Diagnosis and treatment of tonsillar calculi; spud; acid dressings. Trauma of soft palate by stick, probang, file, molar. Abscess of palate. Treatment; laxative; expectorant; antiseptic; lancing. Cleft palate and hare lip.
Rudimentary as these organs are in the equine race they are important enough to have become the seat of hard calculous masses. These have been found by Goubaux and Blanc in old asses, and by the author in old horses. They vary in size from a pin’s head to a pea and consist of concentric layers of a granular material arranged around a central nucleus, which is usually a foreign body introduced with the food. This nucleus is usually of a vegetable nature, while the enveloping material is made up largely of the imprisoned and degenerated epithelium of the follicle. Both diagnosis and treatment are difficult in such cases. The adventitious masses should be dislodged by the aid of a smooth, blunt metallic spud, and the surface thereafter washed or swabbed with an antiseptic and astringent solution. Swabbing with a solution of hydrochloric acid will tend to dissolve and remove them.
The region of the fauces is sometimes injured by sharp pointed bodies swallowed in the food, by the giving of boluses on the end of a pointed stick, or by the careless use of a probang or of a file upon the posterior molars. An overgrown last molar will sometimes lacerate the velum. In other cases the inflammation of sore throat is especially concentrated on this part, giving rise to cough, difficulty of swallowing, redness, infiltration and swelling of the parts, and even abscess. In the dog it is often associated with tonsilitis.
Treatment. A laxative is usually desirable to be followed by salammoniac or chlorate of potash. In case of actual traumatic lesions, the astringent and antiseptic lotions advised for tonsilitis will be in order, and if abscess is recognized it should be opened promptly.
In exceptional cases the soft palate has failed to unite in the median line, and is represented by two lateral flaps separated by a v-shaped hiatus in the middle. In a specimen in the N. Y. S. V. College, taken from a trotting colt, the fissure is continued forward for several inches between the palatine bones and the palatine processes of the superior maxillary, establishing a direct communication between the mouth and nasal chambers. In still other instances the fissure is continued forward between the maxillary and anterior maxillary bones, throwing the whole length of the buccal and nasal chambers into one irregular cavity, and forming harelip.
It would be possible to remedy some of these conditions by plastic operation, but the value of the young animal will rarely warrant any such resort.
Causes: traumatic; thermic; gaseous; medicinal; chemical; physiological irritants; in solipeds, cattle, swine, dogs; debility; exposure; cold baths; youth; age. Microbes in solipeds, cattle, dogs, birds; facultative microbes. Symptoms: constitutional; difficult swallowing; nasal rejection of water; pharyngeal swelling and tenderness; extended head carried stiffly; cough loose; salivation; in cattle, grinding of teeth; in dogs, rubbing of chops; buccal heat and redness; often fœtor. Course. Duration. Diagnosis from parotitis, from abscess of guttural pouch, from pharyngeal tuberculosis, from actinomycosis, from adenitis and phlegmonous pharyngitis, from specific fevers affecting the pharynx. Lesions: redness and swelling of mucosa, epithelial degeneration, elevations, erosions, and ulcers; lesions of tubercle, glanders, rabies, anthrax, actinomycosis, etc. Prevention. Treatment: soothing; dietetic; laxative; expectorant; eliminating; locally antiseptic astringents in solid, liquid, or vapor; embrocations and blisters; tonics.
Causes. As in stomatitis the starting point of pharyngitis is usually in a local injury or a systemic condition which lowers the vitality of the pharyngeal mucous membrane. It may come in all animals from the hot air of burning buildings, from acrid gases inhaled, food, drink or medicines given at too high a temperature, from caustic alkalies, acids or salts, from physiological irritants like croton, euphorbium, cantharides, from barley and other spikes entangled in the follicles, from drinking freely of iced water. In solipedes there are the injuries caused by giving boluses on pointed sticks, and the wounds caused by tooth files in careless hands, and by coarse fibrous fodder, which has been swallowed without due mastication. In cattle injury comes from foreign bodies impacted, from the rough use of probang, rope or whip and even of the hands in relieving choking. Swine have the part scratched and injured by rough or pointed objects which they bolt carelessly with the food. Dogs and especially puppies are often hurt by solid and irritant bodies that they play with, and swallow accidentally or wantonly. They also suffer at times from the pressure of a tight or badly adjusted collar.
The system is debilitated and rendered more susceptible by chills consequent on exposure to cold blasts, or draughts, or rain or snow, when heated and exhausted, by cold damp beds, by pre-existing disease, by underfeeding and by overwork. In the larger animals this may come from the excessive ingestion of iced water, while in dogs the plunging in rivers, ponds or lakes may chill.
The weakness of early age and old age have a perceptible predisposing influence especially in solipeds and carnivora.
Finally as in other catarrhal inflammations the local action of disease germs on the mucous membrane must ever be borne in mind. These may be the germs of specific diseases localized in the pharynx;—in Solipeds the streptococcus of strangles, the bacillus of glanders, the diplococcus (streptococcus) of contagious pneumonia, the germ of influenza, and actinomyces;—in Cattle the bacillus tuberculosis, the bacillus of anthrax, actinomyces, the germs of aphthous fever and of pseudomembranous angina; in dogs canine madness and distemper;—in birds the bacillus of pseudomembranous pharyngitis.
In addition to such specific germs the micrococci, streptococci and bacilli which are normally present and harmless in the mouth and pharynx, enter, colonize and irritate the debilitated tissues in case of trauma, inflammation or constitutional disorder and serve to perpetuate and aggravate the affection.
Symptoms. Acute pharyngitis is manifested by impaired or lost appetite, dullness, weakness, by difficulty in deglutition, by the rejection through the nose of water or other liquids swallowed, by swelling over the parotid and above the larynx, and by a disposition to keep the head extended on the neck and the nose raised and protruded. Fever is more or less marked according to the severity of the attack the temperature being raised in mild cases to 100°, and, in the more violent, to 104° or 106°. The pulse and breathing may be excited, amounting sometimes to dyspnœa, the throat is tender to the touch and its manipulation rouses a cough, the nasal mucosa is congested and the buccal membrane, and especially along the margin of the tongue may be red and angry. Salivation is shown more or less, in solipeds the saliva accumulating especially during mastication in froth and bubbles at the commissures of the mouth, while in ruminants the grinding of the teeth or frequent movement of the jaws in the absence of food or actual mastication leads to a free escape of the filmy liquid at the same points. Dogs will rub the jaws with the foot as if to remove some irritating object from the mouth. In the last named animals the swelling of the tonsils, fauces and pharyngeal mucous membrane, may be seen marked by patches and spots of varying redness and swelling, covered with glairy or opaque mucopurulent secretions, or particles of food, or even showing erosions.
The cough of pharyngitis is painful, paroxysmal, and softer and more gurgling (even in the early stages) than that of laryngitis or bronchitis. It is roused by handling the throat, by swallowing, by a draught of cold air or by passing out of doors, in dogs by opening the mouth, and in cattle by pulling on the tongue which causes pain and resistance. The cough is followed by the rejection, mainly through the nose in solipeds, but also through the mouth in other animals, of a glairy mucus or an opaque mucopurulent discharge often mixed with and discolored by the elements of food or in bad cases by blood.
The course of the disease is comparatively rapid, and it usually ends in recovery in seven to fifteen days, in cases that are not complicated by dangerous local infections.
Diagnosis is mainly based on the stiff carriage of the neck with the nose elevated, the swelling and tenderness of the throat, manipulation above the larynx rousing the cough, the soft or rattling nature of the cough, the ejection of liquids and foods through the nose, the movements of the jaws apart from mastication and the salivation. From parotitis it is distinguished by the concentration of the swelling and tenderness to the deepseated region above the larynx, by the abundance of the discharge, by the ejection of liquids through the nose, and by the readiness with which the cough is aroused. From abscess of the guttural pouch it is differentiated by the more continuous discharge from the nose, rather than the intermittent one. From tuberculous pharyngeal glands by its acute nature, by the absence of the glandular swellings in which the tuberculosis is concentrated, also by the absence of tubercles in other parts of the body. From actinomycosis by its more rapid progress and by the absence of the hard indurated cutaneous or subcutaneous swellings, and of the open sores with minute sulphur colored granules that mark that affection. From adenitis and phlegmonous pharyngitis it is distinguished by the absence of the glandular swelling and dyspnœa which attend on that affection. From the various fatal febrile affections, the germs of which may be localized in the throat, it may be diagnosed by the absence of the more profound constitutional disturbance, and of the more characteristic local symptoms of these which are seldom altogether awanting, though often greatly modified.
Lesions. Beside the thick covering of mucopurulent and alimentary matters, the pharyngeal mucosa, when washed, shows redness, ramified or reticulated, more or less swelling amounting at times to œdema, a soft friable consistency, which like the œdema may in bad cases extend into the submucous tissue, granular elevations, and raw abrasions caused by the destruction and removal of the epithelium. In some instances the ulcers may become quite extensive.
In the more specific inflammations (tubercle, glanders, rabies, aphthous fever, contagious pneumonia, anthrax, actinomycosis), the lesions will vary according to the specific nature of the disease.
Prevention. Avoid the various thermal, chemical, mechanical, and unhygienic causes already referred to, and the exposure to such infectious diseases as are liable to localize themselves in the throat.
Treatment. A piece of blanket or sheepskin placed round the throat with the wool turned inward, a moderately warm stall with pure air, and a diet composed of soft, warm or tepid mashes, (all hard or fibrous food, oats, hay, etc. being withheld) are important conditions.
If costiveness exists a dose of Glauber salts for the larger animals, and of jalap for the small, may be useful. Or pilocarpine or eserine may be given hypodermically. Following this, mild saline diuretics will serve at once to eliminate offensive products of the disease and lower the general temperature.
The most important resorts however, are the local applications of dilute acids, astringents and antiseptics to the pharyngeal mucosa, mouth and nostrils. In severe cases benefit may be derived from inhalation of water vapor, but this is rendered far more effective by the addition of vinegar, carbolic acid, creolin, camphor, tar, or sulphurous acid. The last may be obtained by the frequent burning of a carefully graduated quantity of sulphur in the stall, the others by mixing them with hot water, saturating cloths hung in the stall, or sprinkling them on sand laid on the floor.
Chlorate of potash or borax may be dissolved in the drinking water, care being taken not to exceed the physiological dose. Mercuric chloride (1:2000) may be used to wash the lips and nostrils, but cannot be safely injected into mouth or nose. Powdered alum or tannic acid may be used by insufflation.
As a mouth wash and general medicament a saturated solution of chlorate of potash in tincture of muriate of iron, diluted by adding thirty drops to the ounce of water, may be given every hour or two. Or a solution of chlorine water diluted so as to be non-irritating, may be substituted with somewhat less effect. Even a weak solution of hydrochloric acid may be employed.
Borax may be used in a solution of 2 per cent., or carbolic acid in one of 1 per cent., or bisulphite of soda in the proportion of ½ oz. to the pint, or salicylate of soda ½ oz. to the pint of water. The same agents may be made into electuaries with honey or molasses and smeared every hour or two on the tongue or cheek. In such cases the addition of powdered liquorice, and, if the suffering is acute, of extract of belladonna will serve an excellent purpose.
The danger of infection of the stomach and bowels may be met by combining with the above or administering separately salol in doses of 2 to 3 drachms or naphthol in doses of 4 to 5 drachms to the larger animals. For sheep or swine one-fourth of these doses may be given, and for a shepherd’s dog one-sixteenth to a twentieth.
As alternate antiseptics may be named, boric acid, permanganate of potash and salicylate of bismuth. These from their comparative absence of taste are especially useful in carnivora.
Counter-irritants to the throat are useful. For the horse, sheep, dog and cat, use equal parts of strong aqua ammonia and olive oil. For the solipeds a cantharides blister. For cattle or swine equal parts of strong aqua ammonia and oil of turpentine with a few drops of croton oil, or grains of tartar emetic.
Finally during convalescence a course of iron and bitters may be useful, especially in debilitated subjects.
Submucous inflammation and abscess. Solipeds especially. Specific, or due to microbian pus infection. Traumatism; from foreign bodies in tonsillar and mucous follicles, from rough, fibrous food, instruments, etc.
As a sequel of catarrhal pharyngitis. Symptoms; as in catarrhal form, with more swelling and tenderness, glandular swelling, dyspnœa, and difficulty in swallowing; local induration followed by fluctuation and pointing. Complications; asphyxia, laryngeal œdema, purulent or inhalation pneumonia, pharyngeal fistula, palsy of vagus, secondary abscesses, septicæmia. Lesions, local, general. Treatment; General and local, fomentation—hot or cold and antiseptic. Embrocations. Lancing. Tracheotomy.
As distinguished from catarrhal pharyngitis this is inflammation of the submucous tissue and adjacent lymph glands, tending to abscess.
It is especially common in solipeds and rather rare in other classes of domestic animals. As a specific infectious disease it has its type in strangles (infectious adenitis), also in cattle in the complicated infection of purulent tubercle, but apart from such it is often the result of the penetration of the pus microbes from a catarrhal pharynx into the lymph plexuses and lymph glands. Traumatism may play an important part in causation as when vegetable barbs, awns, chaff or seeds, or strong hairs or bristles enter the open mouths of the mucous follicles, or the tonsillar cavities. Similarly trouble may arise from scratches by tough, fibrous fodder, from pricks by pointed or cutting instruments, by fractures of the hyoid, or by bruises by probangs, or tooth rasps. An overgrowth of the last molar, and a resulting wound and ulcer of the soft palate, and the presence of local deposits like those of glanders and actinomycosis, are other occasions of the entrance of the pus organisms. It will be recognized that this affection is not necessarily due to a difference in the infecting organism, but rather of the tissue involved, the microbes gaining the submucous tissues and expending their violence on these instead of confining their ravages to the surface layers of the mucosa. For this reason the deeper or phlegmonous affection may supervene on a catarrhal inflammation which may have already persisted for several days.
Symptoms. Beside the general phenomena of catarrhal pharyngitis, this form of the malady is characterized by a greater swelling and tenderness of the throat, extending from ear to ear, and from the trachea forward in the intermaxillary space; by nodular and painful swellings of the pharyngeal lymph glands, by the greater difficulty of deglutition, the muscular tissue being involved; by wheezing breathing amounting at times to violent roaring and threatened asphyxia. Perspiration on the throat, the ear, the side of the head or neck, of the fore arm, or of the dorsal region is not uncommon, and has been attributed to the compression of the vagus, or of the superior cervical ganglion of the sympathetic by the swelling. Fever usually runs higher than in simple catarrhal pharyngitis, which may be partly accounted for by the implication of the deeper and important structures but also in no small degree by the entrance into the circulation of the ptomaines and toxins, which in the catarrhal affection escape largely from the inflamed surface.
The resulting abscess is usually in or near a gland or group of lymph glands. The part passes through the usual succession of changes, of soft pitting swelling; firm, tense, painful condition in which the exuded lymph has coagulated; and softening and fluctuation which progresses from the centre toward the circumference. The abscess points variously according to its seat. If in the intermaxillary space it opens externally. If sub-parotidean or peripharyngeal it may burst inwardly into the pharynx or outwardly through the skin. If supra-pharyngeal (retro-pharyngeal), it may be so thickly encapsulated in unyielding walls that it may remain long indolent and inactive becoming a cold or chronic abscess. When an abscess opens into the pharynx, there is a sudden and copious flow of pus by the nose, and it may be by the mouth and a simultaneous subsidence of the inflammation.
Among the complications of the affection are asphyxia, œdema glottidis; abscess of the guttural pouch; rupture of an abscess into the larynx, and the descent of pus into the lungs; the entrance of saliva and alimentary matters into the lungs; gangrenous pneumonia; pharyngeal fistula; pressure on the vagus and paralysis of the pharynx or larynx; secondary abscesses; septicæmia.
Lesions. Besides the general inflammatory lesions some rather remarkable ones have been observed. Fractured hyoid, dissection of the mucous from the muscular coat, by aliments, for nearly the whole length of the œsophagus (Brückmüller), purulent infiltration of the supra-pharyngeal muscles (Wakefield), ulceration of the pharyngeal or guttural sac mucosa, or even gangrene, purulent effusion in the tonsils, around the hypoglossal nerve, the lingual branch of the fifth, or the vagus, embolic inflammations, suppurations or gangrene of the bronchia, and implication of the lung tissue and pleura. Catarrhal enteritis and fatty liver and kidney are common.
Treatment. Beside the general measures advised for catarrhal pharyngitis, this type demands especially measures to moderate the intensity of the suffering, and when abscess appears inevitable to hasten its maturation. The first demand is met by hot fomentations persistently applied to the throat. This may be done by spongio-piline, or simply by well washed wool or cotton bound upon the throat and wet at frequent intervals with water rather hotter than the hand can bear. The addition of a little carbolic acid will secure at once some local anæsthesia and a measure of antisepsis. In warm weather the substitution of cold water has been resorted to with apparently good effect. If adopted it should be frequently removed so as to keep up the constant action of cold and moisture. These have been especially recommended in dogs injured by a tight or ill-fitting collar.
When suppuration appears imminent as shown by the dense, hard, circumscribed phlegmon, stimulating embrocations may be used to hasten its progress. Camphorated spirit is suitable for carnivora and sheep. It may be combined with tincture of cantharides for horses. For cattle and swine, oil of turpentine may be added, the three being used in equal proportions. A liniment of ammonia and oil may be used more or less frequently and energetically according to the relative thickness and insensibility of the skin of the animal affected.
When matter has formed and fluctuates, it should be at once evacuated and the cavity treated by antiseptic dressings. In this way secondary abscesses, septic infections, molecular ulcerations and other injurious sequelæ may be largely obviated.
In case of threatened asphyxia the dernier resort of tracheotomy is always available, and this often acts very favorably in improving the æration of the blood, in restoring the flagging vital functions which depend on hæmatosis, and in removing the friction and irritation consequent on the passage of air through the narrowed and tender passages.