plexus, known as brain sand, are frequently met with on post-mortem examinations, but seldom give rise to any appreciable symptoms during life. They are found in horses at all ages, and are slow of development. They are found in one or both of the lateral ventricles, enveloped in the folds of the choroid plexus.
Melanotic tumors have been found in the brain and meninges in the form of small, black nodules in gray horses, and in one instance are believed to have induced the condition known as stringhalt.
Fibrous tumors may develop within or from the meningeal structures of the brain.
Gliomatous tumor is a variety of sarcoma very rarely found in the structure of the cerebellum.
Treatment for tumors of the brain is impossible.
Spasm is a marked symptom in many diseases of the brain and of the spinal cord. Spasms may result from irritation of the motor nerves as conductors, or may result from irritation of any part of the sympathetic nervous system, and they usually indicate an excessive action of the reflex motor centers. Spasms may be induced by various medicinal agents given in poisonous doses, or by effete materials in the circulation, such as nux vomica or its alkaloid strychnia, lead preparations, or an excess of the urea products in the circulation, etc. Spasms may be divided into two classes: Tonic spasm, when the cramp is continuous or results in persistent rigidity, as in tetanus; clonic spasm, when the cramping is of short duration, or is alternated with relaxations. Spasms may affect involuntary as well as the voluntary muscles, the muscles of the glottis, intestines, and even the heart. They are always sudden in their development.
Spasm of the glottis.—This is manifested by a strangling respiration; a wheezing noise is produced in the act of inspiration; extreme anxiety and suffering for want of air. The head is extended, the body profusely perspiring; pulse very rapid; soon great exhaustion becomes manifest; the mucous membranes become turgid and very dark colored, and the animal thus may suffocate in a short time.
Spasm of the intestines.—(See "Cramp colic," p. 74.)
Spasm of the neck of the bladder.—This may be due to spinal irritation or a reflex from intestinal irritation, and is manifested by frequent but ineffectual attempts to urinate.
Spasm of the diaphragm, or thumps.—Spasmodic contraction of the diaphragm, the principal muscle used in respiration, is generally occasioned by extreme and prolonged speeding on the race track or road. The severe strain thus put upon this muscle finally induces irritation of the nerves controlling it, and the contractions become very forcible and violent, giving the jerking character known among horsemen as "thumps." This condition may be distinguished from violent beating of the heart by feeling the pulse beat at the angle of the jaw, and at the same time watching the jerking movement of the body, when it will be discovered that the two bear no relation to each other. (See "Palpitation of the heart," p. 259.)
Spasm of the thigh, or cramp of a hind limb.—This is frequently witnessed in horses that stand on sloping plank floors—generally in cold weather—or it may come on soon after severe exercise. It is probably due to an irritation of the nerves of the thigh. In cramps of the hind leg the limb becomes perfectly rigid, and attempts to flex are unsuccessful; the animal stands on the affected limb, but is unable to move it; it is unnaturally cold; it does not, however, appear to cause much suffering unless attempts are made to change position. This cramp may be of short duration—a few minutes—or it may persist for several days. This condition is often taken for a dislocation of the stifle joint. In the latter the foot is extended backward, and the horse is unable to advance it, but drags the limb. An examination of the joint also reveals a change in form. Spasms may affect the eyelids, by closure or by retraction. Spasm of the sterno-maxillaris muscle has been witnessed, and the animal was unable to close the jaws until the muscle became relaxed.
Treatment of spasms.—An anodyne liniment, composed of chloroform 1 part and soap liniment 4 parts, applied to cramped muscles will usually cause relaxation. This may be used when single external muscles are affected. In spasms of the glottis, inhalation of sulphuric ether will give quick relief. In spasm of the diaphragm, rest and the administration of half an ounce of chloroform in 3 ounces of whisky, with a pint of water added, will generally suffice to bring relief, or if this fails give 5 grains of sulphate of morphia by hypodermic injection. If spasms result from organic disease of the nervous system, the latter should receive such treatment as its character demands. In cramp of the leg, compulsory movement usually causes relaxation very quickly; therefore the animal should be led out of the stable and be forced to run or trot. Sudden, nervous excitement caused by a crack of the whip or smart blow will often bring about immediate relief. Should this fail, the anodyne liniment may be used along the inside of the thigh, and chloroform, ether, or laudanum given internally. An ounce of the chloral hydrate will certainly relieve the spasm when given internally, but the cramp may return soon after the effect has passed off, which in many cases it does very quickly.
Convulsions.—Although there is no disease of the nervous system which can be properly termed convulsive, or justify the use of the word convulsion to indicate any particular disease, yet it is often such a prominent symptom that a few words may not be out of place. General, irregular muscular contractions of various parts of the body, with unconsciousness, characterize what we regard as convulsions, and like ordinary spasms are dependent upon some disease or irritation of the nervous structures, chiefly of the brain. No treatment is required; in fact, a general convulsion must necessarily be self-limited in its duration. Suspending, as it does, respiratory movements, checking the oxygenation and decarbonization of the blood, the rapid accumulation of carbonic-acid gas in the blood and the exclusion of oxygen quickly puts the blood in a condition to produce the most reliable and speedy sedative effect upon the nerve excitability that could be found, and consequently furnishes its own remedy so far as the continuance of the convulsive paroxysm is concerned. Whatever treatment is instituted must be directed toward a removal of the cause of the convulsive paroxysm.
Chorea is characterized by involuntary contractions of voluntary muscles. This disease is an obscure disorder, which may be from pressure upon a nerve, cerebral or spinal sclerosis, small aneurisms in the brain, etc. Choreic symptoms have been produced by injecting granules of starch into the arteries entering the brain. Epilepsy and other forms of convulsions simulate chorea in appearance.
Stringhalt is by some termed "chorea." This is manifested by a sudden jerking up of one or both hind legs when the animal is walking. This symptom may be very slight in some horses, but has a tendency to increase with age. In some the catching up of the affected leg is very violent, and when it is lowered to the ground the motion is equally sudden and forcible, striking the foot to the ground like a pile driver. Very rarely chorea may be found to affect one of the fore legs, or the muscles of one side of the neck or the upper part of the neck. Involuntary jerking of the muscles of the hip or thigh is seen occasionally, and is termed "shivering" by horsemen.
Chorea is often associated with a nervous disposition, and is not so frequent in animals with a sluggish temperament. The involuntary muscular contractions cause no pain, and do not appear to produce much exhaustion of the affected muscles, although the jerking may be regular and persistent whenever the animal is in motion.
Treatment.—In a few cases, early in the appearance of this affection, general nerve tonics may be of benefit, viz, iodid of iron, 1 dram; pulverized nux vomica, 1 dram; pulverized scutellaria (skull-cap), 1 ounce. Mix and give in the feed once a day for two weeks. Arsenic in the form of Fowler's solution is often beneficial. If the cause is connected with organic brain lesions, treatment is usually unsuccessful.
The cause of epilepsy is seldom traceable to any special brain lesions. In a few cases it accompanies disease of the pituitary body, which is located in the under surface of the brain. Softening of the brain may give rise to this affection. Attacks may occur only once or twice a year or they may be of frequent recurrence.
Symptoms.—No premonitory symptoms precede an epileptic fit. The animal suddenly staggers; the muscles become cramped; the jaws may be spasmodically opened and closed, and the tongue become lacerated between the teeth; the animal foams at the mouth and falls in a spasm. The urine flows involuntarily, and the breathing may be temporarily arrested. The paroxysm soon passes off, and the animal gets on its feet in a few minutes after the return of consciousness.
Treatment.—Dashing cold water on the head during the paroxysm. After the recovery 1 dram of oxid of zinc may be given in the feed twice a day for several weeks, or benefit may be derived from the tonic prescribed for chorea.
Paralysis is a weakness or cessation of the muscular contraction by diminution of loss of the conducting power or stimulation of the motor nerves. Paralytic affections are of two kinds, the complete and the incomplete. The former includes those in which both motion and sensibility are affected; the latter those in which only one or the other is lost or diminished. Paralysis may be general or partial. The latter is divided into hemiplegia and paraplegia. When only a small portion of the body is affected, as the face, a limb, the tail, it is designated by the term local paralysis. When the irritation extends from the periphery of the center it is termed reflex paralysis.
Causes are much varied. Most of the acute affections of the brain and spinal cord may lead to paralysis. Injuries, tumors, disease of the blood vessels of the brain, etc., all have a tendency to produce suspension of the conducting motive power to the muscular structures. Pressure upon, or the severing of, a nerve causes a paralysis of the parts to which such a nerve is distributed. Apoplexy may be termed a general paralysis, and in nonfatal attacks is a frequent cause of the various forms of palsy.
General paralysis.—This can not take place without producing immediate death. The term is, however, usually applied to paralysis of the four extremities, whether any other portions of the body are involved or not. This form of palsy is due to compression of the brain by congestion of its vessels, large clot formation in apoplexy, concussion, or shock, or any disease in which the whole brain structure is involved in functional disturbance.
Hemiplegia (paralysis of one side or half of the body).—Hemiplegia is frequently the result of a tumor in the lateral ventricles of the brain, softening of one hemisphere of the cerebrum, pressure from extravasated blood, fracture of the cranium, or it may be due to poisons in the blood or to reflex origin. When hemiplegia is due to or the result of a prior disease of the brain, especially of an inflammatory character, it is seldom complete; it may affect only one limb and one side of the head, neck, or muscles along the back, and may pass off in a few days after the disappearance of all the other evidences of the primary affection. In most cases, however, hemiplegia arises from emboli obstructing one or more blood vessels of the brain, or the rupture of some vessel the wall of which had become weakened by degeneration and the extravasation of blood. Sensibility in most cases is not impaired, but in some there is a loss of sensibility as well as of motion. In some cases the bladder and rectum are involved in the paralysis.
Symptoms.—In hemiplegia the attack may be very sudden, and the animal fall, powerless to move one side of the body; one side of the lips will be relaxed; the tongue may hang out on one side of the mouth; the tail curved around sideways; an inability to swallow feed or water may be present, and often the urine dribbles away as fast as it collects in the bladder. Sensibility of the affected side may be entirely lost or only partial; the limbs may be cold and sometimes unnaturally warm. In cases wherein the attack is not so severe the animal may be able to maintain the standing position, but will have great difficulty in moving the affected side. In such cases the animal may recover from the disability. In the more severe, in which there is complete loss of power of movement, recoveries are rare.
Paraplegia (transverse paralysis of the hind extremities).—Paralysis of the hind extremities is usually due to some injury or inflammation affecting the spinal cord. (See "Spinal meningitis," p. 232, and "Myelitis," p. 233.) It may also be due to a reflex irritation from disease of peripheral nerves, to spinal irritation or congestion caused by blood poisons, etc.
Symptoms.—When due to mechanical injury of the spinal cord, from a broken back or spinal hemorrhage, it is generally progressive in its character, although it may be sudden. When it is caused by agents in the blood, it may be intermittent or recurrent.
Paraplegia is not difficult to recognize, for it is characterized by a weakness and imperfect control of the hind legs and powerless tail. The urine usually dribbles away as it is formed and the manure is pushed out, ball by ball, without any voluntary effort, or the passages may cease entirety. When paraplegia is complete, large and ill-conditioned sores soon form on the hips and thighs from chafing and bruising, which have a tendency quickly to weaken the animal and necessitate his destruction.
Locomotor ataxia, or incoordination of movement.—This is characterized by an inability to control properly the movement of the limbs. The animal appears usually perfectly healthy, but when he is led out of his stall his legs have a wobbly movement and he will stumble or stagger, especially in turning. When this is confined to the hind parts it may be termed a modified form of paraplegia, but often it may be seen to affect nearly all the voluntary muscles when they are called into play, and must be attributed to some pressure exerted on the base of the brain.
Local paralysis.—This is frequently met with in horses. It may affect many parts of the body, even vital organs, and it is very frequently overlooked in diagnosis.
Facial paralysis.—This is a frequent type of local paralysis, and is due to impairment of function of the motor nerve of the facial muscles, the portio dura. The cause may exist at the base of the brain, compression along its course after it leaves the medulla oblongata, or to a bruise after it spreads out on the great masseter muscle.
Symptoms.—A flaccid condition of the cheek muscles, pendulous lips, inability to grasp the feed, often a slow and weak movement in chewing, and difficulty and slowness in drinking.
Laryngismus paralyticus, or roaring.—This condition is characterized by roaring, and is usually caused by an inflamed or hypertrophied bronchial gland pressing against the left recurrent laryngeal nerve, which interferes with its conducting power. A similar condition is occasionally induced in acute pleurisy, when the recurrent nerve becomes involved in the diseased process or compressed by plastic exudation.
Paralysis of the rectum and tail.—This is generally the result of a blow or fall on the rump, which causes a fracture of the sacrum bone and injury to the nerves supplying the tail and part of the rectum and muscles belonging thereto. This fracture would not be suspected were it not for the loss of motion of the tail.
Intestinal paralysis.—Characterized by persistent constipation; frequently the strongest purgatives have no effect whatever on the movement of the bowels. In the absence of symptoms of indigestion, or special diseases implicating the intestinal canal, torpor of the bowels must be attributed to deficient innervation. This condition may depend upon brain affections or be due to reflex paralysis. Sudden checks of perspiration may induce excessive action of the bowels or paralysis.
Paralysis of the bladder.—This usually affects the neck of the bladder, and is characterized by incontinence of urine; the urine dribbles away as fast as it is secreted. The cause may be of reflex origin, disease of the rectum, tumors growing within the pelvic cavity, injury to the spinal cord, etc.
Paralysis of the optic nerve (amaurosis).—A paralysis of eyesight may occur very suddenly from rupture of a blood vessel in the brain, acute local congestion of the brain, the administration of excessive doses of belladonna or its alkaloid atropia, etc. In amaurosis the pupil is dilated to its full extent; the eye looks clear, but does not respond to light.
Paralysis of hearing, of the external ear, of the eyelid, partial paralysis of the heart and organs of respiration, of the blood vessels from injury to the vasomotor nerves of the esophagus, or loss of deglutition, palsy of the stomach, all may be manifested when the supply of nervous influence is impaired or suspended.
Treatment for paralysis.—In all paralytic affections there may be anesthesia, or impairment of sensibility, in addition to the loss of motion, or there may be hyperesthesia, or increased sensibility, in connection with the loss of motion. These conditions may call for special treatment in addition to that for loss of motion. If hyperesthesia is well marked local anodynes may be needed to relieve suffering. Chloroform liniment or hypodermic injections of from 3 to 5 grains of sulphate of morphia will allay local pain. If there is marked anesthesia, or loss of sensibility, it may become necessary to secure the animal in such way that he can not suffer serious injury from accidents which he can not avoid or feel. In the treatment of any form of paralysis we must always refer to the cause, and attempt its removal if it can be discovered. In cases in which the cause can not be determined we have to rely solely upon a general external and internal treatment. Externally, fly blisters or strong, irritant liniments may be applied to the paralyzed parts. In hemiplegia they should be applied along the bony part of the side of the neck; in paraplegia, across the loins. In, some cases hot-water cloths will be beneficial. Internally, it is well to administer 1 dram of powdered nux vomica or 2 grains of sulphate of strychnia twice a day until twitching of some of the voluntary muscles occurs; then discontinue it for several days, and then commence again with a smaller dose, gradually increasing it until twitching recurs. Iodid of potassium in 1 to 2 dram doses two or three times daily may be used with the hope that it will favor the absorption of the clot or obstruction to the nervous current. In some cases Fowler's solution of arsenic in teaspoonful doses twice a day in the drinking water proves beneficial. Occasionally benefit may be derived from the application of the electric current, especially in cases of roaring, facial paralysis, paralysis of the eyelid, etc. Nutritious but not too bulky feed, good ventilation, clean stabling, moderate exercise if the animal is capable of taking it, good grooming, etc., should be observed in all cases.
This may be induced by the irritant properties of blood poisons, exhaustion and exposure, spinal concussion, all forms of injury to the spine, tumors, caries of the vertebræ, rheumatism, etc.
Symptoms.—A chill may be the precursor, a rise in temperature, or a general weakness and shifting of the legs. Soon a painful, convulsive twitching of the muscles sets in, followed by muscular rigidity along the spine, in which condition the animal will move very stiffly and evince great pain in turning. Evidences of paralysis or paraplegia develop, retention or incontinence of urine, and oftentimes sexual excitement is present. The presence of marked fever at the beginning of the attack, associated with spinal symptoms, should lead us to suspect spinal meningitis or myelitis. These two conditions usually appear together, or myelitis follows inflammation of the meninges so closely that it is almost impossible to separate the two; practically it does not matter much, for the treatment will be about the same in both cases. Spinal meningitis generally becomes chronic, and is then marked principally by paralysis of that portion, or parts of it, posterior to the seat of the disease.
Pathology.—In spinal meningitis we find essentially the same condition as in cerebral meningitis; there is an effusion of serum between the membranes, and often a plastic exudation firmly adherent to the pia mater serves to maintain a state of paralysis for a long time after the acute symptoms have disappeared by compressing the cord. Finally, atrophy, softening, and even abscess may develop within the cord. Unlike in man, it is usually found localized in horses.
Treatment.—Bags filled with ice should be applied along the spine, to be followed later by strong blisters. The fever should be controlled as early as possible by giving 20 drops of Norwood's tincture of veratrum viride every hour until the desired result is obtained. One dram of the fluid extract of belladonna, to control pain and vascular excitement of the spinal cord, may be given every five or six hours until the pupils of the eyes become pretty well dilated. If the pain is very intense 5 grains of sulphate of morphia should be injected hypodermically. The animal must be kept as free from excitement as possible. If the urine is retained in the bladder it must be drawn off every four or six hours. In very acute attacks the disease generally proves fatal in a few days. If, however, the animal grows better, some form of paralysis is liable to remain for a long time, and the treatment will have to be directed then toward a removal of the exudative products and a strengthening of the system and stimulation of the nervous functions. To induce absorption, iodid of potassium in 2-dram doses, dissolved in the drinking water, may be given twice a day. To strengthen the system, iodid of iron 1 dram twice a day and 1 dram of nux vomica once a day may be given in the feed. Electricity to the paralyzed and weakened muscles is advisable; the current should be weak, but be continued for half an hour two or three times daily. If the disease is due to a broken back, caries of the vertebræ, or some other irremediable cause, the animal should be destroyed at once.
This is a rare disease, except as a secondary result of spinal meningitis or injuries to the spine. Poisoning by lead, arsenic, mercury, phosphorus, carbonic-acid gas, etc., has been known to produce it. Myelitis may be confined to a small spot in the cord or may involve the whole for a variable distance. It may lead to softening abscess or degeneration.
Symptoms.—The attack may begin with a chill or convulsion; the muscles twitch or become cramped very early in the disease, and the bladder usually is affected at the outset, in which there may be either retention or incontinence of urine. These conditions are followed by complete or partial paralysis of the muscles posterior to the locality of the inflamed cord, and the muscles begin to waste away rapidly. The paralyzed limb becomes cold and dry, due to the suspension of proper circulation; the joints may swell and become edematous; vesicular eruptions appear on the skin; and frequently gangrenous sloughs form on the paralyzed parts. It is exceedingly seldom that recovery takes place. In a few instances it may assume a chronic type, when all the symptoms become mitigated, and thus continue for some time, until septicemia, pyemia, or exhaustion causes death.
Pathology.—The inflammation may involve nearly the whole length of the cord, but generally it is more intense in some places than others; when due to mechanical injury, the inflammation may remain confined to a small section. The cord is swollen and congested, reddened, often softened and infiltrated with pus cells, and the nerve elements are degenerated.
Treatment.—Similar to that of spinal meningitis.
This condition consists in an excess of blood. As the blood vessels of the pia mater are the principal source of supply to the spinal cord, hyperemia of the cord and of the meninges usually go together. The symptoms are, therefore, closely allied to those of spinal meningitis and congestion. When the pia mater is diseased, the spinal cord is almost invariably affected also.
Cause.—Sudden checking of the perspiration, violent exercise, blows, and falls.
Symptoms.—The symptoms may vary somewhat with each case, and closely resemble the first symptoms of spinal meningitis, spinal tumors, and myelitis. First, some disturbance in movement, lowering the temperature, and partial loss of sensibility posterior to the seat of the congestion. If in the cervical region, it may cause interference in breathing and the action of the heart. When in the region of the loins, there may be loss of control of the bladder. When the congestion is sufficient to produce compression of the cord, paraplegia may be complete. Usually fever, spasms, muscular twitching, or muscular rigidity are absent, which will serve to distinguish spinal congestion from spinal meningitis.
Treatment.—Hot-water applications to the spine, 1-dram doses fluid extract of belladonna repeated every four hours, and tincture of aconite root 20 drops every hour until the symptoms become ameliorated. If no inflammatory products occur, the animal is likely to recover.
This may be caused by extreme cold, exhausting diseases, spinal embolism or plugging of a spinal blood vessel, an interference with the circulation through the abdominal aorta, from compression, thrombosis, or aneurism of that vessel; the spinal vessels may be caused to contract through vasomotor influence, a result of peripheral irritation of some nerve.
Spinal anemia causes paralysis of the muscles used in extending the limbs. When the bladder is affected, it precedes the weakness of motion, while in spinal congestion it follows, and increased sensibility, in place of diminished sensibility, as in spinal congestion, is observed. Pressure along the spine causes excessive pain.
If the exciting cause can be removed, the animal recovers; if this fails, the spinal cord may undergo softening.
When caused by tumors or otherwise, when pressure is slight, it produces a paralysis of the muscles used in extending a limb and contraction of those which flex it. When compression is great it causes complete loss of sensibility and motion posterior to the compressed part of the cord.
Compression of a lateral half of the cord produces motor paralysis, disturbance of the circulation, and difficulty of movement, an increased sensibility on the side corresponding to the compressed section, and a diminished sensibility and some paralysis on the opposite side.
Treatment.—When it occurs as a sequence of a preceding inflammatory disease, iodid of potassium and general tonics are indicated. When due to tumors growing within the spinal canal, or to pressure from displaced bone, no form of treatment will result in any benefit.
This may occur from changes in the wall of the blood vessels, in connection with tumors, acute myelitis, traumatic injuries, etc. The blood may escape through the pia mater into the subarachnoid cavity, and large clots be formed.
Symptoms.—The symptoms are largely dependent upon the seat and extent of the hemorrhage, as they are principally owing to the compression of the cord. A large clot may produce sudden paraplegia, accompanied with severe pain along the spine; usually, however, the paralysis of both motion and sensation is not very marked at first; on the second or third day fever is liable to appear, and increased or diminished sensibility along the spine posterior to the seat of the clot. When the bladder and rectum are involved in the symptoms it indicates that the spinal cord is compressed.
Treatment.—In the occurrence of injuries to the back of a horse, whenever there is any evidence of paralysis, it is always advisable to apply bags of ice along the spine to check or prevent hemorrhage or congestion, and 2 drams of the fluid extract of ergot and 20 drops of tincture of digitalis may be given every hour until three doses have been taken. Subsequently tincture of belladonna in half-ounce doses may be given three times a day. If there is much pain, 5 grains of sulphate of morphia, injected under the skin, will afford relief and lessen the excitability of the animal. In all cases the animal should be kept perfectly quiet.
This is rarely observed in the horse, and unless it is sufficiently severe to produce well-marked symptoms it would not be suspected. It may occur in saddle horses from jumping, or it may be produced by falling over an embankment, or a violent fall upon the haunches may produce it. Concussion may be followed by partial paralysis or spinal hemorrhage; generally, however, it is confined to a jarring and some disturbance of the nerve elements of the cord, and the paralytic effect which ensues soon passes off. Treatment consists in rest until the animal has completely recovered from the shock. If secondary effects follow from hemorrhage or compression, they have to be treated as heretofore directed.
Within the substance of the cord glioma or the mixed gliosarcomata are found to be the most frequent, tumors may form from the meninges and the vertebræ, being of a fibrous or bony nature, and affect the spinal cord indirectly by compression. In the meninges we may find glioma, cancers, and psammoma, fibromata; aneurisms of the spinal arteries have been discovered in the spinal canal.
Symptoms.—Tumors of the spinal canal cause symptoms of spinal irritation or compression of the cord. The gradual and slow development of symptoms of paralysis of one or both hind limbs or certain muscles may lead to a suspicion of spinal tumors. The paralysis induced is progressive, but not usually marked with atrophy of the muscles or increased sensibility along the spine. When the tumor is within the spinal cord itself all the symptoms of myelitis may be present.
Treatment.—General tonics and 1-dram doses of nux vomica may be given; iodid of iron or iodid of potassium in 1-dram doses, three times a day in feed, may, in a very few cases, give some temporary benefit. Usually the disease progresses steadily until it proves fatal.
This is caused by a bruise or wound of a nerve or by strangulation in a ligature when the nerve is included in the ligation of an artery. The changes in an inflamed nerve are an enlargement, reddening of the nerve sheath, spots of extravasated blood, and sometimes an infiltration of serum mixed with pus.
Symptoms.—Acute pain of the parts supplied by the nerve and absence of swelling or increased heat of the part.
Treatment.—Hypodermic injections of from 3 to 5 grains of morphia to relieve pain, hot fomentations, and rest. If it is due to an inclusion of a ligature, the nerve should be divided above and below the ligature.
Neuroma may be from enlargement of the end of a divided nerve or due to fibrous degeneration of a nerve which has been bruised or wounded. Its most frequent occurrence is found after the operation of neurotomy for foot lameness, and it may appear after the lapse of months or even years. Neuroma usually develops within the sheath of the nerve with or without implicating the nerve fibers. It is oval, running lengthwise with the direction of the nerve.
Symptoms.—Pain of the affected limb or part is manifested, more especially after resting a while, and when pressure is made upon the tumor it causes extreme suffering.
Treatment.—Excision of the tumor, including part of the nerve above and below, and then treat it like any other simple wound.
These may consist in wounding, bruising, laceration, stretching, compression, etc. The symptoms which are produced will depend upon the extent, seat, and character of the injury. Recovery may quickly take place, or it may lead to neuritis, neuroma, or spinal or cerebral irritation, which may result in tetanus, paralysis, and other serious derangements. In all diseases, whether produced by some form of external violence or intrinsic causes, the nerves are necessarily involved, and sometimes it is to a primary injury of them that the principal fault in movement or change of nutrition of a part is due. It is often difficult or impossible to discover that an injury to a nerve has been inflicted, but whenever this is possible it may enable us to remedy that which otherwise would result in permanent evil. Treatment should consist in relieving compression, in hot fomentations, the application of anodyne liniments, excision of the injured part, and rest.
This disease prevails among horses in nearly all parts of the United States. Its appearance in America is by no means of recent occurrence, for the malady was reported by Large in 1847, by Michener in 1850, and by Liautard in 1869 as appearing in both sporadic and enzootic form in several of the Eastern States. Since then the disease has occurred periodically in many States in all sections of the country, and has been the subject of numerous investigations and publications by a number of the leading men of the veterinary profession. It is prevalent with more or less severity every year in certain parts of the United States, and during the year 1912 the Bureau of Animal Industry received urgent requests for help from Colorado, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maryland, Missouri, Nebraska, New Jersey, North Carolina, Oregon, South Carolina, South Dakota, Virginia, and West Virginia. While in 1912 the brunt of the disease seemed to fall on Kansas and Nebraska, other States were also seriously afflicted. In previous years, for instance in 1882, as well as in 1897, the horses of southeastern Texas were reported to have died by the thousand, and in the following year the horses of Iowa were said to have "died like rats." However, Kansas seems to have had more than her share of this trouble, as a severe outbreak that extended over almost the entire State occurred in 1891, while in 1902 and again in 1906 the disease recurred with equal severity in various portions of the State.
This condition consists in a poisoning and depression of the nervous system from eating or drinking feed or water containing poison generated by mold or bacteria. It has been shown to be owing to eating damaged ensilage, corn, brewers' grains, oats, etc., or to drinking stagnant pond water or water from a well contaminated by surface drainage. Horses at pasture may contract the disease when the growth of grass is so profuse that it mats together and the lower part dies and ferments or becomes moldy.
In England a similar disease has been called "grass staggers," due to eating rye grass when it is ripening or when it is cut and eaten while it is heating and undergoing fermentation. In eastern Pennsylvania it was formerly known by the name of "putrid sore throat" and "choking distemper." A disease similar in many respects which is very prevalent in Virgina, especially along the eastern border, is commonly known by the name of "blind staggers," and in many of the Southern States this has been attributed to the consumption of worm-eaten, corn. Horses of all ages and mules are subject to this disease.
Symptoms and lesions.—The symptoms which typify sporadic or epidemic cerebrospinal meningitis in man are not witnessed among horses, namely, excessive pain, high fever, and early muscular rigidity. In the recognition of the severity of the attack we may divide the symptoms into three grades. In the most rapidly fatal attacks the animal may first indicate it by weak, staggering gait, partial or total inability to swallow solids or liquids, impairment of eyesight; twitching of the muscles and slight cramps may be observed. As a rule, the temperature is not elevated—indeed, it is sometimes below normal. This is soon followed by a paralysis of the whole body, inability to stand, delirium in which the animal sometimes goes through a series of automatic movements as if trotting or running; the delirium may become very violent and the unconscious animal may bruise his head very seriously in his struggles; but usually a deep coma renders him quiet until he expires. Death in these cases usually takes place in from 4 to 24 hours from the time the first symptoms become manifest. The pulse is variable during the progress of the disease; it may be almost imperceptible at times, and then again very rapid and irregular; the respirations generally are quick and catching. In the next form in which this disease may develop it first becomes manifest by a difficulty in swallowing and slowness in mastication, and a weakness which may be first noticed in the strength of the tail; the animal will be unable to switch it or to offer resistance when we bend it up over the croup. The pulse is often a little slower than normal. There is no evidence of pain; the respirations are unchanged, and the temperature little less than normal; the bowels may be somewhat constipated. These symptoms may remain unchanged for two or three days and then gradual improvement may take place, or the power to swallow may become entirely lost and the weakness and uncertainty in gait more and more perceptible; then sleepiness or coma may appear; the pulse becomes depressed, slow, and weak, the breathing stertorous, and paroxysms of delirium develop, with inability to stand, and some rigidity of the spinal muscles or partial cramp of the neck and jaws. In such cases death may occur in from 6 to 10 days from the commencement of the attack. In many cases there is no evidence of pain, spasm, or fever at any time during the progress of the disease, and finally profound coma develops and death follows, painless and without a struggle.
In the last or mildest form the inability of voluntary control of the limbs becomes but slightly marked, the power of swallowing never entirely lost, and the animal has no fever, pain, or unconscious movements. Generally the animal will begin to improve about the fourth day and recovers.
In a few cases the spinal symptoms, manifested by paraplegia, may be the most prominent symptoms; in others they may be altogether absent and the main symptoms may be difficulty in mastication and swallowing; rarely it may affect one limb only. In all cases in which coma remains absent for six or seven days the animal is likely to recover. When changes toward recovery take place, the symptoms usually leave in the reverse order to that in which they developed, but local paralysis may remain for some time, rarely persistent.
On post-mortem the number of lesions observable to the naked eye is in marked contrast to the severity of the symptoms noted. The pharynx and larynx are inflamed in many cases, and sometimes coated with a yellowish-white glutinous deposit, extending at times over the tongue and occasionally a little way down the trachea. The lungs are normal, except from complications following drenching or recumbence for a long period. The heart is usually normal in appearance, except an occasional cluster of hemorrhagic points on the outer surface, while the blood is dark and firmly coagulated. The lining of the stomach indicates a subacute gastritis, while occasionally an erosion is noted. An edema is observed in the submucosa of such cases. The first few inches of the small intestines likewise may show slight inflammation in certain cases, while in others it is quite severe; otherwise the digestive tract appears normal, excluding the presence of varying numbers of bots, Strongylus vulgatus, and a few other nematodes. The liver is congested and swollen in some cases, while it appears normal in others. The spleen is, as a rule, normal, and at times the kidneys are slightly congested. The bladder is often distended with dark-colored urine, and occasionally a marked cystitis has been observed. The adipose tissue throughout the carcass may show a pronounced icteric appearance in certain cases. On removing the bones of the skull the brain appears to be normal macroscopically in a few instances, but in most cases the veins and capillaries of the meninges of the cerebrum, cerebellum, and occasionally the medulla is distinctly dilated and engorged, and in a few cases there are pronounced lesions of a leptomeningitis. An excessive quantity of cerebrospinal fluid is present in most of the cases. On the floor of the lateral ventricles of several brains there was noted a slight softening caused by hemorrhages into the brain substance. There is always an abundance of fluid in the subarachnoid spaces, ventricles, and at the base of the brain, usually of the color of diabetic urine, and containing a limited number of flocculi, but in a few cases it was slightly blood tinged. The spinal cord was not found involved in the few cases examined.
Treatment.—One attack of the disease does not confer immunity. Horses have been observed which have recovered from two attacks, and still others that recovered from the first but died as a result of the second attack.
Inasmuch as a natural immunity does not appear after an attack of cerebrospinal meningitis, it might be anticipated that serum of recovered cases would possess neither curative nor prophylactic qualities. Nevertheless, experiments have been made along these lines with serum from recovered cases, but without any positive results. Similar investigations have been conducted by others in Europe with precisely the same results. With the tendency of the disease to produce pathological lesions in the central nervous system, it seems scarcely imaginable that a medicinal remedy will be found to heal these foci, and even when recovery takes place considerable disturbance in the functions, as blindness, partial paralysis, dumbness, etc., is liable to remain. Indeed, when the disease once becomes established in an animal, drugs seem to lose their physiological action. Therefore, with all the previously mentioned facts before us, it is evident that the first principle in the treatment of this disease is prevention, which consists in the exercise of proper care in feeding only clean, well-cured forage and grain and pure water. These measures when faithfully carried out check the development of additional cases of the disease upon the affected premises.
While medicinal treatment has proved unsatisfactory in most cases, nevertheless the first indication is to clean out the digestive tract thoroughly, and to accomplish this prompt measures must be used early in the disease. Active and concentrated remedies should be given, preferably subcutaneously or intravenously, owing to the great difficulty in swallowing, even in the early stage. Arecolin in one-half grain doses, subcutaneously, has given as much satisfaction as any other drug. After purging the animal the treatment is mostly symptomatic. Intestinal disinfectants, particularly calomel, salol, and salicylic acid, have been recommended, and mild, antiseptic mouth washes are advisable. Antipyretics are of doubtful value, as better results are obtained, if the temperature is high, by copious cold-water injections. An ice pack applied to the head is beneficial in case of marked psychic disturbance. One-ounce doses of chloral hydrate per rectum should be given if the patient is violent or if muscular spasms are severe. If the temperature becomes subnormal, the animal should be warmly blanketed, and if much weakness is shown this should be combated with stimulants, such as strychnin, camphor, alcohol, atropin, or aromatic spirits of ammonia. Early in the disease urotropin (hexamethylenamin) in doses of 25 grains, dissolved in water and given by the mouth every two hours, appeared to have been responsible for the recovery of some cases of the malady. During convalescence tonic treatment is indicated.
Hygienic measures needful.—Whenever this disease appears in a stable all the animals should be removed as soon as possible. They should be provided with clean, well-ventilated, and well-drained stables, and each animal should receive a laxative and be fed feed and given water from a new, clean source. The abandoned stable should be thoroughly cleansed from all waste matters, receive a coat of whitewash containing 4 ounces of carbolic acid to the gallon of water and should have time to dry thoroughly before the horses are replaced. A complete change of feed is of the very greatest importance on account of the belief that the cause resides in diseased grain, hay, and grass.
This disease is characterized by spasms affecting the muscles of the face, neck, body, and limbs and of all muscles supplied by the cerebrospinal nerves. The spasms or muscular contractions are rigid and persistent, yet mixed with occasional more intense contractions of convulsive violence.
Causes.—This disease is caused by a bacillus that is often found in the soil, in manure, and in dust. This germ forms spores at the end of the organism and grows only in the absence of oxygen. It produces a powerful nerve poison, which causes the symptoms of tetanus. The germ itself multiplies at the point where it is introduced, but its poison is absorbed and is carried by the blood to all parts of the body, and thus the nervous system is poisoned. Deep wounds infected by this germ are more dangerous than superficial wounds, because in them the germ is more remote from the oxygen of the air. Hence, nail pricks, etc., are especially dangerous. In the majority of instances the cause of tetanus can be traced to wounds, especially pricks and wounds of the feet or of tendinous structures. It sometimes follows castration, docking, the introduction of setons, inclusion of a nerve in a ligature, etc. It may come on a long time after the wound is healed—three or four months. Horses with a nervous, excitable disposition are more predisposed than those of a more sluggish nature. Stallions are more subject to develop tetanus as the result of wounds than geldings, and geldings more than mares.
Symptoms.—The attacks may be acute or subacute. In an acute attack the animal usually dies within four days. The first symptoms which attract the attention of the owner is difficulty in chewing and swallowing, an extension of the head and protrusion over the inner part of the eye of the membrana nictitans, or haw. An examination of the mouth will reveal an inability to open the jaws to their full extent, and the endeavor to do so will produce great nervous excitability and increased spasm of the muscles of the jaw and neck. The muscles of the neck and along the spine become rigid and the legs are moved in a stiff manner. The slightest noise or disturbance throws the animal into increased spasm of all the affected muscles. The tail is usually elevated and held immovable; the bowels become constipated early in the attack. The temperature and pulse are not much changed. These symptoms in the acute type become rapidly aggravated until all the muscles are rigid—in a state of tonic spasm—with a continuous tremor running through them; a cold perspiration breaks out on the body; the breathing becomes painful from the spasm of the muscles used in respiration; the jaws are completely set, eyeballs retracted, lips drawn tightly over the teeth, nostrils dilated, and the animal presents a picture of the most extreme agony until death relieves him. The pulse, which at first was not much affected, will become quick and hard, or small and thready when the spasm affects the muscles of the heart. In the subacute cases the jaws may never become entirely locked; the nervous excitability and rigidity of the muscles are not so great. There is, however, always some stiffness of the neck or spine manifest in turning; the haw is turned over the eyeball when the nose is elevated. It is not uncommon for owners to continue such animals at their work for several days after the first symptoms have been observed. All the symptoms may gradually increase in severity for a period of ten days, and then gradually diminish under judicious treatment, or they may reach the stage wherein all the characteristics of acute tetanus become developed. In some cases, however, we find the muscular cramps almost solely confined to the head or face, perhaps involving those of the neck. In such cases we have complete trismus (lockjaw), and all the head symptoms are acutely developed. On the contrary, we may find the head almost exempt in some cases, and have the body and limbs perfectly rigid and incapable of movement without falling.