Treatment. - The treatment of acute laminitis in its early stage must be based upon the fact that we have to deal with a congested state of the circulatory apparatus of the whole of the keratogenous membrane. This fact was well enough known to the older veterinarians. It is not surprising, therefore, to learn that jugular phlebotomy was at once resorted to as the readiest means of relieving the overcharged vessels of their blood. As a matter of fact, bleeding from the jugular is still advocated by modern authorities. We cannot say, however, that we unhesitatingly recommend it. Mechanically, of course, the removal of a large quantity of blood is bound to result in a lowering of the pressure in the vessels. The effect, however, is but transient. Blood removed in this way is again quickly returned to the vessels so far as its fluid matter is concerned, and the pressure, removed for a time, is again as great as before. With the other and more vital constituents of the blood-stream - namely, the corpuscles - restoration is not so rapid. We have, in fact, a weakened state of the system, in which it is probable it will not so successfully combat the adverse conditions the disease may induce.
With these prefatory remarks, we may advise bleeding under certain conditions. The quantity removed must be moderate (7 to 8 pints), and the pulse and other conditions must show no signs of weakness or collapse.
Local bleeding, either from the toe or the coronet, is also advised. In the former situation the sole is thinned down until a sufficient flow is obtained, while at the coronet scarification is the method adopted. Bleeding locally, however, is far less effectual than the jugular operation. Neither must it be forgotten that wounds in these situations, more particularly at the toe, are extremely liable, especially with the existing poisoned state of the blood-current, to take on a septic character. What might possibly have remained a comparatively simple inflammation is induced by the operation itself to terminate in the more complicated and serious condition of suppuration.
Other means of combating the congested state of the membrane are principally those of local applications. With many veterinary surgeons warm poulticing is still largely advocated and practised. We do not believe in it. Warmth, as a means of removing local congestion, can only be successful when applied widely round the congested area, and so dilating surrounding bloodvessels and lymphatics. Applied to the congested area itself, and to that alone, it is almost worse than useless.
With the foot, both around and below it, a surrounding area is denied us. The only vessels we are able to dilate with the warmth, and so enable them to carry off the fluid from the congested foot, are those in the limb above. That poulticing cannot be successfully there applied is self-evident. Apart from that, it is an open question whether poultices may not do actual harm in inducing suppuration in cases where, probably, it would not otherwise occur.
For these reasons we hold to the opinion that when a local application is determined on it should be a cold one. Various methods of applying cold are in vogue. Cold swabs are perhaps most in favour. They must, however, be kept cold. When a suitable water-course, pond, or other expanse of shallow water is at hand, then the animal may be kept standing therein, or preferably walked about in it. When suitable apparatus is obtainable, a constant stream over each foot from a rubber hosepipe is most beneficial.
Astringent baths, containing solutions of alum, of copper sulphate, of iron sulphate, or of common salt, or composed of a mixture of two or more of the salts mentioned, may also be used with advantage. In addition to the fact that such solutions are for a time below the temperature of simple water, we have the advantage that they have also a more or less antiseptic property.
While on the subject of the relief of the congestion, we must not forget to mention a treatment which we ourselves have practised with considerable success - namely, that of forced exercise. It appears to have been first brought into prominence by Mr. Broad, of Bath, and the two terms 'Forced Exercise and Rocker Shoes' and 'Broad's Treatment' have come to be synonymous.
The Broad shoe is a shoe with a web of quite twice the thickness of the animal's ordinary shoe, and has this web gradually thinned from the toe backwards until at the heels the shoe is at its thinnest (see Fig. 119).
The excessive thickness of the shoe serves two purposes. It allows of the requisite amount of slope being given to the web, and so enables the animal readily to throw himself back on to his heels, a position in which, as we have already indicated, he obtains the greatest ease. It also minimizes to some extent the effects of concussion.
Fig. 119. - Seated Rocker Bar Shoe (Broad'S) For Treatment Of Laminitis.
With forced exercise, as practised by Mr. Broad, this shoe is first applied, and the animal afterwards made to walk upon soft ground, or even upon the roadway, for a half an hour to an hour and a half three times a day.
For our own part, we consider the shoe to be almost if not quite superfluous, so far as its influence upon the progress of the disease is concerned. We therefore dispense with it, and have the animal exercised in his ordinary shoes. To do this, the patient has sometimes to be severely flogged into taking the first few steps. After that progress gradually becomes easier.
It has been said to be cruel. In so far as we knowingly, and of set purpose, occasion the animal pain, cruel it undoubtedly is; but it is cruelty with an aim that is truly benevolent, and the object of our benevolence is the animal upon whom the cruelty is practised.
One word of advice is needed. The forced exercise must be commenced early. In the later stages, when the stage of congestion has passed from that to the acuter stages of the inflammation and the outpouring of the inflammatory exudate, then forced exercise cannot be safely commenced. The loss of adhesion between the pedal bone and the horny box, which we know to be then existent, negatives its advisability.
By many it is advised to always remove the shoes. From what we have already said, it will be seen that this is not our practice. But one argument in favour of so doing appears to us to carry weight, and that is that 'dropping' of the sole is probably prevented from becoming so marked. That condition, however, is entirely dependent upon the changes occurring within the horny box. It is bound to occur with the animal shod or unshod, and to reach a stage when only contact with the ground prevents its further descent. The complication then sometimes following - namely, penetration of the sole by the bone, is not prevented by having the shoes removed. It may, in fact, be thus rendered more likely.
Internal treatment consists in the exhibition of suitable febrifuges and the administration of a dose of aloes.
With regard to the wisdom of the latter proceeding, opinion seems to be divided. Personally, we hold an open mind concerning it. This much is certain: in many cases of laminitis - those cases which have their origin in overfeeding with an irritating food - there is already a strong predisposition to enteritis. The administration of aloes in this case is extremely apt to induce a fatal super-purgation. Aloes is, again, contra-indicated when the laminitis is a result of excessively long journeys, and the patient is already greatly exhausted. Neither can it be advocated in the laminitis occurring as a sequel to septic metritis or to pneumonia.