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PRIMARY MEDICAL CARE


Primary medical care is a very important and mahouts should study it and practice until they are proficient. Always keep in mind that a sick elephant will not return to normal if it does not get correct treatment, even if the medicines are there.

Primary medical care is very useful because the mahout can provide proper care for his elephant before the veterinarian comes to treat it, can provide follow-up care after the veterinarian has visited, and the mahout or camp manager can treat minor injuries and conditions on his own.

Medicines and drugs to have at hand

There are certain common medicines and drugs that the mahout can easily keep nearby at all times in order to treat minor or emergency health problems. Most of the medicines to be kept at hand are for external use (eye drops, pain-relief ointments, oral pain relievers, etc.) and are useful in emergency situations where there is no veterinarian nearby or where the veterinarian can not be contacted and the mahout or manager must provide the initial treatment.

1. Medicines used on wounds:

Tincture of iodine. A dark brown colour, it can be bought at any pharmacy or veterinary supply store.

Method of use: To put in new, fresh wounds (but not deep wounds) one time only and to cause abscesses to ripen.

Povidone-iodine 1%. A dark brown colour like tincture of iodine, but ten times less concentrated and not so irritating to wounds. It is very widely available and can be bought at any pharmacy or veterinary supply store.

Method of use: Only for treating fresh wounds, sores, scaldings, etc., where it should be mixed one part Povidone-iodine 1% to ten parts water. Dilution is essential because stronger solutions will cause irritation. When washing infected tusks, Povidone-iodine 1% should be diluted 20 to 1.

Acriflavin solution. A yellow coloured liquid. In fact, Thai mahouts call it "yellow medicine" (yaa leuang). Acriflavin is applied after a wound has already been cleaned. It can be bought at any pharmacy or veterinary supply store.

Method of use: Apply to chronic wounds with pus and decomposing/rotten wounds.

Gentian violet. A deep purple coloured liquid. Gentian violet can be bought at any pharmacy or veterinary supply store.

Method of use: Gentian violet is used with wounds in the mouth, trunk, and soft tissues [mucous membranes]. Gentian violet is particularly efficient with wounds that have come about as a side effect of fungal infections.

Hydrogen Peroxide. A colourless transparent liquid. It can be bought at any pharmacy or veterinary supply store.

Method of use: Use to clean infected and decomposing/rotten wounds that have pus. After application, let it sit for about five minutes before washing off with clean water. Hydrogen peroxide should be used only once or twice at the initial treatment for cleaning the wound in order to clear the pus in a wound.

Warning: Absolutely never use hydrogen peroxide on a fresh wound.

Alcohol. A transparent, colourless or blue liquid. It can be bought at any pharmacy or veterinary supply store.

Method of use: Alcohol is used to clean skin before giving an injection or before operating. Alcohol should never be applied on or in a wound.

Antibiotic ointment. A yellowish cream. It can be bought at any veterinary supply store or in any large market area. Brands include Bactacin, Mytocin, etc.

Method of use: Applied to chronic wounds, ulcers, decomposing/rotten wounds, scaldings, etc., two or three times daily. Antibiotic ointments stay with the wound reasonably long and help to promote tissue growth. A disadvantage of the stickiness is that it easily attracts dust and dirt to the wound. After application, it helps if the wound can be covered with gauze.

Antibiotic spray. An antibiotic most often mixed with gentian violet. Sprays can be bought at any veterinary supply store or in any large market area. Brands include Alamycin spray, Tetravet aerosol, etc.

Method of use: Spray on chronic wounds (decomposing/rotten areas, ulcers, etc.) after cleaning.

Anti-insect powder. A mixture of insect-killing compounds and antibiotics that helps wounds to heal. Available at veterinary supply stores. The usual brand is Negasunt.

Method of use: Sprinkle the powder over the wound after having cleaned it and after having applied the primary medicine. The purpose is to prevent infestation from insects, particularly those that attempt to lay eggs in wounds.

2. Medicines for the skin and for muscles:

Inflammation-reducing medicines for the skin. Used after conditions such as damage from chemicals, insect bites, etc. Most often these are steroids applied topically, and most often they come mixed with antibiotics. Available at veterinary supply stores. Brands include Beta-Cream, Beta-Met [Betamethazone cream], etc.

Method of use: Rub inflammation reducers onto the affected area quite frequently because such medicines are absorbed into the skin very quickly.

Analgesics for muscles and tendons. Used for strains, sprains, swellings, etc. There are two types, ointments and oils. Brands include Voltarene ointment, Muay Oil, St. Luke Oil, etc.

Method of use: Rub into painful, swollen or inflamed muscles at least twice a day.

3. Eye medicines:

Eye drops. Liquid. Antibiotics are the most important ingredient. The advantages of eye drops are that it is easy to keep the eye clean and that results come faster than with ointments, usually in about two days. Can be bought at any pharmacy. Brands include Vanafen, Chloramphenicol, etc.

See Medicating eyes, page 103.

Method of use: Use on eyes that are weeping more than usual, eyes with pus, wounds of the cornea, etc. Apply hourly until the condition disappears.

Eye ointments. Ointments will stay in the eye longer than drops, but with the disadvantage that their stickiness attracts dirt, bits of grass, etc. Available in markets. Brands include Vanafen ointment, Tetracycline ointment, Kemicitin, etc.

Method of use: Use on eyes weeping more than usual, eyes with pus, wounds of the cornea, etc. Apply at least twice a day.

Warning: Never use eye drops or ointment that contain steroids in cases of an ulcerated cornea. Leave this for a veterinarian to treat.

4. Medicines to kill pain:

Pain relievers. Have the power to alleviate pain in suffering elephants. Brands include Daga, Nutamol, Paraset, Sara, Bayer aspirin.

Method of use: Grind the pills to a powder and dissolve in water and have the elephant drink or, alternatively, place the pills in ripe bananas or some other favourite food. For mature animals give about 40 to 60 pills at a time, once or twice a day until a veterinarian comes.

Warning: Aspirin and Daga have the power to irritate the stomach wall if administered on an empty stomach. Never give aspirin on an empty stomach.

Tools and equipment

There are two basic groups of tools and equipment, those required at an elephant camp with more than five elephants and those necessary when travelling with an elephant.

Equipment at an elephant camp

This equipment is used by mahouts both for medical care and also daily needs in routine camp life.

A plastic or metal 5-litre bucket is necessary for bringing the elephant drinking water, for bathing the elephant, for cleaning wounds, for giving pellet foods, for unhusked rice, etc. There should be at least two buckets for each elephant. The buckets should be free of any bad smell and chemical contamination.

A 100-litre drum is needed to hold drinking water for elephants when they are far from the watering site. The drum should be washed so it is clean and there is no smell. There should be 3-4 drums for every 5-10 elephants because some elephants are not willing to drink from the same vessel as other elephants, which the mahout should know.

Warning: If either the vessel or the water has a bad smell, the elephant is likely to be unwilling to drink it, such as tap water with chlorine or a vessel that has held petroleum products. The vessel must be washed thoroughly and left full of water until any smell has disappeared before using it to water elephants.

A 20-litre metal pail or a tin with the top cut off used for boiling water and fomentations to reduce pain, swelling, and oedema.

A pail for mixing insecticides used to spray and kill insect parasites and for mixing germicides used to clean wounds and infected tusk cavities, and for sanitizing the floor of keeping sites. This pail should not be used for any other purpose.

A thermometer for taking temperatures of elephants that seem not well. (For method of use, see page 71.)

A 50 cc. plastic syringe. For washing wounds or spraying wounds in situations where the elephant is not willing to have the wound handled. The syringe can be boiled and reused but it should never be cleaned or sterilized with an antiseptic. (See page 66 for the method of cleaning.) Such syringes can be used for all elephants so there should be 3 or 4 of them in a sizeable camp.

A plastic syringe with a capacity of 1 to 3 cc. to be used to apply eye drop medicine. The eye drop applicator can be re-used but it should be used for only one elephant. Keep it in a clean place.

Clean cloths of about 1x2 feet square. There should be 3 to 4 clean [sterile] cloths for each elephant. They are used for cleaning the skin, for cleaning skin around wounds, cleaning medical implements, stanching wounds, etc. Under some conditions such cloths might be used instead of gauze for wiping tears from the elephant's eyes or cleaning before applying eye drops. Use clean cloths only with one elephant.

The cloth used should be soft and highly water absorbent, such as terrycloth. Cloths should be boiled after each use for 15 minutes.

Small clear plastic bags of various sizes starting from 6x9 inches for holding syringes for injecting medicine and other implements in order to keep them clean and dust-free.

Large plastic garbage bags suitable for soaking foot wounds. Garbage bags are also suitable for storing implements.

Small plastic bags (6X9 inches) for holding and keeping various implements used in treating the elephant clean and dust-free.

Small garbage bags are excellent for soaking elephants' feet whenever they get infected.

Pliers for grabbing and pulling out nails, glass shards, stones, or other objects embedded in the elephant's foot.

Liquid soap, such as dishwashing detergent, for cleaning tools.

Equipment for a small camp and traveling

These objects are essential for situations that arise very quickly. It is difficult if you are caught without such implements for giving food and water and for treating the elephant immediately.

A 5-litre water pail is essential for carrying and holding drinking water, for bathing, and for holding food such as unhusked rice.

A 10-litre water pail with a secure lid for drinking water which the mahout must ensure is at hand at all times.

A thermometer for taking temperatures of elephants that seem not well.

Chains and U-bolts and other implements used to control the elephant, such as the hook, knife, and hobbles.

A 1 to 3 cc. plastic syringe to apply eye drops. The syringe can be re-used but only for one elephant. Store in a clean place.

A 50 cc. plastic syringe. For washing or spraying wounds when the elephant is not willing to have the wound handled. The syringe can be boiled and reused but it should never be cleaned with an antiseptic.

Small plastic bags (6x9 inches) for holding and keeping various implements used in treating the elephant clean and dust-free.

Garbage bags are excellent for soaking elephants' feet whenever they get infected.

Pliers for grabbing and pulling out nails, glass shards, stones, or other objects embedded in the elephant's foot.

Clean cloths, about 3 or 4 pieces, for cleaning the skin, for cleaning around wounds, and for stanching blood flow, etc. Sterilise all cloths after use by boiling for 15 minutes.

Medicines that should be at hand when travelling

Hygiene

Everybody knows that germs are tiny little organisms that bring illness and death. Nonetheless, when looking at the tools you are using, the place you are working, or even your own hands, it is all too easy to think, "They look clean, so they must be clean."

Unfortunately, this is not so. A cloth or a knife that looks perfectly clean, without a speck of dirt, might contain many germs. Therefore, each and every time you do a treatment, you should meticulously clean and disinfect all of your tools and, as far as possible, the place where the treatment will occur. Sometimes the lack of spending five or ten minutes on hygiene can cause the death of an elephant worth hundreds of thousands of baht.

Hygiene for the care giver

The most important habit to keep when working with medical tools and with open wounds on the elephant is to be very careful that your hands are clean. Best is to wash them carefully with soap, dry them, and then wash them again. Also make sure that your fingernails are short and clean.

Cleaning medical implements

Most of the implements that are used with elephants are ordinary household items and therefore they are fairly easy to clean and to look after. You wash them with clean water and with soap (dishwashing detergent is fine), wipe them clean, and then store them in a tightly sealed container. Before they are used again, it is a good idea to wash them once more. The exceptions are syringes and the pail which is used to mix medicines for cleaning wounds. If they are not new, syringes without needles used for applying topical medicines should be washed with water alone.

Cloths are not clean unless boiled for 15 minutes and then carefully dried in the sun away from dust and other air-borne contamination. After boiling, store the clean dry cloths in plastic bags or some other sealed container.

Metal pails are expensive and noisy to use but are strong and can be sterilized with boiling water. Plastic pails are liable to break and are more difficult to keep clean.

Cleaning the stable

Most stables in Thailand consist of a hard-packed dirt floor covered by a grass roof. Tile or concrete floors are a rarity. The two types require a different method of cleaning.

Grass roof with packed dirt floor:

Tile roof and concrete floor:

Disposal of waste

The waste that comes about from work and other activities of elephant camps requires appropriate disposal because waste may be a repository of infectious germs and toxins that can impact on elephants and humans health.

Waste that derives from elephants and elephant-related activities:

Collecting samples for analysis

Collecting samples is very important, especially when an elephant is sick and the cause is unknown. Only a veterinarian can investigate and analyse and determine the cause, but many times it is impossible to find the cause because the veterinarian does not see the elephant when it is showing the signs of disease. Therefore the mahout, who is with the elephant all of the time, should be the person who helps by collecting samples for the veterinarian, in order to make the diagnosis quickly and with certainty. Improperly collected samples are a waste of time.

Collecting samples of parasites

Often elephants deposit internal parasites in their dung. The mahout should collect some parasites and then wash them in clean water and put them in a container filled with a 10 per cent formalin solution (one part formalin, nine parts water) or into alcohol. The parasites in formalin solution or alcohol will keep for a long time at ordinary temperatures. Make a label for the container which includes the name of the elephant, the date, the place, and the elephant's name and the name of the mahout or owner.

As for external parasitic insects (ticks, lice and other blood suckers) the mahout should collect some samples and simply put them in a plain container or one with formalin or alcohol exactly as with internal parasites. Place a label on the container with the parasites, recording the details as above but also including the part of the elephant where the parasites were collected.

Collecting faecal samples

Dung is a very good indicator of the health of elephants. The mahout must examine his elephant's dung every day. If he finds loose stool, bloody mucous, parasites, etc., then he should collect a sample and consult a veterinarian. This is done as follows:

Determining health

Most mahouts know their own elephant very well. They know what it likes to eat and what it likes - and does not like - to do. A good mahout knows the month when his elephant usually falls into musth and knows its changes in mood. Such knowledge is very useful to the mahout and to the elephant's owner in caring for the animal. But there is much other knowledge that a person in the process of becoming a mahout should study and learn. For example, what goes on inside the elephant's body? When it eats, where does the food go and what benefit does it have for the elephant? Or if the food is toxic, what effect will that have?

Thailand has nearly 3 000 domesticated elephants but there are not even twenty veterinarians who are expert in treating elephants. At the same time, there are over 3 000 mahouts and thus the profession of being a mahout has great value in conserving Thailand's elephants.

Indicators of good health

Indicators of bad health

Reviewing a sick elephant's recent history

The largest part of an elephant's life is eating, followed by drinking and sleeping. Therefore, a review of the animal's recent eating, drinking, and sleeping in the 3-5 days before it has shown symptoms must come from the mahout.

Feeding: If the elephant has been eating food that is difficult to digest, for example very long-fibered food (such as lianas, banana tree stalks, or palm fronds) that has not been cut to suitable lengths, the elephant can become constipated. Or if the elephant has been eating foods that can cause gas, such as maize [corn] or unhusked rice or wheat or cassava, the elephant can have dyspepsia. These conditions can cause an elephant to die in one to three days.

Drinking water: Illness can come if an elephant has been drinking water that was contaminated with chemicals, because it can be poisoned. Or an elephant might refuse to drink water because the mahout has changed the watering place.

Sleeping: If an elephant will not or does not sleep, it might be because of something wrong with a leg. Or it might be so ill that it will not go to the ground to sleep for fear of not being able to stand up again. If an elephant sleeps during the day, the elephant is exhausted, possibly because the sleeping area has been shifted, or there was a disturbance at the sleeping area, or because the animal was too ill to sleep properly.

Work: The recent work history of the elephant is also important. For example, if the elephant was dragging logs yesterday, extreme fatigue can be considered normal or that work might explain a soreness in a leg.

Using a thermometer

Many mahouts think that using a thermometer is a matter only for veterinarians but this is not so. Taking an elephant's temperature is as easy as measuring the air pressure in the tyres of a car. A thermometer, which you can buy in any store that sells human medicine, costs only 50-100 baht or about as much as a good tyre gage.

Many experienced mahouts feel that they can tell if there is a fever by feeling the elephant's exhalations. This can be a guide but is never as good as the results from a thermometer. Taking an elephant's temperature can save you a lot of time and money. If an animal looks a bit sick but has a normal temperature, you can usually wait a while to see if it goes away before you need to spend time and money for a veterinarian. If there is a fever, a thermometer will let you know very quickly and accurately that you must find a veterinarian, hopefully saving the life of your valuable elephant.

Method of use: Take the thermometer and shake it briskly to make the mercury inside to go low down in the tube. Then stick the hand holding the thermometer wrist-deep in the elephant's rectum; leave it in for one or two minutes while holding onto it, until it is as hot as it will get. If the elephant is struggling or writhing, the thermometer can be inserted into a just dropped bolus of dung. The normal temperature of an elephant ranges between 97.5° and 99° Fahrenheit and in Celsius between 36° and 37°. If the temperature is 100° F or over or 37.8° C or over, the elephant has a fever and you should call a veterinarian. After use, the thermometer should be washed well in a disinfectant solution.

The temperature should be taken at least twice a day, morning and evening. If the elephant is truly ill, you should do it more often. Write down the time and the temperature each time so that you can show it to the veterinarian. He might see a pattern that helps to diagnosis the illness (for example, normal in the morning but a fever in the afternoon).

Medicating orally

Giving medicine through the mouth is usually for pain relievers and restoratives. The elephant is different than other animals because it can use its trunk, which can be compared to a hand, to extract things that have been put in its mouth. If the elephant does not want to swallow the medicine it will pull or drag it out.

The most appropriate methods to give medicines to elephants:

Medicating rectally

The most common substance administered rectally is water in cases of severe dehydration, most especially in case of tetanus. Before inserting the water you must with a hand remove as much dung as possible and then insert a garden hose. It is very important not to cause any injury to the rectum.

Warning: Be sure to lather your arm each and every time you insert it in the rectum.

Mahouts giving injections

In Thailand it is illegal for anyone other than a veterinarian to give an injection to any animal, including an elephant. But in treating elephants, veterinarians often meet circumstances where having a mahout give injections makes sense. Elephants are far more likely than any other valuable animal to be found in the middle of the jungle or in remote villages. Consequently, veterinarians sometimes treat elephants that, if they are not injected by a mahout, will not be injected at all.

A typical case might be an elephant with an infection easily cleared by ten days of antibiotics given as two injections a day - but the elephant is 90 kilometres away from the veterinarian's office, the last 15 kilometres down a very bad dirt road impassable in the rainy season. The veterinarian cannot stay with the elephant for ten days. The elephant is healthy enough that it does not need a hospital, and it would be risking the animal's health unnecessarily to subject it to the stress of a 10-wheel truck ride and adjusting to strange circumstances. Plus, the owner might not be able to afford to rent the truck.

In such a case, any intelligent person will agree that common sense should take precedence over the law, and that mahouts under a veterinarian's strict supervision should be allowed to give injections. This is particularly so because the real purpose of the law is not to stop people from sticking needles in animals but rather to stop people from giving animals the wrong medicines or giving the wrong dosage.

If a veterinarian trusts a mahout enough to give him syringes and drugs, the mahout should repay that trust by using the drugs exactly as the veterinarian orders: never more, never less. Never decide on your own that an elephant has been healed and so you can stop treatment before the time the veterinarian specified. Ten days is ten days. If you stop too early, the infection might return and be made worse because the elephant has developed a resistance to the drug.

Similarly, never use old medicines. Never think, "Eeeh, I have that medicine left over from Tusker Gaew; I think I'll use it with Tusker Bunrawd." Choosing medicines and dosages on your own is not only illegal, it is not smart. You can end up with a dead elephant.

Never inject medicines except under instructions and orders of a veterinarian. Do use the techniques given below.

Method for giving intramuscular injections

Giving injections is supposed to be done only by veterinarians, because it can be dangerous if the proper method is not used. But sometimes an elephant is so aggressive that only the mahout can approach and therefore he must give the injection, with the veterinarian nearby supervising.

1. Get a new disposable syringe of the right size for the dose of medicine to be given, usually a 50 cc syringe. Prepare an unused, sterile needle, 1.5-3 inches in length, number 14-16 gauge.

2. Choose the place where you will inject, picking an area with muscles. With elephants, use the shoulder muscles if you are on foot. Use the neck muscle if you are mounted. (See page 144 for sites.)

3. Clean the area where you are going to inject with cotton wool soaked in alcohol.

4. Draw the medicine from the bottle into the syringe in the quantity determined by the veterinarian. (See picture.) Expel any air that remains in the syringe.,

5. With your clenched fist strike the area to make the animal aware so that it is prepared and is not startled when you insert the needle.

6. Stick the needle in the muscle, up to the base of the needle.

7. Take the filled syringe and connect it with the base of the needle already in the elephant.

8. Before injecting the medicine, pull back the plunger a bit to ensure that the needle is only in muscle and not in a blood vessel. If the needle is in a blood vessel, you will see blood enter the syringe. If you hit a nerve the elephant will writhe or struggle more than usual. If you hit a blood vessel or a nerve, remove the syringe and start over.

9. Inject the medicine entirely. Take the syringe out and then immediately rub the injected area with your hand to help distribute the medicine. Clean the area with alcohol-soaked cotton wool again.

Warning: Some medicines can cause the area to become swollen but this usually soon subsides. The mahout can help to lessen the swelling by using hot compresses or fomentation.

Caring for sick elephants on the ground

Normally elephants sleep four to five hours a day, mostly at night some on the ground and some standing. Elephants sleeping on the ground are very good at sensing when something strange happens nearby, and thus, apart from calves and sick elephants, it is unusual for the mahout or keeper to actually see an elephant sleeping on the ground.

If an elephant is so sick that it cannot rise on its own, the mahout should consult with a veterinarian about how to arrange the position that the elephant has assumed so that it represents the least danger.

Health conditions caused by humans

There are four major health conditions caused by humans which in extreme cases have the same medical urgency as a real disease: overwork, malnutrition, stress, and heat stroke. (Humans can also be a contributor to a fifth, much less common disease-free health condition, collapse from cold.) All of these conditions can befall wild elephants, but they are rare in nature because wild elephants are free to avoid them. Humans, who can restrain and confine elephants and who can send them to inappropriate places, cause these debilitating conditions to occur far more often than they do in wild elephants.

The first four of these health conditions are very common afflictions amongst domesticated elephants in Thailand and they cause great damage, perhaps as much or more as damage from real diseases. Indeed, many cases of real diseases occur only because human-caused health conditions have so weakened elephants that they become easy prey to disease. The sad part is that with professional management and humane principles of care, all of these conditions are usually easily avoided.

Overwork (Exhaustion)

Overwork is simply working an elephant so hard that it becomes exhausted and its physical health degenerates to the point where it requires medical treatment, at the very least complete rest and improved feeding. Exhaustion can weaken the elephant to the point where its body's immune system weakens and the animal becomes susceptible to real diseases. Overwork, beyond using too much of an elephant's energy, also uses too much of its time, and often much of that time would have been spent feeding. Overwork thus often leads directly to a closely related human-caused health condition, malnutrition from having eaten too little food.

Malnutrition

Malnutrition is often found in elephants that are working to make money doing piece work, such as elephants giving rides at tourist venues, elephants panhandling in cities, etc. The more hours the elephant is made to work, the more money the people make. The result is that the elephants are getting insufficient food or that the food they are eating is not as varied as they would get in more natural circumstances. Sometimes elephants get bored with the food given and sometimes they stop eating. Orphaned elephants are very often malnourished. (See page 46.)

Malnutrition comes in two basic forms, although the two can happen at the same time. First, and simplest, is simply not getting enough food. Second is when through eating only one, or only a very few kinds of food, the elephant is deprived of some essential nutrient, such as protein, minerals, a trace element, or something else.

Human-caused malnutrition is rare in Thailand, except perhaps in some old and crippled animals of little economic value, but many overworked elephants in poor condition suffer borderline malnutrition.

Underweight elephants are usually working elephants that have been given insufficient food, although the problem is also found in old elephants with old and inefficient teeth and digestive systems.

For mahouts and owners, the most important thing is to provide the elephant with the best food available and enough time to eat it. Giving the elephant very good food might appear expensive, but in the long term the poor health that results from inadequate food can cost a great deal of money in lost work time and expensive veterinary treatment, and perhaps even the cost of a dead elephant

Clinical signs: The elephant is thin, swollen with fluid under the jaws, listless, has little strength, and the skin is hard and wrinkled.

Treatment:

Spasms from a calcium deficiency are usually found in tourism camps where elephants do not get a chance to eat natural mineral salts.

Elephants which are forced to do very hard work with insufficient rest are also often affected, as are elephants made to travel very long distances.

Clinical signs: The elephant has spasms and cannot control its muscles.

Treatment:

Rest the elephant.

· Supplement the food with mineral salt, such as the mineral salt blocks

· given to cattle and water buffalo. Or you can give calcium pills, but you should consult with a veterinarian about the amount to be given daily.

If the condition does not improve, consult a veterinarian.

· White muscle disease, which is not encountered very often, is found in newborn elephants born in areas where the soil and vegetation is deficient in selenium. White muscle disease is a condition that is very difficult to treat and thus prevention is much better. If you have a pregnant cow that is thin or in less than perfect health, especially in the last 3-6 months of her pregnancy, consult a veterinarian who can prescribe appropriate food supplements. The mineral selenium is often called for, but because administering it is complicated, it is best done under the supervision of a veterinarian.

Clinical signs: The calf is not able to get to its feet and stand after birth. Most such calves die within two weeks.

Treatment: In the last 3-6 months of pregancy consult a veterinarn.

· Consult a veterinarian immediately.

· Lack of mother's milk in orphaned calves means that they often die because they get diarrhoea from germs introduced in preparing powdered milk. Another cause of diarrhoea and often death is because the wrong kind of milk is given, such as powdered cow's milk, which many calves cannot digest properly. The best answer is to buy a special infant formula (Prosobee, for example) which is not based on milk.

Clinical signs: The calf does not develop normally, shows stunted growth, suffers diarrhoea often, has coarse and wrinkled skin, and has soft bones.

Treatment: Feed the same as other orphans. (See page 46.)

Stress

Stress is often the cause for other illnesses and conditions. In elephants, stress often arises when elephants are overworked, when elephants are put to unusual or unnatural work, when elephants have not had enough to eat, are in too hot a place, are in an environment that is too noisy or too confined, when people are moving around in a disorderly fashion, etc. Getting a new mahout often causes stress.

Clinical signs: Generally, the elephant does not show clear, easily readable signs of stress, but usually there are indicators such as when the elephant is chained, the elephant sways its head and body regularly, often increasing in speed. Some elephants will take their tethering chain and rhythmically strike it against the tree it is tied to or even against its own tusks. In some situations where nothing seems out of the normal and the elephant has been behaving well, the elephant suddenly becomes "crazy" [baa] and dangerous to people. Thus, each mahout must be good at "reading" whether his elephant is happy or unhappy.

It is also important to consider the other elephants nearby. Sometimes an elephant will become upset just because it is too near an elephant it does not like or it fears.

When elephants showing such conditions are not properly cared for, when the ultimate causes are allowed to occur, they are susceptible to conditions such as constipation, not eating, exhaustion, etc.

Treatment: Use the elephant only for inappropriate work. Take care of the elephant like a friend taking care of a friend. Do whatever is needed to keep the elephant from developing stress. Do not keep elephants, especially young elephants and female elephants, in isolation.

Advice to camp owners: If an elephant is out of condition in a way hard to explain by physical causes, consider changing mahouts or assigning a highly experienced mahout to observe the situation.

Heat stroke

Heat stroke [heat stress] is found in elephants that have been worked very hard or made to walk long distances in hot direct sunlight. Heat stroke is also common in elephants that have been given insufficient food and rest.

Clinical signs:

Treatment:

Collapse from cold

Elephants collapsing from cold are quite common in the cool season, especially in the North. Collapses occur in all cold weather but especially when it is both cold and wet. The best form of prevention is to keep all animals under observation and be ready to treat affected elephants as below.

Most cases are elephants that are old, ill, thin, or just not strong. Also particularly vulnerable are elephants that are under stress or that have just moved from a warmer area. Elephants in any of these categories should be observed especially carefully.

Clinical signs:

Treatment:

All elephants that have suffered a collapse from cold should be given complete rest (about 1-2 weeks).

Wounds

Wounds are very common with elephants. If you see an elephant with no wounds or scars, you know that the elephant has an excellent, caring mahout.

Treating wounds

Wounds, whether open wounds or wounds about to become open, can easily become infected. Infected wounds can in turn lead to systemic infections that are extremely dangerous to the elephant. Therefore, when following up on treating a wound it is best if the elephant is kept in a stable with an easily cleaned concrete floor so that the elephant can not blow unclean substances such as dung or dirt into the wound. If there is no stable nearby, then the area where the elephant is chained should be very carefully cleaned so there is no dung or droppings from other animals.

Stanching bleeding

Being able to stop bleeding is of the highest importance when elephants have open, bleeding wounds. Bleeding can be stopped using several easy techniques. You can select just one method, or use any or all of them, but generally you should try them in the order given below.

After the bleeding has stopped or if the bleeding does not stop, call a veterinarian.

Wound cleaning materials

When cleaning fresh wounds, infected wounds and lanced abscesses, the cleaning material used must be as free from germs as possible. There are three main choices: a clean cloth, cotton wool, and sterile gauze (such as used in hospitals). Mahouts treating wounds should know the characteristics of each.

When cleaning a specific wound, the mahout should consult with and strictly follow the instructions of a veterinarian.

1. Clean cloths, uncoloured, are easily available and cheap. Usually they are used for cleaning around wounds or pressing against or stuffing into wounds to stop bleeding in emergencies. Such cloths should be boiled for at least 15 minutes and hung to dry and then stored in a plastic bag. If stored for long, they should be boiled again before use.

2. Cotton wool is very cheap and also very easy to find. When used to clean wounds it should be used only with water containing an antiseptic and used only under the instructions of a veterinarian

3. Sterile gauze is used normally only at an elephant hospital or under the instructions of a veterinarian.

Cleaning fresh infected wounds

1. With clean water, wash all dirt, mud, and foreign matter away from the wound. If deep, then use water pressure, such as water from a garden hose. Search for and remove any foreign bodies. Wash the wound with Povidone-iodine 1% (diluted to 1:20 solution).

2. Dry the water off the surrounding area and inside the wound with a clean cloth or gauze. If the wound is deep, use cotton buds.

3. Wipe the area with cotton wool or gauze soaked in alcohol.

4. Wipe the wound with cotton wool or gauze dipped in undiluted Povidone-iodine 1 % or tincture of iodine. If a deep hole use cotton buds.

5. Apply an anti-insect powder to the skin around the wound.

Cleaning chronic infected wounds (See photograph, page 139.)

1. With clean water, wash all dirt, mud, foreign matter and pus away from the wound and the surrounding area. Then wash with hydrogen peroxide once a day for two or three days until all of the pus is gone.

2. Leave the hydrogen peroxide for about half a minute. Rinse the wound with clean water until all of the hydrogen peroxide is cleared away. Then wipe the inside of the wound with a clean cloth.

3. Disinfect the area surrounding the wound by wiping with cotton wool or gauze soaked in alcohol.

4. Use cotton wool or gauze soaked in "yellow medicine" [yaa leuang, Acriflavin] to wipe the wound. If the wound is deep, use cotton buds. In big wounds, use an antibiotic ointment such as Bactacin. The ointment will help promote tissue growth and control infection.

5. Sprinkle anti-insect powder all over the area of the wound.

Hot and cold applications

Hot and cold applications are used to reduce swelling, alleviate pain, and oedema; heat and cold are the operative agents.

Cold compresses: Take ice and wrap it in a clean cloth, and then press it over the affected area. Use cold compresses within the first 24 hours after an injury or condition. Cold applications are good for acute sprains when these involve lameness, pain, heat, and swelling.

Massage with Muay Oil or other analgesic balms. Rub over the area that is swollen or painful, using the palm of your hand. It is best not to use your fingers to press or massage. Treat two or three times a day.

Hot compresses: Take a brick, a stone, a banana tree stalk, or a bundle of the stalks of the crinum lily (Crinum asiaticum Linn.) and leave it in a fire until it is hot, and then wrap it in a clean cloth. Another method is to put hot water in a hot water bottle and apply it to the affected area. Hot compresses should be used after the condition has existed for 24 hours or more.

Fomentation: Using a mop-like device to 'swat' hot water, usually mixed with medicinal herbs, is a common traditional technique in Northern Thailand. The best way to learn this technique is to consult with an expert mahout.

Types of wounds

Wounds can be divided into the following types:

Abrasions

1. Abrasions occur when elephants rub up against trees and boulders until wounds appear. Abrasions are most common on the sides, the head, the feet and the rump. Abrasions often begin when elephants alleviate itching caused by burrowing insects or by small skin wounds.

Treatment:

Blunt-edge wounds

2. Blunt-edge wounds [contusions] such as being struck with the back of a knife, back of a hook, or by a wooden implement are common. They usually occur around the head, sides, back, and ankle joints. The affected area is bruised and sometimes very swollen. If you squeeze such wounds, they are soft. If left untreated, strike wounds will often harden and develop into internal [subcutaneous] abscesses.

Treatment:

Slice wounds

3. Slice wounds, such as from a knife or a spear thrust, are usually found on the head, trunk, or the ankles. Sharp-edge wounds are usually long or wide but not deep. Normally, there is not much bleeding.

Treatment:

Puncture wounds

4. Puncture wounds, being pierced by a foreign object such as a nail, wire, a glass shard, or a sharp stone, are usually on the footpad. Often the elephant will limp. The wound can be shallow or deep. There might be bleeding but usually not very much. Puncture wounds can easily become infected with tetanus. With a large blade such as a machete the wound will be wide, deep and bleed copiously.

Treatment:

Gunshot wounds

5. Gunshot wounds are usually found on the trunk and the legs, particularly the feet. You can see the bullet or pellet hole, often with flowing blood. Usually the wound is swollen.

Treatment:

Bites

6. Bites from being attacked by another animal, such as an elephant [on tail] or a dog usually occur on the tail or legs. (Snake bite is covered on page 93.)

Treatment:

Pressure wounds

7. Pressure wounds are caused by hard pressure, such as from a logging harness breast band, a too tight saddle girth, or from lying too long on the ground, such as a sick elephant. Pressure wounds most frequently occur at joints, bone protrusions, cheek bones, and on the back from logging or saddle harness. The wound is an ulcer with a thick edge and sometimes has pus; if left untreated, it is likely to turn into a "pus hole" [phroong nawng or fistula]. (See photographs, page 137.)

Treatment:

Burns

8. Burns are often found at the end of the trunk, on the back, and legs. Burns can be broken down into four main types: tree sap burns, sunburn, burns from fire or boiling water, and chemical burns.

Warning: Nearly all of this class of wounds are open or can become open, so they are extremely susceptible to secondary infection. Consequently, for convalescence try to find a shelter with a concrete floor so the elephant cannot throw dirt on the wound. If you cannot find a concrete floor, pick a place where there is no residue from dung from elephants or other animals.

Burns from corrosive tree sap of various kinds, such as the papaya plant or the black varnish tree, usually cause the skin to break into a rash and become itchy, but if the condition is not treated it can turn into an infected [septic] wound.

Treatment:

Sunburn comes from overexposure to the sun, often occurring in bulls in musth that are chained in open areas. The sores are swollen, red, and infected. The skin can split open from internal pressure and can slough off in sheets. The flesh can die and pus can form under the skin. The elephant will constantly try to use its trunk to spray water or spread dust over the sores. If not treated, the animal will quit drinking and eating and will die. (For heatstroke, see page 80.)

Treatment:

Chemicals burns, such as from oil fuels and acids, for example, are common. After exposure to such caustic chemicals, the skin will swell and turn red and often become infected and in the end decay. Most often chemical burns are from liquids that leak from a container kept in the elephant's saddle.

Treatment:

Burns from fires and from scalding water usually happen to young calves, because the keepers build fires near them at night, especially for orphaned calves. Special precautions should be taken with fires and boiling water around young calves because mahouts often leave them free, unchained or unpenned. If the burns or scalds are large, the elephant is likely to die. Such wounds are often swollen and they are prone to slough off.

Treatment:

While waiting for the veterinarian, give a pain killer every 4 hours; keep the label of the pain killer to show the veterinarian. (For how to give painkillers, see page 72.)

Impact wounds

9. Impact wounds come from a strong blow, being struck by a vehicle, a fall, being struck by a log, an accident during a performance, etc. Such wounds are usually found on the legs, shoulder joint, other joints, or on the back. Impact wounds range from bruises and swelling to internal bleeding, external bleeding, and broken and cracked bones.

Treatment: Consult a veterinarian as quickly as possible.

Wounds from explosives

10. Wounds from explosives are usually on the front feet and legs. There will be torn skin and tissue. Usually some tissue will die. There is a sooty residue of the explosive over the whole wound.

Treatment: Consult a veterinarian as quickly as possible.

Abscesses

Abscesses come in many kinds, so the easiest way to think of an abscess is as an infection out of control locally. Some abscesses become so bad that they lead to systemic infections of the blood.

Abscesses occur quickly under the skin, in the muscles, and in internal organs. In elephants abscesses usually occur under the skin. Abscesses are often associated with wounds and injuries. Some abscesses start with small wounds that then become larger when the elephant, to ease its irritation, rubs the wound against a tree or a boulder. Sometimes the condition begins with a small abscess but when the abscess erupts, it becomes an infected wound. Sometimes it is hard to tell which came first, the wound or the abscess, because they are so interrelated.

Abscesses start from many causes. A common cause is being regularly struck by the mahout. Another cause is wounds from breast bands from logging harness or from saddle girths that have pressed deeply into the skin for a long time. Some abscesses start where insects have laid eggs and or where medicine has been injected.

The abscesses that are found in elephants can be divided into two main types, acute abscesses and chronic abscesses

Acute abscesses

Acute abscesses begin very quickly, within two weeks from when a foreign object pierced the skin or an infection occurred. If you press on the abscess, the elephant clearly feels pain. The wound area feels hot. At the start of the condition, the abscess feels hard but as the abscess ' ripens' it becomes softer and then opens.

Abscesses can begin in deep muscle. In the beginning the elephant will have a fever but the abscess will not be swollen; still, the elephant will not be able to use that organ or to move as normal. About two to four weeks after infection, pus erupts or there is swelling in the surrounding area. Sometimes there is a deep hole leaking pus [fistula].

Treatment:

Chronic abscesses

Chronic abscesses develop very slowly, often over one or two years but sometimes as long as ten years. The walls are very thick and like a thick scar. Sometimes chronic abscesses are called 'cold abscesses' and sometimes they are called "easy abscesses" [fii sabai].

Treatment:

Toxins

Elephants are liable to be poisoned by chemicals either through contact on the skin or through ingestion. In the past, elephants were often bitten by snakes, but today elephants are more likely to be affected by toxic chemicals in insecticides and herbicides, such as Diquat, Paraquat, etc. Consequently, the mahout must be very careful about where he takes his elephant to keep and to eat.

Naturally-occurring substances

Toxic metals are found in earth, rock, and in some water sources. Nitrates that are suffused in some water sources can, if a sufficient quantity is drunk, kill elephants. Or elephants can absorb metallic toxins in food, such as minerals found in red dirt, selenium for example.

Clinical signs: Symptoms usually manifest long after ingestion and absorption, which can make it difficult to ascertain the cause. But it is easy to tell the cause when more than one elephant becomes ill at the same time after ingesting the same contaminated food or water, because the condition is most likely to have come from the same source.

Treatment: Consult with a veterinarian and an environmental official to try to diagnose the condition and to analyse the real cause.

Toxins in plants, both by contact and ingestion, such as, for example, cassava, monkey pod (Samanea saman Merr.) or velvet bean (Mucana pruriens [L.] DC). Often the symptoms are obscure. The possible presence of toxic plants is something that the mahout should think about both before taking his elephant to eat in a particular place. It the elephant shows signs of poisoning, it should be taken off of work immediately and a veterinarian should be called.

Man-made toxins (Insecticides, herbicides, and industrial waste)

Insecticides can be contacted either by ingestion or through the skin. The most important are the organophosphates (such as Malathion, Parathion) and the organochlorines (such as DDT, Aldrin, carbamate insecticides, etc.). Poisoning is often found in elephants wandering in cities where they eat many contaminated cucumbers, guavas, etc.

Clinical signs: Insecticides affect the central nervous system, causing nervousness and apprehension and suppressing breathing. These toxins can cause salivation, vomiting, colic, diarrhoea, tremors of the skin, convulsions, laying on the ground and ultimately death. The elephant will begin to show signs within about 12 hours after having ingested the toxin. Nervous signs can be delayed for up to two days.

Treatment:

Herbicides like Diquat and Paraquat are often ingested when, after the harvest, elephants are let free to feed in the villagers' fields and paddies. Animals are sometimes poisoned after drinking from contaminated containers.

Clinical signs: Affects the central nervous system and causes the elephant to vomit, salivate, have diarrhoea, tremble and die.

Treatment:

Industrial wastes that have contaminated grass and water frequently affect elephants that wander in cities.

Three chemicals in the environment are a particular danger to elephants. Arsenic will cause elephants to have great stomach pain, to go the ground, and to ultimately die. Strychnine causes elephants to suffer convulsions. Lead causes elephants, for about three days, to walk unevenly, to salivate, and to have glazed eyes; elephants will become excited, tensing and suffering convulsions.

Treatment: Call a veterinarian immediately.

Snake bite is most often suffered by calves.

Clinical signs:

Treatment:

Note: Old-time mahouts say that in cases of snakebite, besides looking for fang puncture marks, you should also check to see if hairs can be pulled out easier than usual.

Advice to camp managers: Very often when an elephant has died quickly with no immediately apparent cause, the mahout will say that it is from snakebite, because that is a very easy answer. But often the real reason is that the mahout hasn't moved the elephant to new feeding sites, has chained the elephant where there is no water, and the elephant has actually died for lack of food or water.


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