SllfP i. B. im iOibrarg Nortl? (EaroUna ^talF This book was presented by MILTON M. LEONARD, D.V.M. TO THE VETERINARY MEDICAL LIBRARY This book IS due on the date indicated below and is subject to an overdue nneas posted at the circulation desk EXCEPTION: Date due will be earlier if this item is RECALLED. 200M/09-98-981815 A ' TEXT-BOOK OF GENERAL THERAPEUTICS FOR VETERINARIANS BY EUGEN FROHNER AUTHORIZED TRANSLATION FROM THE FOURTH REVISED GERMAN EDITION BY LOUIS A. KLEIN PROFESSOR OF PHARMACOLOGY AND VETERINARY HYGIENE IN THE SCHOOL OF VETERINAaV MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA, AND DEAN OF THE FACULTY PHILADELPHIA & LONDON J. B. LIPPINCOTT COMPANY Copyright, 1914, by J. B. Lippincott Com pant PRINTED BY J. B. LIPPINCOTT COMPANY AT THE WASHINGTON SQUARE PRESS PHILADELPHIA, U. S. A. TRANSLATOR'S PREFACE The popularity of Frohner's General Therapeutics among veterinarians to whom it is accessible in German and the lack of a smiilar work in English suggested this translation, which it is hoped will prove equally as serviceable to American and English veterinarians. A few additions which have been made to the text, most of them of an explanatory character, have been placed between brackets ([]). The German regulations governing dis- infection for the different infectious diseases have been included in the translation; while they do not have the force of law in this country, the methods they describe, with some allowance for differ- ences in conditions, are also applicable here. The etymological footnotes explaining the derivation of the terms referring to therapeutic action have been omitted. In the descriptions of the therapeutic uses of the individual drugs, the names used in the United States Pharmacopoeia and in the United States Dispensa- tory have been employed, and these have been followed, wherever it seemed desirable, by the common or English name. Non- official drugs are indicated by an asterisk (*). Doses are given in the metric system, as in the original, with the equivalent in the apothecaries' system. Louis A. Klein. Philadelphia, July, 1914. PREFACE TO THE FOURTH EDITION In the new edition of General Therapeutics the chapters on chemotherapy, protective vaccination, and disinfection have been rewritten. The "therapia sterilisans magna" of EhrUch has become of great importance to veterinarians, although at the beginning of its introduction the judgment concerning it was too optimistic (contagious pneumonia!). Considerable development has also occurred in the last ten years in the field of protective vaccination. The more complete vaccination statistics now available make pos- sible a more exact judgment concerning the value or worthlessness of the different immune sera. More recent observations have compelled a partial modification of our views in regard to disinfec- tion; this is especially true in respect to preliminary disinfection and its relation to cleaning. The new German veterinary sanitary- law has been included in the revision. The reader will also find numerous changes and improvements in other chapters. E. Frohner. Berlin. PREFACE TO THE FIRST EDITION After I had written special text-books on Pharmacology, including pharmacognosy and pharmaceutical chemistry, on Pre- scription Writing, and on Toxicology, there remained as a final task, in my restricted department of instruction. General Thera- peutics. The present book is therefore a supplemental and con- cluding volume to the first three. The presentation of the fundamentals of general therapeutics will always remain a difficult undertaking. No department of medicine undergoes such frequent changes in methods and opinions as therapeutics. A permanent system of general therapeutics cannot be set forth, especially in our own day, in which great changes have occurred in the domain of general pathology, the for- mer absolute domination of the cellular pathology being to some extent shaken by the developments in serum therapy and the old humoral pathology again appearing in the scheme. On the con- trary, the discussion must rather be limited to a presentation and interpretation of the present status of the knowledge concerning the subject. This applies especially to the two modem questions of the day in general therapeutics, — namely, disinfection and vac- cination. But there are several other questions which at this time have not been definitely settled; for instance, the nature of the antipyretic, diuretic, expectorant, cholagogue, and derivative actions. To find the correct middle ground in the midst of all this uncertainty is not easy. If there is in anything an imminent temptation to present an extreme optimistic or pessimistic con- ception, it is certainly the case with general therapeutics. At any rate, it is always commendable in a text-book prepared for students and young veterinarians to accept the positive rather than the negative stand-point in doubtful cases. To fill a studious young man at the outset with nihilistic views concerning the efficacy of this or that therapeutic method appears to me to be more hazard- ous than if one in good faith presented some particular curative system perhaps in a somewhat too optimistic light. There will be an opportunity in practice later to test everything and to retain the best. But if the practitioner, on account of preconceived opinions brought with him from school, excludes one and another curative viii PREFACE TO THE FIRST EDITION method from this test, there will necessarily result a narrowness in therapeutic methods. A second difficulty in the preparation of a text-book on general therapeutics is the abundance of material. One must here choose between a broad, voluminous discussion or a short, concise pres- entation. I am fully aware of the advantages and disadvantages of the two plans. I decided that this book should be as concise as possible, because, for one reason, among others, we already have in our veterinary literature a large and valuable text-book on therapeutics (Ellenberger), in which the assistance of nature in healing and the history of therapeutics especially are given a large amount of space. Therefore, I have limited my discussion of the subject to a presentation of artificial assistance. There are yet to be subjoined some observations concerning the relations between veterinary curative methods and those of human medicine. There can be no doubt that in veterinary medicine we have derived very many, if not the most, of our therapeutic con- ceptions from human medicine. But it may not also be known that there are several curative methods peculiar to veterinary medicine, as, for instance, blisters, the actual cautery, lactagogues and ruminatorics; and that some methods, as vaccination and dis- infection, are much more extensively employed in veterinary than in human medicine. The prophylactic measures also show, as is well known, a greater stage of development, especially in reference to combating epidemics (sanitary laws), in the domain of veterinary medicine than in that of human medicine, in which in our day preparations were first made for the formulation of sani- tary laws. On the other hand, different highly developed curative methods in human medicine can never obtain practical considera- tion in veterinary medicine, — for example, pneumotherapy, bal- neotherapy, climatotherapy, mechanotherapy, orthopaedics, sug- gestive therapy, etc. Those who are interested in these subjects must be referred to the text-books on General Therapeutics by Ziemssen, A. Hoffman, and others. Finally, in justification of the introduction of the numerous etymological footnotes into the book, I may remark that on account of the strangeness of many of the therapeutic terms a short explanation seemed to me to be necessary in the interest of students. Beelix. E. Frohneb. CONTENTS PAQB Introduction 1 The History op Therapeutics 9 1. Hippocrates 10 2. Galen 12 3. Paracelsus 14 4. Boerhaave I7 5. Brovra 18 6. Rademacher I9 7. The Homoeopathy of Hahnemann 19 8. The Cellular Pathology of Virchow 21 9. The Serum Therapy of von Behring 22 10. The Chemotherapy of Ehrlich 23 General Therapeutics of the Diseases of the Organs op Digestion 25 I, General Therapeutics of the Diseases of the Stomach 25 1. Dietetic Treatment 29 2. Medicines. (Stomach Remedies. Stomachics) 29 3. Mechanical Treatment 33 4. Operative Treatment 34 II. Emetics 34 III. General Therapeutics of the Diseases op the Intestines 38 1. Dietetic Treatment 40 2. Cathartics. Laxatives 40 3. Constipating Remedies. Styptics 48 4. Mechanical and Operative Treatment 51 IV. General Therapeutics of the Diseases of the Liver ... 52 1. Cholagogues. Stimulants to Bile Secretion 54 2. Dietetic and Mechanical Methods 55 General Therapeutics of the Diseases of the Organs of Circu- lation 56 I. General Therapeutics of the Diseases of the Heart. . . 56 Cardiacs. Heart Remedies 57 ix X CONTENTS II. General THEBAPEtmcs of the Diseases op the Blood ... 60 Dietetic Method. Blood-forming Remedies. Blood Plastics . 63 III. General Therapeutics of the Diseases of the Blood- vessels 64 1. Methods of Arresting Hemorrhage 66 2. Vasomotor Stimulants. Drugs that Contract Blood- vessels 71 3. Vasodilators. Agents that Dilate Blood-vessels 72 IV. General Therapeutics op the Exudates and Transudates. Resorbents 73 Resorbing Medicines. Resorbents 76 General Therapeutics of Fever 80 Medical Antip3Tetics 84 General Therapeutics of the Diseases of the Nervous System . . 88 Drugs Acting on the Nerves. Neurotics. Nervines 90 1. Stimulants to the Nervous System. Excitants 93 2. Drugs that Calm the Nerves. Sedatives 97 3. Narcosis and Anaesthesia 101 General Therapeutics op the Diseases of the Respiratory Appa- ratus 103 Expectorants 107 General Therapeutics of the Diseases of the Urinary Organs. 112 Diuretics 113 General Therapeutics of the Diseases op the Genital Organs. 118 1. Ecbolics. Abortives 119 2. Drugs that Stimulate the Sexual Impulse. Aphrodisiacs 120 3. Drugs that Depress the Sexual Impulse. Anaphrodisiacs. . . . 121 4. Drugs that Increase Milk Secretion. Galactagogues 122 5. Drugs that Depress Milk Secretion. Antigalactagogues. ... 127 General Therapeutics of the Glands (Diaphoretics and Siala- GOGUES) 128 1. Drugs that Stimulate the Secretion of Sweat. Diaphoretics . 129 2. Drugs that Stimulate the Secretion of Saliva. Sialagogues. . 131 General Therapeutics of the Diseases of Metabolism 133 1. Plastic Remedies. Plastics 134 2. Nutrients. Roborants 137 3. Reducing Remedies. Antiplastics 138 CONTENTS xi General Therapeutics op Diseases of the Eye 141 1. Pupil-dilating Remedies. Mydriatics 141 2. Pupil-contracting Remedies. Myotics 142 General Therapeutics of the Skin and Mucous Membranes .... 143 1. General Therapeutics of the Diseases of the Skin 144 2. Cutaneous Irritants. Aeries 146 3. Caustics 152 4. Firing. Cauterization 156 5. Astringents 157 Drugs that Kill Parasites. Antiparasitics 160 1. External Antiparasitics. Antepizoa 160 2. Worm Remedies. Anthelmintics 165 Disinfectants. Antiseptics 169 1. Disinfection in General 169 2. Disinfection for Infectious Animal Diseases 183 I. Supplement A to the Instructions of the Federal Council, December 25, 1911 (Disinfection in Infec- tious Diseases) 184 II. The Most Important Disinfectants for Animal Infections 201 3. Disinfection of Wounds 209 4. Internal Antiseptics 213 5. The Conservation of Animal Products 214 Antidotes 216 Vaccination. Immunization. Inoculation 225 1. Immunity, Mitigation, and Methods of Inoculation 225 2. The Different Varieties of Vaccination 235 I. Protective Vaccination 236 Veterinary Police Regulations Concerning Vaccina- tion 237 Protective Vaccination for the Different Animal Infections 237 II. Curative Vaccination 252 III. Diagnostic Inoculation 254 Water as a Remedy. Hydrotherapy 265 Massage 276 Electricity as a Remedy. Electrotherapy 282 xii CONTENTS Bleeding 286 General Therapeutics of the Organs of Locomotion (Muscles, Tendons, Nerves, Articulations, Bones) 288 Indifferent Remedies. Mechanicals 290 1. Protectives 290 2. EmoUients 291 3. aeansing Remedies 292 Air as a Remedy 295 Index 297 TEXT-BOOK OF GENERAL THERAPEUTICS FOR VETERINARIANS INTRODUCTION Natural and Artificial Healing. — In the healing of disease two possibilities are to be considered. The disease is healed by the curative forces of nature without the assistance of medicines (natural healing), or artificial — i.e., medical — healing processes are necessary (artificial healing). Whether a disease can be left to nature's powers or whether medical treatment is expedient or neces- sary is the question which the therapeutist must first consider carefully in every case. What may be healed by nature? What may be healed by medical treatment? To these questions may be added a third: What is usually incurable? 1. What May be Healed by Nature?— The answer to this question may be based upon clinical observations and experi- mental investigations in general surgery and pathology. In sur- gery as well as in pathology it has been demonstrated repeatedly that the natural healing force and the regenerative capacity of the individual tissue cells and organs are extraordinarily great. The spontaneous healing of wounds and fractures of bones, the reactive protective processes of the body in inflammation (local leucocy- tosis) and in fever (general leucocytosis), the spontaneous checking of hemorrhage, the organization of a thrombus, the encapsulation of purulent areas and of foreign bodies, the restoration of epi- thelium and of nerve-fibres, the formation of anastomoses, anky- loses (spavin, ring bone), and nearthroses, the throwing off of gan- grenous parts, the resorption processes in pneumonia and pleurisy, the compensatory processes of the heart, kidneys, liver, and lungs, the spontaneous healing and natural immunity of the infectious 1 2 INTRODUCTION diseases (aphthous fever, strangles, influenza, contagious pneu- monia), the spontaneous recoveries from colic in numerous cases, and many other natural healing and corrective processes verify this statement. A clear insight into the nature of spontaneous healing is afforded by a study of the processes of inflammation. While the inflam- matory changes were formerly regarded as harmful and were com- bated with remedies that reduce inflammation, especially cold, it is now known that inflammation is a healing reaction and should not be opposed but favored. Just as fever, pain, cough, vomiting, diarrhoea, and other disease phenomena exert a natural healing tendency in removing and combating the cause of disease, so do the processes attending inflammation constitute a natural elimi- native and healing process. The dilation and hypersemia of the vessels; the change in the capillary walls by which they become permeable; the out-wandering of the white blood-cells (local leucocjrtosis) and the exudation of blood-plasma into the tissues; the removal of endotoxins from the inflamed area by phagocy- tosis; the proliferation of the autochthonous connective-tissue cells; the liquefaction and resolution of the solid inflammatory products by enzymes (lysins) ; the occurrence of toxin-binding, neu- tralizing antitoxins, of bacteria-destroying humoral and leucocytic bactericides (bacteriolysins), of bacteria-clumping agglutinins, and of opsonins which prepare the bacteria to be taken up by phagocy- tosis; the leucocytosis of the blood (lymphocytes, neutrophiles, eosinophile leucocytes); positive and negative chemotaxis; the regeneration of the injured tissue-cells by increased growth of cells; proliferation of tissues and capsule formation— all these are nothing more than protective and healing processes directed against the causes of disease, especially bacteria, and to the regener- ation of the injured tissue, such regeneration occurring in living, healthy animal bodies through the adaptability and reproductive powers of the cells. These natural eliminative and regenerative processes should not be disturbed by improper treatment, but should be regarded as natural healing processes and not only favored but even stimulated under certain circumstances. INTRODUCTION 2. What May be Healed ArtificiaUy?— The problem of artificial assistance consists above all in supporting, promoting, and acceler- ating the natural healing processes. Natura sanat medicus curat. Disinfected, ligatured, and bandaged wounds, reduced bone frac- tures, and incised abscesses heal better and more rapidly than when left entirely to nature's efforts. This is also true of the artificial removal of fluid exudates (hydrothorax, ascites, acute hydro- cephalus, laminitis), and of the medicinal treatment of heart weak- ness and dangerously high fever, pulmonary congestion, cerebral hypersemia (phlebotomy), and numerous other diseases. In many cases natural healing entirely fails to remove the dis- ease. Then it is only curable through artificial methods. Sur- gery and obstetrics are especially rich in examples of this kind. To this class of cases belong most of the neoplasms and parasitic diseases, especially mange, deviations in the position of the foetus and of the gravid uterus, invaginations and incarcerations of the intestines, herniae and prolapses, ulcers and fistula?, urinary calculi, foreign bodies in the stomach and intestines, tympanites of the rumen and intestines, wounds of the carotid artery, etc. 3. What is Incurable?— The answer to this question will depend upon the present extent of medical knowledge. There is a large number of diseased conditions which are incurable in spite of all discoveries and therapeutic progress, and which will probably remain so in the future. A dead tissue or organ cannot be replaced in its original form. Incurable also are atrophic conditions, chronic hydrocephalus, chronic interstitial nephritis and hepatitis, ankyloses, many neoplasms in internal organs, fractures of the cer- vical, dorsal, and lumbar vertebras, atrophy of the optic nerve, detachment of the retina, emphysema of the lungs, progressive atrophy of the posterior crico-arytenoid muscle (roaring), general- ized carcinomatosis, sarcomatosis, tuberculosis, and actinomycosis, echinococcus disease, glanders, and rabies. In the large domestic animals (horses, cattle) fractures of the upper bones of the extrem- ities, severe pelvic fractures, purulent inflammation of the large joints, and perforating wounds of the intestines are, as a rule, incurable. Many diseased conditions are curable in man that are 4 INTRODUCTION incurable in animals, because in the treatment of animals the external conditions necessary to healing are not obtainable in the same degree as in the treatment of man. For instance, many bone fractures in horses and cattle are incurable because a fixation dress- ing cannot be applied to the part affected. Some operations can not be performed on large animals because of the difficulty of main- taining asepsis. Furthermore, the task of the veterinarian is essentially different from that of the physician. Frequently, the purpose of veterinary therapeutics is not the healing of disease, but to make the animal serviceable. A horse with an ampu- tated leg is, indeed, healed, but is not serviceable. Neurectomy, on the other hand, does not heal ring bone or spavin, but it makes the horse again serviceable. Even economical considera- tions (value of the animal, time required for treatment) often govern the veterinary therapeutist. Remedies and Medicines. — The remedies which may be used in the treatment of disease are numerous and various. The term remedy does not signify the same thing as medicine or drug; the latter is only a special form of the former. There is not always, as is frequently incorrectly assumed by the laity, a sharp contrast between medical and drugless treatment (so-called natural method). On the contrary, the same therapeutic effect produced by drugs may frequently be obtained from other, non-medical remedies, — e.g., through mechanical methods. In general, dietetic, chemical (medicines), mechanical (massage, hydrotherapy), thermic (heat, cold), electrical (electrotherapy), and operative measures are to be considered as therapeutic remedies. Also of importance as healing factors are rest, movement, and exercise. Disinfection, inocula- tion, and sanitary police regulations are of especial value in com- bating infectious diseases. If, after the use of this or that therapeutic measure, the disease is cured, this is not in itself proof that the treatment applied was the cause of the cure. Post hoc is not propter hoc. On the contrary, every recovery should be considered candidly and objectively to determine what share in the cure is to be credited to the healing powers of nature and what part was played by the therapeutic INTRODUCTION 5 measures employed. The observance of this rule is very neces- sary, especially in veterinary therapeutics. Fallacious, speculative conclusions from meagre casuistic material, and unjustifiable com- mendation and overrating of new remedies are in veterinary medi- cine almost more common than in human medicine. Healing Methods. — General therapeutics differs considerably from special therapeutics and pharmacology. The latter con- siders in a detailed manner the actions and uses of the individual medicines in the different diseases. General therapeutics em- braces the different views concerning the treatment of diseases and the action of remedies in general. Out of the sum of indi- vidual observations it constructs certain general rules and laws, on which are based the employment and systematic grouping of the curative agents. Such a consideration of the healing agents naturally leads to the formulation of the so-called healing methods. General therapeutics can therefore be defined as the study of the healing methods. The number of healing methods has been large from the remotest times. From an entirely general standpoint there are usually distinguished as special healing methods the direct, indirect, and derivative, the local and general, the causal, radical, and symp- tomatic, the empirical, statistical, rational, and physiological, and the prophylactic, expective, abortive, and vital. Concerning the nature of these methods, the following may be stated: 1. The direct healing method consists in the direct or imme- diate application of the remedy to the disease (indicatio morbi). A direct therapeutic process, for example, is the employment of antiseptics, antiparasitics, and antidotes — the bacteria, parasites, and poisons concerned being directly influenced. Other- examples are the use of caustics and many operations (extirpation of tumors, removal of foreign bodies). 2. The indirect healing method attacks the disease through the medium of the circulation and the nervous system. It is, therefore, also called the general method. This method includes the dietetic medicines, which influence disease through nutrition and metab- olism; the resorbents and derivatives, which act through the 6 INTRODUCTION circulation; and cutaneous irritation, which operates reflexly through the nervous system upon the distant disease process. The derivative action is also regarded as an independent healing method. This action can be attained through the operation of cutaneous stimulation, cathartics, diuretics, diaphoretics, sialagogues, and bleeding. By far the greater number of cases of all diseases are treated by the indirect method, because only in isolated cases can the therapeutic measures be applied directly to the disease. 3. The causal method attacks not the disease itself but the cause, e.g., in the infectious diseases, the bacteria; in poisonings, the poison. To this extent it agrees with the direct method. With reference to its value, it must be observed that the removal of the cause is only possible in certain diseases (surgical measures, anti- sepsis, antiparasitics, antidotes, emetics, cathartics). Further- more, after the removal of the cause the disease frequently does not cease, e.g., rheumatic diseases after the removal of the cold irritant; and finally, in many diseases the cause is either not acces- sible (distomatosis, echinococci) or is not known (ultra visible virus, epilepsy, diabetes mellitus). 4. The radical method is directed against the root or source of the disease and not merely to the removal of the associated dis- turbances. As the definition indicates, the radical method is related partly to the causal and partly to the direct (local) method. Goitre and actinomycosis may be treated indirectly through the medium of the blood stream with iodine. The radical method consists in the operative removal of the diseased parts. In a simi- lar manner are herniae and urinary calculi treated radically, — i.e., by operation. Unfortunately, there are only a small number of diseases in which complete restoration can be attained by the radical method. 5. The symptomatic or palliative method is directed against neither the cause of the disease nor the disease itself, but only against the symptoms of the disease. In the infectious diseases, for example, the fever is treated, in laryngeal catarrh the cough, in gastric catarrh the vomiting, in intestinal catarrh the diarrhoea, in brain diseases the psychic excitement and convulsions, in lameness INTRODUCTION 7 the pain (neurotomy). Practical experience teaches that in very many cases treatment must be confined to this method. 6. The rational or physiological method is based upon scientific observations and experimental investigations of the cause, nature, and pathogenesis of the different diseases, and the action of the individual medicines. The therapeutist seeks to explain scientifi- cally the action of his remedies upon the basis of the contempo- raneous knowledge of therapeutics. Inflanmaation and the infec- tious diseases, for instance, are caused by the action of micro- organisms and are therefore treated with antiseptics; the diseases of the heart with drugs whose physiological action upon the heart has been exactly investigated (digitalis). 7. The empirical healing method is, in contradistinction to the rational, based upon practical experience only, without the nature of the disease and the action of the remedies being considered scientifically in connection with each other. This method includes the former common emplojmient of potassium nitrate, calomel, phlebotomy, and the other so-called antiphlogistics in the inflam- matory diseases. It should be the endeavor of scientific thera- peutics to extend the rational method more and more and to reduce empiricism. On the other hand, it must not be overlooked that our knowledge of the nature of disease and of the action of healing remedies is not yet so complete that the empirical method can be dispensed with entirely. Furthermore, many valuable thera- peutic measures, which are at this time regarded as rational, were discovered in a purely empirical manner (massage, hydrotherapy, folk-medicines). The statistical healing method is in a certain sense a subdivision of the empirical. It is based upon the statis- tical demonstration of the effectiveness of a remedy or a cure. 8. The expectant or waiting method leaves the mastery of the disease to the healing powers of nature and resorts to medication only when the automatic regulation of the body fails. It conforms in part to the dietetic method, and is very properly practised more in recent times than formerly. Especially in the infectious dis- eases with a typical course (influenza, contagious pneumonia, strangles, foot-and-mouth disease) is therapeutic interference 8 INTRODUCTION indicated only when certain abnormal complications appear (very- high fever, heart weakness, diarrhoea, etc.). The same principle also applies to catarrh of the upper air-passages, gastric catarrh, intestinal catarrh, and to numerous surgical conditions (distor- tions, tendinitis, spavin, etc.)- 9. The prophylactic method is, strictly speaking, not a curative method, but a process of preventing the occurrence of disease and its extension to healthy animals. Nevertheless, it is of great impor- tance ("Prevention is better than cure"). It consists in attention to hygiene, dietetics, rational breeding and feeding, disinfection, and the sanitary police measures for controlling disease. 10. The abortive method combats disease in its initial or for- mative stage. Emetics and calomel appear to have an abortive effect against certain infectious diseases (canine distemper, swine erysipelas) in consequence of their action in removing the cause of the infection from the body. In poisonings an abortive cure can be spoken of in the same sense. This is also true of arecoline and phlebotomy in laminitis and in cerebral inflammation, likewise of amputation of the tail in tetanus resulting from infection of a wound in the tail. On the other hand, the claim that contagious pneumonia of horses is influenced by the intravenous injection of salvarsan, in the sense that inflammation of the lungs does not develop or that complications and secondary diseases do not occur, does not appear to have been proved. 11. The conservative method aims at the greatest possible con- servation of the diseased organ. In veterinary surgery it has a certain importance (preservation of cutaneous flaps in abraded wounds and also in wounds of the wings of the nostrils and of the eyelids). 12. The vital method (vital cure, indicatio vitalis) concerns itself with the preservation of life when it is suddenly threatened in the course of a disease. It is really a symptomatic method (trache- otomy in pharyngitis and oedema of the glottis; bleeding in oedema of the lungs; puncture of the pleural cavity, peritoneal cavity, the rumen, intestines, and bladder when collections of fluids or gas threaten life). THE HISTORY OF THERAPEUTICS The history of therapeutics, or medicine, extends far back into the remotest antiquity. The earUest traditions are derived from Indian (Upavedas, Agurveda, Susrutah des Dramoantari), Egyptian (Isis, Osiris, Horus, Harpocrates, priest medicine), and Hebraic (Moses, Levites, prophets, Essenes) hterature. Very old also is the Chinese medicine (Ching de chung Ching). But the real scientific therapeutics begins only with the Greeks, with an introductory period which may be designated as the philo- sophical (Thales of Miletus, Pythagoras, Alcma3on, Empedocles, Anaxagoras, Democritus). The Grecian medicine was also in the beginning a "priest medicine." The so-called Asclepiadse were associations of priests, purported to be founded by ^sculapius the god of medicine, who held temple-polyclinics in which they prac- tised their secret medical art, which was transmitted by oral com- munication. Out of one of these temples of Asclepiadse at Cos came Hippocrates (400 B.C.), the founder of Grecian medicine. His teachings, the humoral pathology, entirely dominated Grecian and later also Roman medicine; its influence extended even through the middle ages into modem times (sixteenth and seventeenth cen- turies). The writings of Galen (131-200 a.d.), which were regarded as medical dogma of Biblical authority throughout the entire middle ages, a period of not less than fifteen hundred years, are nothing more than an amalgamation of the medicine of Hippoc- rates with the philosophy of Plato. The Arabian school (900- 1000 A.D.) introduced by Rhazes and Avicenna, and the so-called Monks' medicine, especially the school at Salerno (about 1100 A.D.), were also founded upon the teachings of Hippocrates. The Arabian school also included the new factors of alchemy and spiritualism. In the sixteenth century, Paracelsus (1493-1541) began the actual reformation of the Galenic and Hippocratic teachings. Believing chemistry to be the basis of therapeutics, he created his 10 GENERAL THERAPEUTICS FOR VETERINARIANS system of chemiatrics or iatrochemistry, but, as he was strongly under the influence of the spirituaUsm of the Arabian school, his ideas in part acquired a mysticism. The scientific foundation of modem therapeutics was laid in the period from the sixteenth to the eighteenth century by exact anatomical, pathological, phys- iological, and clinical-pharmacological investigations. Prominent in this work were VesaUus (1514-1564), Fallopius (1523-1562), Malpighi (1628-1694), the founder of modern anatomy and his- tology; Morgagni (1682-1771), the creatorof pathological anatomy; Harvey (1578-1657), the discoverer of the circulation of the blood and founder of physiology; Ambroise Par6 (1517-1590), the reformer of surgery, and Sydenham (1624-1689), the master of practical clinical medicine. A special position in the modem history of therapeutics is held by Boerhaave (1668-1738), the founder of the modem humoral pathology (haematopathology) ; Brown (1735-1788), the author of Brownianism; Rademacher (1772-1849), the author of the experi- ence or empirical method; Hahnemann (1755-1843), the father of homoeopathy, and also several discoverers of natural healing methods, especially Huf eland (1762-1836), Schonlein (1794-1864), and Priessnitz (1799-1851). The history of modem therapeutics in the nineteenth and twen- tieth centuries lacks the prominent, central character of former periods, because it consists of the special history of the several branches into which medicine has been divided. Of general cura- tive methods, only three are of importance : the cellular therapy of Virchow, the senmi therapy of von Behring, and the chemotherapy of Ehrlich. The first locates the disease and also the healing powers in the cells, the second uses the therapeutic action of the immune bodies of the blood-serum (antitoxins), and the third treats certain infectious diseases (protozoa, trypanosomes, spirilla) with specific chemical substances. 1. HIPPOCRATES Biographical. — Hippocrates was bom in the year 460 B.C., on the island of Cos, in Asia Minor, the son of HeracUdes, one of the HISTORY OF THERAPEUTICS 11 AsclepiadsB and a teacher in the medical temple school at Cos. He was a contemporary of Pericles. He travelled in Asia Minor, Greece, Scythia, and Lybia and resided subsequently in Thes- saly, where he died in Larissa in 364 (375?). He published the medical secrets of the priests of the Asclepiadae and his own experiences in several books (Aphorisms, Prognostics, Epidem- ics, Treatment of Inflammatory Diseases, Wounds of the Head, Herniae). His expression, " Life is short, art is long, oppor- tunity fleeting, experience deceptive, judgment difficult," is well known. The Theory of Hippocrates. — The humoral pathology of Hippoc- rates attributed all diseases to changes in the fluids of the body. The body contained four cardinal fluids or humors : the blood, the mucus, the yellow and the black bile. The normal mixture of these four fluids (i.e., health) is the crasia, while an unequal mixture generates disease, or dyscrasia. The problem of therapeutics is to change dyscrasia into crasia. This can be accomplished in three ways: 1, by removal of the superfluous fluid, — e.g., of the blood by phlebotomy, of the bile by cholagogues, of mucus by drugs that increase the secretion of mucus (derivative, depletive method) ; 2, by altering or rendering harmless the superfluous fluid in the body by cooking, ripening, or transforming, — pepsis, coctio, maturatio, alteratio (alterative method); 3, by restoring deficient cardinal fluids (dietetic method). In addition to the crasia theory, Hippocrates also formulated a crisis theory. According to this latter theory the fever reaches the crisis or turning point on certain so-called critical days. The seventh day especially was regarded as the critical day and as the proper time for therapeutic interference. Depleting drugs espe- cially were administered on these days to increase the critical elimi- nations. Cathartics and emetics, especially the vegetable drastics (veratrum, cuphorbium, daphne), were used for their derivative action. Phlebotomy was employed to reduce fever only in strong and full-blooded individuals. In addition to the external reme- dies, he assumed the presence of an internal, primitive healing force which induces the crisis. 12 GENERAL THERAPEUTICS FOR VETERINARIANS Aristotle, also of a family of Asclepiadae; lived from 384 to 322 B.C.; was teacher of Alexander the Great; pupil of Plato; founder of natural history and comparative anatomy; teacher of the elementary qualities; discovered the nerves and gave the aorta its name. Herophilus and Erasistratus, celebrated anatomists of the Alexandrine school (time of the Ptolemies). Herophilus discovered the sensibility of the nerves, the finer anatomy of the eye, distinguished between systole and diastole, and named the duodenum. Erasistratus discovered the lymph- vessels and healed liver abscesses by operative incision. 2. GALEN Biographical. — Claudius Galenus was born in Pergamos, 131 A.D., during the reign of the Emperor Hadrian. He was the son of a builder. After pursuing a course of study in philosophy, he studied four years in the school of the Pergamonic physicians. He then visited Smyrna and Corinth, Asia Minor and Palestine, and finally the at that time celebrated medical school at Alexandria, where anatomy especially had flourished from ancient times and where alone the dissection of the human body was permitted. In addition, toxicology was there thoroughly taught. Poisons and antidotes at that time formed the chief part of pharmacology. Returning to Pergamos in 159, he was appointed physician to the gladiators. In 165 he received an appointment under the Emperor Marcus Aurelius in Rome, where he gave lectures on physiology and prepared the royal electuary, a mixture of 62 drugs. The prescrip- tion was written by Andromachos, the physician of Emperor Nero, and was obtained from the Alexandria school. In 180 Galen was the physician of Emperor Commodus, and in 193 of Emperor Sep- timius Severus. He died in the year 200 a.d. His numerous writ- ings, in all about 500, were destroyed in great part through the burning of the Temple of Peace in the reign of Commodus. Eighty- three medical works were preserved, among them the A\Titings on "Healing Methods," "Critical Days," "Functions of the Parts of the Human Body," "Combination and Force of the Simple Medi- cines," and "Differentiation of the Different Varieties of Pulse." The teachings of Galen were later acknowledged even by the church; doubt of their correctness was regarded as sacrilege. His HISTORY OF THERAPEUTICS 13 dogmas received a consideration only equalled by that given to the Bible, and because of this were a serious hindrance to the develop- ment of medicine for the succeeding fifteen hundred years. When the students of medicine explained that dissection was necessary to discover the errors of Galen, the church forbade the opening of human bodies and stated that Galen never could have erred and that dissections were therefore not only unnecessary but would be reprehensible. Pergamos, his native city, had golden medals struck in honor of Galen, and he was for other reasons well aware of his position, as is shown by the following statement: "Hippocrates indeed had made something of a track and broken the path, but I have smoothed it and made it passable, as Emperor Trajan did with the military roads in the Roman Empire. " The Galenic Theory.— The humoral pathology of Hippocrates, with its four cardinal fluids and the crasis and crisis theories, was the nucleus of the Galenic system of medicine. In addition to dys- crasia, Galen regarded as causes of disease changes in the so-called elementary qualities (heat, cold, dryness, and moisture). Natural, primary forces of the body were attraction, adhesion, secretion (apocritical), and ehmination. He assumed that every medicine possessed specific elementary qualities. In his anatomical and physiological studies he came very close to the discovery of the cir- culation of the blood. He was convinced that respiration served to maintain the body heat; he compared the respiration with combustion and contended that the flame and animal life were supported by the same constituents of the atmosphere. These constituents he called "air spirits," and, after they were taken into the blood, "life spirits" (spiritus vitalis). Fever was an unnatural change in the temperature. The lightest form of fever, the "ephemeral," occurred when only the "air spirits" were embarrassed. If the blood and fluids were affected, there arose "septic" or putrid fever. When the heart and solid parts of the body became hot, then the fever was "hectical." A fever continuing one day was due to mucus; three days, to yellow bile; four days, to black bile. 14 GENERAL THERAPEUTICS FOR VETERINARIANS Arabian Medicine. — Ita foundation was the theories of Hippocrates and Galen. Added to these were the new elements of chemistry and pharmacy. As alchemists, the Arabian physicians discovered analysis, synthesis, distil- lation, sublimation, precipitation, preparation of salts, and the manufacture of alcohol. They were also beUevers in spiritualism, and considered mcdi- cLues as the bearers of a spirit, to which their power was due. The most celebrated Arabian physicians were Rhazes (923 a.d.) and Avicenna (978 a.d.). Rhazes was first a teacher of medicine and philosophy in Bagdad, later director of the lazaretto in Ray. His works were: "On the HeaUng of Diseases," "Aphorisms," and "Antidotes." They contain the earhest discussion of smallpox. Medicines mentioned are: mercurial preparations, copper sul- phate, arsenic, nitrate of potash. Avicenna, a native of Bokhara, studied in Bagdad, was private physician to the prince of Ray and later Vizier in Hamadan. On account of an insurrection he fled to Ispahan, dressed as a monk. To his chief works he gave the name of "Canons"; they contained nearly everything concerning the entire subject of medicine and attained a wide circulation in Europe. His catalogue of medicines was very extensive (rhubarb, silver, gold, many plants). Monks' Medicine. — From the sixth to the axteenth centmy, a period of one thousand years, in Italy, Germany, France, and other countries of western Europe, medicine was almost exclusively in the hands of the monks, who conducted special medical schools. Of the latter the most celebrated was the school at Salerno, from the tenth to the thirteenth century, a NeapoUtan Benedictine cloister, where pharmacy, pharmacology, and dietetics especially were taught (Regimen sanitatis Salemi, Antidotariam minus, De simphci medicini, Eros). Another Neapolitan cloister school was the one at Monte Casino. In France, in the thirteenth century, was the school of Montpellier, which later developed into the University. 3. PARACELSUS Biographical. — Philippus Aureolus Theophrastus Bombastus ab Hohenheim, called Paracelsus, was born near Zurich in 1493, the son of a physician. He studied in Basel and travelled in ahnost all the countries of Europe. In 1527 he became professor of physics, medicine, and surgery in Basel and also city physician, but left there secretly a year later on account of differences with the munic- ipal authorities. After that he lived an unsettled, wandering life in a number of cities in Alsace, Bavaria, Wiirtemburg, Austria, Switzerland, and other lands, until, at the age of 48 years, he died in 1541, in Salzburg, where he was buried. Besides a large number HISTORY OF THERAPEUTICS 15 of philosophical and theosophical works he wrote numerous medical books. Of the latter the most important are: "Commentary on the Aphorisms of Hippocrates," the "Three Great Books on the Treatment of Wounds, " "The Hospital Book," the "Seven Books on Open Wounds," "Lectures on Wounds," "Minor Surgery," "The Bath of the Priests, " "Booklet on the Pestilence in the City of Stertzingen, " "On the Gout," "On Syphilis." Opinion con- cerning the influence of Paracelsus as a reformer of medicine was formerly very much divided. Disregarding his personal short- comings, with which his pupils especially reproached him, and his inclination toward mysticism, there can be no doubt that Para- celsus, by his thorough refutation of the crasia theory and humoral pathology of Hippocrates and Galen, and through his own new, chemiatric system, exerted a very great effect upon the develop- ment of medicine. The Theory of Paracelsus. — The so-called chemiatric, chemical or spagyrical system of Paracelsus was the first to associate the chemical properties of medicines with their action upon the body. He called these properties "virtue and force in medicines." In opposition to the humors and elementary substances of Galen, he attributed life and disease to organic processes within the body, and spoke of a "vita propria " of the organs. Chemistry, in his opinion, was the foundation of all therapeutics. We owe to him the intro- duction into the materia medica of several important chemicals, especially iron and its compounds, the preparations of antimony, sulphur, copper, zinc, and sodium nitrate. He also gave exact indications for the use of the mercurial preparations. His chief remedy was opium in the form of a tincture, called after him Tinc- tura Paracelsi. In place of the formerly exclusively used decoc- tions, he used tinctures, extracts, and essences. He also called attention to numerous chemical combinations that were incom- patible, and was the first to discuss the composition and action of mineral waters. His efforts in the domain of surgery were also con- siderable. He was the first to declare that the surgeon should also be a physician. Pus, he said, was a "natural balsam" which fav- ored cicatrization, and its healing action should not be interfered 16 GENERAL THERAPEUTICS FOR VETERINARIANS with by the excessive use of salves or plasters. In his philosophical writings two terms frequently occur which are used in modem natural science: macrocosmus and microcosmus. The first term, as he used it, indicated nature as a whole, the latter the separate individuals. Vesal. — Andreas Vesal (Vesalius), founder of modem anatomy, was bom in Brussels in 1514, but had to flee from Belgium on account of his activ-ity in anatomical work. He studied in Paris under Sylvius, held in Italy the posi- tion of demonstrator of anatomy, and in 1537 was called by the Republic of Venice to be professor of anatomy at Padua, after he had published his cele- brated work "De corporis humani Fabrica libri septem" in 1535. Subse- quently he was private physician to Karl V and Philip II in Madrid. Con- demned to death by the Spanish inquisition as a magician or conjurer, he was pardoned by PhiUp II to take a penitential journey, and died in 1564 on a pilgrimage to Jerusalem. Vesal opposed the theory of Galen, and demon- strated, among other things, that Galen's anatomy was founded upon the ape and not upon man. Fallopius. — Gabriel Fallopius, pupil and successor of Vesal, was born in Modena in 1523, and from 1547 on was professor of anatomy and surgery in Ferrara, Pisa, and Padua. He wrote " Observationes Anatomicse" in 1561 and discovered the Fallopian canals in the temporal bone. Malpighi. — Marcellus Malpighi, 1628-1694, discovered the capillary cir- culation and laid the foundations of the microscopical anatomy of animals and plants (Malpighian corpuscles of the kidneys). He was professor of anatomy in Bologna, Pisa, and Messina, and, at the time of his death, private physician to Pope Innocent XII. Morgagni. — Giambattista Morgagni, founder of pathological anatomy, pupil of Valsalva, born in Forli in 1682, was called in 1711 to the University at Padua to the chair formerly held by Vesal. Here he attracted numerous students from all lands, especially Germany. In 1761 he issued, in five books, his famous work: "De Sedibus et Causis Morborum." His name is a part of several anatomical terms (Morgagnian liquor between the lens and its capsule. Morgagnian cavity). He died in 1771, 89 years old. Harvey. — William Harvey, founder of physiology, pupil of Fabricius ab Aquapendente, born in Folkstone in 1578, elected professor of anatomy in London in 1615, discovered the circulation of the blood in 1628. He was the author of the conclusion "omne animal ex ovo," and showed that, contrary to Galen, the blood was not one of four fluids, but the only vital fluid ("humor cardinalis " ) . Ambroise Pare. — Ambroise Pare, founder of modem surgery and obstet- HISTORY OF THERAPEUTICS 17 tics, lived in Paris from 1517 to 1590, and became known through his use of ligatures on the blood-vessels in operations. Sydenham. — Thomas Sydenham, 1624 to 1689, physician in London, reformed practical clinical medicine, bringing it back to the methods of nature and of experience. Symptoms of diseases were regarded by him as the effort of nature to eliminate the disease materials. The tincture of opium was named after him Tinctura Sydenhami. 4. BOERHAAVE Biographical. — Herman Boerhaave was bom in the Netherlands in 1668, the son of a clergyman. He became professor of medicine, botany, and chemistry in Leyden, where he published his cele- brated works: " Institutiones medicae in usum annuae exercitionis" (1708) and "Aphorismi de cognoscendis et curandis morbus" (1709). In addition to these, he published the "Elementa chemiaB" (1718). He died in 1738. His best-known pupil was van Swieten (1700-1722), the private physician of the Empress Maria Theresa and the founder of the Vienna school. The System of Boerhaave. — Boerhaave can be regarded, to a certain extent, as the founder of the modern humoral pathology, since he pointed to the chemical changes in the composition of the blood as the cause and essence of disease. His humoral pathology is therefore a haemato-pathology. The treatment recommended by him was the removal from the blood of the injurious substances or irritants by means of cathartics, diuretics, disinfectants and resol- vents. He assumed the presence of different kinds of harmful irritants in the blood: acid, alkahne, salty, fatty and glutinous. In his opinion organic life consisted of motion. Fever he regarded as the effort of life to overcome death (compare the concurrence of this view with the modern idea that fever is a protective reaction against the infectious material) . Worthy of note also is his concep- tion of inflammation, which he regarded as a complete stasis of blood in the smaller vessels. F. Hoffmann. — Founder of the so-called iatromechanical or mechanico- dynamic school; bom in Halle 1660; professor in Halle 1694; private physician to King Frederic I and professor in Berlin 1708 to 1712; died in Halle in 1742. His name is preserved in the preparation introduced by birn known as "Hoff- mann's drops." 2 18 GENERAL THERAPEUTICS FOR VETERINARIANS Stahl. — Founder of the chemical phlogiston theory and the spiritual theory (principal work: Theoria medica vera, 1701); expective method of treatment. Bom in Ansbach in 1660, professor in Halle 1694; private physi- cian to King Frederic WiUiam I in BerUn 1716; died 1734, Stahl's ointment for bums and Stahl's pills perpetuate his name, Albrecht von Haller. — Physician, anatomist, physiologist, botanist, and poet. Discoverer of the irritability of the muscle fibres. Bom in Bern 1708; professor in Gottingen 1736; president of the Royal Society of the Sciences. Died in Bern 1777, 5. BROWN Biographical. — F. Brown was born in Bumbe,England, in 1735. At first a linen weaver, he later studied theology and medicine and was a physician in London. His principal work, " Elementa medi- cinae," was written in 1780. He died in London in 1788. His most celebrated follower was the Italian, Rasori (died 1837). Brown's Theory. — Brown was the fomider of the so-called Brownianism, which was in direct opposition to the humoral pa- thology and attributed all disease to a deficiency or excess of stim- uli or excitability. A medium degree of stimulation or excitability constituted health. Disease was due to either an increase of the excitability (sthenia) or a decrease (asthenia). Medicines also were sthenic, i.e., strengthening (alcohol, camphor, arnica), or asthenic, i.e., weakening (bleeding, hunger). The one-sided Brownian theory was later transformed by Roschlaub into the so- called ''stimulation theory" and by Rasori into the theory of "contra-stimulus" (irritant and counter-irritant). These two modifications of Brownianism are also only of historical interest. Hufeland. — An opponent of Brownianism, he contrasted the vital forces, vis vitalis, with the natural healing forces, vis natures medicatrix, and promoted especially the antipyretic method of treatment (cold-water applications). His chief work was entitled "Makrobiotik," published in 1796. Bom in Langensalza in 1762, he died in 1836 in Berlin, where he was a professor and private physician to King Frederic WiUiam III. Schonlein. — Founder of the expective method of treatment. He regarded disease as an independent process which must be allowed to run its course. He taught medicine from the stand-point of the natural sciences and intro- duced methods of clinical examination. The foimdations were laid by him of the so-called natural-history school and the later physiocratic or natural HISTORY OF THERAPEUTICS 19 healing method (in contrast to the technocratic or artificial healing method). He was born in Bamberg in 1793, was a professor and clinician in Wurzburg, Zurich, and Berlin from 1839 to 1859, and died in 1864. 6. RADEMACHER System of Treatment. — Rademacher (born in 1772 in Hamm, physician in Goch, on the lower Rhine, died 1849) is the founder of the system of treatment based on experience, or the empirical method. In his work, " Rechtf ertigung der Erfahrungsheillehre der alten scheidekiinstigen Geheimarzte, " he assumes, entirely upon empirical grounds, the existence of specific relationsbetween certain medicines and certain individual organs. Diseases he divided into two classes: "organic diseases" and "universal diseases," and he also recognized two corresponding divisions of medicines: "organic remedies" with local action and "universal remedies" with multi- ple action. He tested the effect of the individual organ remedies and universal remedies upon the different diseases and named the disease after the remedy found to be effective. The local diseases, for example, were named: digitalis disease of the heart, chelido- nium disease of the liver, and antimony disease of the lungs, while the universal diseases were called: copper disease, iron disease, saltpeter disease. In this way he caused the diagnosis to be based upon the therapeutics. While the fundamental thoughts of the Rademacher system concerning the importance of experience and the specific local action of drugs may be acceptable, his nomen- clature and many of his conclusions certainly are not. His influ- ence upon therapeutics was therefore only temporary. Natural Healing Method. — The author of the natural healing method — i.e., the drugless treatment of disease with water, diet, heat, exercise, rest, air, and dressing — was Priessnitz (1799-1851). With reference to his method, see chapter on hydrotherapy. In addition, the following are also to be mentioned as followers of the natural healing method: Schroth (dry diet, dry-bread cure), G. Jager (wool), Lahmann (cotton wool), and others. 7. THE HOMCEOPATHY OF HAHNEMANN Biographical. — Samuel Hahnemann, the founder of homoe- opathy, was born in Meissen in 1755. He practised medicine in 20 GENERAL THERAPEUTICS FOR VETERINARIANS Kothen from 1820 to 1835, when he moved to Paris, where he died in 1843. Hahemann came into prominence with his new doctrine in 1796. His chief works were: " Organon der rationellen Heilkunde " (1810) and " Reine Arzncimittel- lehre" (1811). Hahnemann's Theory. — Disease, according to Hahnemann, consists of the symptoms only. The treatment of disease, there- fore, consists of combating and removing the symptoms (symp- tomatic method). Certain drugs produce in the healthy organism symptoms like those caused by disease. Digitalis, for example, produces symptoms exactly similar to those of heart disease. In the treatment of any disease, therefore, a drug should be used that will produce in a healthy organism symptoms similar to those observed in the particular disease; in heart disease, for instance, digitalis. Hence the motto of homoeopathy: Similia similibus curantur. Hahnemann further maintained that every drug acted the more powerfully the more it was diluted. For this reason a drug should always be administered in extreme dilution, i.e., in the smallest dose possible. Moreover, only one drug should be used at a time. Allopathy, according to Hahnemann, acts contrary to the purpose. There are three forms of homoeopathic preparations: Triturates, dilutions, and pellets. A triturate of one part of the drug and 99 parts of milk sugar is called the first triturate; one part of the first triturate with 99 parts of milk sugar forms the second triturate, and so on. Similarly, the first dilution or potence is a solution of one part of thedrugin99 parts of alcohol, the second dilution or potence a solution of one part of the first dilution in 99 parts of alcohol, etc. With these dilutions the pellets, which are made of milk sugar, are moistened. The charlatanism of the homoeopathic theory is not without effect upon the laity even to-day. However, it is more to be deplored that Hahnemann has found many followers in medical circles. If, on the one hand, the so-called newer homoeopathy has sought to coincide more with modem investigation, and if, on the other hand, serum therapy in many respects has assumed a homoeopathic char- HISTORY OF THERAPEUTICS 21 acter, this cannot change the judgment concerning the homoeo- pathic fundamental of potency or dilution, which is far too incon- sistent to be accepted by the healthy human understanding. Isopathy.— A variety of homoeopathy, which treated "hke with Uke" {wqualia (Bqualtbus curantur), e.g., the use of roasted proglottides against tape-worms and the administration of powdered pieces of carcinoma in the treatment of carcinoma. The preparations of the modern organotherapy (thyroid gland against goitre, prostate against diseases of that gland, ovaries in ovarian diseases, spermatozoa in impotence) and also vaccination (Jennerization) show a close relation to the old isopathy. Mesmerism.— Mesmer, the originator of mesmerism or the theory of animal magnetism, was a physician in Vienna and Paris (1734 to 1815). He claimed to be able to cure disease by touch and stroking, through a "magnetic force" that passed from him to the patient. Mesmer was the forerunner, on the one hand, of the fraudulent spiritualism, and, on the other, of hypnotism (suggestion), which in recent times has become an important therapeutic factor for man. 8. THE CELLULAR PATHOLOGY OF VIRCHOW Definition of Cellular Pathology.— According to Virchow, there are no general or universal diseases. On the contrary, the patholo- gist finds in every diseased body a considerable, indeed, as a rule, by far the greater part of the organs normal. A diseased body, in which every part is changed, is never seen. The diseased or the inert portion includes only a part of the body. The question that confronts the physician is: where is the disease {uhi est morbus)? and he must be able in every case to point out the location of the malady in the body (principle of localization) . The scientific inves- tigation with reference to the situation of the disease {Sedes morhi) is extended to the tissues and finally to the cells of the organs which show the actual areas of disease (cellular pathology). In some diseases, especially many nervous diseases and intoxi- cations, visible anatomical changes are not present in the organs or cells. Nevertheless, the localization of the disease in such cases must be established upon a physiological or chemical basis, even in the absence of anatomical alterations which can be demonstrated by the usual methods. 22 GENERAL THERAPEUTICS FOR VETERINARIANS As a basis for treatment, Virchow's theory requires that medi- cines must exert a local action upon the diseased organ or its cells (cellular therapy, localized therapy). 9. THE SERUM THERAPY OF VON BEHRING Definition of Serum Therapy. — The etiological investigation of the infectious diseases begun by Pasteur and Koch resulted in an etiological therapy, which was first used by Lister in surgery (anti- septic treatment of wounds). This etiological principle was intro- duced in internal medicine especially by von Behring. His system, because of its specific, pronounced humoral pathological character, is the direct opposite of the cellular pathology theory. According to von Behring, in the course of infectious diseases in the animal or human body chemical bodies are formed, especially in the blood- serum, which can be employed not only as protectives but also as curative agents against these diseases. The so-called antitoxins are specific antidotes to the poisons (toxins) and bacteria of these diseases; some neutralize chemically the poisons formed by the pathogenic bacteria (antitoxic action), others destroy the patho- genic organisms (bacteriolytic action). They form the foundation of the modern serum therapy or isotherapy. Recently, isotherapy has developed in two different directions, which are to be dis- tinguished as isotherapeutic and homoeotherapeutic principles in the restricted sense. Isotherapy uses the so-called isobodies for immunization, i.e., the same agent which causes the disease to be combated: the bacteria themselves. It includes Jenner's method of vaccination against smallpox, Pasteur's system of anthrax vaccination, and von Behring's protective vaccination against tuberculosis. Homceotherapy does not use the living or killed organisms, but the toxins or antibodies produced by them, and may therefore be called isotoxic therapy. To this division belong von Behring's diphtheria serum, tuberculin and mallein, tetanus, swine erysipelas and hog cholera serum, etc. For more extensive details of serum therapy see the chapter on immunity and vaccination. HISTORY OF THERAPEUTICS 23 10. THE CHEMOTHERAPY OF EHRLICH Definition of Chemotherapy. — Formerly, the pharmacology of medicines was tested only on healthy animals, and only drugs which produced symptomatic effects were included in the tests. Medi- cines which act specifically were tested rarely (quinine against malaria, mercury and iodine against syphilis). The new experi- mental therapeutics produces certain infectious diseases artificially in experimental animals and studies the action of curative agents upon these diseased animals. Specific medicines are also produced synthetically for use in the treatment of certain infectious diseases. Ehrlich has shown experimentally that the specific relations of the curative agent to different parts of the body, its so-called tropic properties, may be very different. A distinction must be made between the organotropic action, i.e., the relation to certain organs (neurotropic action, etc.), and the parasitotropic action, which is exerted not upon the animal body itself but upon the parasites present in the body. In serum therapy, products of the body act as protective agents in a purely parasitotropic manner and without any organotropic effect. Since the body and its cells are not influ- enced by these protective substances, serum therapy excels any other method of treatment in those cases to which it is applicable. But serum therapy cannot be employed in some of the infectious diseases, e.g., in malaria, trypanosomiasis, and spirillosis. In such cases, chemical antiparasitic remedies must be used (chemotherapy instead of serum therapy). These chemical substances, however, are mostly poisons, which are not only harmful to the parasites but also to the organism (parasitotropic and organotropic action). In chemotherapy, only such medicines can be used as will kill the parasites without doing any considerable harm to the body. Cor- rosive sublimate, carbolic acid, and arsenic are not suitable on account of their strong organotropic action. On the other hand, the extremely poisonous organotropic action of arsenic can be re- duced by certain synthetical combinations and the parasitotropic action relatively increased. The first of these synthetic, chemo- therapeutic, arsenical preparations were atoxyl (sodium arsanil- 24 GENERAL THERAPEUTICS FOR VETERINARIANS icum), an amino derivate of phenyl arsin, an organically com- bined arsenious acid, and arsacetin, an acetyl compound of atoxyl. The knowledge that only the trivalent arsenic group exerts a poisonous effect upon the cells of the body led by degrees to syn- thesis of arsenophenylglycin and salvarsan, organic arsenical prep- arations with a predominant, parasitotropic, specific action against syphilis and spirillosis. A remedy with a similar action against trypanosomes is trypanred. The complete and immediate sterili- zation of the organism with parasitotropic chemical substances is termed by Ehrlich therapia sterilisans magna. GENERAL THERAPEUTICS OF THE DISEASES OF THE ORGANS OF DIGESTION I. General Therapeutics of the Diseases of the Stomach Pathology. — The diseases of the organs of digestion in our domestic animals are more varied and therefore more difficult to treat than those of man, especially the diseases of the stomach. While gastric ulcers and carcinoma of the stomach are generally rare in animals and the nervous dyspepsia so frequent in man prob- ably does not occur at all, the therapeutics of stomach diseases in veterinary medicine is very complicated because the anatomical arrangement of the stomach is different in the several species of animals. The ruminants, especially, with their peculiar gastric apparatus, are in a separate class from the animals with a single stomach. Among the latter there exists again a considerable dif- ference between the gastric digestion of the herbivora (horse), car- nivora (dog, cat), and omnivora (swine). Other peculiarities are observed in the gastric apparatus of fowl. The most important and the most frequent diseases of the stomach in animals are those occurring in connection with feeding (absolute and relative overfeeding, impaction of the rumen, acute tympanites, spoiled feed) . The therapeutics is therefore first of all prophylactic (diet). In most cases the anatomical changes are confined to the mucous membrane (acute and chronic gastric catarrh, gastritis). However, in cattle all three layers of the stomach wall are very frequently affected (traumatic gastritis) , In some animal species, parasitic diseases of the stomach are of impor- tance (stomach-worm disease). Poisons also are not infrequently the cause of stomach diseases (irritants and irritant narcotic poi- sons). The stomach is also very often affected secondarily in general infectious and constitutional diseases. Physiology. — The physiological processes concerned in gastric digestion are partly mechanical and partly chemical. Therefore. 25 26 GENERAL THERAPEUTICS FOR VETERINARIANS the therapeutics of diseases of the stomach will vary according to whether the disturbance of digestion originates in the muscular action and innervation of the stomach wall, in the gland secretions and chemical properties of the gastric juice, or in decomposition of the stomach contents. Accordingly, treatment may be required for the muscles, the glands, or the contents. From a therapeutic standpoint, the following physiological facts are of importance: 1. Mechanism of the Stomach. — In the horse, as well as in the other domestic animals with a single stomach (dog, hog, cat), the pylorus and cardia close immediately after a meal, and remain closed for a time. Then, the muscular layer in the stomach wall begins to contract, the pylorus is opened simultaneously, and the contents of the stomach are gradually emptied into the intestines. A part of the food and water ingested at this time, likewise of any medicines administered, pass directly into the intestines without detention in the stomach. This explains why medicines given by the mouth are sometimes surprisingly prompt in their action (cathartics, acetanilid, anthelmintics). The opening of the pylorus appears to be caused reflexly by the stimulant action of the gastric juice secreted and collecting in large amount. In addition, stimuli originating in the duodenum also operate to empty the stomach. In a similar way, other stimulants (alcohol, veratrum, oil of tur- pentine and spices) act reflexly through the intestines as well as the stomach and accelerate the opening of the pylorus and the empty- ing of the stomach. The normal period of retention of food in the stomach differs greatly with the kind of food, the method of feeding and the ani- mal species, as well as with the individual, in horses, after a small meal of oats, the passage of the contents of the stomach into the intestines begins in 2 to 3 hours and continues for more than 12 hours. Drinking water during or immediately after eating hastens the passage of the material in the stomach into the intestines. Water alone or fluid medicines, on the contrary, pass through the stomach of the horse very quickly; part in a few minutes. Exer- cise, especially trotting, retards the emptying of the stomach of the horse. DISEASES OF THE DIGESTIVE ORGANS 27 In ruminants (cattle, sheep, goats), the mechanism of the stomach is especially compUcated. Solid food and medicines pass into the rumen and reticulum and often remain, especially in the rumen, several days. Medicines should therefore not be admin- istered to cattle in solid form if a prompt effect is desired. On the other hand, fluids or fluid medicines pass in part directly through the omasum and abomasum into the intestines, where they are rapidly absorbed and act promptly; the greater part, it is true, passes into the reticulum and thence into the rumen. Rumination results from the muscular activity of the rumen and reticulum and the pressure of the inferior abdominal muscles. The necessary conditions for the occurrence of rumination are a medium-full rumen and a certain amount of fluid in the rumen and reticulum. When the rumen is over-full or empty, or when the contents are dry, rumination ceases. The correction of these defects, especially sup- plying water when the contents of the rumen are dry, is of great therapeutic importance in disturbances of digestion. For the same reason, evacuating medicines which also stimulate gland secretions (arecoline, pilocarpine) are to be preferred to the mere muscle stimulants (eserine, barium chloride) in the treatment of impaction of the rumen. The innervation of the stomach consists of the vagus and the sympathetic nerves and the automatic gastric centres — one each for opening and for closing the pylorus and the cardia. The motor centre (vagus) is situated in the corpora quadrigemina; the inhibi- tory centre (sympathetic) in the spinal cord. Contraction of the stomach wall may be produced by stimulation of the vagus nerve, or reflexly by stimulation of the gastric mucous membrane (stimu- lant stomachics). The secretion of gastric juice is influenced by the vagus. 2. Chemistry of Gastric Digestion. — The principal con- stituents of the gastric juice are hydrochloric acid, secreted by the glands of the fundus, and pepsin, secreted by the glands of the fundus and of the pylorus. Other ferments, rennet, a fat-splitting ferment, and a lactic acid ferment, are also present in the stomach. The function of the gastric juice is a double one. Of first impor- 28 GENERAL THERAPEUTICS FOR VETERINARIANS tance is the antiseptic and antizymotic action of the hydrochloric acid. In consequence of the presence of this substance the gastric juice is a natural protective agent against abnormal fermentative and putrefactive processes, and likewise against pathogenic bac- teria. These facts are of the greatest therapeutic importance (prophylactic, causal, radical treatment of disease). It is also worthy of note that the antiseptic protective action of hydrochloric acid may be obtained from other acids, as lactic, acetic and phos- phoric. The proteolytic or peptonizing action of the gastric juice, or of the pepsin, is only of secondary consideration therapeutically. Moreover, the digestion of proteids is not an exclusive physiological function of the stomach, but can be entirely accomplished by the pancreatic ferment (trypsin) and in part by the enzyme of the intes- tinal juice (erepsin). The proteolytic action of pepsin in the stomach occurs only when the contents are acid (hydrochloric, lactic, acetic acid). The optimum acidity is 0.2 per cent. If the acidity is less than 0.1 per cent, or more than 0.6 per cent, peptoni- zation is inhibited. Accordingly, the average therapeutic dose of hydrochloric acid for the horse is 15 grams [one-half ounce], jBiguring the volume of the stomach to be 15 litres [15 quarts]. Absorption is relatively slight in the full stomach, especially in the stomach of the horse and in the first three stomachs of ruminants, and is limited to fluids or dissolved food and medicines. It is more rapid in the empty stomach of the fasting animal, especially in the stomach of dogs and in the abomasum of ruminants. These facts should be considered in administering medicines. On the other hand, of no special therapeutic importance are the different periods of gastric digestion in the horse (proteolytic pepsin digestion, amyl- olytic action of the saliva, mixed digestion) or the fact that in ruminants only maceration (rumen) and amylolyi:ic (saliva) diges- tion occurs in the first three stomachs and proteolytic digestion in the fourth. More important is the fact that the contents of the stomach are arranged in layers and that no mixing takes place. Therapeutic Methods. — Diseases of the stomach may be treated in several different ways. The methods most used are the dietetic, the medical, the mechanical, and the operative. DISEASES OF THE DIGESTIVE ORGANS 29 1. DIETETIC TREATMENT Since the greater portion of the diseases of the stomach in the domestic animals is due to abnormal properties in the food or to excessive feeding, the most important task of the veterinarian is the regulation of the diet. Sound, easily digested food, given in small quantity and at frequent intervals, is a primary requisite — green fodder, hay, carrots, molasses, etc., for herbivora; milk, raw meat, mucilaginous soups for dogs. In some cases, especially in colic of the horse, impaction of the rumen in cattle and acute gastric catarrh in the dog, it is advisable to withhold food entirely. Dogs must be deprived of water also sometimes; in morbid conditions of the stomach these animals drink large quantities of water and per- sistent vomiting results. These methods, by resting the affected parts, bring about complete recovery in many cases. Work ani- mals should have bodily rest in addition, because severe exertion or exercise reduces or entirely suppresses gastric digestion. 2. MEDICINES. (STOMACH REMEDIES. STOMACHICS) Synonyms: Digestives in a restricted sense, peptics, ruminatorics, anti-dyspeptics, antemetics, antacids, neutralizants, absorbents, suppletives; stimulants to the appetite, improvers of the digestion, acid-combating, stimulants to rumination. Classification. — According to their action and composition, the stomachics are divided into the following groups: (a) Physiological Stomachics. — These are normally con- tained in the gastric juice and when decreased in quantity or absent are supplied artificially. They are: acidum hydrochloricum and pepsinum. It is best to administer both together, as it is not prac- ticable to determine in animals if one or the other is absent. They can be used in the treatment of all diseases of the stomach and in all disturbances of digestion in the course of febrile and general dis- eases with the exception of the rarely occurring gastric ulcers (calves). In veterinary practice hydrochloric acid is most com- monly used. The dose of hydrochloric acid for cattle is 15-30, 3ss to 3j; horses, 10-20, 5ijss to 3v; calves, sheep, goats and swine, 1-2, 30 GENERAL THERAPEUTICS FOR VETERINARIANS 1TRXV to xxx; dogs, cats and fowl, 0.1-0.5, njj to vij. Of pepsin, the dose for horses is 5-10, 3j to oijss; dogs, 0.1-1, grs. jss to xv. Phosphoric acid or lactic acid may be used in place of hydrochloric acid. (b) Saline Stomachics stimulate the secretion of hydrochloric acid, dissolve collections of mucus upon the gastric mucous mem- brane, and at the same time combat fermentation. The most important are sodii chloridum, sodii bicarbonas, sodii sulphas and *Carlsbad salts.^ They are the best remedies for chronic gastric catarrh. The dose of sodium chloride, sodium bicarbonate, sodium sul- phate and Carlsbad salts for cattle is 50-100, 5 jss to iij; horses, 25-50, 3vj to xij; sheep and goats, 2-5, grs. xxx to 3j; dogs, 1-2, grs. XV to xxx. (c) Bitter Stomachics (Amara). — In disturbances of gastric digestion these improve the appetite, increase the secretion of gastric juice, stimulate rejflexly the contraction of the stomach wall and prevent or check fermentation. The alleged negative results obtained in experiments with bitter stomachics on healthy indi- viduals and outside of the animal body do not disprove their favor- able effect upon disturbances of digestion. Gentiana and aloe are the most important of those used in veterinary medicine. Others are: *condurango, cinchona, *absinthium, taraxacum, calumba, *centaury, *menyanthes, *centaurea, quassia, *cetraria, *achillea, [nux vomica], and strychnina. As a rule, the amara are adminis- tered in small doses. The dose of aloes as a stomachic for cattle is 5-10, 5j to ijss; horses, sheep and goats, 2-5, grs. xxx to 5 j ; dogs 0.1-0.5, grs. jss to vij . Of gentian, absinthe and the other vegetable amara, except nux vomica and strychnine, the dose for cattle is 25-50, 5 vj to xij ; horses, 10-25, 5ijss to vj; sheep and goats, 2-5, grs. xxx to 3j. The tinctures of these drugs are usually administered to dogs, the * [Not official in the U. S.] ^ [The formula for artificial Carlsbad salts, Sal Caroliniun factitium, is as follows: Sodium sulphate 22 parts, sodium bicarbonate 18 parts, sodium chloride 9 parts, and potassium sulphate 1 part.] DISEASES OF THE DIGESTIVE ORGANS 31 dose being 5 to 10 drops. Strychnine is also administered [in Ger- many] in the form of the tincture to dogs, calves, and lambs. [In the United States, where the tincture of strychnine is not official, tinctura nucis vomicae is prescribed as a bitter stomachic in the following doses: for horses and cattle, 4-25, 5j to vj; dogs, 0.3-1, vjiv to XV.] Oxgall, fel bovis, is obsolete; it is also harmful, as it precipitates pepsin. Condurango is alleged to be a specific for gastric carcinoma. In the old therapeutics there were superfluous subclasses of the bitter stomachics: Amara vera or pura (gentian), A. mucilag- inosa (cetraria), A. aromatica (absinthe), A. salina (magnesium sulphate), A. adstringentia (cinchona), A. tetanica (strychnine), A. cathartica (aloe). (d) Aromatic Stomachics. — These stimulate the activity of the glands of digestion, the appetite and the peristalsis of the stomach. To this class belong rheimi, calamus, anisum, fcenic- ulum, carum and *fructis juniperi; also sinapis alba and nigra, ♦angelica, Valeriana and aurantii amari cortex. The dose of rhubarb as a stomachic for horses and cattle is 10-25, 5ijss to vj. Of the other aromatics mentioned, the dose for cattle is 25-50, 5vj to xii; horses, 10-25, 5ijss to vj; sheep and goats, 2-5, grs. xxx to 5j; dogs, 0.5-2, grs. vij to xxx. Rhubarb is given to dogs in the form of the tincture, the dose being 4, 5j. (e) Stimulant Stomachics. — The most important of these is alcohol, which is also antiseptic ; in addition, the group includes the pungent spices: piper and capsicum, likewise the new remedy, *orexin. All these substances cause hypersemia of the gastric mucous membrane, abundant secretion of gastric juice, increased peristalsis and a more rapid emptying of the stomach. They are contra-indicated in severe affections of the stomach. The dose of alcohol as a stomachic for horses and cattle is 25-50, 3vj to xij; dogs, 2-5, n^xxx to 5j- The dose of the peppers for cattle is 10-20, 3 ijss to v; horses, 5-10, 3 j to ijss; swine, 1-2, grs. xv to xxx; dogs, 0.1-0.2, gr. j to iij. (f) Disinfectant Stomachics. — These are used in fermenta- 32 GENERAL THERAPEUTICS FOR VETERINARIANS tion and decomposition of the stomach contents, also in infectious gastric catarrh and against parasites (stomach worms, larvae of the bot fly). To this class belong acidiim hydrochloriciim, creolin, creosotum, naphthalenum, bismuthi subnitras, quinina, iodum, oleum terebinthinae and carbonei disulphidum. Of these, the most important in veterinary medicine are hydro- chloric acid and creolin. Both may be given to cattle and horses in doses of 10-25, Sijss to vj; sheep and goats, 0.5-1, nj^vij to xv; dogs, 0.1-1, TiEJ to xv; fowl, 0.1-0.25, ttjjj to iij. The dose of carbon disulphide (bot fly larvse) for horses is 10, Sijss, repeated four times at intervals of one hour. (g) Narcotic Stomachics (Antemetics) are prescribed in painful affections of the stomach and in persistent vomiting. The sedative remedies are opii pulvis, cocainae hydrochloridum and menthol. Opium is most frequently used. Dose for horses and cattle, 5- 25, 5j to vj; dogs, 0.1-0.5, grs. j to vij. [Of the tinctura opii, the dose for horses and cattle is 30-60, 5j to ij; dogs, 0.2-2, nuiij to XXX.] (h) Antacids (Acid-neutralizing Stomachics, Absorbents). — These combine with abnormal acids or an excess of normal acids in the stomach and neutralize excessive amounts of hydrochloric and lactic acids or abnormal acids (fatty acids, carbonic acid, poisonous acids). To this group belong sodii bicarbonas, potassii bicarbonas, soap, liquor calcis, calcii carbonas praecipitatus, *sodium, *potassium, magnesii oxidum, magnesii carbonas, aqua ammoniae and ammonii carbonas. Soap is an important absorbent for carbolic acid especially; lime water for oxalic and sulphuric acids, and the other substances mentioned above for hydrochloric, lactic and the fatty acids, etc. The dose is ad libitum except for sodium, potassium, and the oxide and carbonate of magnesia. Of the latter, the dose for horses and cattle is 5-25, oj to vj; sheep and goats, 1-2, grs. xv to xxx; dogs, 0.2-1, grs. iij to xv. (i) RxJMiNATORics. — The drugs that stimulate rumination are emetics, muscle stimulants, and drastic stimulants of the gastric DISEASES OF THE DIGESTIVE ORGANS 33 mucous membrane. Those most commonly used are antimonii et potassii tartras, veratnim, ipecacuanha, alcohol, *veratrina, areco- linae hydrobromidum, physostigminae salicylas or sulphas [eserine], *eseridin tartras, pilocarpinae hydrochloridum or nitras, oleum terebinthinae, *tabacimi, colchici semen, ammonii carbonas and aqua ammonise. In cattle practice, the most important ruminatorics are tartar emetic, veratrum, veratrin and arecoline. Doses: Tartar emetic, for cattle, 10-20, 5ijss to v. Powdered veratrum or the tincture, for cattle, 5-10, 5i to ijss; sheep and goats, 0.5-2, grs. vij to xxx. Oil of turpentine, cattle, 25-50, 5vj to xij; sheep and goats, 2-5, TtEXxx to 5j. Veratrin and eserine, for cattle, 0.1-0.2, grs. IJ^ to 3. Arecohne, for cattle, up to 0.05, gr. %. In camivora, an emetic not rarely acts as a good stomachic. 3. MECHANICAL TREATMENT In ruminants, the rumen is situated in the left flank and is in contact with the abdominal wall when greatly distended. It can therefore be very easily massaged. Massage, or kneading, of the rumen is of the greatest importance in the treatment of digestive disturbances in cattle, especially impaction of the rumen, acute tympanites and all atonic conditions of the musculature of the rumen. It stimulates reflexly the muscular contractions of the rumen, which under normal conditions occur about twice a minute. In dogs, the stomach when full also lies close to the abdominal wall and can also be massaged. It is not possible, however, to massage the stomach of the horse, because even when full it can not be palpated through the abdominal wall. Of the other mechanical methods, the most important is the introduction of the oesophageal sound in ruminants and of the stomach tube in horses to remove gas and the fluid contents of the stomach. Electrotherapy and hydrotherapy are not usually em- ployed on animals. The emetics also act in a mechanical manner in emptymg the stomach of its contents (see p. 34). [For several years, American veterinarians have been using soft rubber tubes to remove gas from the stomach of horses and to 34 GENERAL THERAPEUTICS FOR VETERINARIANS wash out the stomach. There are two types of these tubes: one is passed through the mouth and the other is mtroduced into the oesophagus by way of the inferior meatus of one of the nasal cavi- ties, a flexible rattan stilet being inserted into the tube before it is passed, and withdrawTi after the tube is in position. In the small animal clinic at Copenhagen, Prof. Hansen washes out the stomach of dogs, as well as other parts of the alimentary canal, by injecting per rectum a 0.9 per cent, solution of sodium chloride at body temperature, the posterior part of the body being elevated. After 2 to 3 litres are injected into small dogs and up to 9 litres in large dogs, the fluid, mixed with alimentary matters, is vomited. The injection is continued until the fluid is vomited clear. The method has been in use in the small animal clinic at the University of Pennsylvania for the last two years. In toxic, hemorrhagic, and catarrhal enteritis and in icterus the results are very satisfactory.] 4. OPERATIVE TREATMENT In acute tympanites of ruminants puncture of the rumen is in most cases necessary to remove the gas. The rumen may at the same time be irrigated with water or fluid medicines introduced through the cannula. Gastrotomy is resorted to to remove foreign bodies from the stomach of dogs (stones, coins, balls, corks) and cattle (metalUc foreign bodies in the reticulum, abnormal collec- tions of food and poisonous plants in the rumen). Finally, dis- eases of the stomach may be treated indirectly by operation, as by the extraction of diseased teeth in the dog. II. Emetics Synonyms: Vomitives, vomitories, nauseosa, nauseotics. Method of Action. — Vomition results, according to some, from an active, primary contraction of the stomach; according to others, from the passive compression of the stomach by the convulsive contraction of the inferior abdominal muscles and the diaphragm. The cardia being relaxed at the same time and the pylorus closed, DISEASES OF THE DIGESTIVE ORGANS 35 the contents of the stomach are forced upward and forward. Vomiting is under the control of the centre of vomition (a paired centre situated in the region of the calamus scriptorius). This centre can be directly stimulated through the blood and indirectly by stimulation of peripheral parts of the body, especially the stomach. Emetics which can cause vomiting by acting through the blood and stimulating the vomiting centre without necessarily coming in contact with the stomach are called central or general emetics. Apomorphine is a good example of this variety. Those that cause vomiting reflexly by irritating the gastric mucous mem- brane are called local or topical emetics. Examples are copper sulphate, zinc sulphate, tartar emetic. Some emetics operate both ways, e.g., emetin. Pathology teaches that vomiting may also be caused reflexly by the irritation of numerous peripheral parts out- side of the stomach, as the mucous membrane of the base of the tongue, the throat, oesophagus, intestines, uterus, pelvis of the kidney and gall ducts, and the terminations of the auricular branch of the vagus (otorrhoea). Centric vomiting may also occur in dif- ferent diseases of the brain and in uraemia. Finally, stimuli applied to centres related to the centre of vomition appear to pass readily over the latter. Hydrocyanic acid, which stimulates the respira- tory centre, may exert a similar action upon the centre of vomition. The drugs that have a specific stimulant effect upon the vagus centre (digitalis, squill, strophanthus) may also stimulate the vomiting centre. The effects of vomiting upon the stomach and other organs of the body are very extensive. In the first place, the stomach, oesophagus, pharynx and to a certain extent the buccal cavity are emptied. The peristaltic movement of the stomach wall is increased through the contraction of the gastric musculature. Intestinal peristalsis is also increased, being stimulated reflexly by the contraction of the stomach. Emetics which exert an espe- cially pronounced action upon the intestines are called emeto- cathartics. A further effect of vomiting is the reflex stimulation of the secretion of the stomach and intestinal juices and of the bile. The contraction of the inferior abdominal muscles exerts 36 GENERAL THERAPEUTICS FOR VETERINARIANS compression upon all of the organs in the abdominal cavity. In consequence of this, the elimination of bile and pancreatic secretion is accelerated and a certain amount of blood is expressed out of the large vessels and organs of the posterior part of the abdomen, these organs becoming anaemic while the neighboring organs become hyperaemic. During vomiting the pulse and respiration are accelerated, metabolism is increased, and there is also at the same time increased activity of the sweat glands and the mucous glands of the bronchial membrane. The forced expiration occur- ring during vomiting increases the expectoration of secretions from the bronchi and lungs. The nervous system in general is stimu- lated, but it is questionable if the irritability of the muscles is decreased. Finally, the nausea that precedes vomiting has an alterative effect upon the gastric nerves. Emetics which pro- duce a pronounced and long-continued nausea are called nauseat- ing emetics (apomorphine). Uses. — The diverse and wide-spread effects of emetics demon- strate that the use of emetics has unwisely been discredited. In veterinary medicine, they are indispensable in the treatment of certain diseases; in other diseases practical experience, in confirma- tion of the aforementioned physiological effects, has shown that they are of decided value. The most important indications for the employment of emetics are the following: 1. The removal of excessive quantities of food, foreign bodies, and poisons from the stomach and oesophagus. 2. To empty the stomach of decomposing or fermenting food, and of collections of mucus in gastric catarrh. 3. Licking-disease of cattle and wool-eating of sheep are most promptly cured by emetics. This is also true of other forms of depraved appetite (eating of sand by horses). 4. The removal of stasis of bile (icterus). 5. The removal of infectious material from the stomach in infectious diseases. For example, in the early stages of canine distemper and erysipelas of swine an emetic is indicated. In such cases emetics act as alteratives (so-called abortive treatment). DISEASES OF THE DIGESTIVE ORGANS 37 6. Expectoration of inflammatory products from the respiratory- tract, especially in young dogs affected with distemper. 7. The removal of blood stasis in the liver and other organs in the posterior part of the body. Emetics are contraindicated in very weak animals, gastric ulcers, inflammation of the stomach, advanced pregnancy, herniae and certain diseases of the heart and blood vessels (aneurism). Emetics. — 1. Apomorphinae hydrochloridum. This is the best emetic for dogs. The dose subcutaneously is 0.002-0.01, gr. 1/40 to 1/8. As a specific against licking-disease in cattle and wool-eating in sheep, it is used subcutaneously in doses of 0. 1-0.2, grs. jss to iij. Cats as a rule require ten to twenty times the dose for the dog. Apomorphine usually does not cause vomiting in swine. 2. Veratrina. The most important emetic for swine. Dose: 0.02-0.03, gr. ^ to 1/3, in alcohol, subcutaneously. In place of veratrin subcutaneously, veratrmn may be administered per os or per rectum. Dose for swine, 0.5-2, grs. viij to xxx; dogs, 0.05-0.2, grs. ^ to iij. 3. Ipecacuanha. An emetic for cats, dogs, and swine. Dose for dogs and swine, 1-3, grs. xv to xlv; cats, 0.25-0.75, grs. iij to x. [Vinmn ipecacuanhae, on account of its stimulating properties, is a valuable emetic in canine and feline practice. Dose for dogs, 1-4, rjxv to 5j; cats, one-half the quantity.] 4. Antimonii et potassii tartras. Tartar emetic, an emeto- cathartic; therefore suitable only for robust animals (swine, large dogs). Dose for swine, 1-2, grs. xv to xxx; dogs, 0.1 to 0.3, grs. jss to jv. Vinum antimonii is also useful and is given to dogs in teaspoonful to tablespoonful doses. 5. Cupri sulphas. A specific emetic in phosphorus poisoning. It unites with the phosphorus to form phosphor-copper, which is not poisonous. Dose for dogs, 0.1-0.3, grs. jss to jv. Emetics like mustard, table salt, ammonium carbonate, and zinc sulphate, which were formerly much used by the laity, are now prescribed only in emergency. For antemetics, see the chapter on stomachics. 38 GENERAL THERAPEUTICS FOR VETERINARIANS III. General Therapeutics of the Diseases of the Intestines Pathology. — The diseases of the intestines most frequently requiring treatment are acute and chronic intestinal catarrh, very often associated with gastric catarrh; constipation; colic, -with its numerous anatomical causes (impaction, displacements, etc.); the different forms of enteritis, and helminthiasis (tape worms, round worms). More rarely, foreign bodies and neoplasms are present in the intestines, which are also affected secondarily in many of the infectious diseases. The incurable chronic intestinal catarrhs, which are especially frequent in cattle and dogs, and some cases of chronic gastric catarrh are not merely a superficial disease of the epithelium but a severe parenchymatous affection of the intestinal glands, accompanied by atrophy of the latter and formation of new connective tissue; the pathological processes being analogous to those of chronic nephritis. These circumstances explain the fruitlessness of treatment. Physiology. — The cause of the normal peristaltic movements of the intestines is the reflex stimulation of the intestinal nerves by the intestinal contents. In addition to a number of automatic centres in the intestinal wall (plexus myentericus), there are also constrictor and dilator nerve apparatuses. The accelerator nerve is the vagus (cranial); the inhibitory nerve is the splanchnic (spinal). Stimulation of the vagus causes intestinal contraction. Stimulation of the splanchnic (morphine) retards or inhibits intes- tinal contraction; paralysis of the splanchnic (atropine) increases the intestinal movements. The average time required for food to pass through the digestive tract is 3 to 4 days for horses and cattle, sometimes double this period and more for the latter; for dogs 12 to 15 hours; swine 24 to 36 hours. The reaction of the contents of the anterior part of the intes- tines is acid, because of the presence of the acid from the stomach. The small intestines are therefore relatively poor in bacteria. In the large intestines, and in herbivora even in the ileum, the reac- tion is alkaline in consequence of the neutralization of the gastric DISEASES OF THE DIGESTIVE ORGANS 39 juice by the bile, pancreatic juice and intestinal secretions, all of which are alkaline. Intestinal digestion takes place principally in the small intestines. In the large intestines a further digestion takes place, and here also occur, especially in the caecum, in addi- tion to the resorption of the fluid and dissolved substances, fermen- tative and putrefactive processes (indol, skatol, phenol, cresol, fatty acids, amido acids, ammonia, carbon dioxide, hydrogen, hydrogen sulphide, and other products of the decomposition of albumin and cellulose). In contrast with the small intestines, the large intestines, on account of the alkaline reaction and the ab- sence of oxygen, are a place for the incubation of anaerobic bacteria (colon bacillus, bacillus putrificus — decomposers of albumin). The bile and the pancreatic juice are the most important of the digestive secretions, the intestinal juice possessing only a slight amylolytic and at times a proteolytic action. The bile possesses antitoxic and antiseptic properties (inmiunization in infectious diseases, removal of poisons from the blood). It also prepares the fats for absorption in the intestines and operates as a stim- ulant to peristalsis of the large intestines. The pancreatic juice contains proteolytic (trypsin), amylolytic and fat-splitting ferments. In regard to intestinal absorption it is to be noted that the nutrient substances in solution and the fats are absorbed by the activity of the intestinal epithelium and the contraction of the villi, assisted by the amceboid functions of the leucocytes (phago- cytosis). The water-soluble substances are also taken up by dif- fusion. When the intestinal epithelium is desquamated over a considerable area, as in catarrh, or when the intestinal villi are paralyzed, as in inflammation, then absorption is distributed or entirely suppressed. Therapeutic Methods. — The diseased intestine may be influ- enced in several ways. The mucous membrane may be treated directly with demulcents, narcotics, astringents, antiseptics or stimulants. The glands may be acted upon by pilocarpine or arecoline; the muscles by eserine or barium chloride; the nerves by morphine. Treatment of the intestinal contents is also very impor- AO GENERAL THERAPEUTICS FOR VETERINARIANS tant and is accomplished by dieting and by the administration of cathartics, intestinal stj^jtics, disinfectants and anti-ferments. The principal therapeutic methods are similar to those used in the treatment of diseases of the stomach, namely: dietetic, medical (cathartics, stjrptics), mechanical and operative, 1. DIETETIC TREATMENT Fasting, or a diet of non-irritating, easily digested food, will serve, more than anything else, to alleviate a catarrhal or inflamed mucous membrane. Green fodder, bran, or Unseed meal is best for horses; raw meat, milk, eggs, and mucilaginous soups for dogs. When catarrh is present in the intestines, the stomach is fre- quently healthy and the appetite is very good. This must be remembered so that overfeeding will be avoided. Taking a large quantity of food at one meal is not to be permitted. 2. CATHARTICS. LAXATIVES Synonyms: Purgatives, drastics, lenitives, eccoprotics, aperients, aperi- tives, evacuants, peristaltics, osmetics. Classification. — For the purposes of general therapeutics it is best to divide the cathartics into three groups according to the intensity of their action: mild, medium and strong. Although these different degrees of action may be obtained with the same cathartic by simply varying the dose, and although the intensity of action may vary with the species, yet for practical reasons and because it affords a better conception of the large number of cathartics, it is desirable to classify these drugs in the three fol- lowing groups: (a) Drastics, very powerful cathartics, which operate on the horse in doses of a few grams, decigrams and even centigrams. This group includes arecoline, eserine, pilocarpine, tartar emetic, calomel, podophyllum, croton oil, gamboge, jalap, colocynth and barium chloride. (b) Purgatives, cathartics of medium strength, laxatives in the restricted sense. In this group are included aloes and the saline DISEASES OF THE DIGESTIVE ORGANS 41 purgatives: sodium sulphate, potassium sulphate and magnesium sulphate; also, fructus rhamni catharticae, frangula and cascara sagrada. (c) Laxatives or Lenitives, mild cathartics, which must be given in very large doses and most of which do not operate upon horses and cattle. This group includes castor oil, senna, sulphur, manna, tamarind, syrup, honey, glycerin, and the fixed oils. Theories Regarding Catharsis. — The question of how and in what manner catharsis is brought about after the administration of a cathartic has been answered in many different ways. A num- ber of theories have been proposed by Liebig, Buchheim, Aubert, Voit, Hay, Brieger, Radziejewski, and others. From these we learn that catharsis is not a simple process but a very complicated action resulting usually from several factors operating together. (a) According to Liebig, the neutral salts operate principally in a purely physical manner, i.e., in accordance with the laws of osmosis. Water passes from the blood, which is poor in salts, into the intestines, which contain a large amount of salt. The "animal membrane" separating the blood from the intestinal con- tents is the intestinal mucous membrane. If a solution of Glauber's salt or epsom salt is placed in an isolated loop of the small intestine the latter will be filled to distention in a few hours with a clear yellow, alkaline fluid. At the same time the mucous membrane will retain its normal pale color. The fluid which passes from the blood into the intestines operates as a stimulant to peristalsis and diarrhoea occurs. (b) On the other hand, Buchheim asserts that the neutral salts produce catharsis by retarding or suppressing absorption of intes- tinal fluids in consequence of their slight diffusibility. The more slowly and least diffusible salts, sodium sulphate, potassium sul- phate and magnesium sulphate, therefore, possess a cathartic action in contrast with the rapidly and readily diffusible sodium chloride. Other cathartics, especially the drastics, probably re- tard absorption by paralyzing the intestinal epithelium and villi. (c) Peristalsis is reflexly stimulated and accelerated through the direct stimulation of the nerves in the intestinal mucous mem- 42 GENERAL THERAPEUTICS FOR VETERINARIANS brane by most of the cathartics, including calomel, aloes, rhubarb, sulphur and especially the neutral salts. The latter operate in at least three different ways. Proof of their stimulant action is found in the fact that very dilute solutions, which could not gener- ate an osmotic stream, produce diarrhoea. Radziejewski studied experimentally the influence of cathartics upon peristalsis by means of intestinal fistulae in dogs and found that the peristaltic movements of the intestines and the flow of fluid through the fistulae were considerably increased after the administration of laxatives. Intestinal peristalsis may be stimulated reflexly from the stomach by some drugs; croton oil, for example, will produce diarrhoea while it is yet in the stomach. Acceleration of peri- stalsis causes a more rapid discharge of the intestinal contents. On account of the decreased absorption of the intestinal fluids, the discharges are thin and fluid; they are the unchanged contents of the small intestines. (d) Increased secretion of the intestinal glands with increase of the intestinal fluids and acceleration of peristalsis. The most important representatives of this group are arecoline and pilo- carpine, specific gland stimulants. The neutral salts also stimu- late the intestinal glands during their elimination from the blood, thus making their action a four-fold combination. Intestinal secretion is also stimulated reflexly by those drugs which irritate the mucous membrane, especially the drastics. The intestinal fluids, including the secretions of the mucous glands, Lieberkiihn's and Bruner's glands, the pancreas and liver, can only be increased in sufficient amount to produce diarrhoea when the blood is rich in water. As Hay has pointed out, fluid bowel discharges are not produced by the neutral salts, even in large doses, when animals have been without water for several days and have received only dry feed. This observation agrees with the well-known experience of veterinarians that a horse or cow which has received a cathartic must be permitted to drink a large quantity of water in order to accelerate the action of the drug and increase its effect. (e) Transudation and exudation of blood-serum as a cause of DISEASES OF THE DIGESTIVE ORGANS 43 collection of fluid and increased peristalsis occur as the result of the action of any of the irritant cathartics which produce hyper- emia, catarrh or inflammation in the intestinal mucous membrane. In this group are included croton oil, tartar emetic, colocynth, jalap, gamboge and other drastics. These drugs should not be prescribed in acute inflammatory conditions of the intestines. (f) Intestinal tetanus, with rapid expulsion of the intestinal contents, is the cause of the cathartic action of eserine, nicotine and barium chloride and partly also of arecohne and pilocarpine. (g) Paralysis of the splanchnic, the inhibitory nerve of the intestines, results in the acceleration of peristalsis. Atropine acts in this manner. (h) Lubrication of the intestinal walls mechanically accelerates the passage of the intestinal contents. This is the mode of action of the fixed oils, but in part only of castor oil. Results of Catharsis. — Scarcely any other action of drugs is accompanied by so many local and general effects as catharsis. To begin with, the intestinal canal is emptied of whatever it may contain: normal contents, fermented or decomposed food, calculi, concrements, poisons, inflammatory products, parasites or infec- tious materials. Secondly, peristalsis is accelerated and the secretions of the intestinal glands increased. Some cathartics, as aloes, rhubarb, colocynth and podophyllum, at the same time increase the secretion of bile; these are called the cholagogue cathartics. The withdrawal of fluid from the blood into the intes- tines has the effect of condensing the blood, in consequence of which the blood absorbs fluids from the tissues (hydragogue cathartics). The volume of the blood is decreased by the loss of fluid and the blood-pressure is lowered. The distribution of blood is materially changed and the body temperature is lowered. While the intestinal mucous membrane and the other abdominal organs are rich in blood, especially after the administration of drastics, the more distant organs, as the brain, lungs and skin, are corre- spondingly poor in blood, the blood being diverted from the latter to the intestines. The activity of the kidneys is at first increased by some cathartics; for example, diuresis is increased a few hours 44 GENERAL THERAPEUTICS FOR VETERINARIANS after the administration of the neutral salts. Usually, however, the secretory activity of the kidneys is reduced by cathartics. This is also the case with the sweat glands. Another ejffect of the increased secretion of the intestinal glands is the elimination of mfectious material, metabolic products and poisons from the blood. Emptying the intestinal canal withdraws nourishment and more or less disturbance of the appetite, and digestion is also associated with catharsis. Finally the drastics, like cutaneous irritants, by irritating the sensory nerves in the intestinal mucous membrane exert reflexly a general stimulant action upon the nervous system, affecting the animal as well as the vegetative functions. In this action the principle of coimter irritation plays an important role. Use of Cathartics. — On account of their manifold action cathartics are employed in the treatment of a large number of dis- 1. Constipation and depressed peristalsis in the course of intestinal catarrhs, constipation-colic in horses, fecal stasis in dogs, and high fever with suppressed intestinal secretions. 2. Overfeeding of herbivora; also the presence of foreign bodies, poisons, parasites, bacteria, and toxins in the intestines. 3. Diarrhoeas and gastric catarrhs due to fermenting food- masses or infectious materials in the intestines. These conditions occur in dysentery, canine distemper, influenza of horses, swine erysipelas and fowl cholera. Calomel is especially indicated in these conditions because it is also disinfectant. 4. Liver diseases, especially catarrhal icterus. 5. HjrperaBmia and injQammation of the lungs, pleura, brain, spinal cord, skin (urticaria), pododerm (laminitis; arecoline) and udder (mastitis). In these conditions cathartics are used for their derivative and antiphlogistic effects. 6. Dropsical conditions; also to assist the resorption of fluid and solid exudates. 7. Acute and chronic nephritis, and urasmia. The compensa- tory increase in the secretions of the intestinal glands relieves the kidneys in these conditions. DISEASES OF THE DIGESTIVE ORGANS 45 8. In obesity, gout and increased sexual impulse to withdraw nourishment and reduce bodily strength. 9. Prophylactically, against parturient apoplexy and azoturia. 10. To prepare cryptorchids for operations; also animals for intestinal operations (laparotomy). Cathartics are contraindicated in severe non-infectious in- flammation of the stomach or intestines, in very weak, anaemic animals, in advanced pregnancy, in peritonitis (extension of the inflammation over the whole peritoneum by the increased peri- stalsis), and in prolapse of the rectum. When a cathartic is abso- lutely necessary in any of these conditions castor oil or calomel should be used. On account of the elimination of cathartics in the milk, neutral salts or other indifferent substances should be given to milk cows instead of aloes. The Individual Cathartics. — 1. Physostigminae salicylas. Physostigminae sulphas. Eserine. An important cathartic for the horse in constipation colic. Operates within a half hour. Also used in combination with pilocarpine. Contraindicated in excessive distention and paralysis of the intestines, engorgement of the stomach, tympanites, spasmodic colic, pregnancy and dyspnoea. Dose for the horse, 0.05-0.1, gr. ^ to jss, subcutaneously. 2. Arecolinae hydrobromidum. Arecoline combines the action of physostigmine (eserine) and pilocarpine, is cheaper, more stable and is effective in smaller dose. Especially valuable in laminitis, colic and inflammation of the brain. Dose for the horse, 0.05-0.08, gr. ^ to j. 3. Aloe. Aloes. A cathartic for horses and cattle in impaction colic, chronic intestinal catarrhs, inflammation of the brain and lami- nitis; also a cholagogue. It has the disadvantage of operating slowly: 18 to 36 hours after administration. Dose for the horse, 25-50, 5vj to xij; for cattle, 40-60, 5x to 5ij. [Dose of aloin for the horse, 8-12, 5 ij to iij ; produces less dulness, nausea and grip- ing than aloes and is more prompt in action.] 4. The neutral salts: Sodii sulphas, magnesii sulphas, and *sal Carolinum factitium (artificial Carlsbad salts). Mild and slow acting cathartics; used alone or to assist other cathartics, as aloes, 46 GENERAL THERAPEUTICS FOR VETERINARIANS arecoline and eserine, in constipation and colic, and to produce a derivative action. They are at the same time diuretics and chola- gogues. For cattle, they are in general somewhat too weak, and in horses their action occurs only after 1 or 2 days. They are too bulky for dogs. The dose of sodium sulphate, magnesium sulphate and Carlsbad salts for horses is 250-500, lb. ss to j; for cattle, 500-1000, lb. j to ij ; sheep and goats, 25-50, 5 vj to xij ; swine, 25-50, 5vj to xij; dogs, 10-25, 5ijss to vj; cats and fowl, 2-5, 5ss to j. 5. Hydrargyri chloridum mite. Calomel. The most impor- tant cathartic for dogs and swine; best intestinal disinfectant; may also be given in inflammatory and ulcerous conditions of the intes- tines; should not be administered to cattle and should be used on horses with caution. Dose as a laxative, for swine, 1-4, grs. xv to 5j; dogs, 0.2-0.4, grs. iij to vj; cats, 0.1, grs. jss; fowl, 0.05-0.2, grs. ^4: to iij. 6. Antimonii et potassii tartras. Tartar emetic. A good laxa- tive for horses and cattle, especially in colic and parturient apoplexy and to produce a derivative action upon the intestines; should not be given to weak animals. Dose for horses, 2-10, 3 ss to ijss; cattle, 10-20, 5 ijss to v; sheep 0.5-2, grs. vij to xxx; calves, 0.3-0.5, grs. iv to vij. 7. Oleum ricini. Castor oil. A mild cathartic for all the domestic animals, but especially for dogs; may also be given in inflammation of the intestines; contraindicated in phosphorus and cantharides poisoning. Dose for dogs, 15-60, 5 ss to ij ; horses, 250-750, Oss to jss; cattle, 500-1000, Oj to ij; foals, calves, sheep and goats, 50-250, B jss to viij; swine, 50-100, 5 jss to iij; cats and fowl, 10-30, 3 ijss to oi- [8. Oleum lini. Linseed oil. In the United States linseed oil is more commonly used as a cathartic for horses and cattle than castor oil. Dose same as castor oil.] 9. Oleum tiglii. Croton oil. The most powerful drastic cathartic for the horse; other drugs are more desirable; contrain- dicated in all cases of intestinal inflammation and for weak and sensitive animals. Dose for horses, 0.6-1.5, tijx to xx; cattle, 1-2^ TTRXV to xxx; dogs, 0.07-0.12, ttrj to ij. DISEASES OF THE DIGESTIVE ORGANS 47 10. Rheum. Rhubarb. A very mild cathartic for dogs and cats, the catharsis being followed by constipation. Also a stom- achic and cholagogue. Dose for dogs, 5-15, 5j to iij; cats and fowl, 2-5, oss to oj- [Of Tinctura rhei, the cathartic dose for the dog is 1 to 2^ tablespoonfuls; cats, 3 specific mallein reaction. II. AppUcation—Either fluid maUem (raw maUein) or dry [precipitated] mallein is used. ^ >^ f With a brush or dropper (eye pipette), a few drops of fluid, undiluted mallem or of a freshly-prepared 1 percent, solution of dry [precipitated] mallein m distilled water or physiological salt solution are introduced into the right eye. The left eye serves as a control. In order that the eye may be examined for the symptoms of the specific reaction m dayhght, it is recommended that the test be begun m the morning 264 GENERAL THERAPEUTICS FOR VETERINARIANS or in the evening. When the mallein is instilled in the morning, the reaction will appear at the earliest in the afternoon; when it is made in the evening, the first observation of the eye can be made the next morning. Since drops of pus flowing from the eye and sticking to the hair may be thrown off by movements of the head and thus escape detection, restless horses should be tied up short during the test. The presence of fever does not interfere with the application of the test. The test does not influence the blood test. III. Judgment. — The test may terminate in three ways: positive, nega- tive, doubtful. The reaction is positive if a purulent discharge from the eye occurs in 12 to 24 hours. The reaction is negative if a discharge from the eye does not appear in 12 to 24 hours. The reaction is doubtful if after 12 to 24 hours only a serous, Beromucous or mucous discharge occurs from the eye, or if only a drop of purulent secretion collects in the inner canthus of the eye without any discharge. The judgment of the test is based upon the following principles: 1. The presence of glanders is assumed as probable if a positive reaction occurs 12 to 24 hours after the instillation of the mallein. 2. The absence of glanders is assvuned as probable if a negative reaction occurs 12 to 24 hoiu-s after the instillation of the mallein and if, in addition, a negative reaction is again obtained upon a repetition of the test three weeks later. (In the initial stages of glanders the hypersensitiveness to mallein is absent; this appears only toward the second week after infection.) 3. If the reaction to the first test is doubtful, a second test is begun on the same day. If the reaction to the second test is positive, the presence of glanders is assumed as probable. If the reaction to the second test is negative or doubtful, then a third test is made after 3 weeks. If the reaction to the third test is negative, it is assumed as probable that glanders is not present. If the reaction to the third test is positive, the presence of glanders is assumed as probable. If the reaction to the third test is doubtful, the horse remains under suspicion of glanders. WATER AS A REMEDY. HYDROTHERAPY Synonyms: Hydrotherapy, hydriatrics, balneotherapy, Priessnitz's* cure, water-cure. General.— Water has been employed as a healing remedy since ancient times. In spite of this, it is not possible to present to-day a clear, scientific analysis of its method of action. Some of the undoubted successes of hydrotherapy are still based upon pure empiricism (Priessnitz), and cannot at this tune be scientifically explained at all, or only mcompletely. The difficulty of placmg hydrotherapy on a rational foundation is due to the circumstance that the effect of water upon the body is very complicated. Several very different factors apparently cooperate in the water-cure. Not only the water itself, but also its temperature and likewise certain mechanical factors appear to exert a combined action. The continuance of the application and the change from cold to warm water are also of unportance. Among the different proper- ties of water, the irritant action of cold water upon the skin is of the greatest consideration in veterinary therapeutics. The internal use of water (mineral water), as ordinarily employed in human medicme, is not practicable in vetermary medicine. As with the other cutaneous irritants, the effect of water upon the body is very extensive, which accounts for the frequent use of hydro- therapy m the most varied disease conditions. Actions.— 1. Upon the skin water has in the first place a cleansing effect, and consequently hi a certain sense a disinfectant action. In addition, when its mfluence is long continued, it brings about a swelling and loosening (maceration) of the epithelial cells with increased desquamation of the same. Since the capacity of cold water for heat is very great, it takes up heat from the body ' Vincent Priessnitz, agriculturist in Grafenberg, Austrian Silesia; lived from 1799 to 1851, and founded in 1826 the first hydropathic establishment. 265 266 GENERAL THERAPEUTICS FOR VETERINARIANS when applied locally or generally and therefore operates as an antipyretic in conditions of abnormally high temperature. Cold and hot water act as cutaneous irritants, producing at first a con- traction of the cutaneous vessels and of the smooth muscle of the skin with a consequent ansemia, followed by a pronounced reactive relaxation of the vessels of the skin and of the underlying parts with a decided hyperaemia of the same. On this account, cold water is to be regarded as an epispastic rubefacient which not only influences and changes the local circulatory relations of the skin and the tissues beneath it (subcutis, tendons, tendon sheaths, muscles, articulations, bones) but also, when used extensively, affects the blood distribution of the entire body, causing the blood to flow from the centre of the body to the periphery and depleting the internal organs. While cold water produces a passive hyper- emia, hot water, and moderately warm water when the application is long continued (cataplasms), generate an active hyperaemia. These actions upon the skin point to numerous indications for the treatment of local diseases of the skin, the subcutis, the mus- culature, tendons, bones and articulations as well as general febrile and internal diseases. Furthermore, the hyperaemia produced considerably stimulates the secretory activity of the skin (water, urea and metabolic products), sometimes even to the extent of pro- ducing perspiration. Since a relation exists between the secretory functions of the skin and different internal organs, especially the kidneys and lungs, a therapeutic action may be exerted upon these organs by the use of water. Depending upon the temperature, water exerts a stimulant action upon nerves or exerts a sedative effect in abnormal, painful conditions. Of great practical importance in all these cases, in addition to the temperature of the water, is the continuance of its action and a change from cold to warm. In reference to the temperature, a distinction must be made between cold (0-15° C), tepid (15- 30° C), warm (30-38° C.) and hot (38° C. and above). Only cold and hot water exert a pronounced action as cutaneous irritants in the manner described above. Warm water corresponding in HYDROTHERAPY 267 temperature to that of the body is indifferent, and the action of tepid water is weak. The colder or the warmer the water in com- parison to the body temperature of the animal, the more pro- nounced is its action upon the skin. In regard to the continuance of action, when cold water is used for the purpose of reducing tem- perature its application must naturally be continued as long as possible. But if the water is employed as a cutaneous irritant, then the therapeutic effect is in direct relation to the shortness and frequency of the individual applications. When a single applica- tion of cold water produces a reaction in the skin in the form of a change in the circulatory relations (hyperaemia), the condition dis- appears after a certain interval, and a renewal of the cutaneous irritation is naturally required to again bring about the same reaction with its healing effects upon the organism. One long- continued application of cold water produces only a single reaction, which occurs in the beginning. For these reasons frequent applica- tions are uidicated, and on this account Priessnitz dressings, for example, are changed frequently (on the average every 3 hours). The effects produced under these circumstances are as follows: When the dressing which has been dipped in cold water is first applied, ansemia and cooling of the skin occurs; this is gradually followed by a hyperaemia, which is continued several hours and which is promoted by the warm overlyirig dressing. After this period, the circulatory relations are again equalized and in order to produce a new reaction the cold irritant must be renewed; i.e., a new cold dressing must be applied. Failure of a patient to show any reaction in the skin after a proper application of cold water is evidence of great weakness of the nervous system and justifies an unfavorable prognosis. For prophylactic purposes, the frequent use of cold water in healthy animals is recommended to facilitate the occurrence of the reaction and to exercise and strengthen the skin (cold rub-down for horses and cattle, washmg). 2. The circulatory apparatus is influenced in very different directions by hydrotherapy. As already observed, cold water 268 GENERAL THERAPEUTICS FOR VETERINARIANS causes at first, in consequence of irritation of the peripheral vaso- motor centres (Lenaschew, Pliigers Archiv., vol. 26), a contraction of the cutaneous vessels with anaemia of the skin, which drives the blood to the interior and also increases the blood-pressure, the activity of the heart and the internal temperature. With the occurrence of the reaction in the skin, contrary effects are pro- duced. The blood-vessels dilate, the blood flows from the centre to the periphery, and blood-pressure, heart activity, pulse fre- quency and internal temperature decrease. It is therefore pos- sible to act with hydrotherapy upon every single factor of the circu- lation : upon the lumen and tension of the blood-vessels, upon the heart, upon the blood-pressure, upon the blood distribution and upon the blood heat. Water is consequently a valuable remedy in all conditions of ioflammation and congestion and m general febrile diseases. It is also a derivative remedy, particularly on account of its regulating influence upon blood distribution. Inter- esting investigations have been made by Schiiller (Deutsches Archiv. fiir Klin. Medizin, vol. 14) concerning the derivative effect of water upon the deeply situated organs, which are of therapeutic importance, especially in inflammation of the brain. In trephined rabbits, constriction of the vessels of the pia and contraction of the brain were observed after the application of warm compresses to the skin, while the employment of cold dressings on the skin or a cold bath caused a dilation of the vessels of the pia. The same action apparently extends to the spinal cord, the lungs and the other vis- cera. These experimentally established facts justify scientifically the hydropathic derivation which has been hitherto practised empirically, especially lq inflammation of the brain, pneumonia, pleuritis and peritonitis. Finally, since cold water also increases metabolism, as is shown by the increased elimination of carbon dioxide and the increased absorption of oxygen demonstrated in animals experimentally by Rohrig and Zuntz, the resorbent effects of external applications of water in connection with the stimula- tion of the circulation are readily understood. 3. The nervous system is affected in different ways, accord- HYDROTHERAPY 269 ing to the temperature of the water. Cold water stimiilates the activity of nerve tissue; warm water, on the contrary, has a seda- tive effect, soothing and depressing. Depending upon whether the application of the water is local or general, a local or total alteration of innervation can be brought about, either of the nature of a stimulation or depression, which is not possible with other cutaneous irritants. Upon the nerves of the skin the action is direct, while the other parts of the nervous system are inJBuenced reflexly through the skin (counter-irritation). By the application of cold water, a weakened nervous system is stimulated, entirely inde- pendent of the change in circulation (derivation), while warm water applications depress an abnormally stimulated nervous apparatus. This is true of the brain and spinal cord as well as of the nerves of the different internal organs, such as the stomach, intestmes, kid- neys, uterus, lungs, heart, etc. Well-known examples of these actions of water are the stimulant effects of cold and the sedative, anodyne effects of warm water applications in colic of the horse and the favorable action of the Priessnitz dressing in abnormal sensibility of the larynx (cough), pharynx (difficult swallowing), brain, musculature (rheumatism), articulations and tendons (inflammation). 4. The body cells are nutritively stimulated by moist heat (cold acts reversely) and their function of forming antitoxins and their regeneration activity are thereby accelerated. Local leu- cocytosis is also promoted by heat, but is inhibited by cold (see the chapter on aeries). 5. The glands of the body (liver, kidneys, pancreas; gastric, intestinal and cutaneous glands) are also influenced m different ways by applications of water, partly through the circulation (derivation) and partly through the nervous system (counter-irri- tation). The secretions of the liver and kidneys in particular are stimulated by cold and decreased by warm water applications. 6. The musculature has, as is well known, special relations with the skin; the diseases caused by chilling (rheumatism, rheu- matic haemoglobinaemia [azoturia]) demonstrate that the two are 270 GENERAL THERAPEUTICS FOR VETERINARIANS intimately associated. In these diseases, it may be assumed, the chilling acts as an abnormal cutaneous irritant, causing a disturb- ance of the circulation, innervation and especially the metabolism of the musculature. Similar influences can be exerted upon the diseased musculature by the employment of hydropathic dressings, the disturbed circulation and innervation being affected by deriva- tion and counter-irritation. Warm water is most desirable for this purpose because it at the same time allayspain. Cold water is more suitable to the prophylactic hardening against the diseases men- tioned. Experience has taught that muscular rheumatism as well as rheumatic hsemoglobinaemia [azoturia] can be effectively pre- vented by accustoming the skin to the irritation from cold and hardening it against the harmful results. Avoiding too warm stabling and covering, accustoming to cold, and especially frequent cold rubbing down when rationally employed afford good protec- tion against these diseases. 7. The respiration is stimulated by cold water. Cold appli- cations are therefore employed as stimulants in weakness and paralytic conditions of the respiratory centre (syncope, poisoning by chloroform) and to strengthen expiration in pulmonary and bronchial diseases. On the other hand, the diseased lungs are relieved by the derivation of the blood from the lungs to the skin (cutaneous respiration) by means of moist, warm applications. In these respects hydrotherapy is of importance in the treatment of pneumonia and other respiratory diseases. 8. Locally, cold at first causes contraction of the arteries and ansemia (checking hemorrhage, antiphlogistic action), later dila- tion and congestion of the veins with slowing of the circulation and resorption and decrease of the leucocytes. Moist heat, especially the Priessnitz dressing and cataplasms, promotes local blood cir- culation and cell activity and also local leucocytosis and the formation of antitoxins. Hot applications generate an active hyperemia, which extends to a considerable depth (musculature, peritoneum) and continues for 24 hours and longer; in addition, the circulation of lymph and consequently resorption is stimulated HYDROTHERAPY 271 (h3T)erlymphia, oedema formation). See the experimental inves- tigations of Schaffer.2 Hyperaemia as a Healing Remedy. — Bier* has drawn attention to the favorable effects of chronic passive hyperaemia, produced artificially by elastic bandages and by hot-air apparatuses, upon surgical suppurative and inflam- matory processes. Passive hjiJeraemia, like active hypera;mia, has a resorbent, bactericidal and anodyne action and stimulates the formation of new tissue. The same effects are produced by the continued emploj-ment of high degrees of heat by means of Ullmann's^ hydro-thermo regulator, which was introduced into veterinary surgery by Bayer* and Eberlein* and found by them to be of value especially in chronic tendinitis, tendovaginitis, shoulder boils, exostoses, thickening of the skin, articular and muscular diseases, wounds and ulcers of the horse (constant, regulated heat treatment in the form of dry or moist heat). Upon the basis of his experiences in the Vienna clinic, Schmidt^ has formed the following conclusions concerning the value of Bier's passive hyper- aemia in veterinary medicine: The aspirator is most useful in diseases of the paws of small animals (phlegmon, panaritium). The rubber tubing and the elastic bandage can be used on all of the domestic animals, but the technique presents numerous difficulties, which are greater in animals than in man. Purulent inflammations of the articulations and tendon sheaths and phleg- monous processes in the hoof are best suited to the passive hjrperaemic treat- ment. On account of the technical difficulties and the dangers attending the treatment, however, it can only be employed in stationary cUnics under con- tinual control; its use in general practice and in polyclinics is precluded. According to Roder^ also, the field for the use of Bier's passive hyperaemia is limited; he recommends venous stasis by means of bandages in wounds of the coronet, in contused wounds and after resection of the lateral cartilage, and the employment of the aspirator in shoulder boils. Kriiger,' as a result * Schiiffer, Der Einfluss imserer therapeutischen Massnahmen auf die Entziindimg. Stuttgart, 1907, Ferd. Enke. ' Bier, Die Hyperamie als Heilmittel. Leipzig, 5. Aufl., 1907. * Ullmann, Wirkungen und therapeutische Verwertung konstanter Warme- appUkationen. Physikhnisch-medizinische Monatshefte, 1904. ' Bayer, Der Hydrothermoregulator. Zeitschr. f. Tiermed., 1903. » Eberlein, Der Hydrothermoregulator. Berl. Archiv., 1905. " Schmidt, Die Biersche Stauungshyperamie in der TierheUkimde. Mo- natshefte fijr prakt. Tierheilkde., 1907. 8 Roder, Dresdener Natiirforscherversammlung, 1907. ' Kriiger, Hjrperamie als Heilmittel in der Tierheilkunde. Zeitschr. fur Vet., 1910. 272 GENERAL THERAPEUTICS FOR VETERINARIANS of his experiences in the Berlin Horse-shoeing School, agrees vrith Schmidt and Roder that passive hyperjemia, when properly employed in suitable cases, is to be regarded as a good healing method in veterinary medicine. Eberlein and Braun^o have cured foiir cases of inflammation of the temporomaxillary articulation in the horse with IQapp's aspirator. Uses. — The external use of water for healing purposes is in many cases similar to the use of the cutaneous irritants (see p. 148). The indications for the employment of hydrotherapy are, however, more numerous than for the use of cutaneous irritants. More- over, the water is often preferred to these drugs because of the simplicity of its application and the cheapness of the hydropathic apparatuses. The most important diseased conditions treated with water are the following: 1. Local surgical affections of the skin, subcutis, tendons, tendon sheaths, muscles, joints, bones, and lymph glands. The application of cold water is indicated only in active hypersemia and in entirely fresh, acute inflammatory conditions in these parts. On the other hand, warm, moist applications or cataplasms are indicated in all subacute and chronic inflammations, in passive hypersemia and in extravasations in the parts named. This is true especially of fluid and sohd exudates, indurations, old swellings and thickenings of the skin, subcutis, tendons, articulations, bones and muscles, and also of purulent inflammations and ripening abscesses. The moist heat in these cases dilates the vessels, accel- erates the disturbed and sluggish blood and lymph circulation, promotes metabolism and resorption, softens hard inflanmiatory products, encourages the outwandering of white blood-cells (phago- cytosis, histolysis), accelerates connective tissue formation and cicatrization and stimulates the formation of antitoxins. 2. General febrile diseases. The antipyretic action of cold water in the form of cold poultices, irrigations, douches, baths, fomentations and rectal infusions depends upon the withdrawal of heat; the cold must continue to operate for a long time, however, " Braun, Die Saugbehandlung nach Klapp bei der .Arthritis purulenta des KiefOTgelenks des Pferdes. Monatshefte fiir prakt. Tierheilkunde, 1912. HYDROTHERAPY 273 because a temporary application causes at first a rise of the internal temperature. Warm, moist applications also exert an antipyretic effect, since under their influence blood is drawn from the centre of the body to the periphery and gives off heat; cooperating with this action is the influence upon the vasomotor and caloric nerve centres. 3. Inflammation of the limgs, pleura, peritoneum, brain and spinal cord, stomach and intestines, kidneys, liver, and uterus. The hydropathic effect of warm, moist applications consists of the contraction of the dilated vessels in diseased internal organs and of the derivation of the blood to the skin. 4. (Edema of the lungs, brain, and glottis. The action is the same. 5. Muscular rheumatism. The warm, moist applications exert a derivative and anodyne action. 6. Colic and cough. The action is the same. 7. Paralytic conditions of the nervous system (cerebral, spinal and peripheral paralyses, weakness of the loins, parturient paresis, poisonings, paresis of the gastric and intestinal musculature). Cold or hot water (cutaneous irritation, counter-irritation) is indicated in these conditions. 8. Excited conditions of the nervous system (pains, spasms, hyperaesthesia, increased reflex activity). Warm water (sedative action) is employed in these conditions. 9. Exudates (fluid and solid) in the internal organs. The warm, moist applications promote the circulation, leucocytosis, metabolism, and resorption. 10. Kidney and liver diseases (stimulation of the secretion, derivation). 11. Catarrhs of the respiratory apparatus (mhalation of steam). 12. Obesity (stimulation of metabolism). Forms of Application. — 1. Priessnitz's dressing. This is ap- plied in the following manner: The skin is first covered with a piece of linen or cotton cloth, or a bandage, which has been dipped in cold water, and over this cold, wet dressing a dry, woollen cover- 18 274 GENERAL THERAPEUTICS FOR VETERINARIANS ing or bandage is so applied that the surface of the dressing re- mains entirely dry (warm, moist poultice). After about 1 to 3 hours, a reactive hypersemia of the skin has taken place under the bandage in the manner before described, so that the dressing must be renewed after this period. A renewal of the dressing is also indicated when the inner layers of the bandage have become dry. On account of the early occurrence of maceration of the skin, care must be taken not to continue the use of the dressing too long; in order to avoid inflammation of the skin, it is recommended that the dressing be left off over night or every second or third day. 2. Irrigation. By this is understood the irrigation of the body or parts of it with cold water by means of a rubber hose. This serves to withdraw heat generally and locally in fever and in inflammations of peripheral parts (hoofs, tendons, joints, head). 3. Douche. This is the application of a stream of cold water with the simultaneous action of mechanical force (pressure from a syringe or from water pipes, irrigation from a higher level); it acts as a powerful stimulant to the nervous system, especially in depressed conditions of the brain and spinal cord. 4. Baths. The domestic animals are in general rarely sub- jected to complete baths for hydrotherapeutic purposes; on the other hand, cold and warm local baths are employed in different forms, especially foot baths for horses, cattle and dogs, for the purpose of reducing temperature, softening and cleansing. Ac- cording to Wenz (Dissertation, Giessen, 1911), a preliminary warm bath increases the effect of a succeeding cold bath, while the reverse of this order is unfavorable. Additional investigations on the action and use of baths on animals have been published by Lucas (Berl. Arch., 1910). 5. Cold rectal infusions. These serve to reduce the tempera- ture in fever and to stimulate intestinal peristalsis and evacuate the rectum; they are used most frequently on the horse (clysters, irrigations). G. Clay poultices. This is the oldest form of hydrotherapy used in veterinary medicine. The cooling effect is slight, accord- HYDROTHERAPY 275 ing to Bayer, the temperature being only temporarily depressed a few degrees. 7. Cataplasms. These are effective especially because of their neat and moisture. _ Other forms of hydrotherapy which may be mentioned are simple cold and hot poultices, the ice poultice (ice pack) Leiter's coolmg apparatus, and the different cold and warm washes In regard to the use of the thermo-regulator, see the text-books on operations and instruments. This apparatus makes possible the uninterrupted (24 hours and more) action of radiating heat of 42 to 44 C. MASSAGE Synonym: Mechanotherapy. Nature and Forms. — Massage is the application of pressure upon the skin and the parts beneath it. It has been used for a long time in veterinary medicine, intentionally in the form of rubbing and unintentionally in the application of ointments. It is also one of the oldest methods of healing used in the treatment of man (Chinese, Greeks, Romans, primitive people). After being forgotten for a long time (during the entire middle ages up to modem times), the method was to a certain extent rediscovered in Sweden by Per Hendrick Ling (Swedish medical gymnastics). Zander displaced the masseur by mechanical apparatus (mechano- therapy). Mezger, Mosengeil, Zabludowski and others have recently built up the method practically and scientifically. The following varieties of massage are distinguished: 1. Stroking (Effleurage). — This consists in passing the finger tips or the flat of the hand superficially and gently over the skin. 2. Rubbing (Massage a Friction). — In this variety of mas- sage, the skin is rubbed under strong pressure. 3. Kneading (Petrissage). — The part of the body concerned is pressed with the finger tips or fist as dough is kneaded. 4. Tapping (Tapotement). — The diseased member is tapped or struck at short intervals (edge of the hand, fist, stick). Tapping is employed in paralyses of muscles and nerves and as preliminary massage in the neighborhood of articulations. In addition, compression (constant pressure), vibration (inter- mittent pressure by special apparatuses) and active and passive movement (mechanotherapy in the restricted sense, Swedish medical gymnastics) may be considered as forms of massage. Action. — As in the case of cutaneous irritation and hydro- therapy, the effect of massage upon the body is very extensive. 276 MASSAGE 277 The action appears to be not exclusively mechanical but partly- dynamic. The most important local effects of massage are a cleansing, stimulant, anodyne and a dynamic action. In addi- tion, massage produces important general effects. Its influence upon the individual organs is as follows: 1. The circulation of the blood and lymph is mfluenced by massage first of all. The action here is the same as that which occurs during motion in the vessels of the extremities, where the venous blood and lymph is forced centripetally toward the heart by the contraction of the muscles and the tension of the fascia with the cooperation of the valves of the vessels, a process which may be called a natural or physiological massage. The pressure exerted upon the body by artificial massage produces at first an anaemia of the parts concerned in consequence of the blood and lymph being pressed out of the veins and lymph vessels toward the heart. With the cessation of the pressure, a large amount of fresh blood flows into the empty spaces and the area becomes hyperamic (aspiratory and pressure action). The repeated alter- nate occurrence of anaemia and hyperaemia stimulates and acceler- ates the circulation in the massaged parts. 2. The acceleration of the circulation brings about an increase of metabolism, leucocytosis, histolysis, and local antitoxin forma- tion, promotes retrogressive changes and regeneration, sthnulates the resorption of the products of fatigue and metabolism, patho- logical products, exudates and extravasations, and improves the nutrition of the part massaged (experiments of Mosengeil with pigments injected into the jomts). 3. Solid, fibrinous exudates and blood coagula beneath the skm, m tendon sheaths and m joint cavities are mechanically crushed by massage and thus prepared for resorption. In addi- tion, swellmgs of the skin and mucous membranes, subcutis, musculature, tendons and tendon sheaths, jomts, etc., are reduced in volume. 4. Contractions of the musculature are overcome by tappmg the muscle; simple rubbing and stroking brings about hyperaemia 278 GENERAL THERAPEUTICS FOR VETERINARIANS with increased nutrition and blood formation; in addition, the capacity for work is increased, as by training. 5. The nervous system is stimulated by massage in the same manner as by cutaneous irritation. The cutaneous nerves are stimulated by kneading and tapping and the stimulation acts reflexly upon the central nervous system. Paralyzed peripheral nerves (motor and sensory) especially are treated by massage. Light massage (stroking) appears to reduce increased suscepti- bility of nerves. 6. Other general efifects of massage include mcrease of cardiac activity, pulse and body temperature, reflex stimulation of gastric and intestinal peristalsis, diuresis and diaphoresis, change in the distribution of the blood (depletion of the central organs, deriva- tive action), improvement of the general state of nutrition and strengthening of the body constitution. Uses. — Massage is used prmcipally in surgery; it can, however, be employed with advantage in internal medicine. But its value in veterinary medicine must not be overestimated. The alleged results of massage in practice are in great part to be attributed to the healing power of nature and to the simultaneous employ- ment of hydrotherapy and medical treatment. For horses espe- cially, massage will never attain the same importance as for man, where suggestion is frequently the prmcipal healing factor; in addition, the hair of the horse, the resistance of many animals and the bodily difficulties arising for the masseur hinder the application of the method. Furthermore, much time is often lost with massage; blisters and firmg are much more valuable therapeutic measures than massage. The most important indications for massage are the following: 1. Blood stasis, lymph stasis, oedemas of the skin, mucous membranes, and subcutis (especially prophylactically agamst formation of thrombi and in decubitus). 2. Contusions, hemorrhages and lymphorrhagia on the sur- face of the body (saddle pressure, hsematomas of the thigh). 3. Subacute, aseptic inflammations of the skin, subcutis, ten- MASSAGE 279 dons, tendon sheaths, joints, bones, glands and udder (milking). Massage should not be applied too early in fresh distortions of the joints and in acute periostitis (only after several days' treatment). 4. Chronic inflammatory thickenings and indurations in the organs mentioned in paragraph 3, splints, galls, ulcers, badly granulating wounds, stiffness and weakness of the limbs in old horses and after hard work. 5. Muscular rheumatism, muscular paralysis, muscular atrophy and muscular cramp. 6. Paralysis of peripheral, motor and sensory nerves, spinal and cerebral paralytic conditions. 7. Chronic inflammation of the cornea (leucoma); oedema of the eyelids. 8. Colic, constipation, tympanites, paresis of the rumen, atony of the gastric and intestinal musculature. 9. Febrile general diseases, mflanmiation of internal organs, obesity, diabetes, anaemia (Weir Mitchell's method), cardiac failure (Oertel's method). 10. In healthy animals, massage in the form of training and rubbing down after exercise is an important factor m maintaining health, especially in horses. Contraindications.— Since massage promotes the resorption of the products of mflammation (fibrin, serum, blood), it can be employed only in simple, non-septic inflammations. In all cases in which septic material is present in the area of inflammation, especially the bacteria of septicaemia and pysemia, massage must be omitted, otherwise a general infection of the body will result from the resorption of the infectious material. Massage is espe- cially contraindicated in phlegmona, abscesses, septic mastitis, metastatic tendovaginitis (contagious pneumonia of horses), ery- sipelatous swellings (influenza), mahgnant oedema, black leg, all purulent, sanious and septic inflammatory conditions in general and in fresh keratitis. Massage is to be avoided particularly in phlebitis, lymphan- gitis and purulent lymphadenitis, because here the danger of a 280 GENERAL THERAPEUTICS FOR VETERINARIANS blood infection is the greatest. In addition, phlebotomy fistulae and venous thrombi should not be massaged, since lung emboli may result from the disintegration of the thrombus. Massage of arterial thrombi cannot be unqualifiedly recommended because of the danger of peripheral emboli. Finally, massage is forbidden in animals in many cases by the local sensitiveness. Technique of Massage. — To massage correctly requires on the one hand good instruction and practice and on the other hand a certain adaptabihty of the fingers and hand. Definite rules concerning the variety and the con- tinuance of massage can not be laid down. Massaging according to a fixed system should be especially avoided; each case is to be scientifically individ- ualized. The principle of massage is that the stroking, rubbing and kneading movements should be centripetal where possible, i.e., in the direction from the periphery toward the heart. On the legs, for example, one massages from below upward, and on the neck from above downward, following the course of the venous blood and lymph. The movements may also be circular, from above downward and the reverse alternately; the chief result is then altera- tion of the circixlation. Usually, massage is begim and ended with stroking. The "introductory massage" is begun on the healthy, centrally situated parts in order first of all to clear the paths of diversion. Massage is usually per- formed with the dry hand (finger tips, surface of the hand, thmnbs, fist); when massage is long-continued the hand is moistened or is anointed with pure oil, paraffin ointment, lard or with a medicated ointment (camphor ointment, iodoform ointment). The official paraffin ointment^ (white vaseUne) is the best. Massage is continued on the average for 10 to 20 minutes and is appUed once or twice daily. In massaging articulations, flexing, extending and rotating movements are employed. Very hard indurations, as spUnts, etc., can be massaged with the assistance of sticks and plates. Aids of this kind are unnecessary in other conditions; this is also true of the use of objects placed upon the skin to receive the pressure or blow. Tapping is used in paralytic conditions and as a preUminary massage in distortions. The sur- face of the fingers and the hollow of the hand are well adapted for stroking, both hands being used alternately; deep-lying parts are massaged with the tips of the thiunbs. Rubbing is performed with the joints of the fingers and hand held rigidly, the hands moving in straight lines or in a circle over small sur- faces. In kneading, the soft parts are grasped transversely with the hands and pressed with the fingers progressively toward the centre of the body. Tap- ping consists of elastic taps with the loose-jointed hand or slapping with the [^ Petrolatum album of the U. S. Pharmacopoeia.) MASSAGE 281 hoUow of the hand; the fist and instruments are also used. Massage of the rumen and intestines is performed by pressing both fists into the flank region against the organ concerned; general rubbmg of the abdominal waU operates mdu-ectly. In colic of the horse, the large colon can be massaged from the rectum. Massage of the cornea is performed by placing some ointment (yeUow mercuric oxide salve, 1 : 25) between the lids, drawing them over the eye and gently rubbmg. The articulations, tendons and muscles are most frequently massaged For more detaUs of the technique of massage, see the works of von Mosengeil, Reibmayr, Zabludowski, Vogel and others. Concerning the action and uses of massage m veterinary medicine see also Kohlhepp (Disser- tation, Giessen, 1906), Goldbeck (Zeitschr. f. Vet., 1908) and Leuffen (Mo- natshefte fiir prakt, Tierheilkunde, 1912). ELECTRICITY AS A REMEDY. ELECTROTHERAPY Synonyms: Gal vano therapy, Farado therapy, Franklino therapy. General. — Although electricity has been employed for healing purposes for a long time, it is only within the last seventy years that its action upon the body has been closely examined scientific- ally (Remak, Ziemssen, Erb). Furthermore, its physiological action remains unexplained to-day in many respects. Electro- therapy is therefore still in part a purely empirical healing method. In veterinary medicine, electricity is seldom employed for curative purposes and, indeed, is used mostly only on dogs and horses. According to the form of electricity employed and the object of the treatment, the following forms of electrotherapy are differentiated : 1. Galvanotherapy consists in the employment of the con- tinuous (galvanic) current generated in galvanic batteries, 2. Faradotherapy uses the interrupted (faradic, induced) current, which is generated by means of an induction apparatus. 3. Franklinotherapy is seldom employed; static or friction electricity is used. 4. Electrolysis (galvanolysis) is the chemical decomposition of fluids by the galvanic current, the electrodes being placed upon the skin. 5. Electropuncture (galvanopuncture) serves the same purposes as the needle-shaped electrodes which are used to penetrate the tissues. 6. Galvanocaustic is the use of the galvanic current to heat firing apparatus. Action. — The effects of electricity upon the living animal body are very complicated and have not been completely investi- gated. The nervous system and the musculature are influenced first of all by the electric current. But the fluids of the body, especially the blood, and the glands and other tissues appear also 282 ELECTROTHERAPY 283 to be changed in certain respects by electricity. In general the following effects are recognized: 1. The stimulant action is produced most strongly by the induced (faradic) current. It causes burning of the skin (cutaneous irritation), stimulation of the sensory and motor nerves, muscular contraction, dilation of the blood-vessels (stimulation of the vaso- dilators), increase of gland activity and of metabolism. Electricity therefore operates as a stimulant to most of the organs of the body. 2. The electrotonic action consists m the alteration of the physiological electrotonus, i.e., a change in the susceptibility of the nerves (anelectrotonus, catelectrotonus). To this are probably due in great part the curative results of electrotherapy in nerve diseases. The electrotonic action of the continuous current espe- cially is sedative, reducing the receptivity of the nerves. 3. A chemical action is undoubtedly produced by the electric current, especially in the region of the poles (anode, cathode). It acts first of all upon the fluids (serum, blood) and upon the salts contained in them. As is well known, salts and other compounds (water) are separated by electrolysis into their positive and nega- tive elements and the positive (alkaline) elements are attracted by the negative pole or cathode while the negative elements (acid) are attracted by the positive pole or anode. The electric current in muscles and nerves is probably due to a similar combination of chemical opposites. 4. A cataphoric action is manifested by substances which ordi- narily are not diffused through the tissues of the body becoming diffusible under the influence of the electric current. Because of the results obtained in experiments with potassium iodide and cocaine, it is assumed that pathological products also become diffusible. The so-called catalytic (alterative) action appears to consist essentially of a stimulation of the vasomotor and trophic nerves and consequently falls under the first-named action. Uses.— In veterinary medicine, electrotherapy is indicated in 284 GENERAL THERAPEUTICS FOR VETERINARIANS the following diseased conditions in the smaller domestic animals and in horses: 1. As a stimulant in pareses and paralyses of the posterior quarters and in paralyses of the peripheral nerves and muscles (pa- ralysis of the facial and radial nerves, tongue, bladder, quadriceps and penis, and amblyopia). In these conditions, the interrupted (faradic, induced) current is used in medium strength, because every single one of the numerous interruptions stimulates the nervous system. 2. As a sedative in excitable conditions of the muscles (twitch- ings after canine distemper). The galvanic or continuous current is used as mildly as possible. 3. As a diagnostic and prognostic to demonstrate the retention or loss of sensory and motor excitability in paralytic conditions of the nervous system and musculature (testing electric excitability). The surgical employment of the galvanocaustic and electro- puncture for the destruction of new formations has not been made use of in veterinary medicine. Technique. — The best induction apparatus for veterinary purposes is the email, handy apparatus of Spamer (price, $7 to $10). If the electric treat- ment is hmited to paralytic conditions, this apparatus will be entirely sufficient. For other cases, a small galvanic apparatus can be used. The method of using these apparatuses is described in the directions which accompany them. In general, it is to be remembered that the hairy skin of animals is a poor con- ductor of electricity and that the electrodes must therefore be moistened (salt water is best) before they are apphed. It is also to be remembered that the electric excitability is increased in the region of the negative electrode (cath- ode), while it is decreased in the region of the anode. Of especial practical importance are the facts already mentioned, namely: that the nerves are soothed by a weak galvanic ciurent, while they are stimulated by a strong faradic current. In the employment of the faradic current, a weak current is used in the beginning and the strength is slowly increased until a reaction (twitching, pain) is obtained; the current is permitted to operate in the latter strength on the paralyzed part for 10 to 15 minutes, one to three times a day. If a weaker current later produces twitching it is an indication of improvement. The strength of current iised can be exactly regulated with the apparatus. The application of the electrodes differs; usually one electrode is placed as ELECTROTHERAPY 285 close as possible to the paralyzed nerve or muscle, while the other one is applied m the neighborhood. In spinal paresis of the posterior quarters an electrode IS placed on the moistened sole of each hind foot so that the current wiU pass through the entire posterior parts; in paralysis of a single limb, one electrode IS apphed to the sole of the foot and the other in the region of the lumbar cord The spmal cord is either treated longitudinally, with the anode placed upon the upper (anterior) and the cathode upon the lower (posterior) part; or trans- vei^ely with the electrodes upon the stemmn (anode) and spinal column (cathode); the galvanic current, with the largest electrodes possible, operates best. The brain is treated with the electrodes apphed to the back of the neck and to the forehead, the weakest galvanic current possible being used A more complete discussion of electrotherapy will be found in Grundriss der Elektrotherapie fiirTieriirzte by Tereg (Berlin, 1902), and in the special works of Erb, Pierson-Sperhng, Rosenthal, Benedikt, Levandowski, Meyer Graupner and others. ' Thermopenetration.-This term refers to the generation of heat in the inner parts of the body with the assistance of the electric current. The un- limited high-frequency current can be introduced into the body in any strength desired without producing any effect upon the nervous system. It exerts a favorable influence on man, especially in neuralgias and rheumatic affections An electnc warm-current healing apparatus called the "Stangerotherm" has been recommended for animals. BLEEDING Synonyms: Venesection, phlebotomy. General. — Bleeding, a healing method of the old therapeutics, has in the last several decades very correctly passed out of fashion. A critical examination of its indications has shown that in most cases in which it is employed early it is at least unnecessary, while in a large number of cases it is even directly harmful. This is especially true of its former conventional employment in all febrile and inflammatory diseases. Still, it cannot be entirely dispensed with even to-day, especially in veterinary medicine. There are some very well-defined diseases, especially of horses and cattle, in which bleeding under certain circumstances saves life. Action. — The most important effect upon the body of the decrease in the total quantity of blood (5 to 10 liters in horses and cattle) which results from bleeding is the withdrawal of a large amount of water. In this respect, the effect of bleeding agrees entirely with the action of diaphoretic, sialagogue, diuretic, and laxative drugs, especially arecoline. Following this withdrawal of water, the blood seeks to regain at least its former volume as quickly as possible by taking up any fluids in the body at its disposal (lymph, fluid exudates), creating a temporary hydrsemia. Upon this process rests one of the most important effects of bleed- ing. Another important effect is the derivation of the blood from the internal organs ; the quicker the blood is withdrawn in bleeding the more rapidly and promptly this action occurs. The other effects of bleeding upon the body are of no special practical im- portance. It may be mentioned that bleeding also corrects dis- turbances of the circulation, removes poisons from the body with the blood and increases proteid metabolism, while the fat and carbohydrate metabolism is depressed (increased excretion of urea, decreased elimination of carbon dioxide and decreased absorption of oxygen, according to Bauer). 286 BLEEDING 287 Uses. — Bleeding is still indicated to-day in the following conditions: 1. Laminitis of horses. Experience has taught that a free bleeding as early as possible in this condition, in connection with arecoline, is the best treatment for laminitis (founder), 2. In the first stages of inflammation of the brain, so long as symptoms of cerebral congestion are present (pronounced injec- tion of the visible mucous membranes of the head, increased temperature of the cranium, strong pulsation of the arteries of the head, symptoms of psychic excitement). 3. In congestion of the lungs with threatened cedema of the Itmgs. 4. In poisoning of the blood (carbon monoxide, illuminating gas, haemoglobin, uraemia). Bleeding is also recommended in rheumatic haBmoglobinaemia [azoturia] of horses, as a prophylactic against parturient apoplexy and in different mtemal circulatory disturbances (heart diseases). In some sections it is used empirically in the beginning of fattening. On the other hand, its employment has been proven to be not without objection in inflammation of the brain and lungs, in pulmonary hemorrhage and in chlorosis (it is alleged to promote the formation of blood in chlorosis of man). Bleeding exerts no prophylactic effect against infectious diseases, as has been estab- lished experimentally by Zschokke. Transfusion. — This method is imnecessary in veterinary medi- cine and its use in human medicine is strongly contested. It con- sists in introducing into the veins of a diseased individual defibri- nated blood from an individual of the same species. Transfusion is recommended in excessive loss of blood and in poisoning of the blood (carbon monoxide). It has, however, been recently sup- planted by infusion and injections of sodium chloride in solution. Infusion. — By this is understood the introduction of solutions of medicines directly into the circulation through a vein. In human medicine, infusion of sodium chloride solution especially is recommended in place of transfusion in poisonings, cholera, etc. GENERAL THERAPEUTICS OF THE ORGANS OF LOCO- MOTION (MUSCLES, TENDONS, NERVES, ARTICULATIONS, BONES) Therapeutic Methods. — The diseases of the organs of locomo- tion comprise the principal part of surgery. They include the consideration of inflammation, atrophy, paralysis and laceration of the muscles, paralysis of the nerves, inflammation and lacera- tion of tendons, inflammation and fracture of the bones, and inflammation and dislocation of the articulations. The thera- peutic methods employed in the treatment of these diseases are naturally very nmnerous and differ with the character of the individual case. With regard to them and the excellent natural healing processes which operate in these conditions, especially in bone fractures, the reader is referred to the text-books on general surgery. Nevertheless, there are some observations to be made from the standpoint of general therapeutics. The surgical methods of treatment most frequently used are the following: 1. The rest treatment is the most important method of healing in all painful and acute inflammatory conditions of the muscles, tendons, bones, and articulations. "Rest the afilicted part." Simply permitting horses to " stand " will alone in many cases bring about healing (natural healing). The application of a plaster-of-Paris dressing in fracture of bones and sprained joints acts in the same manner. 2. The exercise treatment, on the contrary, is indicated in some chronic inflammatory conditions of the muscles, nerves, tendons and articulations (muscular rheumatism, atrophy of muscles, paralyses of muscles and nerves, and contractions). By exercise, as by massage, the circulation, resorption, innervation and metabohsm are stimulated locally and generally, muscular activity and the body constitution are strengthened, and under ORGANS OF LOCOMOTION 289 certain circumstances pain is decreased. In addition, exercise operates as a prophylactic against haemoglobinaemia [azoturia], parturient apoplexy and stable founder. 3. Hydrotherapy (cold, heat, Priessnitz dressing), cutaneous irritants, firing, massage, and electrotherapy are very important methods of treatment in numerous acute and chronic surgical disease conditions. (See the chapters on those methods.) 4. The medical method consists in the use of direct stimulants of the muscles and nerves: veratrin and strychnine; also in the subcutaneous and parenchymatous injection of morphine, cocaine, sodium chloride, and oil of turpentine (shoulder lameness). 5. The operative treatment is either direct or indirect. Exam- ples of the direct method are: section of contracted tendons or muscles (tenotomy, myotomy), incision of purulent mflammations of muscles, bones and tendon sheaths, and resection of necrotic tendons, while neurotomy is an example of the indirect or symp- tomatic method. 6. Regulation of the shoeing is very important in numerous surgical diseases (diseases of the hoof, ring bone, spavin, diseases of tendons). 19 INDIFFERENT REMEDIES. MECHANICALS Definition. — The terms indifferent and mechanical are used to designate a group of therapeutic agents which in general do not produce any chemical or pharmacological effect upon the organ- ism and which are employed only for their mechanical action. The group includes protective, emollient, cleansing, absorbent, dilating, and uniting remedies. L PROTECTIVES Synonyms: Obtegents, invol vents, obvolents, lubricants; covering, pro- tecting, soothing remedies, bandages or dressings. Uses. — The protectives serve to cover the skin and mucous membranes in inflammatory conditions and when wounds are present; also to guard and defend these structures against injurious influences. Wounds upon the skin are most frequently treated by the use of bandaging materials. In addition, the different varieties of eczema, erosions and bums and also the specific inflam- mations of the skiQ require the emplojnment of protective remedies in the form of salves. The latter are also applied to the skin prophylactically to protect it from flowing secretions (pus) and caustic substances (cantharides). The protectives are admia- istered internally in the different inflammatory conditions of the mucous membrane of the pharjmx, oesophagus, stomach and intes- tines and as mechanical antidotes in intoxications (see p. 216) ; the mucous membrane of the bladder and rectum is also accessible to applications of protectives. Finally, they are used to prevent the dissipation of heat and moisture from the skin, to promote cu- taneous resorption in the epidermatic application of medicines and to lubricate the instruments and hands. Remedies. — 1. Fats and oils: Lard, olive oil, linseed oil, pea- nut oil, almond oil, rape oil, poppy-seed oil, cod liver oil, cacao oil, 290 INDIFFERENT REMEDIES. MECHANICALS 291 coca oil, mutton suet, spermaceti, ointment of rose water, and sevum salicylatum.^ 2. Mucilaginous remedies: Linseed, acacia, althaea, traga- canth, salep, mallow, dietetic remedies (oat and barley mucilage). 3. ParaflSn ointment,^ lanolin, simple cerate. 4. Plasters and liniments: Adhesive plaster, Lund's plaster,' Carron oil (linamentum calcis). 5. Silver nitrate (silver covering of bums and other cutaneous affections). 6. Gelatin, collodion, traumaticin [gutta-percha dissolved in chloroform], water glass. 7. Starch, lycopodium, zinc oxide, bolus, talcum, pulvis talci salicylicus (N.F.). 8. Cotton and other dressing material, 2. EMOLLIENTS Synonyms: Demulcents, solvents; softening, loosemng, liquefying, dis- integrating remedies. Actions and Uses. — ^The emollients operate upon the different pathological indurations of the skin, subcutis, tendons, tendon sheaths, and muscles by mechanical diffusion and imbibition (water, oil, glycerin, soap), by preventing the dissipation of heat and water (poultices) and by chemical solution (lyes, alkalies), disintegration and liquefaction. The remedies concerned in in- ternal softening and solution have already been considered in the chapters on resorbents (p. 76), expectorants (p. 107) and diuretics (p. 113.) The external disease conditions which are most frequently treated with emollients are thickenings of the skin, calluses, scabs and crusts upon the skin, squamous eczema, thickenings of the subcutis, hard swellings in the tendons and tendon sheaths as in [1 Salicylic acid 2 parts, benzoic acid 1, mutton suet 97.] P Petrolatum album.] [' Turpentine and pitch, equal parts; liquefy by heat, mix, and spread on cloth.] 292 GENERAL THERAPEUTICS FOR VETERINARIANS tendinitis and tendovaginitis, indurations of glands, udder nodules and rheumatic indurations of muscles. Remedies. — 1. Water and all remedies containing water (baths, cataplasms, moist applications). 2. Moist heat, especially in the form of the Priessnitz dressing and cataplasms. 3. Fats, soaps, glycerin, and lyes (soda lye, potash lye. potas- sium sulphate). 3. CLEANSING REMEDIES Action and Uses. — The ordinary cleansing agents, water and soap, operate mechanically to remove dirt, scabs, pus, and other disease products, and particularly infectious materials. In the latter respect, the cleansing agents act at the same time as dis- infectants. As already stated (p. 182), a thorough cleansing is in many cases equal in value to a disinfection. Water and soap, when rationally used, frequently suffice as disinfectants; provided the water is clean, i.e., free from infectious materials, that it is used in sufficient amount and, when possible, warm or hot, and that a good preparation of soap is used. An entirely neutral soap is best for cleansing the skin (soft soap irritates the skin, as may be frequently observed especially in dogs). On the other hand, for cleansing utensils and other articles a soap with a strong alkaline reaction is desired, i.e., a soap which contains free lye, because the free lye exerts a disinfectant as well as a cleansing effect. Soft soap is therefore preferred for this purpose. Absorbent Remedies (Imbibents, Rophetics). — These serve to absorb blood, serum, pus, and other fluids. Their action is purely physical. They include dressing materials (cotton, wood wool, jute, etc.). Wood wool possesses the greatest imbibing properties. Freshly-burned charcoal absorbs gases (SH2) and poisons, and starch absorbs iodine. Dilating Remedies (Dilatants). — A mechanical dilation by means of dilating pencils (laminaria, tupelo) is used in surgery and obstetrics. INDIFFERENT REMEDIES. MECHANICALS 293 Uniting Remedies (Contentives). — These serve to unite solu- tions of continuity (wounds, fractures of bones). The so-called immovable dressings are made of rubber, gelatin, water glass, plaster-of-Paris, starch paste, etc. Medical uniting substances for wounds are coUodion, traumaticin [gutta-percha dissolved in chloroform], and adhesive plaster. Am AS A REMEDY General. — While the air acts as the excitant or carrier in differ- ent diseases, it is also an important healing factor in a number of diseases. As regards the harmful effects of the air, these can be referred in part to its temperature and in part to the admixture of dust, bacteria, and poisons. Stable air is an especially frequent source of diseases of all kinds. Its constant, uniform temperature, which is usually too high, exerts a relaxing effect upon the general body constitution and produces a consequent predisposition to dis- ease. The best known of the stable diseases which occur through the influence of the temperature of the stable air are rheumatism, rheumatic hsemoglobinaemia [azoturia], catarrhs, brain and lung diseases, and also summer wounds in army horses. Secondly, stable air operates pathologically through its contained bacteria, gases and mechanical admixtures. These favor especially the development of tuberculosis, glanders, contagious pneumonia of horses and other infectious diseases. The carbon dioxide, ammonia and other gases which may be present act harmfully upon the respiration. The outside air can also cause disease in different ways (hot air, dusty air, arsenical fumes, lead vapors). By a careful prophylaxis all of these disease conditions may be indirectly avoided. Furthermore, air is a very important direct curative agent. Its healing action is in part due to the oxygen it contains (open suppuration, anaerobes), in part to its temperature and in part to its purity. To what extent the ozone of the air possesses healing properties has not been scientifically determined. Therapeutic Action of Cold Air. — Cold air operates first, like cold water, as a cutaneous irritant. The anaemia produced primar- ily in the cutaneous vessels is followed by a reactive hypersemia of the skin. As a consequence the circulation is stimulated through- 294 AIR AS A REMEDY 295 out the entire body and the blood is driven from the internal organs, especially the lungs, digestive apparatus and brain, to the periphery, metabolism is increased and the constitution is strength- ened. Heat is given off by the body to the surrounding cold air, provided the action of the latter continues long enough. Cold air consequently acts as a refrigerant. Upon the basis of these actions, cold air is employed in the form of ventilation of stables, and animals are exercised in cold air, bivouacked and placed in cold compartments and in shady places to make them hardy; cold air is also employed as a preventive against rheumatism and other diseases due to chilling, as a curative agent in all febrile diseases of the internal organs, and in congestion of the lungs and brain. Therapeutic Action of Pure Air.— Pure air, rich in oxygen, poor in carbon dioxide, free from bacteria and other impurities, is the best natural remedy in all catarrhal affections of the respira- tory apparatus. It is employed in the form of good ventilation, the air in the stable being renewed as often as possible, or the animal is placed in the open air (pasture, bivouac, exercise in the open). The renewal of the air in the bronchi and alveoli promotes respiration and removes the injurious air from these structures. Furthermore, the introduction of fresh air dilutes and removes the infectious material present, which is also in part destroyed by the oxygen (disinfectant action of fresh air). Especially good results have been obtained in this respect in strangles, contagious pneu- monia, tuberculosis, and other infectious diseases. Climate.— Climate can only be made use of for healing purposes in veter- inary medicine in exceptional cases, which is in contrast to the very highly- developed climato-therapy of human medicine. The importance of cUmate in a hygienic sense for the domestic animals haa, it is true, been known for a long time. It is known, for example, that the mountain breeds, because of the vigorous climate, are more resistant to diseases of all kinds than the breeds of the lowlands. It is further known that imported animals (monkeys, parrots) are very susceptible to disease and frequently die of tuberculosis because of the change of climate. A similar effect is observed on horses, cattle and sheep when they are taken into a new region with a different climate! 296 GENERAL THERAPEUTICS FOR VETERINARIANS For economical reasons, a change of climate for therapeutic purposes is per- missible with the domestic animals only in very rare cases (removal to ele- vated pastures or to distant farms), although frequently such a change ap- pears to be indicated, especially in convalescence. Light. — The use of light as a heaUng remedy was introduced by Finsen of Copenhagen. He uses the bactericidal (chemical action of the ultraviolet, violet and blue rays) as well as the inflammation-producing (thermal action of the red rays) forces of light and has in this manner cured numerous cases of lupus in man. His method consists in concentrating the rays of a very strong arc light by means of a rock crystal and directing them through a layer of distilled water which is continually cooled. Iwanow (Repert. d. pol. Sanit. v6t., 1902) has obtained excellent results with Finsen's apparatus in the treatment of eczemas of the horse. Rontgen's Rays. — These are used in surgery for the local treatment of malignant neoplasms (carcinomas, sarcomas). Radium acts in a similar manner (radiotherapy). In internal medicine, the Rontgen rays have proven less satisfactory (employed in chronic myelomas and in lymphatic leukaemia and aleukaemic splenic tumors). INDEX Abortive method, 8 Abortives, 119 Absorbent materials, 292 Absorbents of gas, 32, 52 Acid-neutralizing stomachics, 32 Aeries, 146 Air as a remedy, 104, 294 harmful effects of, 294 Alactics, 127 Alterants, 76, 159 Amara, 30 Amblotics, 119 Anajsthesia, general and local, 101, 102 Anaesthetics, 97 Analeptics, 93 Analgesics, 97 Anaphrodisiacs, 121 Anexosmotics, 48 Angio-asthenics, 72 Angiosthenics, 71 Anodynes, 97 Antacids, 32 Antagonistics, 216 Antagonists, 216 Antaphrodisiacs, 121 Antatrophics, 134 Antemetics, 32 Antentozoa, 165 Antepizoa, 160 Anterotics, 121 Anthelmintics, 165 Anti-asthmatics, 97 Anticatarrhalics, 159 Anticathartics, 48 Anticonvulsives, 97 Antidepertitorics, 134 Antidiarrhoeics, 48 Antidotes, 216 chemical, 217 mechanical, 216 physiological, 219 symptomatic, 220 Antidyscratics, 159 Antidysenterics, 48 Antidyspeptics, 29 Antiepileptics, 97 Antifcbrilics, 84 Antifennentatives, 169 Antiforments, 52 Antigalactagogues, 127 Antigalactics, 127 Antihidrotics, 132 Antineural^cs, 97 Antiparalytics, 93 Antiparasitics, 109, 160 Antipediculous, 160 Antiperiodics, 84 Antiphlogistics, 159 Antiphthiriacs, 160 Antiplastics, 76, 138 Antipsorics, 160 Antiputrids, 169 Antipyretics, 84, 86 Antiscabious, 160 Antisepsis, 170 Antiseptic stomachics, 31 styptics, 49 Antiseptics, 109, 169, 172 for wounds, 209 internal, 213 Antisialagogues, 132 Antispasmodics, 52, 97 Antitaenics, 165 Antitetanics, 97 Antithermics, 84 Antitoxics, 216 Antitypics, 84 Antityposics, 84 Antizymotics, 169 Antodontalgics, 97 Aperients, 40 Aperitives, 40 Aphrodisiacs, 120 Arabian medicine, 14 Aristotle, 12 Aromatic stomachics, 31 Artificial arrest of hemorrhage, 68 Asclepiadae, 9 Asepsis, 170 Aseptics, 169 Astringent styptics, 49 Astringents, 48, 157 Attenuation, methods of, 230 Balneotherapy, 265 Bechics, 109 Bitter stomachics, 30 Bleeding, 286 Blisters, 146 Blood diseases, dietetic treatment of, 63 general therapeutics of, 60 297 298 INDEX Blood-forming remedies, 63 Blood plastics, 63, 134 Blood-vessels, general therapeutics of the diseases of, 64 Boerhaave, 10, 17 Bone plastics, 134 Bradysphygmics, 57 Brown, 18 Calefacients, 159 Cardiac diseases, general therapeutics of, 56 sedatives, 58 stimulants, 58 tonics, 58 Cardiacs, 57 Carminatives, 52 Cathajretics, 152 Catharsis, results of, 43 theories of, 41 Cathartics, 40, 45 Causal healing method, 6 Causes of immunity, 227 Caustics, 152 Cauteries, 152 Cauterization, 156 Cellular pathology, 21 Cerebralics, 91 Chemical antidotes, 217 Chemotherapy, 23 Cholagogue laxatives, 54 Cholagogues, 54 Cleansing remedies, 292 CHmate, 295 Coagulants, 157 Cold, 69 Colyseptics, 169, 172 Composting, 202 Compression, 68, 276 Confortants, 137 Confortatives, 137 Conservants, 169 Conservation of animal products, 214 Conservative healing method, 8 Constipating remedies, 48 Contentives, 293 Corrosives, 152 Curative vaccination, 252 Cutaneous irritants, 146 mallein test, 263 tuberculin test, 260 Demulcent styptics, 48 Demulcents, 291 Derivants, 146 Derivative healing method, 5 medicines, 146 Dermerethistics, 146 Diagnostic inoculation, 254 Diaphoretics, 129 Diapnoics, 129 Dietetic method, 7 treatment of blood diseases, 63 intestinal diseases, 40 liver diseases, 55 stomach diseases, 29 Digestive organs, general therapeutics of, 25 Digestives, 29 Dilatants, 292 Dilating remedies, 292 Direct healing method, 5 Discutients, 76 Disinfectant stomachics, 31 Disinfectants, 169 for infectious diseases, 201 for wounds, 209 mechanical, 208 relative rank of, 173 Disinfection for infectious animal diseases, 183 of wounds, 178, 209 preliminary, 182 preparation for, 182 Diuretics, 113 Drastics, 40 Ebriantics, 97 Ecbolics, 119 Eccoprotics, 40 Ectrotics, 119 Electropuncture, 282 Electricity as a remedy, 282 Electrolysis, 282 Emesis, effects of, 35 Emetics, 34, 216 Emmenagogues, 119 EmolUents, 291 Empirical healing method, 7 Enterostyptics, 48 Epileptifacients, 93 Epispastics, 146 Erasistratus, 12 Erethistics, 146 Erotics, 120 Errhines, 107 Erythrotics, 63 Escharotics, 152 Euphorics, 93 Euplastics, 63, 134 Evacuants, 40 Excitants, 93 Exhilarants, 93 Expectant heaUng method, 7 INDEX 299 Expectorants, 107 Exsiccants, 157 External antiparasitics, 160 Exudates, general therapeutics of, 73 Eye diseases, general therapeutics of, 141 Fallopius, 16 Faradotherapy, 282 Febrifuges, 84 Fever, general therapeutics of, 80 Firing, 156 Foods, 134 Franklinotherapy, 282 Galactagogues, 122 Galactics, 122 Galen, 12 Galvanocaustic, 282 Galvanotherapy, 282 Gas absorbents, 52 Gas-expelling drugs, 52 General healing method, 5 Genital organs, general therapeutics of the diseases of, 118 Glands, general therapeutics of, 128 Hajmatics, 63 Haimatinics, 63 Hajmatopoietics, 63 Haemostatics, 69 Hahnemann, 19 Harvey, 16 Healing methods, 4 Heart diseases, general therapeutics of, 56 remedies, 57 sedatives, 58 stimulants, 57 tonics, 58 Heat, 69 Hemorrhage, methods of arresting, 63 Hepatic stimulants, 54 Hepatics, 54 Herophilus, 12 Hidrotics, 129 Hippocrates, 10 History of therapeutics, 9 HofTmann, 17 Homoeopathy, 19 Hufeland, 18 Humoral pathology, 11, 13 Hydragogue cathartics, 43 diuretics, 113 Hydriatrics, 265 Hydrotherapy, 105, 265 Hyperemia as a remedy, 271 Hyperinotics, 63 Hyperkinetics, 93 Hypnotics, 97 Imbibents, 292 Immunity, 225 acquired, 226 active, 226 artiOcial, 227 causes of, 227 individual, 225 inherited, 226 natural, 225 passive, 226 species, 225 Indifferent remedies, 290 Indirect healing method, 5 Inhalations, 105, 106 Inoculation, diagnostic, 254 methods of, 225 Internal antiseptics, 213 Intestinal diseases, dietetic treat- ment of, 40 general therapeutics of, 38 mechanical treatment of, 51 operative treatment of, 51 Intracutaneous tuberculin test, 260 Intradermal tuberculin test, 260 Involvents, 290 Irritants, 146 Kneading, 276 Lactics, 122 Lactifuges, 127 Laxatives, 41 Lenitives, 41 Ligation, 68 Light, 208, 296 Litholytics, 113 Lithothryptics, 113 Liver diseases, dietetic treatment of, 55 general therapeutics of, 52 mechanical treatment of, 55 remedies, 53 Locomotory organs, general thera- peutics of, 288 Lubricants, 290 Mallein, 260 test, cutaneous, 263 ophthalmic, 260, 263 subcutaneous, 261 Malpighi, 16 Mange remedies, 160 Massage, 276 300 INDEX Masticatives, 131 Masticatorics, 131 Mechanical antidotes, 216 disinfectants, 208 treatment of intestinal diseases, 51 of liver diseases, 55 of stomach diseases, 33 Mechanicals, 290 Mechanotherapy, 276 Medicinal plastics, 135 Metabolism, general therapeutics of the diseases of, 133 Metasyncritics, 159 Methods of healing, 4 Mitigation, methods of, 230 Mon]k's medicine, 14 Morgagni, 16 Mucous membranes, general thera- peutics of, 143 Mucus-dissolving remedies, 109 Mydriatics, 141 Myotics, 142 Narcosis, 101 Narcotic stomachics, 32 styptics, 49 Narcotics, '97 Nauseosa, 34 Nauseotics, 34 Nerve sedatives, 97 stimulants, 93 Nervines, 90 Nervous system, general therapeutics of diseases of, 88 Neurotics, 90 Nutrients, 134, 137 Obstruents, 48 Obtegents, 290 Obvolvents, 290 Odinegogues, 119 Operative treatment of intestinal diseases, 51 of stomach diseases, 34 Ophthalmic mallein test, 260, 263 tuberculin test, 259 Osmetics, 40 Palliative method, 6 Paracelsus, 9, 14 Paralyzants, 97 Parasitics, external, 160 Pare, 16 Paregorics, 97 Parturefacients, 119 Pasteurization, 207 Pellentics, 119 Peptics, 29 Peripherics, 92 Peristaltics, 40 Phlebotomy, 286 Physical antidotes, 216 Physiological antidotes, 219 healing method, 6 stomachics, 29 Plastics, 134 food, 134 medicinal, 134 Pneumatics, 107 Polysphygmics, 57 Preservants, 169 Preservation of animal products, 214 Priessnitz, 19, 265 Priessnitz's dressing, 273 Prophylactic method, 7 Protective vaccination, 236 Protectives, 48, 290 Ptarmics, 107 Ptyalogogues, 131 Pupil-contracting remedies, 142 Pupil-dilating remedies, 141 Purgatives, 40 Pustulants, 146, 148 Rademacher, 19 Radical healing method, 6 Rational heaUng method, 6 Reducing remedies, 138 Refrigerants, 159 Regulations concerning vaccination, 237 for disinfection, 184 Resolvents, 76 Resorbents, 76 Respiratory apparatus, general thera- peutics of the diseases of, 103 Roborants, 137 Rontgen's rays, 296 Rophetics, 292 Rubbing, 276 Rubefacients, 146, 148 Ruminatorics, 32 Saline stomachics, 30 Schonlein, 18 Sedantics, 97 Sedatives, cardiac, 58 nerve, 97 Serum therapy, 22 Sialagogues, 131 Sialics, 131 Skin, general therapeutics of, 143, 144 Solvents, 291 INDEX 301 Somniferics, 97 Soporifics, 97 Spasmodics, 93 Spinalics, 92 Spinants, 93 Spontaneous arrest of hemorrhage, 66 Stahl, 18 Statistical healing method, 7 Sternutatories, 107 Stimulant stomachics, 31 Stimulants, cardiac, 58 nerve, 93 Stomach diseases, dietetic treatment of. 29 general therapeutics of, 25 mechanical treatment of, 33 operative treatment of, 34 Stomachics, 29 Stroking, 276 Styptics, general, 70 intestinal, 48 local or topical, 69 Subcutaneous mallein test, 261 tuberculin test, 258 Sudorifics, 129 Suppletives, 29 Suppurants, 148 Suppuratives, 146 Sydenham, 17 Symptomatic antidotes, 220 healing method, 6 Tapping, 276 Temperantics, 97 Temperants, 159 Tetanies, 93 Thermopenetration, 285 Tonics, 137, 157 cardiac, 58 Torsion. 68 Transfusion of blood, 62 Transudates, general therapeutics of, 73 Tuberculin, 258 test, cutaneous and intracuta- neous, 260 ophthalmic, 259 subcutaneous, 258 Udder, general therapeutics of the diseases of, 118 Uniting remedies, 293 Urinary organs, general therapeutics of the diseases of, 112 Uteri nes, 119 Uterus, general therapeutics of the diseases of, 118 Vaccination, 225, 250 curative, 252 emergency, 236 for the different diseases, 237 methods of, 233 prophylactic, 236 protective, 236 purposes of, 235 varieties of, 235 Vaso-astringents, 71 Vaso-constringents, 71 Vasodilants, 72 Vasodilators, 72 Vasomotor stimulants, 71 Venesection, 286 Vermifuges, 165 Vesal, 16 Vesicants, 146, 148 Vibration, 276 Vital healing method, 8 Vomiting, effects of, 35 Vomitives, 34 Vomitories, 34 Von Haller, 18 Waiting healing method, 7 Water as a remedy, 265 Worm remedies, 165 Wound disinfectants, 209 JAN 1 1 ZUUl; JJI^.;, ||>r.,M,, ,,:|,,j;|,„| l!!il!i 4 ;''!,!i