Part 4

_Symptoms._ Mercurial stomatitis is a local manifestation of a general poisoning. Salivation is one of the most prominent phenomena, the watery saliva falling in streams from the angles of the mouth. The buccal mucosa generally becomes red and swollen and the tongue becomes indented at the edges by pressure against the molars. The gums especially suffer and the teeth raised in their sockets by the swelling of the periodontal membrane, become loose, and easily detached. The mucosa of the gums becomes soft and spongy, bleeds readily under pressure and soon shows erosions and ulcers. This condition extends to the lips, cheeks and lower surface of the tongue while the upper surface of the latter organ, the fauces and pharynx commonly escape. The breath and buccal exhalations are very offensive, and the animal loathes food, and has little power of mastication or deglutition. Sometimes the ulcers extend even to the bones.

Along with these local symptoms there are usually gastro-intestinal irritation, tympany, inappetence, continuous rumbling in the belly; badly digested fœtid stools, often diarrhœa, small weak pulse, hyperthermia, accelerated breathing, cough, and great langor and prostration. A tendency to blood extravasation is shown in sanguineous fæces, epistaxis, bleeding from the mouth, the throat or the womb and even into the skin. Pregnant females may abort. The eyes are dull and sunken, and the conjunctiva yellow. Eczematous or pustular eruptions may appear on the skin on the nose, lips, neck, back, loins, croup or perineum.

_Lesions._ In addition to the lesions described above, there are usually gastro-intestinal inflammation, œdema of the peritoneum and pleura, in the lung as well as in the serosæ, (pneumonia is not uncommon especially in sheep), intestines, kidneys and muscles, hæmorrhagic spots are not uncommon, the blood forms a loose black coagulum, and the encephalon is anæmic and softened.

_Treatment._ The first consideration is to cut off the supply of mercury. Mercurial applications on the skin should be washed off with tepid water and if necessary soap. An application of sulphide of potassium will precipitate the mercury in an insoluble form. For mercurial agents in the alimentary canal an emetic may be given (if the animal is one susceptible to emesis) followed by a saline laxative. This may be combined with or followed by raw eggs, mucilage, wheat gluten or other albuminoid, sulphide of potash or sulphur, to precipitate the mercury and prevent its absorption. Later, when the bowels have been cleared, iodide of potassium in small doses will serve to dissolve and remove what mercury may be lodged in the tissues.

Locally one of the best applications is chlorate of potash as a mouth wash, 2 drs. to the quart of water. To this may be added tannic acid or other vegetable astringent and even alcohol.

Finally a course of iron and bitter tonics will serve a good purpose in restoring the general tone.

STOMATITIS FROM CAUSTICS.

Caustic Alkalies; symptoms, lesions and antidotes. Caustic Acids; symptoms, lesions and antidotes. Caustic salts; symptoms, lesions and antidotes.

=Caustic Alkalies= (soda, potash, ammonia and their carbonates) often cause stomatitis. What is supposed to be _weak lye_, given to counteract indigestions, colics, and tympanies often proves dangerously irritating, and some of the worst forms of stomatitis we have ever seen in the horse originated in this way. As the animal refused to swallow, the caustic liquid lay in the mouth and virtually dissolved the epithelium and surface layers of the fibrous mucosa. The surface in such a case is usually of a deep red, and where the cuticular covering remains, it is white and corrugated. The antidote is a weak, non-irritant acid, such as vinegar, boric, citric, or salicylic acid. When the caustic alkali has been thoroughly neutralized in this way the ordinary treatment for catarrhal stomatitis may be followed. The attendant gastritis must receive its special treatment.

=Caustic Acids.= Sulphuric, nitric and hydrochloric acids act by abstracting liquids and charring the tissues. The lesions from strong sulphuric acid turn black, those due to nitric acid, yellow, (zanthoproteic acid,) and those due to muriatic acid are white, with the characteristic odor of chlorine. The antidote in such cases is a non-irritant basic agent, such as chalk, lime water, soapsuds, calcined magnesia, and mucilaginous liquids, albumen, gluten, flax seed, with opium. The same agents are applicable to the attendant gastritis and when the acids are thoroughly neutralized the treatment is as for simple inflammation.

=Caustic Salts.= Among caustic salts may be named mercuric chloride, sulphates of copper and iron, chlorides of iron and zinc, tartar emetic. These may be treated by albumen, blood, white of egg, milk, gluten, mucilage and other sheathing, protecting agents which will form with the salts insoluble and harmless coagula. The subsequent treatment will follow the lines marked out for simple stomatitis. To prevent infection of the raw surface Cadeac recommends: tannic acid 1 oz., benzo-naphthol 3 drachms, powdered gentian 6 drachms, honey, sufficient to make an electuary.

MYCOTIC STOMATITIS IN FOALS, CALVES AND BIRDS. THRUSH. MUGUET.

Oidium (saccharomyces) albicans; a parasite of the young; cultures. Symptoms in foals and calves; congested buccal mucosa; curd-like concretions; erosions. Diagnosis from rinderpest. Treatment; disinfection; sunshine; open air; exercise; locally antiseptics.

This is a form of stomatitis manifested by a raised white patch on the mucous membrane and determined by the presence of the =oidium albicans= (=saccharomyces albicans=), a cryptogam discovered by Berg in 1842 in thrush in children. It is closely allied to the _mucor_, and attacks only the young and feeble. The white crust consists of epithelial cells intermingled with an abundance of the white mycelium and oval spores of the fungus. Andry in his artificial cultures found that it was pearly white when grown on gelatine, dirty white on potato, and snow white on carrot.

=Foals and Calves.= _Symptoms._ The buccal mucosa red, congested and tender, shows here and there white curdy looking elevations, or red erosions caused by the detachment of such masses. These bear a strong resemblance to the concretions seen on this mucosa in rinderpest, but are easily recognized by the absence of the attendant fever, and by the discovery, under the microscope, of the specific microphyte. The eruption may extend to the pharynx and œsophagus and interfere fatally with deglutition, but usually it merely renders sucking painful and is not serious.

_Treatment._ It is always well to destroy floating germs by cleansing and whitewashing the stable, and to invigorate the young animals by sunshine, free air and exercise. Locally the most effective agent is the old favorite remedy borax which arrests the growth of the parasite whether in artificial cultures, or in the mouth. The powder may be rubbed into the sores or it may be mixed with honey or molasses and used as an electuary. As substitutes boric acid, salol, thymol, chlorate of potash, or permanganate of potash may be used.

=Birds.= The affection has been twice observed as occurring in the œsophagus and crop of two chickens. Martin tried in vain to inoculate it on other fowls, and Neumann failed to convey it from child to chicken by feeding. The element of individual susceptibility was manifestly lacking. From its seat in the crop the malady passed unnoticed during life. In cases that can be recognized, treatment would be the same as in young mammals.

PARALYSIS OF THE TONGUE. GLOSSOPLEGIA.

Causes: Nervous lesions—central or peripheral, parasitic, inflammatory, infectious, traumatic or degenerative. Symptoms: unilateral and bilateral. Treatment: remove cause; use nerve stimulants, embrocations, blisters, frictions, galvanism, suspension of tongue.

Paralysis of the tongue depends on a lesion of the medulla oblongata, or of the 7th or 12th cranial nerve. The central lesions may be connected with cœnurus or other parasites in the brain, hydrocephalus, meningitis, cerebro spinal meningitis, infectious pneumonia, abscess (strangles), and tumors. The distal or nerve lesions may be due to neuroma, tumors, traumas, lacerations, bruises, or violent distension of the tongue. Parotitis, abscess of the guttural pouch and tubercle may be added as occasional causes. As direct traumatic injuries those caused by wearing a poke by a habitual fence-breaker, excessive dragging on the tongue in operations on the mouth, and compression of the tongue by a loop of rope passed over it, require mention.

_Symptoms._ In =unilateral= paralysis the affected half of the tongue remains soft and flaccid and is liable to be crushed between the teeth, the active muscles of the opposite half pushing the organ over to the paralyzed side. In =bilateral= paralysis the tongue hangs out of the mouth, and being crushed and torn by the teeth, it swells up, and may even become gangrenous.

_Treatment._ Will vary according to the cause. After removal of the central or nervous lesions, the remaining functional paralysis may be treated by strychnia, internally or hypodermically, by frictions or stimulating embrocations to the intermaxillary region, or by electricity. The tongue must be suspended in a sling to prevent œdema, inflammation and wounds by the teeth. In bad cases of bilateral traumatic glossoplegia in meat producing animals it has been advised to have the subject butchered.

DISEASES OF THE SALIVARY GLANDS.

Modifications of the secretion are commonly simple excess or deficiency, with a correspondingly high or low specific gravity of the product. There may, however, be a virulent element as in the case of rabies.

SUPPRESSION OF SALIVARY SECRETION. XEROSTOMIA.

Causes; fever; vascular vacuity, after bleeding, diarrhœa, etc.; destruction of glands; Calculus. Symptoms; slow, difficult mastication; digestive disorder. Treatment; remove mechanical obstruction; correct constitutional disorder; employ stimulation to gland—pilocarpin, electricity.

Entire suppression of salivary secretion is usually the result of some other disease. It may be a manifestation of the general tendency to retain water in the febrile system, or it may be an indication of vacuity of the vascular system as after bleeding, profuse diarrhœa, diuresis, or diaphoresis, or it may be the result of the entire destruction of a salivary gland or the obstruction of its duct by some foreign body or calculus. In proportion to the completeness of the suppression, mastication and deglutition become difficult or impossible. The condition must be met by the removal of the cause which is operative in the particular case. The treatment may be surgical for the removal of obstructions, or medical with the view of overcoming anæmia, fever, profuse secretions from other emunctories, or the simple physiological inactivity. To meet the last indication small doses of pilocarpin, or the application of a gentle current of electricity will usually succeed.

EXCESSIVE SECRETION OF SALIVA. SALIVATION. PTYALISM.

Causes; a symptom of other diseases, of the mouth, teeth, throat or stomach; rank aqueous vegetation, lobelia, pilocarpin, muscaria, tobacco, mustard, and other acrid vegetables; caustic alkalies, acids, salts; compounds of mercury, gold, copper, iodine; palsy of lips; harsh bit; fungi on clover, sainfoin, etc. Symptoms; salivary escape; frequent deglutition; thirst; disordered digestion, etc. Treatment; remove cause; astringent washes; sedatives; embrocations to the glands.

This is often a symptom of some other affection such as aphthous fever, dumb rabies, epilepsy, stomatitis, pharyngitis, dentition, caries and other diseases of the teeth, wounds and ulcers of the mouth, gastric catarrh, etc. In other cases it is due to direct irritants in the food or medicine, as very rank, aqueous, rapidly grown, spring grass, lobelia, pilocarpin, muscarin, tobacco, wild mustard, colchicum, pepper, garlic, ginger, irritant and caustic alkalies, acids and salts, and the compounds of mercury, gold, copper, or iodine employed locally or internally. The application of mercurials to the skin is especially liable to salivate cattle and dogs, partly because of a special susceptibility to the action of this metal and partly from the tendency of these animals to lick the medicated surface. Paralysis of the lips causes a great flow of saliva from the mouth though no more than the normal amount is secreted. The irritation of a large or harsh bit will increase the secretion and still more the former habit of attaching to it small bags of spicy or irritant chemicals. Certain fungi determine salivation. Mathieu saw profuse salivation in horses, cattle and sheep fed on clover and sainfoin which had become brown.

_Symptoms_ consist in the profuse flow of saliva, either in long stringy filaments, or if there is much movement of the jaws, in frothy masses; frequent deglutition; increased thirst and disordered digestion (tympany, inappetence, colics, constipation, diarrhœa). In mercurial salivation there may be loose teeth, swollen, spongy, ulcerated gums, tympany, rumbling, and the passage of fœtid flatus and soft ill-digested stools.

_Treatment_ consists in removing the cause, whether this is to be found in faulty food or drink, diseased teeth or gums, disordered stomach, or the irritant food medicine or poison ingested. If more is wanted simple astringent washes like those recommended for stomatitis and a free access to pure water will often suffice. Tartar emetic or opium has been known to succeed in obstinate cases. Friction over the parotid or submaxillary gland with camphorated spirit, tincture of iodine or soap liniment is sometimes required. In mercurial salivation chlorate of potash is especially to be commended, and when the bowels have been unloaded of the agent, iodide of potassium will hasten its elimination from the tissues and blood.

DILATED SALIVARY DUCTS. SALIVARY CALCULUS. SALIVARY FISTULA.

These are all surgical diseases and are to a large extent inter dependent. The impaction of the calculus in the duct leads to overdistension of the duct posterior to the obstruction, and the rupture or incision of the distended duct, determines the fistula. It is only necessary here to point out the seat of these lesions: the distended sublingual ducts constituting a more or less rounded swelling to one side of the frænum lingui, the Whartonian duct forming a tense rounded cord from the papilla back of the lower incisor teeth backward on the inner side of the lower jaw, and the Stenonian duct forming a similar tense cord from near the middle of the cheek down around the lower border of the jaw in company with the submaxillary artery and backward on the inner side of its curved border to the parotid gland.

For the more precise lesions, symptoms and treatment of these, see a work on surgery.

INFLAMMATION OF THE PAROTID GLAND. PAROTITIS.

Causes: traumatic; calculus; grains; barley and other beards; infecting microbes. Symptoms: fever, dullness, buccal heat, salivation, difficult mastication, swelling of gland and duct, protruded nose, stiff neck, fœtor, dyspnœa, facial paralysis, induration of gland, abcess. Diagnosis from pharyngitis, abcess of guttural pouch or pharyngeal glands; from tumors. Treatment: avoidance of causes; derivation; astringent, antiseptic washes; wet antiseptic bandages to throat; cool pultaceous diet. Open abscess and disinfect. For induration deobstruents. For sloughing antiseptics.

This may be caused by traumatism, such as incised punctured or bruised wounds. Wounds inflicted by the goad, by horns, and even by the yoke in cattle must be looked on as factors. It occurs from obstruction of the salivary ducts by calculi, or by grains, seeds, or pebbles introduced from the mouth; from their irritation by the beards of barley and other plants (brome, rye, wheat, etc.); and from the localization in the gland of specific inflammations like strangles, pyæmia, canine distemper, tuberculosis and pharyngitis. In most of these cases infective microbes are prominent factors. They enter with penetrating bodies from the skin; they extend through the weakened and debilitated tissues in bruises; they penetrate the Stenonian duct with the various foreign bodies from the mouth; irrespective of foreign objects they make their way up the duct by continuous growth from the buccal orifice; in case of calculus or other obstruction their extension is favored by the local congestion and debility and by the stagnation of the saliva above the point of arrest. When present these microbes even favor the deposition of the salivary salts and formation and increase of calculi so that the affection may advance in a vicious circle, the microbes favoring calculus and the calculus favoring the increase of microbes.

_Symptoms._ In the horse in particular there may be premonitory symptoms of fever, dullness, heat of the mouth, ptyalism, slow and imperfect mastication, and the retention of food in the cheeks.

The Stenonian duct becomes swollen and painful. The parotid becomes hard, hot, tender, and is surrounded by a softer pitting infiltration which may extend down around the entire throat, and even along the intermaxillary region to the chin. When the canal is obstructed it may stand out as a thick rope-like resilient swelling extending around the lower border of the jaw and upward toward the cheek as far as the point of obstruction. When one parotid only is involved, the contrast with the other is quite marked. The head is extended and carried stiffly. When the nose is depressed, or when the head is turned to one side or the other, the patient gives evidence of suffering from compression or stretching of the inflamed region. The breath and mouth exhale an offensive odor, determined by the decomposition of mucus and of the retained food products.

Among remote effects may be named dyspnœa and threatened suffocation from pressure on the pharynx and laryngeal nerves, and facial paralysis from pressure on the seventh nerve.

The disease may go on to induration and remain permanently in this condition, or it may suppurate and discharge through the skin, into the pharynx or through the duct of Stenon. It may communicate with both the duct and the skin and determine a fistula. When suppuration occurs there is an access of fever, a chill may be noticed, the swelling becomes more tense, harder, more tender to the touch, and even emphysematous, and finally points internally or externally. This may take place from the fifth to the tenth day or later. When it opens into the duct it may be seen oozing from the orifice in the cheek when the mouth is opened, and in case the jaws are suddenly parted, it may escape in a jet. In such a case and especially if the microbes have come originally from the food the odor is very fœtid. The abscess is not always single and when multiple the pus may escape externally by a variety of orifices. The pus is usually whitish, yellowish or grayish and creamy, but it may be grumous or bloody or serous and of a most offensive odor. In exceptional cases the gland becomes more or less gangrenous and such parts, exposed in the wound are hard, bloodless and insensible, and add very materially to the fœtor. This may lead to general septic infection, or the necrosed masses may slough off and the cavities fill up by granulations.

_Diagnosis._ Parotitis is distinguished from pharyngitis and abscess of the guttural pouch by the absence of cough and nasal discharge; from abscess of the pharyngeal glands it is differentiated by the limitation of the hard swelling to the parotid gland and by the superficial seat of the resulting abscess. The co-existence of active inflammation serves to distinguish it from ordinary tumors.

_Treatment._ By way of prevention, the avoidance of injuries by yokes, forks, pokes, and goads is important. Also the disinfection of the mouth by a liberal supply of pure water and even by antiseptic washes:—borax, boric acid, creolin, tannin, chlorate of potash. Also by the removal of foreign bodies or calculi from the canal.

When the inflammation has set in, a saline laxative is often of value. Wash the mouth with a solution of vinegar and salt, or other antiseptic, repeating this at least after every meal. The swollen, painful gland may be covered with a damp compress or anointed with vaseline to which may be added a little creolin, naphthol, carbolic acid or salicylic acid, together with lead acetate and belladonna or other anodyne. The diet must be soft, cool mashes, sliced or pulped roots or any bland agent that will demand little or no mastication. Cool, fresh water should be allowed _ad libitum_. When the laxative has set, it may be followed by cooling diuretics such as nitrate or acetate of potash.

If suppuration occurs it should be opened as soon as the pus can be definitely recognized, and the cavity treated antiseptically to prevent further local or general infection by the microbes. In deep abscess there is a certain danger of wounding blood vessels and salivary ducts, but this can be to a certain extent obviated by making an incision through the skin only and then boring the way into the abscess with a grooved director or the points of closed scissors. When the cavity is penetrated the pus will ooze out through the groove or between the scissor blades. When the pus has been evacuated the cavity should be washed out two or three times a day with mercuric chloride solution (1 : 1000), or permanganate of potash solution (1 : 100).

When the gland becomes indurated and indolent seeming to merge into the chronic form it may be stimulated to a healthier action by a cantharides blister, or it may be subjected to daily massage, or to a daily current of electricity for ten or fifteen minutes. If the inflammation is slight or unrecognizable, the surface of the gland may be daily painted with tincture of iodine, and iodide of potassium maybe given internally, in daily doses of ½ to 1 drachm.

Gangrene, the result of septic microbes, a weak system or too severe treatment, may be met by astringent and antiseptic agents locally, and by tonics, stimulants and a generous diet internally.

In =cattle= the disease usually responds readily to local antiseptics, and stimulating germicidal embrocations. Camphorated spirit, alone or combined with tincture of iodine; cantharides ointment with carbolic acid; and camphor and phenol may be cited as examples.

SUB MAXILLARY ADENITIS. MAXILLITIS.

Mostly in solipeds and unilateral. Causes; traumatic; calculus; infections; ablation of papillæ. Symptoms; tardy mastication; salivation; buccal heat and fœtor; submaxillary swelling and tenderness; morsels retained under tongue; papilla and duct swollen, tender and firm; abscess. Treatment; remove causes; dislodge foreign bodies; antiseptic lotions and packing.

This is rarely seen in other animals than solipeds, is mostly unilateral, and due to the introduction of microbes along with vegetable spikes (barley awns, brome, wheat or oat spikes or glumes) or other foreign bodies. It may also be caused by calculi obstructing the duct. The orifice of each duct, to one side of the frænum lingui, is imperfectly closed by a triangular valvular projection, which in some countries is erroneously cut off as a diseased product (barbs), thus opening the way for the introduction of foreign objects. The microbes are usually pus germs and tend to abscess of the gland. As in the case of the Stenonian duct the presence of these germs tends to the precipitation of the salivary salts and the formation of calculi.