On the other hand, when the disease has occurred as a result of long standing in the stable and an overloaded condition of the bowels, or where one full meal of some constipating food, such as whole wheat, pea or bean meal, wheat or barley meal, has occasioned the attack, then a dose of aloes at the commencement of the treatment is productive of good.
Suitable febrifuges are found in potassium nitrate, potassium chlorate, sodium sulphate, or magnesium sulphate, either of which or a mixture of two or more of them, the animal will readily take in his drinking-water.
The administration of sedatives is also indicated. In this connection aconite will be found most useful. More especially in the early stages of the disease, when pain is excessive and the temperature high, will its good effects be noticed. This also the animal will often take in his drinking-water. We have been in the habit of so prescribing the B.P. tincture in 1/2-dram doses three times daily. By its use the temperature is rapidly lowered, the pulse reduced in number and in fulness, and the pain in some instances perceptibly diminished. With others hypodermic injections of morphia and atropine have given equally satisfactory results.
Needless to say, good nursing is a sine quâ non. During the first stages of the fever a light and easily digested diet should be allowed - bran-mashes, roots and grass when obtainable, and a carefully regulated supply of water. The animal should be warmly clothed and the box well ventilated, even to the opening of the doors and windows. Only in this way is pneumonia as a sequel sometimes prevented. The patient's comfort should be attended to in providing him with a suitable bed. Anything in the shape of long litter should be avoided. When nothing else is at hand, litter that has already been broken and shortened by previous use is best. With this the box floor should be thickly covered, and matting of the material prevented by constant turning. A good bed for the horse with laminitis is peat-moss mixed with short straw. This, without being dragged into irregular heaps, remains springy and elastic with but little attention. Better than all, however, especially with good weather, is an open crewyard. Here the animal has an abundance of fresh air, has a bed that is always soft, and has plenty of room in which to get up and down with some degree of ease.
Leaving the dietetic and medicinal, we may consider other treatments of laminitis that come more particularly under the heading of operative.
The first matter that here demands our attention is that of allowing the exudate to escape at the sole. If after the expiration of three or four days pain and other symptoms of distress continue, then it may be judged that the inflammatory exudate has made its appearance. Operative measures allowing of its escape, though not giving absolute ease, do undoubtedly relieve the more marked expressions of suffering, and should be at once determined on. To do this completely it is necessary to cast the animal. The sole is then thinned at the toe with the drawing-knife until the sensitive structures are reached. A flow of yellow and sometimes blood-stained discharge is immediately obtained, and the sole itself found to be underrun to a considerable extent. An opening sufficiently large to admit of free drainage (about the size of a half a crown-piece) is made, the wounds antiseptically dressed, and the hobbles removed.
If showing an inclination to do so, the animal should then be allowed to remain and rest. In one instance in which we so operated (a case of laminitis in the hind-feet alone), the relief given was at once manifested. For three days previously the animal had remained standing in agonizing pain. On the fourth he was cast, and the discharge - partly inflammatory exudate, and partly a sanious foetid pus - liberated. The hobbles were removed, and the animal allowed to remain down while our attention was drawn to another case. This attended to, we walked back to the field where, our first patient was lying. His breathing, but a short time before distressedly short and catching, was now so slow and deeply regular that for one brief moment the thought flashed across our mind that he was dead. He was in a profound sleep.
Other operators sometimes give the exudate escape while making the grooves in what is now known as 'Smith's Operation.'
In this operation the hoof is so grooved as to allow of its expansion, so relieving the pressure on the sensitive structures within it. Incidentally, the inflammatory exudate is given exit.
Fig. 120. - Diagram Of Hoof Showing The Position Of The Three Grooves Made In The Treatment Of Laminitis.
The animal is cast, the shoes removed, and three vertical grooves made in the wall. The first is cut down the centre of toe, extending from the coronet to the ground surface. The second is made to the right of this, and the third to the left, each following the direction of the horn fibres, and each distant about 2 inches from the first (see 1, 2, and 3, Fig. 120).
Each of the grooves must run completely from the coronary margin to the ground surface, and each should be carried through the substance of the horn until the horny laminae are reached. This done, the underneath surface of the foot is grooved at the white line (see curved groove 4, Fig. 121) in such a manner as to entirely isolate the two pieces of horn a and b from the remainder of the hoof.
Expansion of the horny box is thus brought about, while at the same time the semicircular groove at the toe is made deep enough to allow of the escape of the exudate.
If thought wise by the operator, the two pieces of horn a and b may be isolated, and the exudate given exit by making the fourth groove in the position of the dotted lines in Fig. 120 - that is to say, at the lowermost portion of the sensitive structures. By this means the sole will be left intact.
Fig. 121. - Lower Surface Of Foot Showing Position Of The Grooves Made In The Treatment Of Laminitis.
Fuller instruction for making the grooves and the instruments required will be found described in Section C of Chapter X (Diseases Of The Lateral Cartilages. A. Wounds Of The Cartilages).
The animal should be afterwards shod, and the bearing on the portions a and b of the wall removed. Almost immediate relief is afforded the patient.