DD DYESS LN) SP XN SK NW INN) OWS WW CUCU Ue N ¥ Ny a VMN Ms iY ; As 4 . LN OM " " Ve Me, A ny mahi Pris PILES CLIO OC MESE TU ee A A AN A Me yr? PO oe PM EKA Oe ON Nh Rout’ : Se cy Py RAN OY AW. QW Wy A y AW AACN | a “a vA Va Ui AX ae. ve yy RE Gy A PB yy ky at i £25 GOCE Cue CPOE ee Cae oe rare AEM OR PPT Poy pie tos Py PPO es aby INE RMR AA LO NE ROU hE muh y hh tn, LD DD ALS DDS Ay SSS SS SSI OC NN STEAL E CR Cu 1. We wt ye Ys | yy ve hr) ( \\ Pu dy PD) a YY ee \ Ny), @ \ Dy f i ‘ y Ge | ee Ui \ | if Dy CA A A, y Va ) Wy SSN i a A \ patats Uf Wi Ps (j Yy yy Y ws Y aN We eee Sees Ot Cig o A xe WS Dt SPs cr Cle « NS iy) Dy Ka ox : \ ca i y yy, NG OX ak a pied huh OK Pry y)) G \\ et at iy Pie i oa pL ’ a OUTLINES OF Clinical Diagnostics OF THE Internal Diseases of Domestic Animals BY S Prof. Dr. Bernard Malkmus Professor of Theory and Practice and Director of the Clinic for Internal Diseases at the Royal Veterinary College of Hanover, Germany SECOND EDITION—REVISED AND ENLARGED Translated from the Latest, Revised German Edition by David S. White, Dean of the College of Veterinary Medicine, Ohio State University and Dr. Paul Fischer, State Veterinarian of Ohio CHICAGO ALEX EGER 1908 oS me COPYRIGHTED AT 3 a Two Gopies Receivoe JUN 29 1908 Sopyriant ‘enwy Z ; ye (Ue WASHINGTON, D.C. ; eo ottet oa ee BY ALEX. EGER ean ai bo 1908 — Pte Ss a thay ae a Authorized Translation Translator’s Preface. | the translation of Malkmus’ “Grundriss der Klinischen Diagnostik” we have endeavored simply to reproduce the author’s ideas with the hope that the English and American Veterinary Students may thus be provided with a text-book for which they have long felt a need. The needs of the students in the College of Veterinary Medi- cine of the Ohio State University have been the direct cause of the hurried undertaking of this work. A few short notes which we thought proper to add here and there, throughout the book, have been placed in [| ]. Columbus, O., Davip S. WHITE, January, 1908. PAUL FIscHER. Preface to the Third Edition. HE ‘favorable reception which this work has met is emphasized by the fact that it has been translated into both the English and French languages. I am convinced that the concise manner in which I have presented the subject of clinical diagnostics has received friendly recog- nition from practitioners. In re-writing the third edition I have endeavored to include everything which would con- tribute toward making it more complete anid better. To this end all recent clinical observations and new methods of examination have been employed. The number of illustra- tions has been increased; and a table in color of the quanti- tative determination of indican has been added. Hanover, April, 1906. MALKMUS. Preface. HE only safe foundation for the treatment of anima! diseases is a correct diagnosis of the malady. In therapeutic as well as in forensic veterinary medicine everything depends on a correct recognition of the disease. This is the most difficult part of veterinary medicine, and methodical training alone will enable the student to de- velop into a practicing veterinarian who can do justice to this demand. The following little work which offers a great variety of material in a most condensed form is intended as a guide for the diagnostician in recognizing and understand- ing the symptoms of disease. Although it represents the result not only of personal, but of veterinary experience in general, for the sake of clearness and general appearance the names of the numerous authors have been omitted. The results of bacteriological research which have an im- portant bearing on diagnostics have been given due prom- inence. I have also deemed it appropriate to call attention, at the proper places, to those diseases or conditions which are considered as factors in annulling, or setting aside a sale. It was necessary to append a brief description of the most common diseases in order to give the student a gen- eral idea of the character of the maladies that affect the various functional apparatus, thus refreshing his memory and enabling him to institute comparisons between what he learns from his lectures and sees in the clinic. The true to life representations of the horse and cow, which are copied from the “Handbuch der Anatomie der Thiere fiir Kinstler,’ I owe to the kindness of Prof. Dr. Ellenberger and Prof. Dr. Baum of Dresden. I here most kindly thank these gentlemen for their unselfish obliging- ness. The ahisline house of Gebriider Janecke have dis- regarded both expense and trouble in order to supply good illustrations and to give the book a neat appearance; to them, too, my gratitude is due. Hanover, November, 1898. MALKMUS. Table: of Contents. PAGE See. PAE NOSIS OF SIISCASES: |... oa Yano ingie vee ewe se ee 11 SS ORD OMg Ie eno ie GM Picts wipe Sakehe seat dee oes 12 Determinine the Diseased Organ: 3.6.0.0... . 14 ie deecorni ition, of te DISEASE \.2 0 see 15 Pe erie IIE? eg ae hee eins hg klere 6 are eee 6 18 HH. Determmine the Status Praesens 2...) 0.0.5 65....- 21 Method of Examination. Ree tiont se. hs oTac Se asks Aes Shas cS 21 OST Re gt Lae eR a ae a a 23 OEE ICEENT a ce att, Sate) eth EST Re Soh ea 2 24 PRG EMERGE ct Pac dR eke ich tp howe ba lane arcs wor8 29 A. General Part of Examination ok De Cri iEPTIE Uy, 35S L oediv ls Sirs A RS se SN TS eee 31 gare che ee i ee ee ee kd > 32 i tritide- ol. tie, Patient (2c. sn. <5. 33 PEP nO CPUENONER hs aS Ee Sows Balsa Ble Bre bes 2 38 Pl wOGarerinalion: Scc< fs end Pre ae ties. 39 ieee M RIMS AIICHE 20% Fates crn ete ard oo he 3s 40 Diseases which are character- ized patiryeuParly “by change ie ROR UE Sorte eg ated acetan cod ® teas Ste 41 SEER NS oii Sa ae Ol Ne aR Oe ce ae oe 43 i, sGondition- or the air Coat... 5 i. 43 LPS Be Sicin’s Moisture «2.5 6..0665 4; 44 Pile mE CAE LIVE SSE ovk cs or vie sob eve 8c 45 1a. Condition of the Skin) Jie: 2.0 eo... 46 V. Swellings in, and immediately under, Lie aes t ck cE 5 Sek Ae OR a ge 47 9G Re ey le a ee Oh gee 49 VIII 4, Examination of the Conjunctiva .............. 5Y l= Discharge from. the-Dyelds*si.22. 59 Ble TOI OE in ois tatu oie) vce ee 59 G. Bodily; “Demperattite. 6 ii. c bat pace eee 62 I. )T he: Normal-Témperature: 42. fons 64 lio temperature of the Skin? 2 osras 65 EET Meyers. os '.6 see eyo ee ee 65 DV. ubnormal | ‘Temperaturens = saa 7 Generation é.¢ ti ots “Dis ea scesen ere B. Special Part of the Examination. 73 6.’ Careulatery, Apparatus... yoo fs)-215 oe eee "3 Rp ISE «5-5 aru s, ade, Stic, AOE mae tonnes camera a 73 Il. Examination of the Peripheral Blood Vessels:! 2h twee eee 79 Hietiehe Heath. fi tecer es eee a 81 Diseases.of the Circulatory Ap eae ek EUS ee, ardsd tye Se wie. pate aaa 88 Wei meespitasory Apparatus: 5. .5s. Demperatute: BP special examinations. i bel coal ccaie oe J a 6. Circulatory apparatus. ?. Respiratory apparatus. 8. Digestive apparatus. 9. Urinary apparatus. 10. Sexual apparatus. 11. Central nervous system. 12. Locomotion, exercise in harness or under sad- dle, etc. Ce Sent ikes examinations. 13. Diagnostic inoculations. 14. Examination of lymphatic glands, 15. Examination of the blood. The anamnesis should be procured and the general and special examination should be made at least once during the first visit to the patient. If the diseased organ or organs have been ascertained they must be carefully re-examined at every subsequent visit, at the same time we must be on the alert for the appearance of possible symptoms in other organs. The specific examinations are made only when necessary for clinching the diagnosis. The determination of symptoms is at times difficult. Sometimes external influences bring about certain con- ditions of the healthy body which must not be interpreted as 14 CLINICAL DIAGNOSTICS. symptoms of disease,, although they might, under other -cir- cumstances, be such; e. g., a horse refuses its feed—this is a frequent occurrence in gastro-intestinal affections or in the course of severe general diseases, but it may also be due to an excitable temperament of the animal or to the fact that the food in itself is undesirable—spoiled, mouldy. Hence the practi- tioner must always endeavor to determine the cause of the symptoms, whether the deviations from the normal are really due to disease or to external conditions. The importance of symptoms depends very largely upon the conditions under which they appear. Rapid respiratory movements may be due to a disease of the respiratory apparatus or to some other affection; again, they invariably occur after bodily exertions, and high tempera- tures, even when the animal is at perfect rest, will cause the respiratory movements to become accelerated. To avoid confusing symptoms produced by muscular ex- ercise, or other efforts on the part of the animal, with symp- toms of disease, the patient should first be examined in a state of rest. Furthermore, all conditions that could possibly influ- ence normal physiological processes must ever be taken into consideration; for example, we will mention age, _ estral period, pregnancy, fright on part of the animal, etc. After noting the symptoms of the disease we come to the most difficult part of clinical diagnostics, viz: The determination of the organ diseased. There are only a few symptoms which point with certainty to an affec- tion of a definite organ, fewer still enable us to recognize the character of the disease; these latter are called pathognomonic symptoms. As a rule all symptoms must be first noted and then considered as a whole, always bearing in mind the prin- ciples of general and special pathology. We distinguish different kinds of symptoms: ~1.. Local symptoms belong to the affected organ or to the disease center. DIAGNOSIS OF DISEASES. 15 2. Direct symptoms are due to the fundamental dis- ease or morbid process. 3. Indirect or accidental symptoms are due to compli- cations, of the fundamental disease. To determine the affected organ all ascertained symptoms are carefully reconsidered in the order in which they were de- termined. The-healthy apparatus are for the time being dis- regarded, the diseased apparatus are given special considera- tion. A variation in the normal functional activity of an organ does not in itself indicate disease, it may simply be a compen- satory variation (one due to an opposite variation in a similar organ) due to the primary morbid condition. The therapeut- ist’s object is to ascertain the primarily affected organ, bring about a cure in this and secondarily cause the sympathetically affected organ to regain its natural condition and activity. ; To discover the primarily affected organ requires a knowledge of the morbid processes that take place in each organ and of the direct, indirect, local and general symptoms produced by them. This requirement is still more important for the final aim or ultimate purpose of diagnostics, viz: The recognition of the disease itself according to kind, etiology, intensity and duration. The method of examination of each organ will therefore be followed by a short description of the most important diseases of each. . One who has not yet learned from his school training or practical experience, to appreciate the various symptoms which characterize each of the diseases and who has not a well- defined mental picture of the appearance of each of the dis- eases with which he must come in contact, will never become a good diagnostician. Diagnosis per se has a different value depending upon whether it is made for a scientific or wholly practical purpose. 16 CLINICAL DIAGNOSTICS. It is often symptomatic and thus merely cloaks our ignor- ance; diabetes insipidus, colic, for instance. The purpose of diagnosis is more nearly attained when it includes the cause of the disease (“etiological diagnosis”), which is of value even if we do not know more of the cause than that it is some specific infection (influenza). An anatomical diagnosis is not conclusive because it does not indicate the cause (nasal catarrh, bowel catarrh). An ideal diagnosis would be “etiologico- anatomical” (skin glanders, acarus mange, verminous bron- chitis). A correct prognosis and rational treatment are largely dependent upon a knowledge of the cause and morbid changes of the disease. It is not enough to diagnose a nodular, itching and spread- ing eruption of the skin, we must also determine the cause or our prognosis and treatment cannot be correct and rational. Such eruptions are due to various causes and an exact knowl- edge of them is an important item. The same may be said of affections of internal organs. A final diagnosis is made either by considering the deter- mined symptoms directly (direct diagnosis) or by a process of exclusion, i. e., we review in our mind all the diseases in which the symptoms determined occur, or in which some of these symptoms occur, and then we exclude those diseases in the course of which, if present, we usually observe additional symptoms (differential diagnosis). Following one or the other of these methods usually suffices to make a diagnosis. Not infrequently, however, even the experienced practitioner must content himself with limit-_ ing his diagnosis to a statement of the general character of the disease and reserve the privilege of expressing his final opinion (special diagnosis) pending further observation and developments. This is particularly the case in the first out- breaks of infectious diseases when localized changes are ab- sent. We also distinguish between a definite, a probable, and a possible diagnosis. DIAGNOSIS OF DISEASES. ili The difficulties encountered in diagnosing internal dis- eases vary considerably ; in some cases a good anamnesis suf- fices as a basis for making a definite diagnosis: epilepsy, par- turient paresis. In other cases the experienced practitioner requires but a glance at the patient: tetanus. The rule, how-_ ever, is never to make a diagnosis until a thorough and careful examination of the patient has been made; but here, too, care- fully cultivated powers of observation and extensive experience go a good way. To acquire either of these, of course, requires continued carefully and methodically conducted examinations. The same diseases do not always present the same set of symp- toms. Therefore, the more often a disease is seen by the prac- titioner, the more readily will he recognize it. The diagnos- tician should be like the experienced botanist who recognizes a plant in all its stages of vegetation. There will always remain a few cases the symptoms of which are so atypical that an exact diagnosis is impossible. If the diagnosis cannot be made definite in every respect, be cautious in your prognosis and therapeutics. . I. Anamnesis. Full statements on the part of the owner or attendant, procured by cautious questioning, concerning the previous con- dition of the patient, the beginning and previous course of the disease (anamnesis) are of great importance in diagnostics, in fact there are some diseases, like epilepsy, for example, that can as a rule be diagnosed in no other way because it is only in exceptional cases that we have an opportunity to observe a typical epileptic fit. As far as the veterinarian is concerned the anamnesis is limited to the observation of the immediate surroundings of the animal. In questioning attendants speak to them in a pleasant tone and manner and use words and expressions with which they are familiar; this tends to infuse confidence and the result is that the information thus obtained will be more apt to be reliable. Any digression in the testimony of informants should be listened to with patience. One should always remember that every anamnesis, from whomsoever it be obtained, is more or less colored by the personal conceptions of the person offering it. This is quite apart from intentional misrepresentations, which are often encountered. A well drawn up anamnesis speaks for the technical ability of the veterinarian as well as for his knowledge of the etiology of the diseases of our domestic animals which are kept under the most variable conditions. t. How long has the-animal beem sveky We may learn by this question whether the disease is an acute or a chronic one, and perhaps also the stage of development we ANAMNESIS. 19 which the disease has reached. Frequently the time given by the owner or attendant is much shorter than the actual duration of the disease. 2 Whatsymptomshastheanimal shown? In the beginning? Later on? The objective observation of the owner must be carefully sifted out from his subjective interpretation of them. Sa wWwatiostt your, @pinton,- could bec the cause of the disease? We cannot search for the causes until we know the symptoms. Where and underi what. conditions did bie animal,.cet. sickir- Peed Meare; ete:, play. an’ im- portant role in the etiology of the internal diseases of ani- mals; therefore the veterinarian must be informed not only as to the kind and character of the feed but also as to soil conditions, water, etc., otherwise he cannot intelligently trace the cause of the disease. The care and attention animals receive wield a great in- fluence upon the genesis of many diseases. It is rare that the veterinarian can obtain from the attendants reliable data con- cerning these. He should judge by the surroundings in this regard. The use to which the animal was put when the dis- ease occurred is of value in tracing the cause, for special uses predispose animals to certain diseases. 4. A number of animals affected by the same disease always points to a common cause, viz.: infection or intoxica- tion (poisoning). The frequent recurrence of a disease in the same stable points to the existence of a permanent cause. 5. It is of especial importance for the veterinarian to know whether any previous treatment has been resorted to and ‘what effect this may have had. Quacks often administer drenches- containing solid particles in suspension; these draughts, instead of taking their usual course, may enter the trachea and thus produce a fatal pneumonia. In removing the contents of the. rectum its wall or mucous membrane is 20 CLINICAL DIAGNOSTICS. also often injured. In such cases the veterinarian must ex- ercise care and judgment and call the owner’s attention to any existing danger. : Although the main points in the anamnesis should be de- termined before we begin our objective examination, other questions will present themselves in the course of the latter. Thus, when examining the respiratory tract we may inquire whether the animal coughs, and when examining the diges- tive apparatus inquire as to condition of bowels, frequency of evacuation, etc., in this way gradually completing our exam- ination. The value of a good anamnesis consists in the fact that not infrequently it is sufficient to base upon it a definite diag- nosis, i. e., careful objective observations of the layman may in some instances be substituted for our examination. How- ever, the veterinarian must always be cautious in complying with the oft made request of owners to treat their animals in absentia. Although the medicines prescribed under such con- ditions may -do no particular harm, rational treatment thus delayed may prove to be a positive injury. Sometimes the veterinarian is misled by the anamnesis. This he may guard against by making a careful examination of the patient. When the anamnesis does not conform to the results of the examination, it should be accepted with caution; where the opposite is true, it may be considered reliable. II. Determining the Status Praesens. To determine pathological phenomena we resort to all those methods which throw light upon the physical state and functions of the different organs. In doing this we should endeavor to follow a definite plan and not proceed without system. The following methods are generally employed and in the order given: 1. Inspection. In examining the different parts of the body it is always best that we first regard that which can be observed with the unaided eye. Students are apt to lay their hands upon the patient too soon. Superficial abnormalities are described ac- cording to their seat, size, color and other external manifesta- tions ; the size and form usually being compared with common objects, unless an exact description is desired when actual measurements are made. The odor emitted by the se- and excretions and the res- pirations is also noted. In designating the seat of visible pathological conditions the exact anatomical region occupied by them should be indi- cated. Regions of the Body. I. Head. sais] A. Face. 1. Nasal region with dorsum of nose, tip of nose, nasal openings. [Nostrils]. 2. Labial region, with upper and lower lips, inter- labial space and chin. 3. Buccal region. 4. Infraorbital region. 22 5. 6. fe CLINICAL DIAGNOSTICS. Ocular region. Masseteric region with maxillary articulation. Intermaxillary space. Fig. 1. B. Forehead. 8. Frontal region. 9. Occipital region with forelock. 10. Temporal region with the temporal fossa, infra- temporal groove and auricular region. [Ears]. II, Neck. ; 11. Parotid region, which merges below into the laryn- geal region. 12. Tracheal region with jugular groove, at the lower end of which is the supra-clavical fossa. 13. Cervical region with crest and mane. 14. Lateral cervical region, sides of neck. III. Chest. 15. .Withers and dorsal region. 16. Lateral pectoral region [sides of chest] with scap- DETERMINING THE STATUS PRAESENS. 20 ular region, cardiac region, costal region. 17. Sternal region. _.18. Anterior pectoral region. [Breast]. IV. Abdomen. 19. Epigastric region with xiphoid space. 20. Mesogastric region with umbilical space, iliac region (flank with “hollow of flafik”) and the lumbar region. 21. Hypogastric region with pubic and inguinal region. V. Pelvis. The different divisions of the pelvis are named according to their anatomical parts; the sacral region is called the croup, the external angle of the ilium the “hip,” just below the anus the perineal region; the anal region, pubic region and inguinal region. VI. Extremities. ; The different parts of the extremities are designated according to the bones and joints which form their bases. Anterior limb: Shoulder, point of shoulder, arm, elbow, forearm, “knee,” cannon, fetlock joint, pastern, coronet, bulbs of heels, hoof. Posterior limb: Thigh, stifle, leg, hock, hind cannon, etc. 2. Palpation. Palpation consists in feeling the part to be examined with the hand or finger tips. Its object is to gain information through the sense of touch as to the consistency, extent, tem- perature and sensitiveness of a part, and permit us to recog- nize abnormalities which do ‘not lie far below the surface. Palpation is of especial importance in taking the pulse. The abdominal viscera can be explored (palpated) through the rectum and the anatomical position, and condition of the con- tents determined. From the difference in consistency of the parts palpated, conclusions as to their physical nature may be drawn. The following peculiarities may be distinguished on palpation: 1. A part is doughy when it feels soft and accepts finger imprints which it retains for a few moments, when the de- pressions are again filled. Tissue is of a doughy consistency when infiltrated with serum: (edema). 24 CLINICAL DIAGNOSTICS. 2. A part is firm when it is of the consistency of normal liver. According to the part’s resistance to the touch it may be firm, tendinous, solid. A cellular infiltration of tissues (phlegmon) or the presence of neoplasms made up of cells, will lend to a part a firm consistency. (connective tissue). 3. A part is hard when of the consistency of bone. 4. gradual loss of coat accompanies chronic, cachectic diseases in sheep and dogs. In chronic diseases affecting nutrition the hairs be- come loose, and may be easily removed by pulling or rubbing. Horses clipped late in the season (November, December) grow short winter coats; when these are shed the following spring, the skin is left partially denuded of hair, giving the animal a half-naked appearance. Where the hairs fall out in patches, and lesions are found in the skin, a disease of the integument is present. ; II. Sweat secretion. The skin is kept continually moist by the secretions of the sweat glands. In healthy ani- mals at rest the supply of secretion is just sufficient to keep pace with the loss by evaporation, so that the skin does not feel wet but soft and pliable. The skin’s moisture is increased by exercise, high atmospheric temperatures and nervous ex- citement. Sweating does not become visible in swine, sheep, dogs, and cats. In disease a more or less profuse outbreak of sweat (hyperidrosis) appears :— 1. When an animal is much weakened from acute or chronic disease. ae GENERAL PART OF EXAMINATION. 45. 2. In severe dyspnea, where it is compensatory, assist- ing the lungs to throw off effete matter; stenosis of the anterior respiratory passages, diffuse pneumonias, pulmonary emphysemas, and organic heart diseases. 3. In painful maladies: founder, colic, enteritis. 4. In diseases painfully affecting the muscles: tetanus, epilepsy, azoturia, cerebro-spinal meningitis. Normally, perspiration is accompanied by a hyperemia of the whole skin. If.this congestion is absent, the sweat being excreted upon a cold skin surface, “cold sweat’ is spoken of, a condition to be judged unfavorably from a prognostic stand- point. Local sweating (hyperidrosis localis), or sweat appearing on only one side of the body (hemidrosis) is seen at times to accompany diseases of the nervous system. A decrease in sweat secretion (hyphidrosis) can be so well developed that the skin feels dry (anidrosis). This condition can best be appreciated on the muzzle of the ox, the snout of the hog, or the nose-tip of the dog. These parts in healthy animals are moist and nearly cold. During high fever, severe diarrhea, diabetes insipidus (polyuria), hyphidrosis is a common attending symptom. In severe dis- eases where life is threatened, the nose feels cold and dry. III. Color of the skin. The hair and pigment prevent us from seeing that color of the skin which is caused by the blood and other physiological fluids flowing through it. With the exception of the horse, nearly all white-coated animals have non-pigmented skins. [Horses having white or grey hair coats show pigmented skins, the white-born (albino) horses forming an exception. The parts of the skin which show white markings (legs, forehead) are as a rule not colored]. Chronic discharges from natural openings (the eye, nose, vulva) cause a loss of pigment from the portions of the skin over which they flow. 46 CLINICAL DIAGNOSTICS. An injection (reddening) of the skin is only of diagnostic importance when not produced by local diseases of the integument. A diffuse reddening of the skin, namely of the abdomen, neck and between the. thighs, is seen in swine erysipelas (Rothlauf). Red spots, often angular in shape, accompanied by swelling of the skin, appearing usually over the neck and along the back, are seen in urticaria and in mild cases of erysipelas in swine. The skin becomes bluish red (cyanotic) when the blood is heavily charged with carbonic acid gas. It is seen in diseases causing swelling of the glottis, heart diseases, con- gestion and edema of the lungs, and in overdriven sheep or swine during hot weather. Yellow (icteric) discoloration and paleness of the skin a be considered under “Examination of the Conjunc- tiva.” (See page 60.) IV. Condition of the skin. The skin of a healthy ani- mal feels pliable and elastic, and is movable upon its underly- ing tissues. If a fold of it be drawn out between the fingers, it soon regains its former place when released. Where the animal is poorly nourished, out of condition, or emaciated from wasting disease, the skin feels Hard and leather-like (sclerosis, induration). [If the subcutis has also lost its elasticity, and the skin adheres closely to the under- lying parts, and cannot readily be drawn out in folds, it causes a condition that is commonly termed “‘hide boundness’’]. In the hide bound animal the epidermis is dry and tough, the outer epidermal layer becomes loose and may be easily removed. The skin is thus coated with a thick layer of scales and the hair filled with dandruff. The exhalations of the skin sometimes have a penetrating wrinous odor, noted not infrequently from bladder rupture, the contents of the organ being poured into the ab- Ss a GENERAL PART OF EXAMINATION. 47 dominal cavity. In the ox urethral calculi commonly cause this condition. . V. Swellings in, and immediately under, the skin. Diffuse or multiple swellings appearing in or immediately under the skin are of great importance as an aid to the diag- nosis of internal diseases which they accompany. Tumefactions of the skin attend the following morbid processes : Edema of the skin and subcutis (anasarca) is an abnormal accumulation of serum in the connective tissue. It is produced by a transudation of fluid (liquor sanguinis) from the blood into the intercellular spaces. The lymph spaces being clogged prevents the escape of the fluid. Ede- matous swelling are doughy on palpation and retain finger im- prints. Edema can be due to: a. Continued venous congestion, the free circulation of the blood being interrupted (dropsy from stasis). In such cases a dropsical swelling appears in pendent portions of the body, removed from the heart. The prepuce, in front of the mamme, ventrally along the abdomen and thorax, hind limbs, brisket and throat are the favorite seats of these enlarge- ments which are neither painful nor hot. Any morbid condi- tion which interferes with the free flow of the blood through the veins, leading to a stagnation in these vessels, tends always to produce edematous swellings. They attend organic heart troubles, chronic pleuritis, pericarditis, and traumatic peri- carditis of the ox. b. A watery condition of the blood (hydremia) with which occurs an abnormal porosity of the blood vessels, and a subsequent transudation into the tissues. The edema of hydremia shows neither increased warmth nor pain. Drop- sies due to hydremia are noted under the jaws of sheep afflicted with animal parasites, [the lung and stomach worms, Str. contortus, Str. filaria; liver flukes, Dist. hepaticum, being 48 CLINICAL DIAGNOSTICS. the most common]. Leucemia and anemia are frequently attended with skin dropsies. c. Inflammatory edema (collateral edema) also pro- duces swellings of the skin, but this is usually local. It is characterized by pain and increased warmth. In one form of anthrax appears a circumscribed, hot, hard, painful tumor on the neck, head, or body—the malignant carbuncle. In some of the infectious diseases a more or less diffuse, or a multiple inflammatory edema, becomes manifest; in in- fluenza of the horse the eyelids, scrotum and limbs swell; in purpura hemorrhagica multiple, later diffuse tumefactions occur on the head, prepuce, lower abdomen, and limbs. [Leg swellings in purpura are characterized by their abrupt, bolster- like, termination]. A local, hot, edematous swelling often betrays the presence of deep-lying inflammation—pus, and is therefore important in diagnosis. In strangles of horses suppuration in unavailable lymph glands is determined by the accompanying edema of the skin in the region of the throat; in glanders it occurs about the farcy bud; in traumatic peritonitis of cattle a hot, doughy swelling appears in the hypochondrium, Emphysema of the skin. Emphysema of the skin signifies the presence of air in the subcutaneous tissue. Such swellings crackle on palpation and are usually well de- fined. The contained air can be temporarily displaced by applying pressure to parts of the swelling, but as soon as the pressure is released the space caused by it refills. Emphysema originating spontaneously is infrequent. It is mostly due to the formation of gas in decomposing blood extravasates or retained abscesses (emph. septicum). Spon- taneous emphysema is pathognomonic of symptomatic anthrax, black leg, where it appears upon the back, neck, and muscular portions of the legs. Emphysema occurs most frequently from the aspiration of air from without into the subcutis. The air may enter GENERAL PART OF EXAMINATION. 49 through a wound in the skin, or may come from some air- containing internal organ. In the first case'the air is sucked or pumped into the subcutis through skin wounds which continually shift. posi- tion during locomotion. Wounds in the neighborhood of the elbow, therefore, produce emphysema of the shoulder and neck. It is a common practice to treat atrophies of super- ficial muscles (“sweeny”) by inflating the overlying skin with air artificially introduced by a bicycle pump or pipe stem]. In the second case the emphysema of the skin has its origin from an internal organ, usually the lung, the alveoli of which are ruptured (interstitial pulmonary emphysema). The course followed by the air is as follows: It passes from the ruptured alveoli into the subpleural connective tissue, making - its way to the mediastinum, between which folds it continues to the upper part of the thorax, then following the course of the trachea, large blood vessels and esophagus, it escapes from the pectoral cavity through its anterior aperture into the subcutaneous and intermuscular tissues. Rupture of the pulmonary alveoli may result from a destruction of the lung tissue by pus or putrefaction (gangrene). Rib fractures in- volving the lung, great intra-thoracic pressure from violent coughing, continued bellowing, forced contraction (straining) of the abdominal muscles in bowel, bladder and uterine trou- bles, may be at the bottom of emphysema of the integument. Sometimes after rumenotomy or trocaring, gas passes from the paunch through the muscular wound into the sub- cutaneous tissue. The skin wound having shifted position, the escape of the gas to the surface is prevented, hence it collects in the loose connective tissue along the back. Diseases cof the Skim The following terms are most commonly employed to denomi- nate the phenomena of skin lesions: 1. Spots (maculae) are well circumscribed abnormal colora- tions of the skin. 50 CLINICAL DIAGNOSTICS. 2. Papules (papulae) are small cutaneous elevations of solid consistency varying in size from that of a pin head to that of a small pea. 3. Vesicles (vesiculae) are elevations of the outer epidermal layer due to the accumulation of fluid beneath. They vary from the size of a millet-seed to that of a pea. 4. Blisters (bullae) are large vesicles. 5. Pustules (pustulae) are vesicles containing pus, and are therefore colored yellow. 6. Ulcers (ulcera) are suppurating wound surfaces which re- sult from necrosis of tissue. 7. Scales (squamae) are epidermic lamellae which have be- come detached from the skin’s surface. 8. Scabs, or crusts, are dried masses of exudate upon the sur- face of the integument. 9. Hives (urticaria, nettle rash) are due to swellings of the papillary bodies, producing well-defined evanescent rounded ele- vations, resembling welts raised by a whip. i Non-patasitic Skin Diged ses. 1. Alopecia (baldness) is a loss of hair due to some disturb- ance in the skin’s nutrition. It may not be attended by lesion. 2. Blood sweating (/ematidrosis) is the spontaneous appear- ance of blood upon the apparently intact surface of the integument. It is peculiar to Hungarian horses. 3. Prurigo is a papular eruption accompanied by intense itch- ‘ing. Biting and rubbing induce additional lesions. 4. Summer surfeit (acne simplex) is a nodular eruption occur- ring usually over the neck and shoulders, leading to a loss of hair. [It is seen mostly during the hot months. This condition is often erroneously attributed to some “disorder of the blood.” Its chief cause is neglect of proper grooming and care of the skin of horses.] 5. Fagopyrism is an acute, diffuse, itchy inflammation of the non-pigmented skin of the head, due to grazing on growing buck- wheat in bright sunshine. Brain symptoms sometimes compli- cate the disease. E 6. Eczema. In a general way the term eczema designates an exudative dermatitis. It has much in common with the catarrhs of mucous membranes, and like the latter can pass through the varied stages of erythema with desquamation, papule, vesicle and pustule formation and finally squammae. It is very common in dogs, appearing along the back. GENERAL PART OF EXAMINATION. 51 7. Foot eczema, produced by potato residue, swill and brewer grain feeding, is a vesicular eczema occurring on the hind legs of the ox. The vesicles rupture soon after formation and their con- tents dry ta thick yellow scabs. The hair of the affected parts stands erect and part of it falls out. In most instances the eczema reaches no higher up the legs than the hock, but may spread to the body or involve the anterior limbs. ri akin. Daseasies Due ito Animal Parasites. The common skin parasites are: 1. Lice or Pediculidae (Haematopinus asini, eurysternus, urius, etc.) 2. Bird lice or Mallophaga (Trichodectes equi, scalaria, etc.)* 3. Louse flies or Hippoboscidae (Hippobosca equina, Meloph- agus Ovis). 4. Ticks or Ixodidae (Boophilus bovis) Texas cattle tick. 5. Fleas or Siphonaptera (Ceratopsyllus serraticeps of dog, Pulex irritans of man). 6. Bird ticks or Gamasidae (Dermanyssus avium, D. gallinae). 7. Mites or Acarina (Chorioptes, symbiotes, horse, ox, goat, etc.). (Psoroptes communis, horse, ox, sheep, etc.). (Sarcoptes equi, canis, suis, cati, etc.). (Sarcoptes mutans of fowl). (Acarus folliculorum or Demodex folliculorum, var. canis, suis, etc.). [*The common hen louse, Menopon pallidum, is remotely related to the trichodectes, and resembles them in general appearance. It is said to pass readily to other species of birds, and to trouble horses kept near lousy henroosts. | 52 CLINICAL DIAGNOSTICS. Haematopinus equi. Trichodectes equi. Blood-sucking Louse. - Scale-eating Louse. Fig. 10 Fig. 11. ea // a eon ety - eee Symbiotes bovis. Psoroptes communis. Ventral side. Ventral surface, Egg in Oviduct. GENERAL PART OF EXAMINATION. 53 Mange (scabies) is a contagious dermatitis due to mites. The principal manges are: a. Symbiotic mange (foot mange). Favorite seats: in the horse, hind limbs, in the ox, root of tail. These mites live on the skin, produce loss of hair, desquamation of epithelium, and intense pruritis, causing the animal to stamp and kick continually. The mites are 0.3—0.5 mm long, head broad. The legs, which are long, are provided at their ends with bell-shaped suckers. b. Sarcoptic mange of fowls (Dermatoryctes mutans). It affects the legs, causing “Scaly Feet.” The lower, naked portions of the legs become coated with calcarious, smeary or honey-like, scaly, thick deposits. The mites are 0.2—0.5mm _ long, legs short, second pair well removed from first. U-shaped chitinous shield behind head. c. Psoroptic mange. Seen in the horse, sheep and ox. Char- acterized by great desquamation, the appearance of vesicles and papules, the hair or wool agglutinated by crusts of dried exudate; wool becomes tufted, falls out in patches, intense pruritis. The psoroptes is the largest mange mite, 0.4—0.7 mm long; head long, pointed, the three-jointed legs provided with tulip-shaped suckers. Fig. 12. id Sarcoptes scabiei. Acarus Ventral side. folliculorum. 54 CLINICAL DIAGNOSTICS. d. Sarcoptic mange. Seen in the horse, dog, swine and cat, etc. This mite burrows tunnels in the epidermis, causes nodules, crust formation, thickening and folding of the skin, pruritis. Most difficult mite to capture for microscopical examination; to obtain material for examination the skin should be scraped to bleeding. Sarcopites are very small, turtle-shaped mites measuring 0.2—0.5 mm head horse-shoe shaped, legs short and stumpy. e. Acarus mange. Most common in dogs and swine, ap- pearing principally on the eyelids, head, extremities, causing little itching. Skin covered with scales, small pustules, and is thickened and folded. In the squamous form circumscribed, bald, bluish-red areas occur, epidermis mother-of-pearl-like, scaly. The parasite is vermiform, 0.2—0.3mm with a long, narrow, jointed body, the anterior portion carrying four pairs of short, three- jointed feet, at the end of each, three pointed hooks. Eggs spindle- shaped. lk Skin Drseases— Dine. tow slau Lamas hese Ringworm (Herpes tonsurans) is induced by the fungus Tri-_ chopyton tonsurans. The disease is characterized by the appear- ance of small round, well-defined hairless patches. The smooth skin, is covered with grey-colored, asbes- tos-like crusts. Spontaneous healing begins in the center of the lesion, extending toward the periphery (‘ringworm’). Vesi- cles rarely appear. Most common in the ox. In the crusts and more especially in the hair follicles great numbers of round or ovoid, light-refracting spores can be seen with the aid of the microscope. The spores measure 4u. Some of the spores are arranged in regular order, like a string of beads, others are disposed in irregular groups. The filaments, which may be sim- ple or jointed, show little tendency to branching; their free ends are rounded. Favus. Rare, but appears in fowls as so-called “white comb” (Tinea _ galli). Small whitish-grey spots come upon the comb, which gradually is encrusted by Trichophyton tonsurans. them. In mammals thick, depressed, yel- lowish brown crusts appear. GENERAL PART OF EXAMINATION. 55 Ivo saxeute Exantthem.as- 1. Foot and mouth disease [said not to occur in the United States], is an acute infectious disease of cloven-hoofed animals, characterized by the appearance of vesicles upon the mucous membrane of the mouth, the skin of the coronet, and in the inter- digital space. Period of incubation 1 to 3 days. The disease is attended by moderate fever, salivation, diminished appetite, lame- ness, recumbent position. The vesicles rupture, leaving erosions Fig. 15.— Urticaria. on the mucous membranes, and dry scabs on the skin. Complica- tions are not infrequent. 2. Sheep pox is a contagious exanthema running an acute course and having a typical character. Incubation 4 to 7 days; artificial inoculation shorter. On the haired portions of the body, around the eyes, nose, mouth, inner surfaces of the legs, appear punctiform reddenings (pimples), later papules. In about six days 56 CLINICAL DIAGNOSTICS. the papules are covered by vesicles filled with a clear, tenacious fluid (eruptive stage). In the next few days the contents of the vesicles become turbid, forming pustules (suppurative stage); then drying of the pustules to a solid crust (exsiccative stage). When the crusts fall off a small depressed cicatrix (pit) remains. During the eruption there is fever, loss of appetite, etc. Course about 3 weeks. [Mortality 10 to 50%]. 8. Canadian horse pox. A contagious pustulous exanthema limited usually to the saddle and harness rests. Period of incuba- tion 2 to 3 days. A few isolated prominences of the size of a half dollar appear, the hair on them is erect and gathered into tufts. The contents of the bullae becomes purulent, erupts, dries to a brownish-yellow solid crust. Caused by a bacillus measuring 2u, which admits of staining with fuchsin. 4. Urticaria (nettle rash) is a peracute exanthema which is characterized by its sudden appearance. Tumefactions from the size of a pepper-corn to that of a hand or saucer come upon the neck, head, inner surface of the hind limbs and on the body. They are prominent, flat, soft, warm, the hair upon them standing erect; itching is rare. Urticaria of swine is to be looked upon as a mild form of erysipelas. WenGemn eoreatleD! i scesaysue (Siawalicine eAC dt treet bens Sucatenie 1. Purpura hemorrhagica (morbus maculosus) is an acute in- fectious disease (an intoxication) characterized by the appearance in the various organs of the body, of multiple hemorrhagic centers of varied size. In the absence of complications, the disease is unattended by fever. On the.mucous membranes of the nasal pass- ages blood spots are seen, more rarely they occur in the conjunc- tiva and buccal mucous membranes. In the skin and subcutis of the lips, cheeks, and nostrils, appear hard, inflammatory, edema- tous swellings from the size of a pigeon’s egg to that of a hand (larger by confluence), causing the head of the horse afflicted to resemble that of a hippopotamus. The extremities also swell, the swellings terminating abruptly at the stifle and the elbow. There is a diffuse edema of the lower abdomen; hemorrhage in the internal organs. Breathing is labored and stentorious from the mechanical obstruction (swelling) to the entrance of air into the upper respiratory passages. There is difficulty in deglutition, colic symptoms, and impaired locomotion. When the disease has existed for several days, the temperature increases. [Course atypical, 6 to 21 days. Mortality about 50%]. GENERAL PART OF EXAMINATION. 57 Virewoute bmnectious, Diseases. which Affect tiehieu. So let ne 1. Black leg (symptomatic anthrax) is an acute infectious dis- case caused by the entrance of a germ through [the digestive-tract or] a lesion in the skin, a peculiar emphysema resulting. On the body, shoulder, neck, upper portions of the extremities (never be- low the knee or hock) appear swellings which are at first hot and painful, but later cold, painless, emphysematous. Incision causes a foamy, fetid fluid to flow out of them. Attending symp- toms are high fever, great depression, lameness, dyspnea. Mor- tality is high. [Prophylaxis, protective inoculation]. The bacilli of black leg are contained in the discharges from the swellings. They measure 3—5u long, 0.5—0.6u broad. One end or the middle is enlarged to receive an ovoid spore which it bears. May be stained by Gram’s method. 2. Malignant edema appears under the same symptoms as black leg; the swellings are more edematous than emphysematous. The bacillus of malignant edema is somewhat like the bacillus of anthrax, 3——3.5u long and 1.1u broad. They are mostly united at their ends to form long threads. In the middle of some of the bacilli or at the ends occur spindle or drumstick-like en- largements to receive the ovoid spore. The spore does not accept ordinary stains. 3. Bovine pest (Rind und Wildseuche) is produced by the bacterium of hemorrhagic septicemia and appears in the exan- thematous, pectoral, or intestinal forms. On the head and neck appear large inflammatory edematous swellings, which spread to the mucous membranes of the mouth and throat. The pectoral form is attended by a croupous-hemorrhagic pneumonia with pleu- ritis, and the intestinal form with hemorrhagic enteritis and swell- ing of the intestinal viscera. The Bacterium septicemiae haemor- rhagicae, like that of contagious pneumonia of swine and of chicken cholera, is 0.6u long, 0.3u broad, oval, stains only at the ends, an unstained belt remaining. 4. Examination of the Conjunctiva. The examination of the conjunctiva serves to determine the quantity and condition of the circulating blood. Method. Avoid all rough and hasty. manipulations. Before grasping the eyelid gain the animal’s confidence by arranging the foretop and gently stroking the forehead. The right evelid should 58 CLINICAL DIAGNOSTICS. be lifted with the fingers of the left hand, the left one with those of the right hand. By means of the thumb the upper eyelid is raised, the index finger then replaces the thumb, and by gently pressing the everted lid inwardly, the mucous membrane of the upper eyelid and the membrana nictitans become visible. The thumb, which is now free, draws the lower lid downward. The other three fingers may be rested against the zygomatic arch, steadying the hand. (See figure 16). Fig. 16. In the ox a good view of the scleral conjunctiva may be ob- tained by simply taking hold of a horn and the nose, and drawing the head to one side. If we wish to arrive at the condition of the blood from an examination of the mucous membrane of the eye, that organ must be free from local irritation. Severe exercise. and high atmospheric temperature cause a healthy mucous membrane to appear very red from physiological congestion ; local inflammation also produces congestions. A careful cémparison of both eyes will enable us to deter- mine the presence of local inflammation. In healthy animals. « £ wes GENERAL PART OF EXAMINATION. 59 the color of the conjunctiva is pale-roseate; in the ox paler than in other animals. A few blood vessels are always visi- ble. In the conjunctiva, the boundary between normal and diseased conditions is not sharply drawn, hence practice alone makes one capable of giving a reliable judgment. I. Discharge from eyelids. Although mostly due to local diseases, some of the infectious diseases have discharges from the eyelids constantly present. The discharge is either bilateral (from both sides) or wzilateral (from one side only). Bilateral discharges are seen in: malignant head catarrh (with keratitis), bovine pest (no keratitis present), dog distemper, fowl cholera, influenza. (Swelling shuts off the tear ducts). Unilateral discharges occur: in continued chronic nasal catarrh, a symptom of glanders, chronic nasal or sinus catarrh. [In all animals showing unilateral discharge from the eyelids, especially when the discharge is copious, a careful examination for foreign bodies should be made]. II. Color. The color of the conjunctiva is due to the quantity of blood circulating in the blood vessels of the organ and the amount of hemoglobin contained in the blood cor- puseles. A pale, anemic color shows that the animal is either deficient in blood or that the blood does not contain its nor- mal quota of red corpuscles. The color varies from reddish- white to greyish-white or white. Paleness occurs suddenly: 1. Following great loss of blood, internal hemorrhages (liver, heart, large blood vessels, etc.). 2. In congestion of blood in the intestines (embolism of intestinal arteries, displacement or torsions of the bowels). Paleness appears as a chronic condition: . 3. In constitutional diseases of the blood-making organs: (leucemia, hydremia). 4. In all chronic diseases which lead to anemia or hydremia, glanders, tuberculosis, distomatosis (liver flukes) and parasitic diseases of the stomach and lungs of sheep. 60 CLINICAL DIAGNOSTICS. Venous engorgement does not come from plethora. It may be ramiform, diffuse or punctiform, and varies in color from a brick red to dark red or muddy (cyanotic). Ranxform congestion from disease occurs: 1. In congestion of the head due to hyperemia of the brain, encephalitis. The blood vessels are plainly marked in the diffusely reddened conjunctiva. 2. When the return of the venous blood from the head is retarded. Characterized by distension of the veins. Occurs in organic heart diseases, heart’s weakness, pulmonary em- physema. A diffuse, faded bluish-red discoloration of the conjunc- tiva is found in conditions leading to an overcharging of the blood with CO,. It is seen in febrile diseases (infectious diseases), and wherever air is prevented from passing freely into the lungs: diseases of the respiratory tract, respiratory muscles, or heart. Inflammation of the mucous membrane of the gastro- intestinal tract in the course of colic, produces a cyanotic con- junctiva; if fever appears it becomes ramiform (a bad sign). Yellow (icteric) discoloration (jaundice) is best observed on the scleral conjunctiva. It is not noticeable by artificial light. If the conjunctiva is pale (bloodless), the yellow can be more readily appreciated. The shades. vary from a mere trace of yellow to pronounced lemon yellow; in most cases combined with congestion. The icteric discolora- tion is due to the abnormal amount of bile coloring matter found free in the blood serum. i According to the origin of the yellow coloring matter we distinguish : 1. Hematogenous icterus originates from a dissolution of the red blood corpuscles, the coloring matter becoming set free and mixing with the blood serum. Hematogenous icterus is really a hemoglobinemia. The dissolved blood coloring matter (the methemoglobin) is not changed to bile pigment a Se ee i ee i GENERAL PART OF EXAMINATION. 61 in the blood, but in the liver. If this organ is able to convert all of the coloring matter to bile and excrete it through the bile ducts, the urine will contain no bile, but the feces will become stained by it (hypercholia) and assume a dark color. It may happen, however, that the bile becomes ‘so thick that it congests the smaller bile ducts, is reabsorbed and stains the urine. Hematogenous icterus is seen in influenza of the horse, azoturia, pyemia, septicemia [Texas fever], and in certain cases of poisoning, especially after prolonged chloroform nar- cosis. 2. Hepatogenous icterus is due to the free flow of bile from the liver becoming retarded (biliary stasis) and its pass- ing over into the blood (cholemia) via lymph vessels and tho- racic duct. The obstruction may have its seat in the biliary capillaries or larger ducts, and often at the ductus choledochus in the bowel. Hepatogenous icterus is characterized by the appearance of bile pigments in the urine while the feces, con-— taining less than normal, are of too light a color. Hepatogenous icterus is seén in duodenal catarrhs with swelling and mucous obstruction of the ductus choledochus, tumors, parasites (ascarides) and concretions which block the bile flow. In lupinosis and phosphorous poisoning a swell- ing of the ducts and parenchyma of the liver occurs leading to the collection and absorption of bile. Malignant icterus (icterus gravis) has associated with it mental depression and slow heart’s action due to the effect of the cholic and other acids contained in bile. III. Swelling. Swellings of the conjunctiva usually are diffuse and may occur in both eyes. They are due to a serous infiltration of the mucosa and submucosa. If of an inflammatory character they are hot and painful. This con- dition finds its best development in influenza of the horse, the greatly swollen, glassy mucous membrane protruding from between the half-closed lids. It is seen further in contagious 0% oO CLINICAL DIAGNOSTICS. pleuropneumonia of the horse, purpura hemorrhagica, ma- lignant head catarrh of the ox, bovine pest, anthrax, dog dis- temper, chicken diphtheritis. The swelling may be due to hydremia, as in primary anemia and in cachectic diseases of sheep: liver fluke disease, lung and stomach worm plague. In the course of chronic diseases of the stomach and in- testines a slight swelling of the conjunctiva, attended with a washed-muddy and sometimes icteric discoloration, appears. The conjunctiva may be drier than normal in severe feb- rile diseases and bad colics. 5. Bodily Temperature. The internal temperature of the body is maintained, with slight variation, at a definite elevation by means of an es- pecial regulating apparatus. The production of heat in the body and the loss of heat from the body are kept equal. If the temperature varies from the -normal, and this variation be preserved for a time, a disturbance due to disease is affecting the regulatory apparatus. The determination of the internal temperature is of great importance in the diagnosis of disease, for each deviation from the normal is to be considered a symptom of considera- ble moment. In all diseases affecting internal organs, the measuring of the temperature is imperative. Method of examination. Thermometry. Formerly the temperature was approximated by laying the hand upon dif- ferent parts of the body, namely the nose, ears, horns, extrem- ities, or by inserting the fingers into the mouth. Such methods require long practice before a reliable estimate can be ob- tained, and they are always deceptive. Only in exceptional cases are they now in vogue. The temperature is most ac- curately measured with a thermometer, graduated in degrees and tenths of a degree. [Except in America, England and perhaps one other country the Celsius (centigrade) thermom- eter is in common use. It is graduated into 100 degrees, and * GENERAL PART OF EXAMINATION. 63 these subdivided into tenths of a degree. In this country the Fahrenheit thermometer is generally used. It is graduated into 212 degrees, each degree being subdivided into fifths. Our preference for this latter instrument is largely tradi- tional, and it is being displaced by the centigrade, which is now almost universally employed in scientific work. The following simple formula will indicate how readily the Celsius scale may be converted into the Fahrenheit scale and vice versa: Fahrenheit = 9-5 C + 382. Celsius = 5-9 (F — 32)]. For veterinary practice a maximum thermometer should be used, preferably a tested or compared instrument. The thermometer should be inserted full length into the rectum, which gives the best results, though in exceptional cases the vagina is chosen. We should, of course, guard against being kicked by the animal, and exercise care that the instrument does not break and injure the mucous membrane. Before introducing the thermometer, the column of mercury should be shaken down. The use of water, saliva ‘or oil facilitates insertion. We should allow the instrument to remain in the rectum from three to five minutes. Taking the bodily temperature once daily is of great value during the course of an internal disease; in important cases the temperature should be registered twice a day (8 A. M. and 5 p. m.).. After diagnostic inoculations (tuberculin, mallein), especially during the critical period, the temperature should be recorded at least every two hours. Thermometry is of great diagnostic importance during an outbreak of an in- fectious disease, the elevation in temperature being often the first symptom shown. By taking the temperature once daily (best at evening), the infected animals may be determined before further symptoms of disease develop; [influenza, 64 CLINICAL DIAGNOSTICS. contagious pleuropneumonia, swine plague ‘or hog cholera, Texas fever. I. The Normal Temperature. The normal tempera- tures of the different animals are as follows: Horse ..37.5—38,5° C. [ 99.5—101.3° F.] OX #7880280". ae PEG oy a | Sheep ..39.0—40.5° “ [102.2—104.9° “] Goat .».390-—40:5°. ae 2-104.9°- “4 Hoe... .38.0=40.0" [1004-104 pee Dog =: 375-259.0". [oo e102 27-3 J Fowls ..41.5—42.5° “. [106.7—108.5° “] The temperature will vary a few tenths of a degree in the same species, and slight variations may occur in one and the same animal within a single day. This latter variation may amount tol” Cokes By. In healthy but pregnant cows the temperature may vary 1.5° C, [2:7° F.]y° a temperature. elevation, therefore, oF 39.9° C. [103.8° F.] would not necessarily mean fever in these animals. . When the organs (muscles, glands) are active a slight rise in temperature takes place, when at rest a slight sinking follows. From long continued exercise at a rapid gait the tem- perature of a horse may rise 2.5° C. [4.5° F.]. Two hours may elapse before it reaches normal again. High: atmospheric temperatures or warm stables, inas- much as they reduce radiation, tend to increase the tempera- ture. Asa rule the temperature is lower in the morning than toward evening. Age, race, sex, temperament and when eating have but little influence on bodily temperature. During the hot sea- son of the year, in cattle kept in stables the temperature may rise: 1.0° (C. tor ‘a»short tame; As a rule the bodily temperature is lowest in the morn- ing and in the afternoon at about five o’clock highest. GENERAL PART OF EXAMINATION. 65 II. Temperature of the skin. The thinner and more vascular the integument and the finer-the hair coat, the warmer the organ feels. Exposed surfaces of the skin feel cooler than more protected, covered parts. The ears and extremities, therefore, are normally colder than the rest of the body. The surface temperature is measured by laying our hands upon the skin. During fever the distribution of the bodily heat is often irregular, therefore it is not uncommon to find one leg .cold while its fellow may be abnormally hot; in fever in the ox, the horns are sometimes hot and cold alternately. The taking of the surface temperature is only of value in the ox and dog, the use of the thermometer being more reliable in the other animals. The surface temperature is elevated (skin hot) in fever and during normal outbreak of sweat. It is reduced (skin cold) when the temperature is below normal (milk fever), collapse, during chill stage of fever and in the cold sweat which usually .precedes death. The temperature of the skin is unevenly distributed (one ear hot, the other cold, ends of ears very hot or very cold, legs cold) in fever. The horns of cattle frequently furnish an index to the temperature of the body. III. Fever. Although the character of fever is not expressed entirely by elevation of temperature, we have be- -come accustomed to associate high temperature and fever, using the terms as if synonymous. As a matter of fact, the increased temperature is only one of the characteristic and most readily available symptoms in the complex phenomenon called fever. As a rule, however, there is a direct relation- ship existing between the height of the temperature and the degree of development of the fever. At times in the ox, the increase of temperature, as measured by the thermometer, fails to correspond with the degree of fever, which can be appreciated by the remaining symptoms. 66 CLINICAL DIAGNOSTICS. Besides mere increase in temperature, the following phe- nomena attend fever: 1. Chill. When the temperature of the body rises very rapidly the peculiar symptoms of chill are shown: pronounced trembling of the muscles, which can shake the whole body, arched back, erect hair coat, cold skin. Chill is not a con- stant symptom of fever, occurring only in certain infectious diseases, such as anthrax, bovine pest, septicemia, pyemia, malignant head catarrh. [It is sometimes seen in animals reacting to tuberculin or mallein]. 2.. Uneven distribution of the external temperature of the body. The ears, horns, nose and extremities are abnor- mally warm or cold, one extreme alternating with the other. The muzzle of the ox, the nose of the dog and the snout of the hog are dry, even creviced and alternately too hot or too cold. 3. Acceleration of the pulse and respirations take place more slowly than the increase in temperature; and they do not bear the same relationship to the temperature in all fevers. The higher the pulse frequency, the more serious the fever, the pulse becoming weak and the artery soft. 4. Loss of appetite and impaired digestion. In fever the secretion of the digestive juices is lessened, peristalsis suppressed (constipation), thirst increased. 5. Mental depression. 6. Albuminuria. Although the variations in the normal temperature of a given animal are confined to narrow limits, when the tem- perature exceeds these limits we are not always justified in assuming the presence of fever. The physiological functions of the organs can momentarily become sufficiently accelerated to produce a degree of temperature in excess of the usual _normai one. The appearance of concomitant symptoms or repeated recording of the temperature will generally decide —— — oer GENERAL PART OF EXAMINATION. 67 whether fever be present or not. In doubtful cases we speak of high normal temperature. The following temperatures may be safely assumed to iclicate fever: In the horse a temperature of 39.0° [102.2° F.] and over. In the ox < 40.0° [104.9° F.] % In the dog e 39.2° [102.5° F.] . In the ox and dog. fever is often present without a rise of temperature. In such cases we must depend upon the sur- face temperature and the other symptoms of fever present. Generally the height of the temperature expresses the Fig. 17. SMa as r= PopSet Ss] =e See Ss ee as ae SS es oy Es] Ey we as a at met = EcEs EERE A === SS Ses oo et ae a = =a *eesaseal ss A 25 som oo oa i hI ose Pa oe oe ae 5s cl Sa et Pe SB Da SRS + is So aa Se SaaS ai ae ae a SS Sass Fos oe as ae = 9 GaSe = — ’ Soot Ss ee =] 220655 =a = a es a a es Be 2 Ss Se ae 7 sto RPE BS SS wes a = BSS are = t-{_}_+_{ +} |} = Stad. incre- Fastigium. Stadium decrementi. menti Crisis Febris continua—Equine Pleuro-pneumonia. ‘ height of the fever. Four degrees of fever are distinguished, which for the horse and dog are as follows: 1. Mild fever 38.5°—39.5° C. [101.3°—103.1° F.]. %. Moderate fever 39.5°—40.5° C. [103.1°—104.9° F.]. 3. High fever 40.5°—41.5° C. [104.9°—106.7° F.]. 4. Very high fever or hyperpyretic temperature 41.5° C. [106.7° F.] and over. Usually in the horse even in the most severe infectious diseases, the temperature does not exceed 41.7° C. [107.0° 68 CLINICAL DIAGNOSTICS. F.]; only exceptionally, in tetanus, contagious pleuropneu- monia, and influenza, is this high mark passed. The highest temperature is carried by fowls, namely 43,5° C. [110,3° F.]. [In cases of “heat stroke” in horses hyperpyretic temperature may reach 110° F.]. During a single day a febrile temperature does not remain constant, but agreeing with the variations of the nor- mal temperature, is lower in the morning than toward even- ing—the so-called morning remissions and evening exacer- bations. Se ae ea =f 41,0 Sala =e mam I 40,0 ta] ste Sel aca 39,0 == [a as ae 38,0 a ica tea me 37,0 =o as =o Se Febris remittens.—South African Horse Sickness. Recording of the variations in temperature which occur during the course of a disease is also of great importance. If the temperature is measured at a certain time daily and the record expressed in a graphic manner, the so-called fever curve is obtained. From the fever curve is recognized the type of fever present. In veterinary medicine the following types of fever are important : 1. Continued fever, daily variation less than 1° C. GG poe eB 2. Remittent fever, daily variation over 1° C. a a ee” 69 Pei NED>= 308 RORRETAHR AGREE ARNE ARR a ROR RUADE CHU REDE TT Fall Abscess. EXAMINATION. GENERAL PART Or Intermittent fever, periodical temporary fall to nor- mal temperature. 9 oO. Atypical fever is one having no regular character. 4, Fig. 19. Relapse. Apyrexia. Febris intermittens—Flagelosis of the Horse. In the course of most infectious diseases, three stages are distinguished, according to the course of the fever, viz.: Fig. 20. 2 > after opening™ Relapse. Abscess developing Initial Fever. Febris atypica—Strangles of the Horse. wal) CLINICAL DIAGNOSTICS. 1. Stage of increasing temperature (stadium incre- menti). 2. Acme, temperature at its highest (fastigium). a) 3. Stage of falling temperature (stadium decrementt). A rapid fall of temperature (within 1-2 days) is called crisis, a gradual decline, lysis. According to duration we distinguish: ephemeral (one day), acute and chronic fevers. IV. Subnormal Temperature. Hypothermia. Like the high normal, the subnormal temperature may be physiolog- 3 ical. Further, it may come from the fact that the sphincter ani is relaxed, or that the thermometer has not been inserted deep enough, or that the rectum is filled with feces, or that defecation takes place just before or during the insertion of the instrument. A subnormal temperature due to disease is uncommen. It is seen to occur, but not constantly, in parturient paresis, ‘certain gastro-intentinal diseases of the dog, anemia, hemor- rhage, icterus gravis. A subnormal temperature is most fre- quent in fatal diseases just before death (temperature of col- lapse). General Infectious Diseases. ‘is Septicemia. Nearly all forms of so-called “Blood Poisonings” are designated by the collective term Septicemia. Symptoms: suddenly appearing fever, often accompanied by chill; fever of the continued type; mucous membranes highly reddened, often icteric, frequently ecchymosed. Very rapid, small pulse. Food and drink refused; fetid diarrhea. Great mental depression, blank counte- nance, eyes sunken. Acute or peracute course. Pyemia is a general disease due to pus cocci gaining access to the blood, and’is characterized by multiple, secondary abscess for- mation (pyemic metastasis) in the various organs, lungs, liver, kidneys, brain, joints, etc. Diagnosis is easy when primary abscess is available; otherwise it is difficult. As each new abscess forms the temperature increases, therefore it is fever of intermittent type. Mucous membranes are congested, icteric. Pulse is continued ‘high. Course subacute. GENERAL PART OF EXAMINATION. 71 Anthrax is an acute infectious disease due to the Bacillus anthracis. Begins. suddenly with high fever; tendency toward hemorrhages from mucous membranes. In the ox and sheep the course is often apoplectic; when course is acute it lasts 1-3 days. Brain symptoms, Fig. 21. convulsive — twitch- a i ings of muscles, rap- id pulse, dyspnea, loss of milk,® are symptoms some- times seen. In horse, colic symptoms oc- DB cur. Formation of anthrax carbuncle in skin is not rare in the horse. In hog, symptoms of severe laryngo - pharyngitis with swelling pre- dominate. Diagnosis is positive only after finding bacilli under the microscope. An anthrax slide is made as follows: A _ thin Anthrax bacilli Stained according to Olt’s method. layer of blood or a. b., Cadaver bacilli. spleen pulp is smeared over a slide, passed three times through the flame of a Bunsen burner, then covered with a 2% watery solution of safranin and allowed to boil by holding over a Bunsen flame for a few moments. Wash and examine. The anthrax bacilli are from 1 to 2 times as long as the diame- ter of a red blood corpuscle, and are composed of from 2 to 8 bacterial cells, which are stained,reddish brown on the slide. Each bacterial cell is cylindrical, slightly longer than broad, appearing almost square in form. The ends are plane or somewhat convex. The bacterial cells are surrounded by a gelatinous capsule, which is stained yellow in the preparation, and which joins the cells together to form the bacillus. The capsule is bounded by a dark line. If the bacilli come in contact with one another they unite, their capsules blending together. Influenza. An acute, infectious disease of the horse, very easily transmitted. Period of incubation 5 to 7 days. First symp- tom is a rise in temperature which continues 3 to 6 days, then crisis. Great debility, slow gait, staggering, great mental depres- sion, head held down or rested on manger, eyelids and conjunctiva swollen, hot, painful, photophobia. Pulse at first strong, little affected, later accelerated. Loss of appetite, diarrhea in about 3 days. In later stages cold, painless edematous swelling of the extremities. Mortality 4%. [Swine Plague and Hog Cholera. Infectious diseases of swine, caused by bacilli which enter the body through the respiratory tract (swine plague of Smith), or via respiratory tract or mouth— ‘e | v } Ih, ara) y }! i. " Wye aT it iu. i ates , i Witte 72 CLINICAL DIAGNOSTICS. with food and water—(hog cholera of Smith). Period of incuba- tion 4 to 21 days. Young pigs most predisposed. One attack pro- duces immunity in most cases. Symptoms: apoplectic form; die very suddenly or after a few hours illness (beginning of an out- break). Usual form: fever, temperature 107°-108°F., appetite im- paired, tremblings of muscles, unwillingness to move, stupid, dull, hide in litter. Beeeete at first constipated: later diarrhea. Eye- lids. filled with mucus. Respiration accelerated, labored; painful, frequent cough. On pendant parts of body, skin is reddened, con- gested; eczematous eruptions, ulceration of skin. Rapid loss of flesh, unsteady, tottering gait. Death within 48 hours to 2 weeks. Mortality 20-100%. Texas Fever. An infectious blood disease of the ox caused by a protozooén (Pyrosoma bigeminum) which enters and destroys the red blood corpuscles. The disease is spread by the cattle tick, Boéphilus bovis, the younger generation of which carries the pro- tozodn, Period of incubation 13-90 days after exposure to tick- infected places. Symptoms: fever (104°-109° F), unnatural recum- bent positions and standing attitudes; animal is dull, stupid; in some cases shows vicious tendencies; horns, ears, and hoofs are hot. Pulse is rapid; dyspnea; constipation, excreta tinged with bile. Visible mucous membranes icteric. In later stages urine red. Ticks of various size to be found on escutcheon, inside of thighs, base of udder or scrotum. Little blood flows from intentional wounds. Characteristic post-mortem changes. Duration 3 days to several weeks. Mortality 20-90%]. Fowl Cholera. Period of incubation 1 day. Apoplectic death common. Great exhaustion, staggering, foamy mucus discharged from bill, dyspnea with respiratory sounds, loss of appetite, diarrhea, bacilli as in Wild und Rinderseuche (wild and cattle plague). Braxy of Sheep. A peracute hemorrhagic inflammation of the abomasum due to the bacillus gastromycosis ovis. In many respects resembles anthrax. South African Horse Sickness. A _ non- contagious’ (though readily transmittable by blood inoculation) disease of horses and mules. Incubation 7 days. Slowly rising fever with morning remissions. Symptoms of pulmonary edema (Dumperre zickte) or swelling of the head (Dikkop). Great muscular weakness, ani- en recumbent. Pulse not very rapid but small. Mortality 80- 90%. B. The Special Part of the Examination. 6. Circulatory Apparatus. An examination of the circulatory apparatus is of impor- tance not only to diagnose those maladies which affect the organs carrying the blood, but also from the fact that all acute general or infectious diseases of a serious character influence more or less greatly the circulation. A methodical examination of the organs carrying the blood includes: bo bakinse the. pwise.. II. Noting the condition of the peri- pheral blood vessels. i Examining the heart. I. Pulse. Method of Examination. The pulse is felt. with the fingers, which may be gently rested upon any Of the superficial arteries having bone or other hard tissue under them. In the horse and ox the sub-maxillary artery is most commonly used, in the latter animal the artery is easily felt on the lateral side of the jaw bone. Other arteries which may be used to take the pulse are the radial, plantar, temporal, transverse facial and coccygeal. In the dog, sheep, goat and cat the femoral artery.is most available. [In dogs and cats the brachial artery can be felt on the medial sur- face of the humerus, just in front of and above the elbow]. In the hog and fowl the pulse can not usually be felt, hence the heart’s beat is used. : From a clinical standpoint the 1. Frequency, 2. Rhythm, and 38. Quality, are of importance to consider in examinin the pulse. a. Frequency. By the frequency of the pulse we mean the number of blood-waves (beats) felt in a minute’s time. here is a great variation in the normal 74. CLINICAL DIAGNOSTICS. frequency, not only in the different species of animals, but also in animals of the same kind. Many physiological con- ditions have great influence upon the pulse-frequency: size, age, sex, race, atmospheric temperature, time of day, pre- hension or digestion of food, exercise, excitement, are all factors. Large animals carry a slower (less frequent) pulse than small ones; adults slower than young; females higher (more frequent) than males; well bred individuals, slower than mongrels; in summer the pulse is higher than in winter; in the morning slower than toward evening; excited animals show a more rapid pulse than animals standing at perfect rest. In nervous animals (horses and dogs) the act of taking the pulse often increases its frequency. Taking these physiological variations into consideration, the following is the average pulse-frequency for the dif- ferent animals. 1. (ELorses “te “ceneral>:, Mi SS eae 28— 40. Warm. blooded* stallions..:... 5... 0. 28— 32. Cold “blooded stallions.....3... 775.36. 28— 36. Colts; ciwo: weeks olds; Soh cee tee. —100. He POUT NVEEES OLE Nar 90 es te cee — 70. ““ six to twelve months old...... 45—— GO: > WO tOsthree years old Sn. De). 40— 50. 2. > ASSES andy Tales nls estes: o wise 45— 50. BD. WO TEES | ahvcon. th see ticks RSet 40— 80. 4) SHED ANG “ROAST ee. was wet ha eae . %0O— 90. BS WARE IE OR HES gt eI SEP eben i tae Ste ae 60—100. G5) DOB S at ia a ws, Ois. tae ebaiis Me seand emeabe 60—120 pie Ee een ee co eR Ea aA NEAR Lees. oS ll A 190530 8- Howls. ard cee ee ee ees 120—160 In regard to frequency we distinguish a slow pulse. (pulsus rarus) and a rapid pulse (pulsus frequens). The slow pulse (pulsus rarus) is very uncommon. It most often accompanies brain diseases attended by great de- pression (chronic and subacute hydrocephalus, tumors in the brain), icterus gravis, and poisoning from alcohol or lead. SPECLAL CLINICAL EXAMINATION. TS In the horse at times it is seen in gastro-intestinal affections with loss of appetite, probably due to some alteration in the sympathetic nerve. Fig. 22. Slow, Sluggish Pulse of Horse. Taken with Marey’s Sphygmograph--Art transversa faciei. The fast pulse (pulsus frequens) is very common in dis- ease. A very rapid pulse, though characteristic of no special disease, is always a sign that the parenchyma of the heart is affected, hence in severe diseases it is an index to the heart’s strength. Rarely in the horse does the pulse frequency exceed 80 beats per minute; if it exceed 100, the prognosis is unfa- vorable. In the ox a pulse of 100, and in the dog one of 120- 150 denotes severe illness. Anabnormallyaccelerated pulseoccurs: 1. In all severe diseases, especially when attended by fever. The frequency of the pulse, however, does not always bear the same relationship to the height of the temperature ; whether the pulse be accelerated or not depends upon the fever’s effect upon the heart, which differs with the disease present. In contagious pleuropneumonia of the horse, septi- cemia, anthrax, and severe inflammations of the bowels and peritoneum, the pulse rate corresponds to the height of the fever; in influenza and in strangles, the acceleration of pulse is not marked, compared with the temperature. 2. In painful conditions (severe injuries, fractures of bones, abscess in hoof, etc.). 3. In mental excitement (fear, anxiety). 4. In severe hemorrhage. b. Rhythm. When the individual pulse beats are sep- arated by intervals of equal duration, the pulse is regular 76 CLINICAL DIAGNOSTICS. (pulsus regularis). In the dog and, according to Cadeac, frequently in mules and asses, the pulse is often irregular and intermittent. Fig. 23. Normal Pulse—Horse. Marey’s Sphygmograph— Art. trans. faciei. The rhythm. of the irregular and of the intermittent pulse is abnormal, 1. e., arhythmic. When the pulse is irregular the intervals between the individual pulse beats are of unequal duration. This is due to lack of innervation of the heart, as well. as to exhaustion of the organ. If the pulse of the horse exceeds 80 it is usually irregular. Irregularity is also ob- served in valvular diseases of the heart, and in myocarditis. The pulse is intermittent when a beat fails now and then. When regularly intermittent, a certain beat can not be felt, as for instance, every fourth or fifth pulse wave; when irregularly intermittent there is a lapse which does not occur between any certain beats. Sometimes the heart’s beat is synchronous with.the intermittency of the pulse; at other times the heart’s beat is normal, the intermittency occurring only in the peripheral vessels. To determine this the radial pulse and heart’s beat can be compared. | The intermittent pulse is commonly physiological, and seen in perfectly healthy horses and dogs, where it disappears after exercise and, therefore, probably due to lacking innerva- tion. Pathologically it appears in chronic hydrocephalus (dummies), severe gastric troubles, and during convales- cence from infectious diseases which have occasioned high pulse (contagious pleuropneumonia of the horse). SPECIAL CLINICAL EXAMINATION. at c. Quality. The pulse beats should be of equal vol- ume. When this is true we speak of an equal pulse (pulsus aequalis ). The quality of the pulse varies with the kind of animal. The normal size, strength and hardness of the pulse can only be learned by experience; it can not be defined. In the horse the pulse is large, strong and the artery only moderately tense; in the ox the pulse is smaller, not so strong but the artery is tenser and may be rolled under your finger like a hard rubber tube. In small animals the pulse is quick, strong and hard. (See 74.) In dogs often it is inequal. According to whether a greater or smaller quantity of blood is forced into the arterial system, we distinguish a full (pulsus magnus) and an empty (pulsus parvus). The pulse becomes empty when much accelerated and in severe hemorrhages. In fatal diseases the pulse finally be- comes imperceptible (pulsus insensibilis), indicating cardiac weakness or anemia. Fig. 24. Small, Irregular and Inequal Pulse of Horse. Marey’s Sphygmograph. If the pulse waves are not of equal volume the pulse is called inequal (pulsus inaequalis). This is a very impor- tant symptom of cardiac weakness, where it is uniformly associated with irregularity, and of valvular (mitral) heart disease. At times there exists a close relationship between an irregular and an inequal pulse. A small wave follows closely a larger one, so that there is a regular alternation of weak and strong beats. It denotes beginning heart’s weak- ness. 78 CLINICAL DIAGNOSTICS. By the strength of the pulse we mean the force with which it lifts the finger palpating it. We distinguish a strong (pulsus fortis) anda weak (pulsus debilis). In hypertrophy of the heart the pulse is strong; in parenchyma- tous degeneration of the cardiac muscle, it is weak. The degree of weakness shown by the pulse indicates the severity of the attack. We form an estimate of the strength of the pulse by noting whether it is readily compressible or not. The hardness of the pulse is due to the distention of the arterial wall and is greatest at the acme of a wave. The pulse is hard (pulsus durus) in severe pain, peritonitis, tetanus and acute brain diseases. [In inflammation of serous mem- branes generally the pulse is hard]. The opposite of a hard pulse is the soft pulse (pulsus mollis). Besides the above the following kinds of pulse deserve mention: Trembling pulse (p. tremulus), where the wave in the distended artery is so small that only a slight trembling can be felt. Thready pulse (p. filiformis) is one which is so small, weak and soft as to be hardly -perceptible. If asso- ciated with this pulse the visible mucous membranes are cyanotic, it shows deficient heart’s strength and justifies a bad prognosis. The wiry pulse is a small, tense and very hard pulse. Occurring in colic it is a bad sign. A less marked wiry pulse may be noted in aortic stenosis and in chronic nephritis. The arch of the pulse wave may become changed in dis- ease. If the wave is very abrupt, we speak of a hopping, swift pulse (p. celer) ; if, on the contrary, the wave is much prolonged, it is spoken of as a “sluggish” pulse (/. tardus). A quick pulse (. celer) is associated with mild cases of cardiac hypertrophy, plainly marked in aortic insufficiency. In the latter case it is due to the regurgitation of the blood, which occurs at systole, into the hypertrophic left ventricle. In both these instances the pulse is full and strong. Remark- ably in heart’s weakness a p. celer is present. However, here SPECIAL CLINICAL EXAMINATION. 79 the pulse is weak and the“artery empty. The “sluggish” pulse (p. tardus) is noted in very lymphatic horses and is character- istic only of aortic stenosis, when it is at the same time small. A peculiar pulse is the dicrotic pulse where two marked expansions can be felt in one beat of the artery. It is seen in cases of lowered arterial tension combined with weak- ened heart’s action, and is, therefore, noted in long continued fevers and in all forms of anemia. Fig. 25. Dicrotic Pulse—Horse. Marey’s Sphygmograph. II. Examination of the Peripheral Blood Vessels. Arteries. A strong pulse attending wasting disease and emaciation calls for an examination of the small super- ficial arteries. An abnormally strong pulsation in the peri- pheral arteries of small caliber is visible in the horse in the branchings of the external maxillary artery. It appears in hypertrophy of the left ventricle especially when the bicuspid valves are defective. Veins. The state of distention of the veins is of primary interest. The veins become prominent after any acceleration of the heart’s action in thin-skinned, fine- haired horses; the condition, which is physiological, being a temporary one. A permanent distention of the veins is path- ological, and is due to an obstruction of the free flow of blood to the right heart. It is mostly plainly visible in the jugulars and their plexus on the head, other superficial veins (external thoracics, milk veins, veins of the extremities) showing it less on account of the edema usually accompanying the con- dition. 80 CLINICAL DIAGNOSTICS. The jugulars can be distended to the size of the human wrist, or even the arm, appearing as great, round strands. The veins of the conjunctiva can also be distended, being rec- ognized as ramiform, often contorted, bluish strands in the mucous membrane. The veins are generally distended: 1. In valvular disease (tricuspid). It is usually sec- ondary, but in the ox mostly primary. 2. In chronic pulmonary diseases interfering with .cir- culation: emphysema. 3. In diseases of the heart’s muscle, the organ having become so weak that it is unable to handle the quantity of blood: traumatic myocarditis of the ox. 4. From excessive intrathoracic pressure upon the heart and large blood vessels: tympanitis, pleuritis, pericarditis traumatica of the ox. Pulsation in veins. Besides being distended, veins can show pulsation under some circumstances. Synchronous with the respirations, and independent of the heart’s action, a slight swelling of the jugulars occurs during the act of expiration, to fall again at inspiration. A so-called jugular pulse is normal in the ox for the following reasons: The jugulars and anterior vena cava in this animal are compara- tively large. The continual flow of the venous blood into the right heart suffers during the systole of the right auricle, which slightly precedes that of the ventricle, a momentary interruption, the blood congesting in the anterior vena cava and jugulars, causing a brief distention of the jugulars, sim- ulating a pulsation. It is therefore not an active pulsation, but merely a passive undulation due to a regurgitation of the blood in the form of waves. The presystolic appearance of the pulse movement characterizes it, therefore it should al- ways be compared with the arterial pulse. The collapse of the vein is synchronous with the arterial pulse. The undulation of the jugular vein is intensified in the ° SPECIAL CLINICAL EXAMINATION. 81 ox and becomes apparent in other animals when the above cited condition prevails, induced by a morbid congestion of the blood at the heart. In the horse the venous pulse is seen near the aperture of the thorax (lower portion of the neck). A true (positive) venous pulse is pathological. It is coincident with the heart’s systole, and is produced by a de- fective closing of the auriculo-ventricular valves, the blood re- gurgitating into the auricle. True venous pulse is a characteristic symptom of tricuspid in- suificienic y- Fig. 26. Venous Pulse— Horse. The valves in the jugulars do not prevent the flowing back of the blood, as they are commonly not well developed, and if the vein be greatly distended they cannot close the lumen of the vessel. ; Til... The Heart. The heart is examined by palpation, percussion and auscultation. Anatomical. In all domestic animals the heart lies in the ven- tral portion of the thoracic cavity between the third and sixth ribs, in the dog extending to the seventh rib. The great mass of the organ (3-5) lies to the left of the median line, so that it approaches nearer the left thoracic wall than the right one. It does not occupy a perpendicular position, but an oblique one directed from the right, in front and above to the left, backward and downward, the left side of the apex reaching the chest wall. Horse. The base of the heart lies below the upper half of the height of the chest cavity, resting against the thoracic wall between the 4th and 5th intercostal space. The point of contact occupies a surface of about 10 cm high and 6-8 cm broad. (See Fig. 27, page 87). Ox and small ruminants. The heart is smaller and does not extend quite as far back as the 6th rib, its base, however, extends to the median line of the chest. Between the 4th and 5th 82 CLINICAL DIAGNOSTICS. . a Ht oe in immediate contact with the thoracic wall. (See ig. 26. Dog. The heart is of rounder form and lies very obliquely, touching the chest wall along a narrow strip from the 4th to the a oe The apex is below the 6th intercostal space. (See ig. 27. 5 Palpation of the heart’s region. The beat of the heart can be felt by laying the flat of the hand over the cardiac region. Inasmuch as the anconeus muscles partly cover the region, the hand should be plated between them and the chest wall. In the depths a dull thud will be felt, produced by the thumping of the heart against the chest wall. The beat is due to a con- traction of the heart’s muscles which causes a slight torsion of the organ to the left, bringing the left side, not the apex, in contact with the wall of the chest. The beat can best be felt in all animals just at the 5th intercostal space at the union of the ribs to’ the cartilages of the sternum. The force with which the beat can be felt depends upon the condition of the animal as to flesh, it being more plainly marked in thin animals, and just after severe exercise or excitement. Only in the dog can the heart’s beat be felt normally on the right side. The force of the heart’s beat can be increased or diminished. When the force of the beat is much increased a palpitation of the heart is spoken of. It occurs: 1. In hypertrophy of the heart (here combined with strong pulse). 2. In heart’s weakness, the muscles of the organ un- dergoing spasm-like contractions incapable of properly pro- pelling the blood to the periphery, the pulse being small. The condition is seen in acute myocarditis, endocarditis and peri- carditis. 3. Where the lung between the heart and the chest wall becomes thickened. . The Heart’ s-beat-ts weak ened: 1. Where the force is enfeebled from degeneration of the heart’s muscle. 2. Where the heart is crowded away from the chest wall by accumulations of exudate in the thoracic cavity (pleuritis, pericarditis), or in some cases of pulmonary em- physema or tumors. y Percussion of the heart. Except in very thin animals (horses) the percussion of the heart is of no great value in SPECIAL CLINICAL EXAMINATION. 83 the diagnosis of disease, the reason being that with the per- cussion hammer we are unable to determine the boundaries of the organ, the adjacent lung tissue so modifying the sound that the merging of the dull sound of the heart’s percussion into the full sound of the lung’s is a very gradual one. Horse. In the horse, under favorable circumstances, in the region of the 4th and 5th intercostal space a zone of dullness about the size of a hand can be brought out by percussion. Its boundaries, however, are generally indefinite. Ox. Although the chest walls are thinner in this animal, the heart is covered more by the lungs than in the horse. Dog. A narrow horizontal line of dullness between the 4th and 7th ribs can be determined by vigorous percussion. Chereuned oF cardiac dwliness) is. .1m- creased in hypertrophy of the heart and where fluids col- lect in the pericardium; tumors and thickenings of the lungs also induce it. rive zome of cardiaec dullness isso me- times decreased from pulmonary emphysema. A tympanitic tone on percussion over the cardiac region is obtained in traumatic pericarditis of the ox, gases of putrefaction accumulating in the pericardium. The percussion of the cardiac region causes the animal pain in pleuritis and pericarditis. - The Auscultation of the Heart. Method. The auscultation of the heart may be practiced by placing the right ear just behind the left elbow, the leg being drawn forward. Small animals may be laid upon the table and the phonendoscope used. Physiology. In the cardiac region and in the neighborhood of the same, we hear at each action of the heart two tones. One of these tones appears at the moment the organ contracts (sys- tole), and the second tone, which quickly follows the first, at the dilation of the organ (diastole). The second tone follows so closely the first one that it is difficult to differentiate between them, except in animals which carry a pulse below 60. In ani- mals which have rapid pulse it may be necessary to compare the pulse at a peripheral artery with the heart’s beat. -The origin of the heart-tones is still subject to dispute, the authorities not agreeing. 84 CLINICAL DIAGNOSTICS. [The first heart-sound (the systolic) is caused by the con- tracting muscles of the organ and the closing of the auriculo-ven- tricular valves. The second sound is produced by the closing of the semilunar valves]. = The first sound in our domestic animals is duller, deeper, more prolonged and usually louder than the second one, which is short, not so-deep, well defined (sharper), not so loud, and at times slightly metallic. There is a great variation in the sound produced by the heart in the different animals, and even in animals of the same species, the sounds being in one case sharper (more metallic) and in another deeper and duller. The thickness of the chest walls is also of influence, in ani- mals with well muscled chests the sounds are seemingly more muffled, duller. By pronouncing the syllables /ub-dub one can mimic the sounds of the heart. I I I I Se ee eh lub dub lub dub Change in Heart-Sounds Due to Disease. Both sounds are increased in: i 1. Hypertrophy of the heart, the valves remaining in- tact. (idiopathic hypertrophy). 2. Anemias. 3. A thickening of the lung tissue around the heart, producing a better conductor of sound. The second sound only is increased: When the arteries are greatly distended, not infrequently the result of a congestion of the pulmonary circulation com- bined with hypertrophy of the heart. Both sounds are weakened when the normal heart be- comes enfeebled through disease of its parenchyma, or where the hypertrophic organ is exhausted. Metallic tones occurring during systole are very com- mon in anemic animals. In traumatic pericarditis of the ox, the pericardium containing gas, a loud metallic tone is heard at each systole when the heart-muscle is still vigorous. TT OO a SS SPECIAL CLINICAL EXAMINATION. 85 Sometimes the sound can be plainly heard the distance of several paces from the affected animal. This is due to the accumulation of gas in the pericardium acting as a resonant mechanism which augments the sound. The first tone is dull in heart’s weakness and in myocar- ditis, especially noticeable in acute infectious diseases. A. splitting | ~-|— -~ or doubling I~ -|— ~~ of the heart sounds, the condition of the circulatory apparatus being otherwise normal, is of no significance. Commonly the first sound is preceded by a short tone -|—~|, which is pro- duced by the contracting of an unusually well developed auricle. Heatt briits. Tleart bruits arée..abnormal sounds and are therefore pathological. They are caused by the sound producing parts of the organ vibrating for too long a time. Endocardial bruits and pericardial bruits are distinguished. a. Endocardial: bruits (noises) come from within the heart and are closely connected with the heart sounds. We can distinguish, therefore, systolic bruits and diastolic bruits, depending upon whether they occur at the first or second sound. If the bruits are produced by anatomi- cal changes of the heart itself, they are called organic, other- wise imorganic. a. The organic or endocardial heart bruits are caused either by a narrowing (stenosis) of the auriculo-ventri- cular or arterial openings or by alterations on the valves pre- venting them from closing properly (insufficiency ). They form most valuable symptoms in the diagnosis of heart diseases. Instenosisthe bruitoccursatthemoment the blood passes ithe. contracted ‘orifice, the walls of which are set in vibration. If the stenosis involves the auriculo-ventricular opening the bruit occurs at diastole, if in the arterial openings, at systole. ‘ i 86 CLINICAL DIAGNOSTICS. In-in'sufficiency the bruit-oceuré at tee momentat whichthe valves shouldclose. In consequence of their inability to close a regurgitation of the blood takes place, which produces a renewed vibration of the valves, and gives a bruit. If the insufficiency involves the auriculo-ventricular valves, the bruit occurs at systole; if the semilunar valves are insufficient the bruit appears at diastole. The character of the bruits is varied, they can be bus- zing, blowing, purring, hissing, humming, sawing, rattling, long or short tones. Insufficiency bruits are generally softer than those due to stenosis. Heart bruits are made more pronounced by an acceleration of the heart’s action, therefore the patient should be exercised before examination. Gmelin recommends digitalinum verum subcutaneously to bring out more distinctly heart sounds or casual bruits. The dose for the horse and ox is 0.025—0.05; for the dog 0.002 0.009. The digitalin is first dissolved in 5cem of 50% alcohol and then diluted with 20ccm of water. ' Insufficiency | of an auric- | ulo- ventric- { ular valve. | Stenosis of an arterial opening. Systolic bruits|~..~|are characteristic of: -; Stenosis of an auricu- | ‘lo-ventricu- Diastolic bruits| —~| are characteristic of : | lar opening. l f Insufficiency of a_semi- lunar valve. SPECIAL CLINICAL EXAMINATION. 87 Although the bruits originate in different parts of the heart, the exact point of origin cannot be determined by auscultation. In the horse and dog valvular lesions have their seat. most commonly in the left heart, rarely are they primary in the right heart. In the ox valvular diseases of the right heart are more frequent than of the left one. The auriculo- Fig. 27. Points at which Endocardial Bruits are most pronounced. a. b.—Line of Shoulder. 1.—Left Auriculoventricular Opening. 2.—Portal. 3.—Pul- monary Artery. ventricular valves are more commonly diseased than the semi- lunar. b. Contrary to the endocardial, organic bruits, the inorganic or anemic bruits occur without that any discernible anatomical alteration appears at the orifices or valves of the heart. Inorganic bruits are systolic, soft, blowing and not constant (accidental). They tend to disappear and reappear 88 CLINICAL DIAGNOSTICS. again. Their origin is not well understood. They are nearly always noted in anemic animals. It is very important to distinguish between or- ganic andinorganic heart bruits, but in practice this is often very difficult. As a rule, soft, systolic bruits (they do not occur during diastole) should be very carefully estimated. Organic heart bruits are always accompanied by hypertrophy and often alteration of pulse, and frequently venous congestion. b. The pericardial bruits. .These bruits. do not come from within the heart itself, but are extra-cardial. They consist in frictional noises due to the pericardium having become so altered that its surface is no longer smooth and slippery, but rough and dry. The bruits are characterized by being scratching, grating or rubbing, frictional tones not in- timately related to either systole or diastole. Pericardial bruits, when present, muffle the regular heart sounds. A pericardial metallic gurgling or liquid bruit, synchron- ous. with the heart’s beat, occurs in the course of traumatic pericarditis when fluid exudate and gas commingle in the per- icardium. ; Diseases of the Circulatory Apparatus. Acute myocarditis. A diffuse parenchymatous affection of the heart’s muscle which attends severe infectious diseases. Symp- toms: great weakness and debility, mucous membranes cyanotic, high fever, heart’s beat weak, systolic sound muffled. Pulse very rapid up to 120 in the horse; small, weak, arhythmic, inequal, finally imperceptible. Course acute or peracute. Mortality high. Hypertrophy and dilatation of the heart. Can be present for years without visible symptoms occurring. Symptoms: Pulse strong, also heart impulse, zone of cardiac dullness enlarged on percussion. Later when the heart is greatly dilated and the valves can no longer close sufficiently, symptoms of bicuspid insufficiency occur; pulse rapid, arhythmic, inequal; heart’s beat sometimes palpitating, increased dullness on percussion. Systolic blowing bruit, diastolic sound intact or louder than normal. Exercise causes dyspnea from pulmonary venous congestion. Termina- ‘tion as in chronic valvular disease. Most common heart disease of horse and dog. : SPECIAL CLINICAL EXAMINATION. 89 Acute endocarditis. Not very common. Fever, greatly ac- celerated heart’s action, irregular pulse, intermittent, very small. Heart sounds are at first normal, later systolic bruit. Dyspnea. General condition altered. Prognosis unfavorable. Valvular disease, chronic endocarditis. Caused by a chronic valvular endocarditis which leads to an atrophy of the valves (insufficiency) or to a narrowing of the orifices (stenosis). Fol- lowing valvular failure a hypertrophy of the ventricle always takes place; in disease of the semilunar valves the left ventricle, in defects of the mitral valve a hypertrophy of the right ventricle. The hypertrophy of the ventricle, which is combined with dila- tation, is compensatory. Bicuspid (Mitral) insufficiency. Most common form of heart disease in dogs and horses. Pulse small, irregular. Sys- tolic bruit. Diastolic sound clear, loud. Dyspnea on exercise. Stenosis of the bicuspid (Mitral) valves. Rare when unattended with insufficiency; an uncommon lesion com- _ pared with insufficiency. Pulse small and very weak. Diastolic and pre-systolic bruits. Great dyspnea. Insufficiency of the tricuspid valves. Rarely primary in the horse, mostly secondary to diseases involving the left ventricle, leading to hypertrophy of the right heart. In the ease agied primary. Systolic bruits, venous congestion, venous pulse. Stenosis of the tricuspid valves. Happens only in the ox and is then combined with insufficiency. Diastolic bruits, great venous congestion, dyspnea. insutipereneysof the aortic .semiltunan valves. Full, strong, hopping pulse, pulsation in peripheral arteries. Diastolic bruit. Hypertrophy of the left heart. Stenosis of the aorta. Mostly combined with insuf- ficiency. Harsh systolic bruit. Long-drawn-out, slow, small pulse (28-32 in the horse). Hypertrophy, attacks of vertigo during exer- cise (work). Valvular diseases of the pulmonary artery are very rare. ; Termination or ‘all valvular diseases. In chronic heart diseases the dilatation of the ventricle is followed by a relative insufficiency of the valves. Semilunar defects lead to a relative insufficiency of bicuspids; bicuspid defects to a relative insufficiency of the tricuspids. The special diagnosis of the pri- mary lesion is then very difficult. As sequela, finally, the follow- ing symptoms appear: small, irregular pulse, systolic and diastolic bruits, congestion of veins, venous pulse, edemas, dyspnea, albuminuria, dropsy, attacks of vertigo, emaciation and great weakness. Pericarditis. Mostly a symptom of other diseases. Moderate fever, congestion of mucous membranes. | Pulse rapid, heart’s beat weak or imperceptible, zone of cardiac dullness increased, pericardial (frictional) bruits, which disappear when fluid exudate 90 CLINICAL DIAGNOSTICS. becomes prevalent. The pressure of the exudate upon the veins causes congestion in jugulars (venous pulse). Traumatic pericarditis of the ox. Begins usually with the symptoms of an acute indigestion (traumatic inflammation of the stomach and diaphragm), which may continue for some time. If the pointed foreign body is driven forward, which is commonly caused by the expulsive efforts of the abdominal muscles during the act of parturition, it usually reaches the heart. The general condition of the patient is greatly disturbed, the expression com- plaining, anxious. The animals stand with back arched and held stiffly, do not like to lie down, and when recumbent rest con- tinually on the sternum. When arising they utter complaints. Temperature variable, external (surface) temperature never quite normal. Pulse rapid; artery tense. Heart beat cannot be felt, zone of cardiac dullness increased and tympanitic when gas has accumulated in the pericardium. On auscultation in the earlier stages pericardial frictional bruits, heart sounds clear, when much exudate is present weak; systolic bruits of a metallic character in consequence of spasm-like contractions of the heart. When putrefactive gases are present the heart sounds can be so loud and metallic as to be heard at a distance. Jugulars distended,. pulsating (undulating), edema of brisket, neck and throat. Course chronic notwithstanding severity of the ailment. Prognosis bad. 7. Respiratory Apparatus. Thevexantination of (theses pire tare tract “is.one' of the most importa treo Sp or'stbilrries: of the veterimatian)) ree because it is frequently subject to disease, and secondly from — its availability to thorough inspection. From the complex anatomy of the apparatus, and the value to diagnostics of the varied clinical phenomena it mani- fests in disease, a searching examination of the respiratory tract can only be made by following a definite system. The examination would include attention to the following: I. Dhée-respiratory movements ares pata; t 10 wis). U.P ihee treat ho. Tis PT hernmesalodise ma ree. ly. The nasal cavities“andi.adpacent sinuses, : V. The st bimaxsiliary lymph, elands. RESPIRATORY APPARATUS, 91 Vinny cbabe “epi by Vib Phe -y oice. VILL The laryngéal region. PAT he ah au GP he peheussion Gf the thorax, AL Th auscaltation ofthe thorax: 1. The Respiratory Movements. [Respirations]. The respirations should be examined in regard to fre- quency, manner in which produced, and any special sounds originating during the act of breathing. These three factors help to determine whether dyspnea be present or not. Frequency of respirations. To determine the number of res- piratory movements per minute each rise or fall of the flanks or ribs is counted. Observing the play of the nostrils is not as certain a method, as these organs can be voluntarily moved by the animal. In winter the breath can be seen appearing as steam at each expiration. The respirations should be counted for at least thirty seconds; in restless animals the veterinarian should stand quietly near, count sev ea) times and take the average ob- tained as the respiratory frequency. The smaller the animal the greater the number of respira- tions. In one and the same animal the number of respirations per minute will vary within physiological limits. Just after partaking of food, or when the abdomen is very full, and especially after exercise, an acceleration of respira- tions is a normal consequence. High atmospheric tempera- tures, restlessness and anxiety, also make the breathing more hurried. In adult animals standing at perfect rest the follow- ing number of respiratory movements per minute may be taken as the average normal: EEE IS (pa ket Oa ei Pe Ce ge ee 8-16 POE tet ME oa gS 2 aie Gh sunt Sa 4a aly ae ie oie s 10-30 Sees VaR Sty a. ai i Uinie's s'est phate sta s 4 eds 12-20 er URN Care! OSs hg sw dy k's ON ee & ced = 10-20 BRP ee peeicti ths A Pies ha 6 Ce WE tenis swe 10-30 ES MES Cent eee oe ae aa Pe 20-30 92 CLINICAL DIAGNOSTICS. A pathological increase in the number of respiratory movements is §poken of as dyspnea (see this). A decrease in the number of respiratory movements is rarely observed. It is seen in severe brain affections (hemorrhage, hydrocephalus, tumors, poisonings, action of septic substances during the course of pulmonary gangrene), also where the anterior air passages are occluded (stenosis), which is combined with a pronounced inspiratory tone. Physiology of respiration. When an animal is at perfect rest, the respirations are produced by the action of the diaphragm. The contraction of the diaphragm produces a dila- tation of the thorax. When the organ contracts it flattens and is drawn backwardly, the false ribs becoming elevated. Notwith- standing: that, (the) diaphsaem — 1s. stretch ea transversely between the thoracic and ab- domunal teavaitive Salts, contraction 4 1d Obes as tout eause (pts! peints ety wneertion to: appragce each other, for the reason that the intestines keep it con- tinually forward, which produces a drawing anteriorly of the ribs rather than to cause them to approach the median line. On account(* of.) the “double “artitalationa’ oT, tite ribs with the dersal weéertebrie >the forward movement of them is accompanied’ by a rota- tion. The diaphragm dilates the thorax in that it draws the ribs forward and rotates them outward at the same time. The expiration follows the relaxation of the diaphragm, which takes place immediately after the inspiration. The dura- tion of expiration is longer than that of inspiration; between them in quietly breathing animals there is a short pause. The normal rhythm of the respirations can be pathologic- ally altered in that: 1. The inspiratory movement lasts too long, the free entrance of air being prevented by stenosis of the respiratory passages. 2. The expiratory act lasts too long, the relax- ation of the diaphragm not sufficing to a complete expiratory movement. As the respirations are in a measure controllable by the will, which depends upon the cerebrum, excitement or inflam- matory conditions occasioning either brain irritation or depres- sion, at times can bring about marked change in the rhythm EE eS eee ee ee ee RESPIRATORY APPARATUS. 93 of respiration. The value of these changes to diagnostics is limited. The intensity (depth) of the respirations is not marked in healthy animals standing at rest. The alae of the nostrils are hardly moved, and the ribs but slightly raised. The intensity is snereased by exercise; if it is augmented and the animal at rest, it denotes disease. Horses dilate the nostrils trumpet-like, dogs open the mouth (pant) and pro- trude the tongue. The movements of the ribs and flanks are pronounced. The development of the intensity agrees with the degree of dyspnea. The intensity is dimin ished when the pleura, chest wall or diaphragm is diseased. The intensity can become asymmetrical in that one side of the thorax undergoes a deeper or more rapid movement than the other side. This is seen in painful unilateral pneumonias or pleurites. When the rhythm and intensity of breathing is normal and the ribs and abdomen are moved with even regularity, the type of the respirations is spoken of as costo-abdomunal. If the respiratory movements are produced principally by the auxiliary muscles of breathing, which dilate the thorax, the type becomes costal. ‘The costal type is seen to occur where air can not pass freely into the thorax or where the diaphragm or adjacent organs are diseased. (abdominal tumors, ascites, tympanitis ). When the abdominal muscles are more active in produc- ing the respiratory movement than the thoracic muscles the type of breathing becomes abdominal. The abdominal type prevails when painful conditions of the chest wall are present and where expiration is difficult, as in pulmonary emphysema (heaves). There is sometimes observed in animals a condition which corresponds to hiccoughs (singultus) in man. It is charac- terized by a rhythmic, spasmotic contraction of the diaphragm 94 CLINICAL DIAGNOSTICS. (abdominal pulsation) with which a jerky movement of the thorax in the hypochondriac region occurs. Occasionally it is accompanied by a dull sound. Its rhythm is synchronous with neither the heart’s beat nor the respirations. The latter, however, are temporarily arrested by the spasms. Singultus is usually temporary and probably due to a diaphragmatic neurosis. Respiratory Sounds. The respirations of healthy animals are performed noise- lessly. Only occasionally do they voluntarily emit audible sounds during the act of breathing. Physiological Sounds. When excited suddenly by perceiving peculiar looking objects, strange persons, unaccus- tomed odors, etc., horses and cattle snort by violently and noisily forcing air through the dilated nostrils. Horses of lively temperament usually snort when led at the end of the halter. Horses blow their noses by causing a forced expira- tion which is accompanied by a vacillating noise. As in man, dust or mucus is thus removed from the nasal organs. Fat, rough coated dogs pant when the weather is warm even when they are at rest. While performing hard work or during forced exercise the breathing is rapid and deep; the air pass- ing in and out of the dilated nostrils at each in- and expiration produces a perceptible puffing sound. Spirited horses while being ridden at a gallop, emit a blowing expiratory sound évery time the forefeet come in contact with the ground. A yawn is a long-drawn-out, deep inspiration taken with the mouth held wide open. The inspiratory muscles assist in producing it. | Pathological Sounds. “When the respiratory apparatus is diseased the following pathological sounds may occur : 1. The wheezing or blowing sound which is stenotic in its character, emanates from the nasal cavities. It is more = ee ee ee ee eee ee RESPIRATORY APPARATUS. 95 pronounced at inspiration, and results from a narrowing of the nasal chambers due to the presence of tumors, swelling of the alae of the nostrils, septum or chonchae, enlargements of the turbinated bones or fractures of these bones, fractures. of the nasal bones, or deposits of exudate on the mucous membrane. Depending upon the condition of the mucous membrane. the stenotic sound may be accompanied by either moist or dry rattling noises. 2. Snoring takes place when the act of breathing is ef- fected through the open mouth, the soft palate undergoing a fluttering motion. In swine and dogs it occurs when the lumen or the nasal cavities is contracted by swelling or thick- ening of the mucous membrane. Snoring is also noted in the ox when the retro-pharyngeal lymph glands are swollen or enlarged; further in the course of parturient paresis. Horses under chloroform sometimes snore. 3. Rattling is a stenotic laryngeal sound which occurs when the vocal cords are relaxed. It is heard in severe in- flammations of the larynx or of the neighboring pharyngeal mucous membrane; phlegmon of the pharynx and edema of the glottis. 4. “The Mucous Click” (klatschender Nasalton) is a peculiar metallic, short expiratory sound first described by Dieckerhoff. It occurs during an inspiratory-expiratory dys- pnea if the nasal mucous membrane is very moist. At a forced inspiration that part of the nasal mucous membrane which unites with the skin of the false nostril, is sucked against the opposite wall to which it adheres for a moment; when an expiration takes place this adhesion is broken, caus- ing a metallic “slapping” tone to be emitted. This sound is of no significance. 5. The most important pathological re- spiratory tone is the stenotic laryngeal tone. Normally the sound emitted by the larynx is a soft stenotic sound audi- ble when the ear is placed over the organ. [It can be imitated 96 CLINICAL DIAGNOSTICS. by pronouncing the German ‘“‘ch’’]. If the lumen of the lar- ynx is narrowed, the noise becomes loud. It is most fre- quently heard in the horse, and is one of the characteristic symptoms of roaring. Ordinarily the tone is emitted when the respirations are accelerated during exercise, but in cases where the lumen of the larynx is much diminished, it may appear when the patient is at rest. The character of the tone will vary from whistling to a pronounced hoarse or roaring sound. Besides it may be due to a firm swelling of the lame mucous membrane (phlegmonous laryngitis, strangles), tu- mors in the larynx or its neighborhood which prevent the free entrance of air. 6. Loud rattling noises [garglings] are heard when the larynx or the trachea contains loose masses of mucus. 7. Sneezing is an explosive expiration through the nose, which originates reflexly from irritations to the nasal mucous membrane. It is heard in rhinitis (nasal catarrh) or when foreign bodies enter the nasal cavities. Sneezing only occurs in the dog, cat, and fowl. 8. Groaning (moaning, grunting) is heard when a long inspiration is followed by a prolonged, ‘audible expiration through a partially closed glottis. The sound is emitted only at expiration. Groaning is not necessarily a sign of disease, for it often occurs in healthy animals, especially cattle after a full feed or when pregnant. Groaning is produced by the pressure of the distended abdominal organs upon the dia- phragm, shortening the expiratory moment, which the animals. seek to retard by partially closing the glottis. d. Labored Breathing, Dyspnea. The collective term dyspnea is applied to essential deviations from the normal in the frequency 4nd kindjofrespiratory move- “fe a RESPIRATORY APPARATUS. 97 Metres, anatile Occurrence of accompany- ing pathological sounds. Physiologically a dyspnea occurs whenever the blood flowing through the respiratory center contains an abnormal amount of CO,. Accordingly, anything which increases the quantity of CO, in the tissues, or interferes with the exchange of gases in the lungs, can cause a dyspnea. Clinically the presence of dyspnoea is recognized: I. If the respirations are accelerated (altered in number ), and the increased frequency is not attended with change in the method of breathing the dyspnea is simple. In the horse, for instance, the number of respirations can exceed 120 per minute and be superficial, only the nostrils becoming dilated. If, however, the respirations arevery difficult,itceasestobesimpledysp- nea, for the method of breathing becomes more intensive and labored, and the dyspnea muzred. Simple dyspnea appears: 1. In fever; the degree of respiratory frequency de- pends upon the severity and nature of the disease. 2. In all conditions which make the respiratory act painful: diseases of the pleura, diaphragm, thoracic wall, peritoneum. 3. Where the breathing surface of the lung is decreased or where the organ is prevented from properly expanding: pneumonia, pulmonary tuberculosis, abdominal tympanitis, ascites. 4. In diseases of the heart which have a congestion of the blood in the lungs as a consequence. II. If the respirations are labored (alteredinqual- ity ) , though the frequency may be normal, aggravated dysp- mea. The occurrence of respiratory noises always indicates a difficulty in breathing. Depending upon whether the expiration or inspiration is dif- ficult, an expiratory or inspiratory dyspnea is distinguished. 98 CLINICAL DIAGNOSTICS. The inspiratory dyspnea. If the entrance of air into the respiratory organs is made difficult, the animal seeks to overcome the condition by taking forced inspirations. Notonlyisthediaphragmactively employed, butothermuscleswhicharenormallynotused during inspiration are called into play. These muscles are: the serratus magnus, serratus anticus, external intercostals, levatores, costarum, scalenus. The following clinical. symptoms character - Lee dys pie a. The nostrils are widely distended; dogs, fowls, cattle and swine breathe with their mouths open. Dogs sometimes close the jaws and breathe through the lateral commissures of the mouth, sucking in the cheek at each inspiration. The head and neck are extended horizontally, the larynx is retraced, the ribs greatly elevated and rolled forward. The forelimbs are spread far apart and the elbows turned out so that the serrati and pectoral muscles can better come into play. If, in aggravated inspiratory dyspnea, the air enters the lung very slowly, notwithstanding that the ribs are greatly elevated, and the thorax is distended to a’ degree which does. not correspond to the quantity of air passing in, a suction pressure will occur, which can be recognized by a sinking of the lower anterior thoracic wall—particularly of its inter- costal spaces. [nepiratory (ey spies 1s ome eta olde 1. Ina pure form in bilateral paralysis (paraplegia) of the larynx and in severe cases of unilateral paralysis of the organ (hemiplegia, roaring). It is characterized by the above cited inspiratory dyspnea and the appearance of a stenotic laryngeal bruit. In less severe cases of roaring this symp- tom can only be brought out by exercising the patient. The act of expiration is performed without difficulty. 2. In less pure form where a stenosis of the nasal pas- Aw 1a RESPIRATORY APPARATUS. 99 sages, pharynx, larynx or trachea exists due to inflammatory swellings, tumors, etc. In such cases a stenotic sound is emitted at each inspiration and the expiration is more or less difficult. 3. In diseases of the bronchi and lungs preventing the free entrance of air: bronchitis, pulmonary edema, pneu- monia. 4. Where the principal respiratory muscle, the dia- phragm, is inactive: rupture or inflammation, tympanitis. Expiratory dyspnea. This occurs when the exit of the air from the lung is made difficult. In this case the expiration ensues not alone passively, but theaccessory Papicatony. miscles actively assists». The muscles aiding expiration are: the abdominal muscles (exter- nal and internal oblique, straight abdominal muscle), the in- ternal intercostals and triangularis.s An-expiratory dyspieay 15... ecopnized uty the following symptoms: The expiration is prolonged and is attended with pronounced movement of the abdominal wall (pumping of the flanks). At first, a limited sinking of the thoracic walls ensues from a relaxation of the diaphragm, then the abdominal muscles become active (contract) and a furrow is formed along the course of their insertion to the costal cartilages— the so-called “heave line.’ The passive and active moments of expiration can be plainly distinguished from each other, so that the movement of the flank appears to be a double pump- ing. The back is elevated at expiration and sinks during inspiration. At the moment of expiration the anus is greatly protruded. When the abdomen is well filled, these symp- toms appear more prominently. Expiratory dyspnea occurs: 1. In vesicular and interstitial emphysema. 2. In chronic bronchitis and_peri-bronchitis. 3. Where the lung has adhered to the costal wall. A mixed dyspnea is present when accelerated 100 CLINICAL DIAGNOSTICS. respiratory frequency is combined with difficult inspiration and expiration (inspiratory and expiratory dyspnea). It is the most common form of dyspnea and attends all severe diseases of the respiratory tract (pneumothorax, hydrothorax) and also those diseases which have no primary seat but whose course is accompanied by a severe intoxication of the blood with CO,—as in many of the infectious diseases. In pronounced mixed dyspnea there is a marked flap- ping of the nostrils. At the beginning of inspiration both wings (medial and lateral) are greatly distended. At the end of the inspiratory movement they again collapse. How- ever, the forced out-flow of air at expiration, which imme- diately follows, forces the medial wing, which is in its path, outward and upward causing a second movement of this wing to occur. 3 According to the seat of the respiratory obstruction one speaks of a nasal, laryngeal, tracheal and pulmonary dysp- nea. II. The Breath. An examination of the air breathed out by the lungs is of diagnostic importance in many morbid conditions. Nor- mally the air is emitted from the nostrils in two odorless cur- rents of equal size. The two deviations from the normal are: 1. The air currents from both nostrils are not of equal size. Where one of the currents is smaller ‘(of less volume) than the other, it points to a narrowing of the nasal passage of that side. Not infrequently a blowing sound accompanies the inspiration. The passages may be con- stricted by thickenings or swellings of the mucous membrane or by tumors. 2. The breath has a bad odor. A bad odor from the nostrils is always a sign that putrid decomposition is taking place in the air passages. It may emanate from various parts of the respiratory tract. The odor is either putrid (fetid) or carious. It is observed: ’ RESPIRATORY APPARATUS. 101 1. Where stagnant masses of putrefying exudate are in the turbinated bones, sinuses, gutteral pouches, or even on the mucous membrane of the upper air passages and bronchi. 2. In putrid decomposition of tumors in the air passages. 3. In suppuration or necrosis of the bones of the head bordering on the air passages: Suppuration in the tooth alveoli, dental caries, necrosis of the turbinated bones. 4. In gangrene of the lungs. It is always important to determine where the odor originates. At first we should be clear as to whether it really comes from the nose or from the mouth. When the mouth is closed, this is usually not difficult; in doubtful cases the odor of the saliva can be tested. The safest way is to make an examination of the buccal cavity, especially of the teeth. When the alveoli of the upper molars are diseased, a carious smell is emitted from both the mouth and nose. (See Examination of the Mouth). If the offensive odor has been found to come from the expired air, it is then necessary to locate the part of the respiratory aoaratiis at which the decomposition is taking place. For this purpose we should first determine whether or not the odor is equally offensive from both nostrils. When the odor from one nostril is more prevalent than from the other, the process of decomposition has its seat in the nasal cavity of that side, and usually it is accompanied by a unilat- eral nasal discharge, bulging of the facial bones and swelling of the submaxillary lymph glands. The examination of the upper molar teeth of that side should never be neglected. When the odor is equally offensive from either nostril, the putrid focus is as a rule contained in the lung, more rarely in the pharynx, larynx or trachea. Putrid decomposition in the lung is not always to be ascribed to pulmonary gan- grene, for not infrequently a decomposi- 102 CLINICAL DIAGNOSTICS. tion ofexudateinthe bronchi, (fetid bronchitis) 1S) pres eat. The presence of elastic fibres in the nasal discharge speaks for pulmonary gangrene. III. Nasal Discharge. Only in the ox a slight nasal discharge is seen to occur in health, which the animal usually removes from the nostrils with its tongue. In the other animals the appearance of a nasal discharge is always a sign of disease, and one of con- siderable diagnostic importance. It can accompany all dis- eases of the respiratory tract which are exudative in char- acter, such as catarrhs of the nasal cavities, sinuses of the head, throat, larynx, trachea, bronchi and lungs. In these cases the discharge is the product of the disease. Some- times the discharge comes from the digestive tract, from the mouth or pharynx, more rarely from the gullet or stomach, when it contains substances such as food particles, water or saliva. The character of the nasal discharge depends upon the organ from which it comes and the nature of the disease pro- ducing it. We should bear in mind that the ox, sheep, goat and dog usually lick off the discharge, hence it is not so noticeable in these animals as in the horse. ; To correctly judge nasal discharge the following should be considered: . a. The quantity, which will vary greatly. The dis- charge is slight in catarrhs that are neither very diffuse nor severe. In tuberculosis, notwithstanding the severity of the case, there is little discharge because what little exudate appears upon the surface of the mucous membranes is re- moved by coughing and eventually swallowed. The discharge is copious in strangles and in diffuse catarrhs of the upper air passages and bronchi. ; Unilateral nasal discharge is characteristic of disease of one side of the anterior air passages as far back as the fauces. RESPIRATORY APPARATUS. 103 A catarrh involving but one side of the soft palate or pharynx may also show a discharge from only one nostril. Of especial importance is the variation in quantity of the discharge. In some cases a copious amount of discharge is ejected when the head is suddenly lowered [unreining after a drive], while for a day or more there is present either no dis- charge at all or only a very slight one. This symptom is characteristic of catarrhs of the frontal and superiormaxi- lary sinuses and of the guttural pouches. b. The color. The color of the nasal discharge de- pends upon the character of the inflammation, and also the presence of foreign mixtures. It will vary from colorless to grey, white, yellow, red, brown or green in all their different tints. During the course of a disease the color of the nasal discharge will change with the character of the inflamma- tion. A serous or mucous discharge is usually colorless; a purulent discharge is grey or yellow or may be of a greenish hue. A green discharge is usually due to an admixture of the ' chlorophyll of the food, deglutition being difficult. Food particles are always present in such cases. In rare instances a greenish tinge is seen, due to decomposed blood coloring matter being present in the discharge. A yellow, rust-colored [“prune juice’| discharge is seen in hemorrhagic hepatization of the lungs (contagious pleuro- pneumonia of the horse). It is due to an admixture of blood coloring matter.. In rare instances a rusty brown nasal discharge is pres- ent in severe catarrhal affections of the anterior respiratory passages (strangles, pharyngitis). A bloody discharge (epistaxis) is observed only when blood in toto is present. It may be due to: 1. Finger-nail injuries to the mucous membrane of the nose or fractures of nasal bones. In the dog the presence of pentastomum tenioides may lead to bloody nasal discharge, and in sheep the larve of cestrus ovis. 104 CLINICAL DIAGNOSTICS. 2. Ulcers; glanders; bleeding tumors in the nasal cavi- ties. 3. Nasal hemorrhages may attend anthrax in the ox, purpura hemorrhagica, or very severe cases of contagious pleuropneumonia of the horse. The discharge may consist entirely of blood, or simply of an admixture of blood. If the hemorrhage is from a nasal cavity, it is unilateral, the blood appears fresh and in- completely mixes with any other discharge present. If from the lungs, it is more or less foamy and in the trachea one may hear moist rales. ; c. The consistency of the nasal discharge depends upon what it contains. It may be serous, mucous or mucil- aginous, with varied intermediations. It may also be floccu- lent, clumpy, or contain great masses of adhering exudate. In the beginning of a catarrh the discharge is serous (clear), but by admixtures of mucus it becomes mucous and loses its transparency from the quantity of epithelial cells it contains. Its color is then grey. When an admixture of pus is present the discharge assumes more of a cream-like consistency and its color changes to greyish-yellow or yellow. A discharge of pure pus only occurs when an abscess ruptures into the nasal cavity. A clumpy, buttermilk-like discharge is observed in chronic catarrh of the sinuses of the head because the exudate has been retained for a time. Adhering masses ofexudate are seen in diph- theritic, croupous, or fibrinous inflammations. d. The odor. The odor of the nasal discharge be- comes. foul, putrid or carious from decomposing processes. In such cases the breath is also tainted. For the determin- ation of the seat of the disorder, what has been said concern- ing the odor of the expired air applies. e. Foreign admixtures. Most commonly we observe air bubbles of large or small size which cause the discharge to appear as foam. | z RESPIRATORY APPARATUS. 105 Fine foam. When the discharge comes from the smaller bronchi in pulmonary edema and bronchitis, the foam is composed of small air bubbles of equal size. When there is much foam the discharge is white in color. Horses suffering from chronic bronchial catarrh after exercise show a white nasal discharge partially made up of fine foam. ™, ~s Fig. 28. Egg of Pentastomum Tenioides. Coarse foam. This is not infrequently unilateral and contains an admixture of food particles. . It comes from the mouth and consists in part of saliva. The air bubbles are of unequal size. Coarse foam is symptomatic of paralysis of the pharynx, pharyngitis (fungus poisoning). When food particles alone make up the nasal dis- charge, it is a sign that vomiting has taken place. The dis- charge is then not foamy, is of acid reaction and contains no admixtures of exudate. E A microscopical examination of the nasal discharge is rarely of practical value. It may sometimes be of use to determine the presence of the embryo or egg of Strongylus filaria in the lungs of sheep or of Pentastomum taenioides in the nasal passages of the dog, or in fetid nasal discharge, the elastic fibres. The examination for pathogenic micro- organisms yields positive results only in exceptional cases. The tubercle bacilli are one of these exceptions as their char- acteristic way of accepting stains serves to identify them microscopically. Microscopical determination of tubercle bacilli. A cover-glass preparation is covered with Ziehl’s carbolized-fuchsin solution 106 CLINICAL DIAGNOSTICS. (fuchsin 1, absolute alcohol 10, carbolic acid 5, aq. dist. 95), and heated repeatedly for about two minutes over a flame. Wash and drain. Gabbet’s sdlution (methylen blue 2, in 100 grammes of a 25% sulphuric acid) is then applied and allowed to remain % minute. Wash and examine. Fig. 29. Sik oie Pees a! tant "| z x x ~ . 4 4 y pees Ge ¢ ) #7 \ ‘ 4 } 4 1 oo eid Foe Sf, ~ " ts fy / j / yr ! i I B) ce Ry >< ee ‘ % ‘ a ek 7 { vs ~- Za ' ‘ ; f ' ) \ . J val a Tubercle bacilli. Besides the tubercle bacillus, other bacilli (acid-fast), which stain by this method, are found in the feces of cattle and in butter. IV. The Nasal Cavities and Adjacent Sinuses. The external appearance of the facial bones will readily betray any deformity. Cuircumscribed enlargements are due to tumors and a bulging of the sinuses in chronic catarrhs. Diffuse enlargements attend rachitis and osteoporosis, “big head.” Depressions have a traumatic origin. Swellings appearing at the nasal openings and nostrils are common in purpura hemorrhagica. Tumors (atheromas) are frequent in the false nostril. The specific pathological conditions which occur about the lips and nose are the pustules and ulcers which attend contagious stomatitis, the pox pustules of sheep pox, and the vesicles on the muzzle of the ox and snout of swine suffering from foot and mouth disease. When a nasal discharge has existed for a long time, the integument of the nose and lips over which it flows loses its RESPIRATORY APPARATUS. 107 ‘pigment. The white streaks thus formed speak for the chronicity of the discharge. The examination of the nasal mucous membrane. The nasal mucous membrane is available to inspection only in the horse. Local lesions occurring on it are often of great diagnostic importance. Method of examination. The head of the animal should be elevated and the inner cartilaginous wing of the nostril grasped between the thumb and middle finger which draws it upward and outward; the extended index finger is then ‘inserted under the outer wing, which it distends. The patient should face the light, except when the rhinoscope (an enlarged ophthalmoscope) is used. Fig. 30. Examination of the Mucous Membrane. a. Discolorations. Jndistinct, punctiform, or ramiform redness is not infrequently seen in acute and chronic catarrhs; they are due to the peculiar anastomosing of the capillaries and are of no diagnostic value. Deep redness is mostly the result of hemorrhages in the mucous membrane. They appear mostly punctiform and can be as large as a ten-cent piece, they are well circumscribed and of round form (petechiac, ecchymoses). When they ~ 108 CLINICAL DIAGNOSTICS. become confluent, the redness is diffuse or appears in irregular streaks. Petechiae are most commonly seen in purpura hemorrhagica, but may also occur in severe anemia (rare) and in leucemia. The spots, which are at first dark red, soon fade and assume a brownish hue. Such suffusions are also observed in septicemic diseases: anthrax, ‘septicemia. b. Swelling of the-nasal mucous mem- brane is characterized by the normal surface of the mucous membrane, which is granular from the many glands it con- tains, becoming firm and smooth. . As the membrane is usually tense, the swelling is not marked. Its origin is in- flammation, therefore the surface appears turbid. Chronic; connective tissue thickenings are most commonly made manifest by irregular, wart-like prominences which show the characteristics of scars. c. Woundsinthemucousmembraneare usu- ally at the lowest part of the septum, and are very often caused by finger-nails, sharp straws and. the like. d. Nodules from the size of a millet seed to that of a peppercorn almost exclusively attend glan- ders. Exceptionally they result from contagious stomatitis, but in such cases like nodules are to be found in the mucous membrane of the mouth. To prevent mistaking particles of mucus for true nodules, the supposed nodule should be pal- pated with the finger; if mucus particles, we can thus wipe them off. ig e. Ulcers. Nexttonodules, ulcers*form the most: important’ criterium (n. di4a s- nosing glanders. Glanders ulcers have jagged bor- ders circumscribed by rounded, elevated walls. The base of the ulcer is sunken, uneven, grey in color, and of lardaceous appearance. The favorite seat of the glanders ulcer is on the medial border of the inner cartilaginous wing of the nostril, hence ‘this place should always be examined. In rare cases ulceration of the nasal mucous membrane RESPIRATORY APPARATUS. 109 also attends stomatitis and purpura hemorrhagica. For dif- ferentiation the concomitant symptoms must be considered, such as ulcers on the buccal mucous membrane, petechiae, etc. Very superficial pittings with sharp borders —not rounded nor red colored — represent the catarrhal or erosion ulcer. f, Cicatrices at the lower end-of the nasal septum are mostly the result of previous wounds. They are often curved (( as if made with a finger-nail. Glanders cicatrices are as a rule more or less star-shaped. The examination of the sinuses of the head is often of importance and should be made whenever a chronic nasal discharge exists, especially when attended with an unilateral bulging (enlargement) of the facial bones. Mere enlarge- ments can be defined by palpation. The presence of exu- dates in the sinuses can sometimes be determined by percus- sion.’ The normal percussion sound of the sinuses is full, but when they are filled with exudate or tumor masses, it becomes fat When the sinuses are only Pouce aa.) ly filled the percussion sound is not changed. Negative results from percussion, therefore, do not exclude the presence of exudate. [A simple method of exploring the sinuses of the head, to determine whether exudate (pus) is present in them or not, is to bore a small hole into them with a “Yankee” drill. If the sinuses contain pus or other exudate, the bit becomes soiled by it and if the contents are fetid, will smell. ] V. The Submaxillary Lymph Glands. Although these glands do not properly belong to the respiratory apparatus, the examination of them is significant in the horse. In this animal especially, the glands become sympathetically diseased when pathological conditions exist within the domain of their lymph vessels. 110 CLINICAL DIAGNOSTICS. Anatomy. The lymph vessels from the nostrils to the ethmoid bone carry their lymph to the submaxillary glands, a small glan- dular packet as broad as and a little longer than a finger, lying on each side of the intermaxillary space. They begin at the point where the inferior maxillary artery passes under the ramus of the lower jaw, and extend forward to the angle of the chin where each unites with its fellow of the opposite side. Each lobule is of about the size of a small bean. In horses of coarse conforma- tion the intermaxillary space is often filled without the glands being swollen. As SOO08 a8 an absoOPp tion ef itritantT- of intectious- substances | baevertey —- aaa place-in;}the-region drained by the lympa vessels of the submaxillary glands, these organs become secondarily giseasedss eae primary disease usually has its seat in the mucous membrane of the nasal passages or sinuses. An examination of the glands, therefore, is of great significance in determining the pathological condition of these mucous membranes. In making the examination the following points are to be considered : a. Is one or both glandsenlarged? In acute infectious catarrhs the glandular swelling is generally bilat- eral; in glanders frequently unilateral, and in tumors in the nasal passages, bad teeth and chronic catarrh of the sinuses, it is, as a rule, unilateral. b. Size and form of the glandular swell- ing. Many or a few of the lobules may be enlarged to the size of a bean, pigeon or hen’s egg, depending upon the pri- mary disease in the mucous membranes. Acute swellings are smooth; chronic swellings lobulated (nodular), which is espe- cially marked in glanders. Well marked, clearly defined, smooth enlargements of individual lobules are observed in leucemia (a hyperplasia), and when malignant tumors are developing in the glands. c.- Consistency of the swollen glands. The swelling is soft in serous, tense and firm in cellular infiltration of the glands. Acute diffuse swellings (stran- ee a _——— _— ee RESPIRATORY APPARATUS. 111 Stes) o1nen lead to. supparation..(.ab- scess), which can be determined by fluctuation. In glanders diffuse abscess formation never occurs in the glands; only rarely does a small purulent focus (farcy bud) appear in the skin over the gland. Firm, hard enlargements are always due to some chronic irritation and consist of con- nective tissue proliferations. Such attend chronic glanders, catarrhs and dental fistulae. d. Temperature and sensitiveness. When the glands are hot and tender (inflamed), the morbid con- dition is acute (strangles). If the enlargement of the gland is firm, cold and painless, it points to glanders, chronic catarrh, tumors or hyperplasias [leucemia]. Movability of the glands. If the irritation. is chronic and attended with the formation of new connective tissue, the process involves the environing tissue, forming ad- hesions with its neighborhood. In acute purulent inflammation of the glands there develops in the vicinity, namely, directly beneath the skin, an inflammatory edematous and later a phlegmonous swelling. The extirpation of a diseased lymph gland is recommended where glanders is suspected. Its object is the patho-anatomical or bacteriological examination of the gland. The operation can be performed on-the standing animal when local anesthesia is employed, and is not dangerous. VI. Cough. Cone. 16 a suddenly. occurring ¢€xpi- ratory impulse which follows a deep in- spiration. The glottis is forcibly opened Hering the-aet; causing a sound to. be -emitted. By coughing accumulations of mucus are re- moved from the bronchi, trachea or larynx. In animals cough is a reflex action which can to a certain extent be suppressed. Although it can be induced by irritation to many peripheral nerves, as a rule it emanates from branches of the vagus nerve 112 CLINICAL DIAGNOSTICS. in the respiratory apparatus. Most sensitive in this particular is the superior laryngeal nerve, which is the sensory nerve of the larynx, and the first three rings of the trachea. The mucous membrane of the trachea is less sensitive, except at the bifur- cation of the bronchi. The bronchi are just>as easily irritated as the larynx; but coughcannot beexcited from the parenchyma of the lungs. It can, however, arise from the pleura when this organ is in a state of irritation. Peripheral irritation is transmitted to the cough-center in the brain, which innervates the expiratory muscles and recurrent nerve, inducing the reflex spasm called cough. In exceptional cases cough can emanate from ter- minals of the vagus nerve lying outside of the respiratory appara- tus, as, for instance, from the external auditory meatus [ear], nose, or abdominal organs. According to Albrecht cough can occur from abscess.in the liver. These are, however, exceptional cases. Cough from the stomach has never been ob- served in the horse. There is a possibility that cough may .have its origin in the brain. These exceptions are worthy of note and should be considered in those cases of cough the cause of which cannot be found to lie in the respiratory apparatus. Cough oecurs’: 1. If foreign bodies are inhaled: smoke, dust (dusty food), acrid gases (ammonia, sulphurous acid, chlorine, etc.). 2. If cold air is inhaled, especially if the respiratory tract is inflamed: catarrhs of the trachea and bronchi, pleuritis, traumatic injuries to the pleura (traumatic gastro-diaphragm- itis of the ox). 3. If mucus, exudate or foreign bodies (food) and para- sites are present in the air passages: Gastrus larvae in the larynx, Syngamus trachealis in the wind pipe, Strongyli in the bronchi. In no case can cough originate when thesensory ter- minals of “the vagus netvesatre 10 toner susceptible to irritation. In severe phlegmonous diseases of the mucous membrane, cough is absent. The cough center in the brain must also be in normal condition. It is disturbed when great mental depression J ‘ i ee ee a ae ee RESPIRATORY APPARATUS. 113 exists. Therefore, when appreciable irritations (rales) are present, unaccompanied by cough, the prognosis is an unfavor- able one. The character of the cough. The character of the cough varies with the species of animal. Healthy horses have a strong, vigorous, loud, full-toned cough; cattle a sharper defined, softer, toneless, prolonged cough, the glottis being held open. The appearance of cough in animals is always ab- normal; its character depends upon the disease which causes it. Whether cough accompanies the disease or not can usually be learned from the anamnesis, although we can not depend upon this to determine its character. It is always best that we induce the patient to cough in our presence; this may be done by pincking the upper three rings of the trachea or pressing the finger ends of both hands against the arytenoid cartilages of the larynx. In sensitive healthy horses.one or a few short coughs will follow the manipulation, while in indolent indi- viduals there is no reaction. In the ox coughing can be in- duced in this way only when the animal is diseased. If the ox can be made to cough by pinching the upper trachea or larynx, or if coughing takes place in the horse when only slight pressure has been used, some abnormal irri- tation exists. If cough can be readily induced by pressing the lower windpipe, a tracheitis is present. The frequency of the.cough. A cough may be occasional or frequent, continual or transitory. If the cough is occasional usually only one or a few impulses occur, but when frequent several in succession— a fit of coughing. The painfulness of the cough is recognized by the general behavior of the patient which seeks to suppress the pain by shaking the head and making masticatory and swal- lowing movements. The animal may also be restless, paw and groan. A painful, painless, burdensome, and torturing cough may be distinguished. The cough is painful in acute 114 CLINICAL DIAGNOSTICS. bronchitis, pleurisy, pleurodynia, and in so-called “whooping cough” of dogs; painless in chronic laryngitis. The force of the cough impulse depends upon the vigor of the action of the expiratory muscles and the elas- ticity of the lungs. Accordingly, the cough may be strong, vigorous, or weak. It is weak if expiration is difficult or if the patient is unable to cough vigorously: reduced, debilitated animals, pulmonary emphysema, bronchitis, hydrothorax; or if the expiration is painful: pleurisy, pneumonia, pleurodynia. The cough is strong if the elasticity of the lungs is normal and no pain attends the act. The: duration of the cough impulse is determined by the force with which the pulmonary air is held repressed by. the closed glottis. If the pressure is great, the glottis will be suddenly forced open and the cough will be short. If the glottis is not completely closed (paralysis of the arytenoid cartilage—roaring) or the repression of the air causes pain (pleurisy), the cough is /ong—prolonged. The depthand magnitude of the cough depend: partly upon the force and duration of the cough im- pulse. The magnitude is influenced by the quantity of‘ ex- pelled air. We speak of a deep and a shallow cough. The cough sound is dependent upon the force of the cough impulse, the tension of the vocal cords and the spe- cial condition of the surface of the mucous membrane. The sound may be loud, low, clear, dull, sharp, whistling, dense, hollow, loose, moist, dry. — The ‘‘return impulse’’ of the cough (Hus- tenruecktstoss). Each cough is followed by a short, deep in- spiration. If the glottis is not fully open at the moment this inspiration takes place, the air rushing in causes the partially stretched vocal cords to vibrate, causing a harsh, short, laryn- geal stenotic sound to be emitted. It is heard in paralysis of the larynx (paraplegia, hemiplegia) and in severe inflamma- tory swelling. ; ~ > ea RESPIRATORY APPARATUS. 115 Expectoration. The act of coughing tends to eject masses of mucus, exudate, etc., from the bronchi, trachea, and larynx. Animals do not expectorate because that which is coughed up into the throat, as soon as it reaches the phar- ynx, is swallowed. Sometimes, however, a part is discharged through the mouth, the lower naso-pharyngeal wall and the soft palate being forced forward by the air passing out, which leaves the opening into the buccal cavity free. The thus ex- pectorated mass is usually mixed with mucus from the phar- ynx and mouth and also with food particles. It is possible to collect “sputum’’ from horses and cattle for microscopic or bacteriological purposes. The method of obtaining it is to cause the animal to cough, then place a spec- ulum in the mouth and reaching back with your hand as far as the larynx, gather the accumulated mucus in this region. Several times in horses suffering from tuberculosis I have thus succeeded in obtaining bronchial discharge in which tubercle bacilli were found. . VII. The Voice. ’ Cattle suffering from nymphomania keep up an almost continuous bellowing; in advanced cases they moan loudly and constantly. At the approach of death horses sometimes utter a shrill neigh. Change in voice is of little significance in. animals. Commonly we observe a hoarse voice in laryngeal catarrhs. This is most marked in dogs. In rabies the voice suffers change. In dogs affected with this disease the bark is pro- longed into a long, dismal howl, the voice being at the same time hoarse. In horses a short, squealing tone is emitted. VIII. The Larynx and Trachea. Inspection. Enlargements in the region of the larynx are as a rule not confined to this organ, but to neighboring tissues as the pharynx, lymph glands, subcutis. 116 CLINICAL DIAGNOSTICS. In birds the larynx may be inspected by simply opening the bill and pressing the larynx upwardly. In dogs and cats, and to a more limited extent in goats and sheep a view of the larynx may be obtained by opening the mouth and drawing the tongue forward. Laryngoscopy. With the aid of the laryngoscope invented by Polansky and Schindelka, the interior of the larynx may be examined directly. For the diagnosis of inflammatory conditions in the larynx this examination is of no practical value. However, Fig. 31. View of the larynx with paralysis of the left side, as seen through the laryngoscope.. in paralysis of the arytenoid cartilages the instrument can be used to advantage. [This instrument, which is a modified endoscope, consists of a cylinder 56cm long and 4.7cm in diam- eter, at one end of which is an optical illuminating apparatus. The light is furnished by an electric battery, and undue heat is prevented by a special cooling arrangement. The instrument is inserted through the nostrils and can be used in the horse without casting.] In left-sided paralysis of the larynx (roar- ing) the left arytenoid cartilage is seen to project farther into the lumen of the organ than the right one. This can be more distinctly seen when the larynx is moving. As the larynx of RESPIRATORY APPARATUS. 17 the horse is usually held in the position of “middle inspiration,” it is necessary to induce forced inspiration and expiration. To do this the thorax is encircled with a girth which is slowly and gently drawn tight and relaxed, alternately, imitating forced breathing. The larynx in the meantime is watched through the instrument. At each inspiration the healthy car- tilage is seen to move outwardly, while at each expiration it approaches the middle line. The diseased cartilage, on the other hand, either remains completely at rest (paralysis) or its movements are very tardily performed (paresis). In bilateral paralysis (paraplegia) of the larynx the patient may show dyspnea when at rest—at any rate, slight excitement will induce it. In such cases one will note that both arytenoids protrude into the lumen of the larynx at inspi- ration ; at expiration they are suddenly forced laterally and set in vibration. The paralysis can be complete or incomplete; it may not be developed to the same degree on both sides. Palpation. When we determine the seat of the en- largements by palpation we may at the same time note their temperature, sensitiveness, and the ease with which cough can be induced by pressing upon them. Where much exudation is found in the larynx, infiltration of the vocal cords or other folds of mucous membrane, a trembling of the organ may be felt (/aryngeal fremitus). In examining the trachea we should look out for scars resulting from tracheotomy wounds. The form of the trachea should also be noted. In chronic trachei- tis of the ox the trachea may be shaped like a saber scabbard. Flattening of the trachea in horses is probably due to a paralysis of the transverse muscle. On auscultation of the larynx or trachea, nor- mally a stenotic sound is heard [like a German “ch”]. It is due to a vibration of the vocal cords and laryngeal walls which is produced by the air forced through the organ. It is heard best at expiration. When the mucous membrane of the lar- ynx is swollen and firm, this sound becomes very pronounced 118 CLINICAL DIAGNOSTICS. and assumes a whistling or hissing character. If the swelling of the laryngeal mucous membrane is loose, or deposits of exu- date cover the membrane, the sound produced is rattling or purring. IX. Percussion of the Thorax. To properly percuss the lungs a knowledge of their topo- graphical position is essential. Anatomy. The lungs and heart do not occupy the whole of the thoracic space. The abdominal viscera encroach upon a greater part of it. The partition between the chest and abdominal organs is the diaphragm. This organ is inserted, in the arc of a circle, to the inner surface of the whole thorax, reaching in an Fig. 32. — — Dorsal and ventral boundaries of the field of pulmonary percussion. — - — Costal attachment of diaphragm. H. heart. d.c. dorsal-colon. 1. v. c. left ventral colon. oblique direction from the sternum backwardly and upwardly to the lumbar vertebrae. In the region of the sternum its points of attachment are at the union of the ribs to their cartilages, farther posteriorly, however, the diaphragm does not extend down as far as the cartilages of the false ribs, but passes obliquely across their inner surfaces until, finally, at the last rib, it finds attach- ment at the superior end. The diaphragm arches forward from RESPIRATORY APPARATUS. 119 its points of insertion, extending into the thoracic cavity in the shape of a cone the apex of which reaches in the various ani- mals, somewhat beyond the middle of the 7th or 8th rib. At expiration the diaphragm lies with its muscular portion directly against the lateral chest wall, the tendinous portion then forming the partition. With the beginning contraction of the diaphragm at inspiration the arch becomes flattened in that the organ is drawn away from the inner wall of the chest. The space left by the receding diaphragm is immediately occupied by the sharp borders of the lungs which then lie close to the points of insertion of the diaphragm. At the acme of inspiration the rounded, cone- like form of the diaphragm becomes more pointed and its base and apex approach each other, the ribs having been drawn _ for- ward. By this drawing forward of the ribs the transverse diam- eter of the thorax is increased and the base of the cone-like dia- phragm broadened. (See page 92.) ——i =— — — Dorsal and Ventral boundaries of field of pulmonary percussion. — - — Costal attachment of diaphragm. — - - — Curvature of diaphragm in median plane. . - - - Anterior boundaries of stomach divisions. H. Heart. P. Paunch. Accordingly, the lateral border of the lung is continually moving backward and forward, traveling a distance in the larger animals of 1-2 hands breadth, and in the smaller ones from % to 1 hands breadth. On an average the posterior border of the lung 120 CLINICAL DIAGNOSTICS. may be defined by a line which in the larger animals is the width of a hand from the points of insertion of the diaphragm. In small animals the distance is one-half this. The availableness of the lungs for clinical examination. Dorsally the area of percussion is defined by the thick muscles of the back. This boundary to percussion, which varies with the condition of the animal, is limited by a line drawn from the posterior angle of the scapula to the external angle of the ilium. Anteriorly the boundary is formed by the scapula and the massive shoulder muscles, Fig. 34. - - - = = Heart, shaded portion not covered by lung. _— Field of pulmonary percussion, — - — Insertion of diapragm. L. Liver. M. Spleen. N. Kidneys. R. Rectum. D. Small intestines. By drawing the leg forward the field of percussion can be somewhat enlarged. Ventrally the density of the sternum, and muscles overlying it render in this region the lungs unavail- able to percussion. The field of percussion is a right-angled tri- angle the right angle of which lies at the base of the scapula. Inall animals the dorsal and anterior boundaries of the field of percussion are the same, the only variation being.in the abdominal boundary. RESPIRATORY APPARATUS. 121 Horse. The abdominal boundary is a line drawn from the 16th intercostal space, crossing the middle of the thorax at the 11th rib, to the olecranon. The vortex of the diaphragm lies slightly above the of the thorax at the 8th intercostal space. Ox. In ruminants the field of percussion is small on ac- count of the less number of ribs (13), which causes the dia- phragm to lie farther forward. The abdominal boundary in this animal is a line drawn from the 11th intercostal space, crossing the middle of the thorax at the 9th rib, to the olecranon. Dog. In the dog the shoulder lies well forward, which gives a larger field of percussion. The abdominal boundary of the field extends to the 9th rib at the middle of the chest wall. Swine. In swine, percussion can rarely be employed, as the thick layer of subcutaneous fat and the restlessness of the animal greatly interfere. The abdominal boundary of the field of percussion extends from the 11th rib to the olecranon. The normal pulmonary percussion sound is due to the vibration of the thoracic wall, the elastic pulmonary tissue and to the air contained in the lungs. The intensity of the sound depends upon the volume of the air-containing lung tissue which is set in vibra- tion. It will vary with the force used in percussing, the thickness of the chest wall and the volume of the part of the lung vibrating. Accordingly, more force is employed in per- cussing a thick-walled chest than a thin-walled one. As the normal percussion sound at the boundaries of the field of percussion merges graduallyintoatympaniticoradull sound, the exact borders of the fungs can not be definitely defined under the ham- net 122 CLINICAL DIAGNOSTICS. In vesicular pulmonary emphysema, interstitial emphy- sema (which is rare), and pneumothorax the field of per- cussion is somewhat enlarged posteriorly, the diaphragm suf- fering permanent backward displacement. An abnormally loud, full sound ecanr ie heard ‘under normal conditions a the, wall of the chest is very thin, under such circumstances the vibra- tion of the lung being unusually audible. Exaggerated pulmonary resonance oc- owt $3 1. If the lung is much inflated with air (emphysema). 2. If the lung is abnormally distended with air as it oc- curs at the border of pleural exudate. 3. In pneumothorax. If the dull or flat percussion sound is heard where the sound should be resonant, it always signifies disease. It occurs: ; 1. Lf the -linge tissue - becomes demee from a. Pneumonic hepatization: in contagious pleuropneumonia of the horse, and in contagious pleuro- pneumonia of the ox as a rule a large portion of the lung be- comes solid and liver-like, and emits, on percussion, a dull or flat sound. In catarrhal pneumonias the pulmonary sound is not so flat, because the solidification of the lung is not com- plete, the morbid process appearing in the form of more or less isolated centers or foci which are not entirely void of air. In hypostatic, mietastatic, and ichorus pneumonias, swin plague, dog distemper, verminous pneumonia and tuberculosis the percussion sound is not diffusely dulled, but a dull sound is . emitted over the dense diseased centers only. b. Chronic interstitial pneumonia com- bined with atelectasis. 2. If tumors or neoformations are pres- RESPIRATORY APPARATUS. 123 ent in the lungs: glanders, tuberculosis, carcinoma, sarcoma, echinococci, ete. 3. If an airless, solid medium come be- tween the lung and the pleximeter. Inflammation, swelling of the thoracic wall (after mus- tard applications) ; neoformations on the pleura; collection of considerable fluid exudate or transudate in pleuritis, conta- gious pleuropneumonia of the horse, contagious — pleuro- pneumonia of the ox, and in swine plague. In the horse the presence of but a few litres of fluid in the chest cannot usually be determined. Pleuritic dullness is characterized by its horizontal upper boundary which shifts if the position of the body is changed, the contained fluid seeking the lowest level. This latter is most marked in small animals. The tympanitic percussion sound is abnormal Wie watt Cee Ors. 12 thes thorax. It appears: iba Collapse of the puwlmemary tissue from a retraction of the lungs in the presence of pleuritic exu- date. The collapsed lung floats upon the exudate, hence above the horizontal line of dullness a tympanitic zone exists. a. In the first and last stages (resolution) of pneumonia. b. If numerous, small tumors occur in the lungs and the. pulmonary tissue amid them is collapsed. 2 -clcavernus, of large bronchiectasies [morbid dilatations of the bronchi] are present in the langs. The intensity and clearness of the tympanitic tone depends upon whether the cavities momentarily contain air or exudate. The tympanitic percussion sound has a metallic tinkling tone when the walls of the air-containing cavity are smooth and distended. The cracked-pot resonance. [This resembles the sound produced by striking the hands, loosely folded across each other, against the knee, the contained air being suddenly forced out between the fingers—Loomis]. It occurs in the thorax 124 CLINICAL DIAGNOSTICS. when a large air-containing cavern is in direct communication with a bronchus. Forcible percussion causes some of the air to be suddenly driven out of the cavern into the communicat- ing bronchus, thus inducing this peculiar resonance. The cracked-pot resonance, however, does not always indicate the presence of a cavern in tive dane. 3. In pneumothorax. 4. In prolapsus of bowel into the thoracic cavity through the ruptured diaphragm. X. Auscultation of the lungs. During breathing, when the air enters the lung and causes it to move, sounds are produced. The occurrence and charac- ter of these sounds furnish important data in regard to the condition of the air passages and of the surface of the lung. The intensity of the sounds varies with the depth of the res- pirations; when the breathing is forced they are augmented. Therefore, to make them more audible it is sometimes advisa- ble to exercise the patient before auscultating. The sounds may also be made more distinct by holding the nostrils shut for a few moments. The partial closing of the nostrils, how- - ever, recommended by some, is not admissible, as it induces a stenotic tone which might prove misleading. a. The vesicular murmur. In auscultating the thorax over healthy lung, we perceive a soft, sipping sound, the vesic- ular or alveolar murmur. The sound can be imitated by softly pronouncing the letter “v.’’ It begins with the inspira- tion, increasing as the inspiration continues, and: becomes at expiration, a fainter, shorter sound, having the character of a softly aspirated letter “f.” As a rule the murmur is softer and less distinct in the horse than in: the ox. As with the laryngeal respiratory sound, so are other sounds originating in the upper air passages transmitted to the or RESPIRATORY APPARATUS. Lz lungs. These are rattling throat sounds, wheezing, groaning, etc. Their appearance in the chest has no diagnostic signifi- cance. An exaggerated vesicular murmur occurs. 1. If the respirations are intensified, therefore in physio- logical and pathological dyspnea. 9. If it is compensatory; that is, if one portion of the lung is required to perform extra work for another portion which is diseased and incapable of taking part in the respira- tory act. [For instance, where one lung does the duty of its fellow which is diseased. | 3. Tf a bronchitis is setting in, the lumen of the bronchi being contracted by swelling of, or collections of exudate on, the mucous membrane. The exaggerated vesicular murmur in such cases is a symptom of great diagnostic importance. A diminished or feeble vesicular murmur occurs: 1. If the thoracic wall is thickened from fat accumula- tions or disease: swelling, neoformations. 9 If the air cannot enter thie vesickes in consequence of great swelling or plugging of the larger bronchi: severe bronchitis. 3 Ifthe exchange of gases in the lungs is impaired: emphysema, beginning hepatization, and a partial compression of the lungs by pleuritic exudate. Absence of the vesicular murmur, and no other sounds present in the lung [i. e., total absence of any pulmonary sound] occurs: 1. If pleural exudates or tumors have displaced the lung tissue : 2. Rarely in severe vesicular pulmonary emphysema, or a complete occlusion of a bronchus preventing access of air into a certain portion of the lung. Jerking, interrupted respiratory sounds are often produced by animals voluntarily, from restlessness or fear. In such cases it is heard in both lungs. Pathologically it is 126 CLINICAL DIAGNOSTICS. confined to certain portions of a lung, and is observed when the free entrance of air into the vesicles is made difficult by a contraction or occlusion of the bronchi (bronchitis ). b. Bronchial tones. The bronchial respiratory sound ‘is normal in the larynx and trachea;its appearance in the chest ie abways- a -sipacot, disd€as &.. ae is audible only when the bronchi are free and the vesicles con- tain no air. Bronchial respiration displaces vesicular respiration: 1. If the vesicles are filled with exudate, therefore in all pneumonias, especially in contagious pleuropneumonia of the horse and in contagious pleuropneumonia of the ox. To be heard, however, the hepatized portion of the lung must be of the size of a double clenched fist and lie next to the costal wall. ’ 2. If the lungs are compressed by pleuritic exudate (atelectasis). The compression must be complete, for if the vesicles contain air at all a feeble vesicular murmur can still be heard. A~special variety of bronchial ‘tes pare ation is the amphoric resfiration, which is a bruit, of a char- acter like the sound produced by gently blowing across the mouth of a narrow-necked bottle. In animals it is rare, but appears if large caverns in the lung communicate with bronchi (pulmonary gangrene). On percussion, in place of the dulled sound which is usual when the respiration is bronchial, a tympanitic tone ora cracked-pot, resonance is bean. That bronchial respiration may become audible the bronchi must not be occluded; if they are filled with masses of exu- date, no respiratory sound is heard. A forcible cough, how- ever, may dislodge and eject the exudate and the -ronchi be- come free again. c. The vague or indefinite respiratory sounds. Such ">" RESPIRATORY APPARATUS. 127° sounds are spoken of when it can not be determined whether they belong to the vesicular or bronchial respiration. Vague respiration is heard if hepatization is setting in, the vesicular murmur becoming weak and the bronchial sound just begin- ning. A slight compression of the lungs or partial occlusion of the bronchi with exudate may also produce it. d. Rales or rhonchi. Kales are heard in disease and appear if the bronchi or a cavern in the lung contain movable exudate against which air is forced. 1. Moist rales appear if the bronchi contain a quantity of light, fluid exudation (bronchitis). The larger the bronchi and the greater the quantity of exudate they contain, the larger will be the bubbles and the coarser the rales. In the large -ronchi and in caverns, the rales may assume a gurgling or bubbling character. We also distinguish medium, coarse, and fine rales; the latter originating in the bronchioli. Rales may occur irregularly and are not always of like intensity. Sibilant rales are heard only at inspiration, increas- ing in intensity as the inspiration progresses; coughing may temporarily remove them. The intensity of rales depends upon the extent of the disease and the topographical position of the diseased part. Moist rales originate from the to-and-fro movement of mucus [pus, blood, liquid exudate], the forming and bursting of bubbles, and the vibrations produced by these acts. Accord- ing to whether rales attend vesicular, bronchial or amphoric respiraticn their tone will vary; metallic rales as a rule accom- pany bronchial respiration. By crepitant rales; we understand very fine, crackling noises, which resemble the sound heard when the ear is rested very lightly upon the haired skin of an animal. Taking their origin into consideration they can be grouped with neither the moist nor the dry rales. They originate from a separation, at inspiration, of the adherinz walls of the bronchi and vesicles. They appear in brcnchiclit!s, pulmonary edema and in the 128 CLINICAL DIAGNOSTICS. exudative (early) stage, and last stage (resolution) of fibrin- ous pneumonia (contagious pleuropneumonia of the horse). 2. Dry rales appear if a small quantity of a tough bronchial secretion is present, or if the mucous membrane is greatly swollen. These conditions produce stenosis of the bronchi, hence the sound is stenotic and of a sonorous, hum-— ming, hissing, squeaky, whistling, (sibilant) character. Dry rales most commonly attend chronic diseases: chronic bron- chitis, compression of the bronchi by nodules (tuberculosis, chronic pneumonia) and tumors (echinoccocci). In the echinococcus disease of the ox the rale has a peculiar (quurk- send) character. A wheezing, crackling, whistling or piping, rale-like sound is heard in interstitial emphysema of the Iungs. It is most pronounced during expiration. e. Pleuritic friction sounds. Normally the pulmon- ary pleura plays noiselessly upon the costal pleura during the movements of each respiratory act. If, however, the pleurae become rough and dry from inflammatory deposits upon them, a sound is produced at respiration. This sound is best heard where the movement of the pleural laminae is greatest, there- fore near the sharp borders of the lung. The intensity of pleu- ritic friction sounds depends upon the extent of the disease ‘[pleuritis]. They are audible as grazing or rubbing sounds just below the ear; if there is an intimate adhesion the sound is emitted in a series of jerking, creaking, or crackling notses. A pleuritic’ friction sound appears in dry or fibrinous pleuritis only. It is most frequently heard in contagious pleuropneumonia of the horse and in contagious pleuropneumonia of the ox. It rarely occurs from the presence of tumors or neoformations upon the pleura. Io tuberculosis; as a rule; no £ric= tion sounds beard: Pleuritic friction sounds are easily confused with rales. Friction sounds are heard regularly at inspiration and 7 : : > RESPIRATORY APPARATUS. 129 expiration, may sometimes even be felt, and occur most fre- quently in a series of abrupt, jerking noises upon which cough has no influence. Rales afe commonly more pronounced at inspiration than at expiration, are not jerking in character, and are removed or modified by cough. Diseases of the Respiratory Apparatus. a. Cavitiés of .the Head. Acute nasal catarrh. Rhinitis catarrhosa. Congestion of thé mucous membranes, serous or mucous, rarely mucopurulent nasal discharge. Only when disease is severe is mild fever present; transient swelling of the submaxillary lymph glands. Chronic nasal catarrh. Mostly unilateral. Discharge often mucopurulent or light colored and “solassy” in appearance; quan- tity varies. Nasal mucous membrane pale, sometimes catarrhal erosions. Enlargement of the submaxillary lymph glands. Chronic catarrh of the superior maxillary and frontal sinuses. Symptoms of unilateral chronic nasal catarrh. When head is lowered discharge suddenly increases. Bulging of the diseased sinuses; if filled with exudate flat sound on percussion. Tumors in the cavities of the head. Most common are sar- comas in the sinuses and polypi in the nasal cavities. Chronic nasal discharge, enlargements, wheezing respiratory sounds, sub- maxillary glands also diseased. Parasites in the cavities of the head. Larvae of Oestrus ovis in the sheep, pentastomum taenioides in the dog. Sneezing, nasal discharge, wheezing respirations, brain symptoms. bolwtyns and Bronce his Acute laryngeal catarrh. Laryngitis acuta. Cough which is at first dry and painful, later more moist. When disease is severe: mild fever, accelerated pulse, dyspnea with laryngeal stenotic sound. - Croupous laryngitis. Sudden fever, sometimes chills. Per- sistent, hacking cough. Loud laryngeal stenotic sounds, great in-- spiratory dyspnea. Edema of the glottis. Suddenly appearing severe inspiratory dyspnea, loud wheezing or shrieking respiratory noise, head held extended. Stenotic sound does not disappear by partially closing the nasal openings.. Peracute course. Chronic laryngeal catarrh. Cough, especially when the animal is first brought out into the air and at work. Roaring. Hemiplegia laryngis sinistra. An atrophy of the muscles of the larynx due to a paralysis of the inferior laryngeal nerve (recurrent), which causes an inspiratory sound. No fever, 130 CLINICAL DIAGNOSTICS. no catarrhal symptoms. Prolonged hoarse cough with return sound. Inspiratory sound when respirations are forced. Partial closing of the nasal openings causes sound to cease. Acute paralysis of the larynx. Suddenly appearing severe inspiratory dyspnea, which is apparent when the animal is at rest or slightly excited; loud whistling or shrieking respiratory noises, anxiety, restlessness. Partial closing of the nasal openings dimin- ishes the sound. General condition not disturbed. Acute bronchial catarrh. May only be diagnosed when dis- ease is well developed. Fever, accelerated pulse, dyspnea, cough which is at first dry, later loose. Full sound on percussion. On auscultation, rales which depend as to character upon the seat and quantity of the exudate. Chronic bronchial catarrh. No fever. As a rule a short, dull, weak cough. Dyspnea not pronounced at rest; at work marked. Sometimes a fine-foamy, serous nasal discharge. Verminous bronchitis. Lung-worm plague. Develops slowly under symptoms of bronchial catarrh with prolific exudation. In mucus: ‘parasites, eggs, or embryos of Strongylidae. Later, anemia, cachexia and death. Strongylus filaria in sheep and goat; strongylus micrus in ox; strongylus paradoxus in swine, and strongylus syngamus in fowls. Cy Mis wing sy Pulmonary congestion and pulmonary edema. Sudden ap- pearance. Severe mixed dyspnea up to 100 respirations per min- ute. Percussion normal, auscultation: exaggerated vesicular res- pirations, crepitant rales, rhonchi. Pleurodynia. This is a congestion of the lungs combined with severe pains in the thoracic walls. .General apathy, excessive dila- - tation of the thorax, which is “held.” Groaning. Respirations 80 per minute, superficial. Temperature high-normal, pulse accel- erated. Super-resonant sound on percussion, feeble vesicular murmur. Catarrhal pneumonia. Bronchopneumonia. Begins usually as catarrhal bronchitis. High, intermittent fever, painful cough. Only when disease is extended can pneumonia be appreciated; circumscribed patches of dullness on percussion; vesicular mur- mur feeble, rarely bronchial respirations. Gangrene of the lungs. Fever. Breath at first of a sickening, sweetish odor, later stinking. Discolored greyish-brown, tena- cious nasal discharge. Percussion: tympanitic sound, cracked-pot sound; at periphery of necrotic centers, dullness. Auscultation: large rales, bronchial respiration, amphoric sound. Not infre- quently combined with pleuritis. Alveolar emphysema. May only be diagnosed when well de- veloped. Expiratory dyspnea with ‘“double-pumping” of the flanks, protrusion of the anus. Cough: short, dull, weak. Super- RESPIRATORY APPARATUS. 131 resonant percussion-sound, field of percussion enlarged posteriorly. Auscultation shows the vesicular murmur to be diminished. Interstitial pulmonary emphysema. Suddenly appearing mixed dyspnea. Cough very supertcial or absent. Super-resonant per- cussion sound with tympanitic accessory sound extended poster- iorly. A piping sound in auscultation. Emphysema of the skin frequent. Echinococcus disease. Ox. Diagnosis is only possible when large numbers of the echinococcus bladders are in the lungs. No fever. Dyspnea. Cough weak and blowing. Percussion dulled in patches or tympanitic. Vesicular respirations diminished. a Pleura. Pleurisy. Pleuritis. Fever depending upon the character of the inflammation. Respirations accelerated and dyspneic. Fre- quent, painful, weak cough. Horizontal line of dullness on per- cussion above which a tympanitic sound is observed. Percussion will vary with the position of the body of the patient. In early stages friction sounds are heard on auscultation, later when much effusion of exudate takes place no respiratory sounds are audible. Pneumothorax. Attends interstitial emphysema of the lungs or penetrating wounds in the chest wall. Tympanitic percussion sound in the upper portions of the thorax. Severe dyspnea. e. Infectious Diseases Which Involve the Respiratory Apparatus. Contagious pleuropneumonia of the horse. (Brustseuche). This is a contagious pneumonia affecting the parenchyma of the various organs and is usually attended with secondary pleuritis. 1.. Stadium incrementi begins with high fever, yellow discolora- tion of the visible mucous membranes, general weakness, crack- ling of joints. 2. Acme. Does not appear before the second or third day. Symptoms of fibrinous pneumonia with or without pleurisy, usually unilateral. Rusty brown nasal discharge, empty percussion sound with resistance under the hammer, bronchial respirations. Pleuritis: Empty percussion sound limited by a horizontal line above which is a tympanitic zone. Friction sounds which soon pass away, later no sound or bronchial respiration. 3. Stadium decrementi: The crisis appears in 7 or 8 days, tempera- ture within 24-36 hours down to normal, all other symptoms, also pulse frequency gradually disappearing in 8 days. Complications: pleurisy, acute myocarditis. Resulting diseases: pulmonary gan- grene, abscesses in the lungs, chronic pneumonia. Scalma (Dieckerhoff) is a diffuse, infectious bronchitis with subacute course. Tuberculosis. Tuberculosis is a contagious disease caused by the bacillus tuberculosis and characterized by the formation of very smail inflammatory centers which soon undergo degenera- tion. The disease develops very slowly. Only advanced cases 132 _ CLINICAL DIAGNOSTICS. can be diagnosed by physical examination. Symptoms will vary with organ affected. Very often general emaciation. 1. Pulmonary Tuberculosis. Respirations often unchanged. Sometimes mucopurulent nasal discharge, especially after cough- ing. Cough regularly present. It is at first vigorous, but later becomes weak and not infrequently in paroxysms. Coughing may be induced by trotting the patient or by temporarily closing the nostrils, if it does not occur spontaneously. Percussion rarely reveals much. Auscultation more valuable, especially after exer- cise: vesicular murmur exaggerated, rough; rales and vague sounds. Great tubercular enlargement of the mediastinal lymph glands induces chronic bloating. 2. Udder Tuberculosis. Begins in one or more quarters in the form of circumscribed, firm inflammatory centers which con- tinue growing larger. After milking more noticeable. The supra- mammary lymph glands are enlarged and often nodular. 3. Uterine and Vaginal Tuberculosis. Frequent periods of heat; animal does not conceive; vulva asymmetrical or sunken. Fre- quently mucopurulent nasal discharge. On mucous membrane small nodules and ulcers size of a pin head. Orificium uteri rarely closed. Uterus enlarged diffusely or in form of nodes. Fallopian tubes may be felt as tortuous, firm strands with nodules along their course. 4. Brain Tuberculosis. Disturbance in movements and hold- ing of head. Twitchings and spasms. Often lie on one side, unable to arise. Symptoms may occasionally be acute. Strangles. Coryza contagiosa is an infectious catarrh of the mucous membranes of the upper respiratory passages with sec- ondary, purulent inflammation of their corresponding lymph glands. Begins with fever of intermittent character. Pulse at first little increased but may reach 80. Nasal discharge serous, mucous or purulent, usually bilateral and profuse. In 3 or 4 days at latest inflammatory swelling of the submaxillary lymph glands, which in 4 to 8 days later have abscesses formed in them. Pharyngitis frequently concomitant. Dysphagia, abscess forma- tion in the subparotid and retropharyngeal lymph glands. If larynx is involved: cough, loud inspiratory noises. In eld horses. disease often limited to the pharynx. Glanders, malleus, is a contagious disease of solidungula, caused by the Bacillus mallei, characterized by the formation of nodules and abscesses in the respiratory mucous membrane and skin. On the nasal mucous membrane we find gray nodules as. large as millet seeds, transparent and surrounded by a red zone. The nodules become yellow, degenerate, form ulcers with raised and jagged borders and lardaceous bottom. Nasal discharge slight, frequently unilateral, varyingly sticky, slimy, purulent, occasionally discolored and bloody. Intermaxillary lymphatic glands en- larged, knotty, firm, adhering to bone or skin. In skin and sub- cutis rather flat, painful, hot nodules varying in size up to that of a hen’s egg, these break, discharge discolored pus and become bat DIGESTIVE APPARATUS. 133 ulcerous. Lymphatics efferent and afferent to these nodules are enlarged to thickness of a finger. See also specific examination for glanders. Contagious pleuropneumonia of cattle is a-~contagious crou- pous interstitial pneumonia. We distinguish an occult stage which is marked by a slight cough, fever, and slight dyspnea. In the acute stage we have distinct fever—41°C [105.8°F] and the symptoms of an acute pleuropneumonia. Great dyspnea, weak, short cough, some nasal discharge, extended empty sound ‘on per- cussion, friction bruits, bronchial respiration, rales. Appetite, rumination and secretion of milk suspended. Malignant catarrhal fever is a specific disease of the ox, has a subacute course and affects chiefly the respiratory and digestive mucous membranes, and the brain. Disease is introduced with chills. Great mental depression, muscular trembling, stiffness, sometimes inability to stand. Conjunctivitis and keratitis. Diph- theritic inflammation of the mucous membrane of the nose, sinuses of the head, trachea and mouth, rattling, wheezing and breathing. No appetite, secretion of milk suspended. Distemper of dogs is a very contagious disease that is char- acterized chiefly by catarrhal affections of the mucous membranes. Symptoms quite varied; we distinguish: catarrhal, nervous and exanthematous distemper. Symptoms of the disease develop slowly. Animals are indisposed, conjunctivitis, keratitis, vomiting, disturbed appetite, slimy nasal discharge, cough, dyspnea, tym- panitic and occasionally dulled sound on percussion of lungs, rales. Spasms affecting the whole body or only certain groups of mus- cles, general muscular weakness, paralysis. Vesicular and pustular exanthema. 8. Digestive Apparatus. Diseases of the digestive apparatus are common in domes- tic animals. Their diagnosis is, in some respects, far more difficult than that of the respiratory apparatus because the organs concerned are not as accessible to examination. For this reason every possible factor must receive most careful consideration. We observe these in the following order: i Food and Drink. mv the - buceal’Cavity:. im, [he Pharynx and Esophagus. Iv. Rumination. v. Vomiting. . vi. The Abdomen. vi. The Intestinal Evacuations. 134 CLINICAL DIAGNOSTICS. I. Food and Drink. Before examining the various organs of the digestive apparatus, we must note the animal’s appetite for food and drink as well as the character of these latter, also observe the way in which the animal takes its food, masticates and swallows it. a. Appetite for Food. The appetite that an animal manifests for certain food depends in part on its palatability and in part on the degree to which the animal has ‘become accustomed to it. This must always be borne in mind when probing for the cause of poor appetite, and hence an inspection of the food must not be neglected. Individual appetites vary widely. One horse may be a good feeder, another a poor feeder, both may enjoy perfect health. High strung horses often refuse their food after active exercise, but their appetite returns after a short rest. A change of stable or unaccustomed loneliness has a marked effect on the appetite of some sensitive horses. Of the various grains horses prefer oats and indian corn and of the grasses sweet timothy or meadow hay. Oats is by far the most suitable grain to feed a horse. In all serious cases of disease the appetite is more or less affected, hay or straw are usually the last part of the: ration, reiused,.Deiective appetite) alomenus neyerarindtcation ot any. pat tic ule 2 oe ease. Asa rule, complete loss of appetite is an unfavor- able symptom; on the other hand, a good appetite in the course of a severe disease may be regarded as a favorable symptom. Desire for water depends in the first place on the amount of water contained in the feed; dry feed requir- ing more water than green feed; of course some water is required in both cases. The demand is also affected by the amount of water given off through the skin, kidneys and intestines. Many horses are very sensitive in the matter of impure water, some even refuse “pure” water if of a differ- ent kind than that to which they have been accustomed le. g. spring water and rain water]. The desire for water is diminished in colic and in all serious gastric and intestinal affections, providing no diar- DIGESTIVE APPARATUS. 135 rhea exists; horses with acute cerebritis also refuse water. Continued refusal of water is on the whole considered as an unfavorable sign; when horses with colic drink water it is regarded as a favorable sign. Thirst is increased in the course of various diseases : 1. Animals with fever like small sips of fresh water at frequent intervals. 9. When the crisis occurs in influenza or contagious pleuro-pneumonia of the horse, increased renal secretion and thirst go hand in hand. Exudative pleuritis and peritonitis. 4. Diabetes insipidus of horses is attended with marked increase of thirst; several pailfuls are taken at a time. =. Gastric and intestinal catarrh [diarrhea] of dogs attended with frequent vomiting. By the term perverted or depraved appetite we mean the craving of unnatural food by otherwise healthy [?] animals. As a rule this is a very important symptom. Of course this condition must not be confounded with playfulness of young animals which gnaw at, bite and even swallow almost any- thing of convenient consistency and size. Thus cattle will lick at one’s clothes, dogs eat blades of grass. _ A craving for alkalies is pathological: e. g. straw soiled with urine and feces, whitewash, etc., on walls, wood ; acids in dyspepsia. Swallowing indigestible substances, like cloth, leather, wood, stones, and similar objects is observed in lick disease of cattle, and wool eating of sheep; in rabies the same is observed. b. Manner of taking food. Healthy horses grasp the food with their lips and pass *t into the mouth, then with the aid of the tongue and cheeks it is forced between the molars. Sheep and goats do likewise. Healthy cattle grasp their food with the extended tongue, curved like a hook. See 136 CLINICAL DIAGNOSTICS. In horses the following changes are observed: 1. In inflammatory swelling of lips and*cheeks as well as in paralysis of the cheeks (facial or 7th nerve), horses take up their food with their teeth and experience difficulty in getting it into the mouth. 2. In cerebral depression they show similar peculiari- ties; while drinking they may insert the nostrils below the level of the water and “masticate” it. 3. In tetanus feeding is very laborious; mastication and suction movements are impossible because the spasmodic con- traction of the masseter muscles has closed the buccal cavity. In cattle normal feeding is disturbed in inflammatory affections of the tongue (actinomycosis), this organ. often becoming hard and rigid (woody tongue). Cattle thus affected grab their food like dogs. The manner of drinking water must also be - observed. Normally only dogs and cats lap their drink. When the facial nerve is paralyzed animals must insert the whole mouth into the water so that they can get it near enough to the pharynx to swallow it. c. Mastication. The briskness with which this act is performed bears a direct relation to the palatability of the food and the appetite of the animals; healthy horses and cat- tle make 60-100 masticatory movements per minute. Masticatory movements are conspicuously retarded in cerebral depression, in the course of severe fevers, and in acute and chronic hydrocephalus. The animals cease masti- cating for some time, seem “absent minded,” and forget to eat. This often happens while the mouth is full of feed, and pieces of hay and straw sticking out of it. Mastication is made difficult in paralysis of the facial nerve; here the food collects in large masses in the lower part of the mouth; it is also observed in tetanus or spasms of the masticatory muscles due to other causes. Mastication is impaired and laborious when mechanical — DIGESTIVE APPARATUS. Lar defects of the teeth exist. Shear jaws, and irregular teeth, projecting teeth, etc. The animals masticate one-sided, cau- tiously and “easy ;’” they don’t masticate thoroughly, the food is “crushed and bruised” but not “ground.” Mastication is painful when acute inflammatory condi- tions exist in the cheeks, temporo-maxillary articulation and in the intermaxillary space as they occur in the course of distemper of horses. Mastication may be voluntarily inter- rupted. If sharp or pointed objects like nails, needles, splin- ters of wood, etc., are taken up with the food horses open their mouths wide and allow the contents to drop out, aiding with the tongue. They do the same thing when injuries are produced by sharp teeth or displaced teeth (alveolar periostitis) ; sudden pain, produced by biting on a diseased or loose tooth, produces the same effect. Horses with dis- eased teeth frequently drop: small masses or balls of, food into the manger, “quibbing.”’” Some horses suddenly raise their head while masticating and hold it sideways, open the mouth and continue masticating in a cautious manner, at the same time making slow lateral movements with the lower jaw. Varied as the symptoms that occur in the course of different affections of the teeth may be, they all have onethingincommon,they make mast ica- tion difficult and painful. In dangerous diseases we often observe gnashing of the teeth, at the same time this is not a “prognostically unfavor- able” sign. d. Deglutition. Deglutition is the closing act of feeding. It is described as occurring as follows: The lips are closed and the jaws are set together, then the tip, the back and the base of the tongue are successively pressed against the palate and thus the contents of the buccal cavity are forced into the pharynx. By contraction of the muscles © of the pharynx in front of the food mass the peristaltic mo- tion thus inaugurated carries the bolus into the esophagus. 138 CLINICAL DIAGNOSTICS. At the same time the pharynx is slightly raised and the pres- sure exerted on the epiglottis by the base of the tongue, which projects backward, closes the larynx and allows the food to glide over it. The nasal openings leading into the pharynx are closed during this act by a raising of the soft palate and a coming together of the borders of the posterior pillars of the fauces brought about by contraction of the muscles of the pharynx. A disturbanceof notmal, dee litt trom is most frequently caused by inflammatory processes in the pharynx that cause infiltration and disturb the function of the local muscles. The result is not only 4 painful condition during swallowing but the closure of the larynx or nasal cavities may be incomplete. Accordingly we may observe manifestations of pain, extended head and neck, the animals often shaking their heads. Incomplete closure of the pharyngeal openings results in food particles entering the larynx or nasal cavities and giving rise to cough, or ejections of- water, saliva or food through the nostrils (re- gurgitation), as the case may be. The degree to which the closure of the pharyngeal openings is imperfect, bears a direct relation to the severity of the affection. In mild cases, fluid only is regurgitated, noticeable while drinking water. Later on as the case becomes aggravated, solids also pass out. When the affection is mild and restricted to one side the regurgitation may also be unilateral. Soft feed is more apt to cause regurgitation than are solid substances. An inflam- matory affection of the pharynx that causes difficulties in deg- lutition may be primary (pharyngitis), or secondary to other diseases :, distemper, morbus maculosus, anthrax. In addition, difficult deglutition is observed in: 1. Paralysis of the pharynx in mycoses, parturient paresis, and rabies. 2. Spasm of the pharyngeal muscles in tetanus. 3. Tumors of the pharynx; actinomycoma, lymphoma. ° eel DIGESTIVE APPARATUS. 139 Besides the symptoms of difficult deglutition we observe ‘1 addition: salivation, foaming at mouth, ejecting food from mouth while coughing, retention and fermentation of food in mouth cavity. Inspection of the,Mouth Cavity. II. The Buccal Cavity. We usually examine the buccal cavity by daylight and without the aid of instruments ; artificial illumination with reflectors, lamps, or electric lights is sometimes useful but not necessary. Method of Examination. In the horse and ox the. hand is passed into the mouth at the bars, the tongue firmly grasped, and the thumb pressed against the palate. This procedure will, as a rule, cause the animal to open its mouth wide. Another prac- tical method consists in grasping with the hands, on both sides, the upper lips at the commissures and resting the thumbs against the palate. In dogs and cats we grasp, with our hands, the upper and lower jaws, at the same time pressing the lips between the teeth: hereupon the animal opens its mouth wide enough to permit inspection. Restless animals must first be secured and then towels or cords are passed between the dental arches, and by means of these the jaws are forced apart. 140 CLINICAL DIAGNOSTICS. In examining the mouth the following should be ob- served: The temperature is elevated in fever and in local in- flammations of the mucous membrane, stomatitis and in pharyngitis. Secretion of Saliva. Secretion is diminished in all acute febrile diseases, severe intestinal-affections, and, as a rule, in colic. An abnormal quantity of saliva in the mouth results either from the fact that the animal does not swallow the normal secretion (dysphagia) or that an abnormal secre- tion has occurred, as in simple catarrhal or traumatic stoma- titis, diseased teeth, foot and mouth disease, stomatitis pustu- -losa contagiosa, malignant catarrh, mycoses, etc. The saliva passes off in the form of clear strands or in the form of foam produced by masticatory movements. In epilepsy this foam is observed at the commissures of the mouth. Odor from the mouth. An “insipid sweetish” odor is observed when decomposing food-particles, epithelial cells or saliva in the course of stomatitis catarrhalis, are present. A putrid odor is produced by decomposition of nitrogenous substances. Exudates are present in malignant catarrh .and stomacace in dogs. A carious odor is produced by suppura- tive processes in bones, especially in alveolar periostitis. Specific morbid conditions. Clamminess of the buccal mucous membrane occurs in digestive disorders (loss of appe- tite) ; reddening and swelling of the mucous membrane with loss of substance is observed after the action of irritants and caustics [chloral hydrate pills]. Simple catarrh is attended with similar but milder symptoms. ; Punctiform hemorrhages occur in morbus maculosus and leucemia. Nodules, pustules and ulcers in stomatitis pustulosa contagiosa. Ulcers on the gums in stomatitis ulcerosa, calf diphtheria, swine plague, mercury and lead poisoning. Blisters in foot and mouth disease, small isolated DIGESTIVE APPARATUS. 141 yellowish vesicles in stomatitis vesicularis. Wounds at the tongue tip and frenulum are produced by rough handling of the bridle bit; sharp teeth produce wounds on the inside of the cheeks, and sides of the tongue. Foreign bodies are of frequent occurrence in horses [corn cobs], dogs, and cats, rare in other animals ; they con- sist of pieces of bone, needles, etc., occasionally ring-like objects slip over the tongue accidentally: e. g. cross sections of the aorta, intestines, trachea, iron rings, etc., [rubber bands slipped on intentionally by children during play]. The symp- toms are: open mouth and salivation, attempts at removal on part of the animal, eating and drinking interfered with, the tongue swollen. C Careful manualas wellasocular e xa m- ination is often necessary to recognize these conditions. Condition of the teeth. Examination of the teeth of horses is of particular importance on account of the frequent occurrence of diseases and malformations of these organs. In dogs diseased teeth are also common. Abnormal position of the incisors (par- rot mouth and pike mouth) point to the existence of a similar defect in the molars. Parrot mouth is not an uncommon occurrence in high bred colts. In ruminants the incisors are normally loose. Carious incisors and molars occur in dogs in the course of rachitis, distemper, anzemia and stomacace. Careful examination of the- molars with the aid of a speculum*® is indicated when horses reject food after partial mastication, when they show any abnormal masticatory movements, and when large quan- tities of coarse food particles occur in the droppings. The *[For horses a speculum is not in all cases necessary for the detection of defects or other abnormal conditions of the teeth. By passing the hand into the mouth at the bars, at the same time pushing the tongue to the opposite side that organ is forced between the molar teeth on that side and the animal will voluntarily keep its jaws sufficiently separated to permit examination of the condition of the teeth without endangering the safety of the operator. The right molars are examined with the right, the left with the left hand, the operator facing the animal. ] 142 CLINICAL DIAGNOSTICS. friction surface and the lateral faces of the teeth can be examined simultaneously by letting the index and middle fingers glide over the former, the thumb and the remaining fingers over the latter. Abnormal conditions of the teeth can usually be felt far better than they can be seen. We should observe the presence or absence of sharp points, slant- ing friction surfaces, shear jaws, interrupted jaws, project- ing teeth, short teeth, carious and broken teeth, cavities, etc. III. Throat and Esophagus. Examination of the throat and esophagus is restricted to external inspection and palpation. Inspection. Diffuse swellings in the region of the pharynx occur in phlegmonous conditions of the mucous membrane (pharyngitis). Circumscribed swellings indicate the presence of abscesses and tumors. Palpation. Increasedtemperature and sen- sitiveness indicate acute inflammation which may be either diffuse (pharyngitis) or circumscribed (development of abscesses). The consistency .is firm, yet yielding; even in abscess formation distinct fluctuation is rarely pres- ent here. Circumscribed painless swellings of firm consist- ency indicate the presence of tumors, usually melanosarcoma in old gray horses and actinomycoma in cattle. Palpation of the esophagus serves to detect the presence of for- eign bodies, mostly observed in cattle in the form of pieces of potatoes, apples, corn cobs, etc. Esophageal diverticula and stenoses cause periodically recurring occlusions of the esophagus. Ingestion of food causes the esophagus to dis- tend—sausage like. Such animals cease eating, or, when they attempt to eat or drink, regurgitation of the ingested mass through the nostrils takes place. Examination with a probe or probang has no special value; the dilated esophagus, regurgitation, vomiting of food and symptoms of choking are sufficient to base upon DIGESTIVE APPARATUS. 143 them the diagnosis diverticulum and stenosis, two conditions usually coexisting. On the other hand, the fact that a pro- bang can be passed freely through the esophagus does not exclude the presence of these conditions. IV. Rumination. Rumination is a specific physiological act of the digestive apparatus of ruminants. These animals feed by taking up food hurriedly and swallowing it after little or no mastication. After ingesting a sufficient amount of food in this manner, the latter, which by this time has become partly macerated by the saliva which accumulated with it in the rumen, is carefully remasticated. During this act the animals prefer a recumbent position. The food is forced into the mouth by a contraction of the secona stomach or reticulum into which it previously passes fromthe rumen. , Every cud is subjected to about 60 masticatory move- ments and is then re-swallowed, this. time passing directly into the omasum and abomasum or true stomach through the esoph- ageal groove. The whole act of rumination requires from one to two hours. -When cattle are driven or oxen put to work before they had time to finish ruminating, this act is temporarily sus- pended to be resumed at the next period of rest. Slight disturbances of the act of rumination can as a rule not be recognized as such. Considerable deviations from the nor- mal or complete suppression of rumination alone are definite signs of disease. Jn the beginning disturbances in rumination due to dis- ease manifest themselves by a reduction in the number of cuds chewed in a certain time, by the number of masticatory movements applied to each cud before being swallowed and by the rapidity with which the animal masticates. The severity of the disease corresponds to the degree to which rumination is interrupted. In severe diseases rumina- tion ceases entirely. Rumination is disturbed in: a. [All severe febrile and painful affections, surgical diseases. | : b. Gastric and intestinal disturbances, especially over- loading and paralysis of the paunch. 144 CLINICAL DIAGNOSTICS. c. Traumatic inflammation of the stomach and dia- phragm. d. [All cachectic diseases. | e. [Many cerebral diseases. ] Eructation or belching occurs normally in ruminants. only. This consists in audible expulsion of paunch gases through the cesophagus and mouth. [Eructations become distinctly audible and abnormally frequent during fermentation processes in the paunch, slight tympanitis, etc. Sometimes they are accompanied by disagreeable odors (fermentations) but the character of the food also plays a role here (onions).] V. Vomiting. Vomiting is a reflex (involuntary) spasmodic evacua- tion of the stomach or paunch contents through the mouth or nasal passages. This act is assisted by simultaneous con- traction of the abdominal and inspiratory muscles. Imme- diately preceding the act of vomiting animals make a deep inspiratory movement. Vomiting is caused by indirect (rarely direct) stimulation of the vomiting center in the medulla oblongata. The ease with which vomiting occurs in our domestic animals varies with the species according to the anatomical construction and the degree of fullness of the stomach. Car- nivora, pigs, and birds vomit most readily and with greatest ease, ruminants less so. Horses rarely vomit. This is ex- plained by the anatomical structure and position of the stom- ach. [The stomach of the horse is comparatively small and even when filled does not always come into contact with the floor of the abdomen, hence is not easily affected by abdom- inal contractions. | Further, the spiral arrangement of the muscular coats, insertion of the esophagus at the middle of the stomach, its contracted and thickened wall at the point of insertion (in contrast to the funnel shaped thin walled structure of this , DIGESTIVE APPARATUS. 145 organ in other animals) and the large fundus of the horse’s stomach must be considered in this connection. A vigorous contraction of the stomach will serve to over- come these obstacles and vomiting may occur in the horse. In such cases, however, there is always danger of rupture of the organ. This is the usual result when the stomach is well filled with food. Vomiting in the course of colic is therefore always a serious symptom. Jf, however, the stomach of the horse is moderately filled with fluid contents, a rupture necd not occur. In such cases the act of vomiting is usually not caused by an overloaded stomach but by direct stimulation of the vomiting center. (Chloroform narcosis, hemorrhages and inflammations near the medulla). Vomiting is always a symptom of di's- ease and occurs under the following conditions: a. During the presence of foreign bodies in the larynx or at the base of the tongue: pieces of bone, fish bones, needles, feathers, etc., also when tough, stringy mucus col- lects in this region in the course of pharyngitis and laryngitis. b. Obstruction of esophagus. } c. Gastric affections, overloading of stomach, gastritis, and in certain poisonings. d. Intestinal affections, such as prevent the normal progress of food masses through the lumen of the intestine and thus provoke antiperistaltic movements which cause the stomach to become distended with intestinal contents, irrita- tion of its mucous membrane, and vomiting. The character of the vomited material may often serve to determine the cause of the act and the origin (stomach or in- testine) of the ejected mass. VI. The Abdomen. Examination of the abdomen is conducted according to the following general rules. ‘a. Inspection. The volume or circumference of the 146 CLINICAL DIAGNOSTICS. abdomen in domesticated animals is subject to great variations and great care must be exercised here in diagnosis. For clini- — cal purposes the size of the abdomen must always be con- sidered in connection with the general condition of the animal, its general make up, feed, care, etc. Animals habitually kept on voluminous food in ample abundance develop a voluminous abdomen. The intensity of the sounds corresponds to the intensity of the bowel movements, and we distinguish lively, weak, hardly audible, short and prolonged sounds or noise. None of the intestinal sounds are continuous, they are always interrupted by quiet intervals, but in healthy animals "3m, Fig. 37. — — Dorsal and Ventral limits of area of percussion. — - — Attachment of diaphragm to ribs. Coec. Coecum. v.c. Ventral fold of the colon. d. c. Dorsal fold of the colon. these intervals are never long. Practice in auscultation is of course necessary to enable us to judge correctly. In disease quantitative as well as qualitative deviations from the normal occur. The sounds may be absent altogether in certain regions, e. g., the small intestine may have a lively peristaltic motion while the large intestine remains at rest. Intestinal sounds are reduced or diminished: 1. In impaction, constipation and tympanitis, a paralytic condition resulting from overdistention and overloading (colic). . j j 156 CLINICAL DIAGNOSTICS. 2. In spasmodic contraction of the small intestine in the - course of spasmodic and rheumatic colic. 3. In persistent diarrhea when the intestinal contents are scanty. . : 4. In severe inflammatory conditions (because peristalsis is then more or less suspended and the intestinal contents are scanty) (enteritis, peritonitis). Very lively and loud intestinal sounds occur in all cases of slight stimulation, especially when the latter is produced by laxative food: green fodder, raw potatoes, wheat bran [clover hay, alfalfa, etc]. The sound of a drop of water falling onto a metal plate or pan is sometimes observed and belongs to a class by itself. It occurs when a loop of intestine is greatly distended and the fluid contents of the overlying intestines (small intestines) is forcibly flung against it and causes its walls to vibrate. The presence of this sound indicates that a loop of intestine is at rest and that it is distended with gas. VII. Intestinal Discharges or Evacuations. The quality and quantity of the discharges depend in the main on the kind and quantity of the food. The amount of water imbibed has little or no influence on the consistency of the discharges. The beginner must make an objective study of the character of the discharges of different animals on vari- ous foods, and in particular cases make comparisons with the discharges of other animals kept under the same conditions in the same stable. There are many diseases in which the char- acter of the bowel discharges is of very great importance. a. Defecation. The act of defecation is accompanied by an arching of the back with hind legs spread and slightly advanced; dogs assuming a crouching position. This is followed by a deep inspiration, fixing of the thoracic walls, contraction of the abdominal and intestinal muscles and relaxation of the sphincter of the anus. Defecation is difficult when the feces are dry or hard (constipation). Continued rest after and during periods of heavy feeding may lead to an accumulation of bowel contents eo DIGESTIVE APPARATUS. 157 or even to constipation. Voluntary defecation is almost im- possible when paralysis of the rectum exists, in such cases the agitation of the body during locomotion causes the feces to be passively discharged through the gaping anus. Involuntary evacuations of the bowels occur in cerebral spasms and in paralysis or relaxation of the anus. The latter is common in the course of severe diarrhceas, here the semi- liquid feces flow down on the legs. Defecation is painful in the course of painful inflamma- tory conditions in the abdominal cayity (intestine, periton- eum), diaphragm or abdominal walls. These conditions all interfere with the normal contraction of the abdominal mus- cles during the act of defecation. In dogs foreign bodies (bones) in the intestines, and obstructions by agglutinated hair at the anus of long haired dogs, are particularly trouble- some. The patients groan, cry or howl during attempts at defecation; they avoid the act as much as possible and thus bring on constipation. b. Frequency of defecation. Carnivora defecate once or twice daily, herbivora much more frequently; horses 8-10 times, cattle 12-18 times. These figures are increased by bodily exercise—particularly in horses that travel much. When the normal frequency of defecation is reduced, we Say the animal is constipated. This is mostly the result of diminished peristaltic motion which is also attended with in- creased absorption of fluids. Constipation may result from impaction, occlusion, and dislocation of the intestine, first stages of intestinal catarrhs, inflammations, etc. Constipation is the principal symptom of colic, it may occur, however, without any other colic symptoms. In ruminants the ingesta are usually retained or retarded in the paunch and omasum, rarely in the intestines. The term diarrhea is applied to frequent and usually copious evacuations of liquid or semi-liquid feces; it occurs in all irritated conditions of the intestinal mucous membrane 158 CLINICAL DIAGNOSTICS. and is caused by feed, catarrh and inflammation. Psychic disturbances may lead to diarrhea by reflex action. c. Volume of feces. Here we must distinguish be- tween the amount passed at a single defecation and the total for a.day. Well fed horses (stable) pass 2 to 4 lbs. at each act, 20 to 30 lbs. per day. In acute and in chronic hydro- . cephalus the volume of the evacuated masses as well as the intervals between evacuations is increased. The evacuations are increased in quantity in diarrhea following constipation, they. are diminished after the use of evacuants and after [prolonged diarrhea], during constipation and when animals are underfed. d. Consistency and form. Under normal and usual conditions horses’ dung is evacuated in balls of a regular form, which on striking the ground usually break. In cattle the dung is voided in the form of a semi-solid mass (porridge), which flattens out upon striking the ground. Sheep and goats pass small firm balls resembling the fruit of the bay-berry. Swine and dogs pass feces somewhat more solid than those of cattle and frequently quite hard. In all animals the character of the food has a great influence on the appearance of the evacuations. In describing the dung of the horse we use the terms hard, firm, or loose balls, very motst balls, thick gruel- like mass, thin gruel-like mass, fluid, watery. Increased firmness or hardness of the feces is observed in all febrile diseases, in constipation, and in the first stages of intestinal catarrhs. -In severe febrile diseases of cattle (malignant catarrhal fever) and in obstinate constipation the feces are dry, hard and resemble peat in appearance. Decreased firmness or abnormal softness of the feces occurs in all forms of diarrheas, intestinal catarrh, inflamma- tion (mycotic and septic), dysentery of calves [hog cholera], influenza of the horse, severe tubercular affections of the mesenteric lymph glands. : DIGESTIVE APPARATUS. 159 e. The color of the feces is due to admixtures of bile, coloring matter in the food (chlorophyll in herbivora, haem- aglobin in carnivora) and secretions. An admixture of frag- ments of bone, in dogs, produces a light gray color. An exclusive milk diet produces yellow feces (bile); green fod- der produces a greenish hue; oats, straw and timothy hay produce a yellowish brown color; corn, beans, rye (especially when coarsely ground) produce a gray or yellowish gray color. In cattle the diet is much more varied than in the horse, consequently it is difficult to determine a normal color. It varies from a distinct green (in pastured animals) to lighter and darker shades of endless variety. Concentrated foods (Kraftfutter) tend to produce a more grayish color. The following morbid changes may be observed: The longer the ingesta are retained in the intestine the darker they become. After continued constipation the feces of horses and cattle assume a blackish brown, peat-like color. A decreased admixture of bile (icterus) produces a gray, or light gray color resembling clay. Admixtures of blood produce a red, brownish red or chocolate color, sometimes almost black. A thorough admixture of the blood with the evacuated contents points to the occurrence of a hemorrhage in the anterior portions of the intestinal tract (hemorrhagic enteritis, dysentery, etc.). If the hemorrhage occurred in the rectum the blood adheres in the form of streaks or clots. Discolorations are produced by catarrhal and inflam- matory affections. In dysentery of calves the feces are gray or grayish white. Some medicines produce specific colora- tions of the feces: iron produces a black, calomel a green color. : f. Covering of the feces.. In herbivora the feces are covered with a thin pellicle of mucus which gives them a shiny appearance. This coating of mucus increases or de- creases in thickness as the time during which the feces are retained in the intestine is increased or decreased. In intes- 160 CLINICAL DIAGNOSTICS. tinal diseases attended with extensive exudation from the mucous membrane the feces are not only coated with mucus but are mixed with it. This mucus may be glossy, colorless, yellowish (bile) or gray (epithelial cells and white blood. corpuscles), Flaky or fenestrated coagulations on the surface of feces have their origin in the rectal mucous membrane (proctitis). g. Odor of the feces. This varies with every species according to the food. Horse dung can hardly be said to Fig. 38 Eggs of Ascaris megalocephala ia dung of horse. Globular in form, diameter 0.1 mm, double contour. have an offensive or repulsive odor, the dung of the ox has an odor peculiar to itself, and the feces of carnivora stink. Horse dung has a sour odor in digestive disorders when con- centrated fcod was given in abundance. The feces of her- bivora stink or have a foul odor when putrefactive processes go on in the diseased digestive tract. If albuminous exudates (blocd) are present under these conditions the odor is car- rion-like (hemorrhagic enteritis, distemper of dogs). DIGESTIVE APPARATUS. 161 h. The chemical reaction of the feces has no particular diagnostic value. Horse dung, as a rule, has an acid reaction, a result of the decomposition processes going on in the large intestine. In digestive disorders and intestinal catarrhs the acidity is often increased. i. Composition of the feces. The composition of the feces as far as food particles and foreign substances are con- cerned demands careful consideration. In the first place the size of the undigested food particles must be considered, this indicates the degree of mastication or rumination to whir’. Fig. 39. , Eggs of Distomum hepaticum in dung of sheep. they were subjected. In cattle the feces should consist of a homogeneous mass; coarse particles of food always indicate insufficient or faulty rumination: overloading of paunch, paralysis or inactivity resulting from inflammatory affections are the cause of the latter. In horses, on the other hand, coarse undigested particles of food occur normally in the dung, and faulty mastication is not indicated unless the coarse 162 CLINICAL DIAGNOSTICS. particles are very numerous and whole or nearly whole grains of corn, etc., and bits of straw or hay can be recognized. The cause of the presence of coarse particles of food consists either in greedy feeding or in defective molar teeth. The degree of the defect bears a direct relation to the degree of coarseness of the food particles. Foreign bodies in the feces of horses usually con- sist of sand, and in. sheep we find wool. Inflammatory products consist of mucus, “ood, pus, croupous membranes; in chronic intestinal catarrh ~* cattle we often find small clots of blood. In cattle and calves suffering with catarrhs or other in- flammatory conditions of the digestive tract the soft feces fre- quently contain numerous gas bubbles; these are due to gas- producing putrefactive organisms which are particularly active in concentrated foods that pass rapidly along the digestive tract. Any parasites of the gastro-intestinal tract may occa- sionally be met with in the feces, either entire (Ascarides, Oxyuris) or in segments (proglottides of tapeworms) ; some- times the eggs only are present (Distoma in sheep and cattle). When Distoma are suspected a microscopical examination of the feces should be made. The eggs of these parasites are yellowish brown oval bodies or capsules provided with a lid, (0.15mm long, 0.1mm diameter). The most common parasites of the digestive tract are as follows: Horse: Gastrophilus equi’ and hemorrhoidalis, Ascaris megalocephala, Strongylus armatus [tetracanthus], Tenia mamillana, perfoliata, and plicata. Cattle: Amphistomum conicum, Ascaris lumbricoides, Strongylus radiatus and ventricosus, Tenia denticulata and expansa, Tricocephalus affinis, Strongylus inflatus. In the bile ducts: Distomum hepaticum and lanceolatum. Sheep: Amphistomum conicum, Strongylus contortus, DIGESTIVE APPARATUS. 163 hypostomus, filicollis and cernuus, Tenia expansa, Tricho- cephalus affinis, and [Tenia fimbriata]. In the bile ducts: Distomum hepaticum and lanceolatum, and [Tenia fimbriata]. Goat: Strongylus contortus, hypostomus, filicollis and venulosus, Trichocephalus affinis, Tenia expansa. Pig: Spiroptera strongylina, Trichina spiralis, Ascaris lumbricoides, Echynorynchus gigas, Strongylus dentatus, Tri- cocephalus dispar. In the liver: Distomum hepaticum and lanceolatum. Dog: Tenia echinococcus, cenurus, marginata, serrata, cucumerina, Bothriocephalus cordatus and latus, Ascaris mys- tax, Dochmius trigondécephalus, Trichocephalus depressiuscu- lus. The discharge of intestinal gases occurs only in horses and dogs; corn and green feed produce these gases in large quantities. In old cows, with chronic affections of the rec- tum or undue laxness of the sphincter ani, air is often sucked in during the act of expiration and expelled again at inspira- tion, thus producing a sound as though intestinal gases were being discharged. Addendum. An examination of the liver and spleen of domesticated animals is usually impracticable and in fact of little importance because primary diseases of these organs are rare. An enlarged liver in the dog can be felt in the region of the last rib, in the large animals palpation of the liver per rectum may, in rare instances, give valuable information. When greatly enlarged the spleen in the horse and the liver in the ox can thus be felt and tubercles, echinococci and tumors recognized. Diseases of the Digestive Apparatus. a Mouth, Pharynx and Esophagus. Stomatitis. Here the morbid changes can be directly ob- served; three forms: Stomatitis catarrhalis, st. vesicularis, st. ulcerosa. Ptyalism. A continued discharge of large quantities of saliva without any assignable cause. 164 CLINICAL DIAGNOSTICS. Pharyngitis, Angina pharyngea. More or less fever accord- ing to the character of the inflammation. Head held up, neck stiff. Appetite present but mastication and especially deglutition impaired. Food and particularly water ejected through the nose. Accumulation of saliva and food in the mouth, salivation; foreign bodies (food) in larynx, and cough. More or less symptoms of laryngitis, in serious cases dyspnea as a result of swelling of laryngeal mucous membrane. Paralysis of esophagus and pharynx. Dysphagia paralytica,. difficult deglutition and absence of inflammatory symptoms. Foreign bodies in esophagus. Most frequent in cattle (but also observed in horses); salivation, inability to swallow, choking, flow of saliva from nose; tympanitis in cattle. Foreign body in cervical portion of esophagus can be seen or felt. Esophageal stenoses and diverticula usually develop slowly and gradually. Symptoms: Sudden interruption in feeding, 1m- paction of esophagus with food; regurgitation, choking. Dis- charged masses are foamy but not sour. Diseases of the teeth in animals produce trouble in feeding. Animals begin eating with apparent appetite, but soon stop or continue with diminished interest, masticate slowly and carefully, , smack their lips, pause, salivate, reject partially masticated food, swallow their grain whole, masticate roughage poorly, don’t eat a full feed, feces contain large particles of food, sometimes there is a tendency to diarrhea. The following conditons of the teeth are of clinical importance, viz., sharp teeth, very oblique grinding surfaces (shear-jaws), an undulating or irregular set of teeth, pro- jecting or depressed teeth; caries of the teeth, tartar deposits; periostitis alveolaris, tooth fistulae, neoformations on the alveolar periosteum. b. Gastric and Intestinal Diseases of the Horse. Acute dyspepsia. Lack or loss of appetite, particularly for grain; animals lick cold objects. Thirst is increased, buccal mu- cous membrane dry, animals yawn frequently. Acute gastro-intestinal catarrh. Usually fever, animal is. downcast, conjunctiva reddened, sometimes icteric. Appetite much impaired, frequent yawning, buccal mucous membrane reddened. and clammy; feces at first dry, later diarrheic; urine acid, with- . out sediment, contains much indican. Chronic dyspepsia. Chronically impaired appetite. Gastric. disturbances. . 1. Simple chronic dyspepsia. Appetite for con- centrated food (grain) impaired, otherwise normal. } 2, Acid dyspepsia. Impaired appetite, but a craving b -for alkalies; licking whitewashed walls, nibbling at soiled litter. " 3. Nervous dyspepsia. This occurs in easily excitable horses and consists in temporary disturbances of appetite after excitement. : Chronic gastro-intestinal catarrh. Gastro-enteritis catarrhalis. chronica. Soft consistency of feces, or hard and soft ailternately,. DIGESTIVE APPARATUS. 165 containing mucus, appetite impaired. Mucous membranes muddy red. Urine acid. Colic of horses. The term colic is applied in a general way to pathological conditions of the gastro-intestinal tract that cause horses to manifest symptoms of pain. As a rule they are caused by interrupted progress of the intestinal contents. The most im- . portant symptoms are those indicating pain, efforts to uri- nate and defecate, diminished peristalsis and retarded defeca- tion. Sometimes impaction or torsion of the bowels can be rec- ognized as the causes (rectal. examination). Before making a prognosis note carefully the condition of the conjunctiva and the pulse. Gastro-enteritis. Inflammation of the stomach andintestine. High fever, great depression of the sensorium, mucous membranes muddy red; pulse very rapid, respiration in- creased. Complete loss of appetite, buccal mucous membrane hot, feces as in diarrhea, foul odor, and bloody. Rising is painful. Forms: Gastro-enteritis rheumatica, toxica, cruposa, mycotica, parasitica. c. ‘Gastric and Intestinal Diseases of Cattle. Acute tympanitis. Hoven, bloat. Rapid tympanitic disten- tion of the paunch, food and drink are refused, defecation retard- ed. Increased and labored breathing, animals are anxious and restless. Acute dyspepsia. Acute derangement of activity of stomach. No fever. Feed is absolutely refused, rumination suspended, belch- ing, abdomen full, paunch contents firm, paunch movements slight, auscultation reveals sounds of bursting bubbles, feces dry, later on containing coarse food particles. Acute gastro-intestinal catarrh. Fever, conjunctiva reddened, pulse frequent, appetite often entirely wanting, flanks sunk in, paunch movements incomplete. Milk secretion suddenly retarded. Chronic gastro-intestinal catarrh. Gradual development and frequent change of symptoms. Appetite reduced, bloating follows a heavy feed, rumination interrupted. Defecation usually retard- ed, feces mixed with mucus, now and then diarrhea. If disease is severe diarrhea is continuous. Animal weak, falls off in flesh. Chronic tympanitis, chronic indigestion. Periodi- cally recurring attacks of slight bloating of paunch that continue for some time. Rumination and paunch movements retarded. Coarse food particles in feces. Dislocation of bewel. 1. Invagination (telescoping) of intestine. Occurs suddenly and without external cause. Animals are restless, lie down, get up again, kick their bellies, groan. These symptoms attended with fever. Feeding and rumination cease, obstinate constipation, discharges of mucus and blood. Pains soon grow less but fever increases. Palpation per rectum usually enables us to feel the invaginated gut. 2. Peritoneal hernia or gut tte in the ox. Symp-. toms same as in invagination, in addition an abducted position of 166 CLINICAL DIAGNOSTICS. ° hind leg which is also extended back. Sacral region depressed. Palpation per rectum reveals presence, at anterior border of ileum, of painful doughy swelling, held in place by vestige of spermatic cord. Licking disease of cattle and wool eating of sheep are pecu- liar chronic affections; afflicted animals have a habit of licking, nibbling, or even swallowing objects of a various nature, including indigestible and often loathsome and disgusting substances. At the same time there is loss of appetite and emaciation. d. Gastro-Intestinal Diseases of the Dog. Acute Gastric Catarrh. Frequently febrile. Usually begins with vomiting of food masses, followed by vomiting of mucus. Loss of appetite, increased thirst, depression, evacuation of bow- els retarded, symptoms of pain upon pressure over the region of the stomach. _ Acute Intestinal Catarrh. Usually febrile and attended with diarrhea; feces of bad odor and frequently fermenting. Icterus and bile pigments in urine common symptoms. Constipation. Cause, as a rule, in the rectum. Defecation retarded, animals make frequent unsuccessful attempts, tail elevated. Abdomen frequently bloated; palpation reveals impac- tion of rectum, painful upon pressure. Digital exploration reveal- ing presence of hard fecal masses. Foreign Bodies in the Intestines. Frequently situated anterior to the ileo-cecal valve. Vomiting, complete loss of appetite, ab- sence of fever. Object can usually be located by careful palpation of pelvic region. Caution: Do not confuse with kidneys, especially in cat. e Diisheaseas of the Reritome um, Acute Peritonitis. Usually secondary, following rupture or perforation of intestine, perforation of abscesses or extension of inflammation of adjacent organs; symptoms therefore not charac- teristic. Symptoms of colic, stiff gait, looking at the flank, groan- ing. Marked depression, staring look, moderate to high fever. Mu- cous membranes reddened. Pulse, rapid, small, soft. Respiration short, superficial, frequent. No appetite for food or water, ab- dominal muscles contracted, painful; peristalsis suspended, some- times diarrhea as death approaches. Defecation and urination retarded, painful. Death often following after a few hours. Chronic Peritonitis. In horses, symptoms of colic and fever, irregular appetite and emaciation. In cattle and dogs colic symp- toms absent, but pain upon palpation, presence of exudates. Traumatic Inflammation of Stomach and Diaphragm in Cattle. Indigestion of sudden appearance without apparent cause. Ani- mals show disinclination to lie down, stand in stiff position, are very careful when rising and don’t stretch. Expression of eyes indicating pain. Surface temperature irregularly distributed, bod- URINARY APPARATUS. 167 ily temperature elevated. Pulse accelerated and hard. Respira- tion rather retarded, groaning and manifestations of pain. No appetite for food or drink, rumination suspended. Pressure on the right side, sixth and seventh ribs, painful. Milk secretion de- creased. Pols ec toOmce Dimsemisces: wit tin lo cali zation tapeies: Winortes ti ye. shiraiG t. Rinderpest is a readily transmissible, acute infectious disease, of cattle. It usually takes a fatal course. Period of incubation 6-7 days. High temperature is the first symptom. Eyelids swol- len, conjunctiva very red, respiration difficult, dirty yellowish nasal discharge, nasal mucous membrane reddened in spots, cough, moist rales, frequently interstitial pulmonary emphysema and cu- taneous emphysema; complete loss of appetite, feces fluid, discol- ored; secretion of milk suspended, great depression, and general weakness of the body. Dark red areas on mucous membranes which (spots) become coated with grayish white layers, when the latter drop off and leave ulcerous erosions. Most animals die on the fifth or sixth day. Stomatitis pustolosa contagiosa is an exanthema with a typical course. It occurs in the form of pustules, principally at the mouth, and is characterized by its mild course. Period of incu- bation 3-5 days. At first appearance of eruption there is fever, but this soon subsides. Horses refuse feed, they salivate, mouth painful to the touch. Within 2-3 days minute nodules or blisters appear on the mucous membrane; these are at first red, then gray or yellow, break open and-form ulcers. Intermaxillary glands swollen, conjunctivitis, now and then ulcers on the outer part (skin) of the lips, forearm and body; healing requires 10 days to two weeks. 2 0 POR ie a eiO ne; Lupinosis is an intoxication disease affecting the body as a whole. It is caused by a poisonous principle (lupinotoxin) which occurs in lupines. Diminished appetite, increased temperature, icteric coloration of conjunctiva, general weakness, cerebral de- pression. Urine yellow, contains bile pigments and albumin. [Loco weed poisoning.* An intoxication disease affecting chiefly the nervous system. Effects not noticeable until a consid- erable quantity of the “loco weed’ has been eaten. Gait slow and measured, eyes glassy and staring, vision interfered with, convul- tions when animal is excited, later on, general emaciation. Occurs in western States. | IX. Urinary Apparatus. In diagnosing diseases of the lungs percussion and aus- cultation of the chest is of fundamental importance. In dis- eases of the urinary apparatus we depend on the results of * U. S. Report. 168 CLINICAL DIAGNOSTICS. physical and chemical examinations of the urine. Experience has taught us that affections of the kidneys and urinary tract are not as common in animals as they are in man and conse- quently urinary analyses hardly merit the same importance that is attached to them by physicians. Besides this the entire field of kidney pathology in animals has received so little at- tention from investigators that our lack of knowledge is often © evident to the diagnostician. Results of a urine examination often enable us to diag- nose affections of other organs the abnormal products of which pass over into the urine. The collection of the urine from animals is always attended with difficulties, in practice it is often impos- sible. As a rule the urine is caught up in a vessel during the natural act of the animal. In horses a vessel can be secured to the sheath and the urine thus collected. In female animals the use of adisinfected catheter is permissible. In the course of the clinical examination we consider the urine first; if the latter shows material changes we also examine the urinary organs. Accordingly we consider the following points and in the order given: Ll sMan Wet f YV etd ine Cie Ur pores ily Bxaminatrom oi-tihe Ua ime, A. Macroscopical examination. B. Chemical examination. C. Microscopical examination. ill: Be amination: oietheUrigary Or cages I. Manner of Voiding the Urine. In our domestic animals urinating is a reflex act inaugurated by the stimulus of the urine on the mucous membrane of the dis- tended bladder. As long as the distention of the bladder is belowa certain point the reflex action of the sphincter vesicae which is also inaugurated by the pressure of the urine, supersedes that of the muscular coat, hence the one gives way to, or takes the place of, the other as occasion demands. ———_ = URINARY APPARATUS. 169 In adult male dogs only do we observe frequent and voluntary urination. For this act they prefer places used for the same purpose by other dogs. Their choice places are trees, the corners of houses, ete. When urine is voided the bladder contracts and this is aided by the abdominal muscles. Every species of animal manifests peculiarities of its own in this act, but it is a rule that all animals stand while urinating. Hozses (both sexes) urinate only while resting and cease feed- ing for the time; not infrequently they emit loud groans. Cows urinate similarly to mares, male cattle on the other hand urinate not only while feeding but also while walking; in fact, in these animals the act seems almost to be a passive one. Old dogs and pigs (male) void the urine in an interrupted jerky stream. a. The frequency of urination depends on the amount of water imbibed, the amount of water lost by respiration, perspira- tior, and per intest'nal tract; accordingly it varies very consider- ably. Healthy horses ordinarily urinate 5-6 times a day. 1. Abnormal frequency of urination occurs during in- creased secretion of urine (polyuria) in the course of dia- betes, and in chronic inflammation of the kidneys, temporarily in the crisis of severe diseases (contagious pleuro-pneumonia of horse). *. Urination is suppressed, when rupture of the bladder has occurred (urethral calculus) in oxen: to determine (in doubtful cases) whether or not an ox urinates a clean cloth is tied in front of the opening of the urethra. b. Abnormally frequent attempts to urinate, only slight quantities of urine being passed at each attempt, stranguria. The cause of this is an abnormal irritability of the mucous membrane of the bladder and urethra. Such conditions are most frequently observed in the course of colic in horses where the distended intestines (impaction, con- stipation, tympanitis) exert a pressure on the bladder, or the sense of fulness of the abdomen causes the animals to make these attempts. Inflammatory conditions of the bladder (bladder diseases, stone and gravel, neoformations, poison- ing with irritating substances) or of the urethra (applica- tions of pepper) are much less common causes. Mares in 170 CLINICAL DIAGNOSTICS. oestrum often show these symptoms at the same time re- peatedly protruding the clitoris. c. When urination is painful the term dysuria is ap- plied. The animals are restless, step to and fro, kick at their bellies, switch their tails, look back at the abdomen, groan, and void urine in drops or thin streams. The seat of the pain may be in the bladder or in the urethra, (concre- ments, strictures, inflammations). Sometimes the pain is caused by abdominal pressure in peritonitis. d. Retention of urine (ischury) is attended with accu- mulation of urine in the bladder. It is observed: 1r Pa obstruction of the wrethra, (eoncg. ments, swellings, strictures, tumors). In such cases the urine is voided in drops or thin streams, and frequently with symp- toms of pain. 2. ln paralysis-of the bladder; trequenms, associated with paralysis of the rectum and of the tail. e. Inability to retain urine, incontinentia urinae, occurs. as a result of paralysis or weakening of the sphincter of the bladder, or as a result of diminished sensitiveness of the urethral mucous membrane, thus suspending the reflex ex- citability of the sphincter. Most frequently observed in dogs. in the course of distemper (spinal affection) but otherwise rare in animals. II. Examination of the Urine. A. Macrostep ical Exams nat me a. The quantity of urine voided depends on the same conditions that regulate the frequency of voiding it: on the average horses secrete 4-5 liters, cattle 6-12 and dogs 14-1 liter per day. As a rule we determine the quantity of urine voided daily by making an estimate. Collecting the urine for actual measurement is cumbersome and, besides, not exact. A decrease in the quantity of urine is observed in: Profuse sweating and diarrhea. ~ we, URINARY APPARATUS. 171 Severe febrile diseases: Formation of large quantities of exudates in the pleural and peritoneal cavities. Weak heart and resulting diminished pressure. Acute and some forms of chronic nephritis. An increase in the quantity of urine occurs in: Diabetes insipidus [polyuria] (very marked) diabetes mellitus (which is rare), the daily average may be 40 liters. Most forms of chronic nephritis. During reabsoption of profuse exudates and in the criti- cal stage of severe infectious diseases. b. The color. The normal pigments in urine have not yet been thoroughly studied; although a number of them are known to exist, only one has been identified, viz. urobilin which is a product of bilirubin and is absorbed from the intestine. The color of normal urine is more or less yellow, increasing in darkness as the amount of urine decreases, and vice versa. In disease the color may become lighter or darker. We distinguish: yellow (pale yellow, light yellow, yellow), red (reddish yellow, yellowish red; red), and brown (brownish red, reddish brown, and blackish brown) urine. Other shades can also be recognized now and then. Pale, water-colored urine always occurs in polyuria (physiological or critical polyuria, diabetes). Red urine is produced by admixture of blood, hemaglo- bin or methemaglobin. The particular cause in each case must be determined with the aid of the microscope. Greenish yellow or brownish yellow urine or yellowish green foam is produced by bile-pigments. Dark colored urine (dark yellow or dark brown) is ob- served in all cases where the quantity has been reduced (con- centrated), but it may also be due to admixture of blood. Color due to medicines: carbolic acid, black; aloes and rhubarb, brownish red. c. Transparency of urine. Normal urine of the horse \ W2 CLINICAL DIAGNOSTICS. is always’ turbid; even the first few drops voided; toward the end it becomes even more so, frequently a light clay color. The turbidity is due to the presence of carbonates which precipitate in the bladder as the fluid becomes more or less condensed from reabsorption processes. When ex- posed to® the air in a vessel the turbidity increases because the soluble acid calcium carbonate (CO,H), Ca after, giving off CO, H,O is converted into insoluble calcium carbonate CO, Ca. This conversion occurs most rapidly at the surface of the liquid, causing the formation of a thin fragile mem- brane at that place (crystals of calcium carbonate). Small granules of lime also precipitate and constitute a part of the sediment. Not infrequently these lime granules are im- bedded in cylindrical masses of mucus that were molded in the uriniferous tubules. This normal turbid urine has an alkaline reaction. Clear urine of the horse is always abnormal and usually has an acid reaction; upon cooling, however, it may become turbid. The turbidities consist of precipitated. phosphates, oxalate of lime, and crystals of gypsum and uric acid salts; these dissolve upon heating the fluid. These salts can be recognized by means of a microscopical examination. Abnormalturbidity may be due to the presence of organized elements (cells) ; recognized by means of mic- roscopical examination. In the ox, sheep and goat the normal urine is clear when voided but becomes turbid on standing; precipita- tion of monocarbonates. The urine of the dog is clear in health, becom- ing slightly turbid after standing; due to precipitation of uric acid salts. . d. Consistency of urine. Normal urine of the horse is a rather thickish, slimy, viscous fluid; the viscosity being due to an admixture of mucine which occurs in the bladder. Besides this the cast off epithelial cells undergo a process URINARY APPARATUS. ive of swelling and thus increase the consistency of the urine. Acid horse urine is always less viscid than such as gives an alkaline reaction because the epithelial cells swell more in the former. All other domestic animals excrete a more watery urine. e. The specific gravity of urine is determined with an areometer, also called urinometer when specially con- structed for this specific purpose. The specific gravity for the horse is 1020—1050, average 1040, Go 1095 104s HC P0R0: dog “ 1020—1060, ve tO G, The specific gravity varies inversely with the quantity. Aside from this an abnormally low specific gravity is observed in diabetes insipidus (1001-1010) and in contracted kidney. An abnormally high specific gravity is observed in all cases where the amount of urine secreted is below the normal (fever) and in acute nephritis. High specific gravity and increased quantity is observed only in diabetes mellitus. Bo Chéemicalstxamination ‘of.the Urine. a. The reaction of the urine of healthy animals de- pends on the kind of food: herbivora (horse, ox, sheep, goat) secrete an alkaline urine, carnivora (dog, cat) secrete acid urine. In omnivora the reaction depends altogether on the food. In herbivora the alkaline reaction is due to the presence of acid bicarbonate of lime CO,H — Ca—CO,H. The organic acid salts of lime which are contained in the food contain the acid radicles of malic, tartaric, succinic and lactic acids. These latter, upon being absorbed into the blood, be- come oxydized into acid carbonates which have an alkaline reaction. . In carnivora acid phosphates. are the cause of the 174 CLINICAL DIAGNOSTICS. acid reaction; PO,H,Na and PO,H,Ca; these come. from the animal diet. Starving herbivora (hence such as live on their own flesh) have an acid urine. Except in cases like the one just mentioned an acid reac- tion of the urine of herbivora is always abnormal. It occurs when the contents of the small intestine have an acid reaction —intestinal catarrh. When the contents of the small intes- tine have a normal (alkaline) reaction the acid phosphates in the food are not absorbed, and consequently do not enter the circulation, but when the reaction is acid the opposite takes place, the acid phosphates are absorbed and excreted by the kidneys, but the organic acid salts are not absorbed. An acid reaction, therefore, depends on the presence of acid phosphates and, in case of herbivora with good appetite, points to the existence of intestinalcatarrh. Abnormal-alkaline reaction of the urine of herbivora and carnivora occurs in the course of fermenta- tions in the bladder (catarrh) and is produced by ammonia, which is a product of fermented urea: CO(NH.). + 2H50 > ==. €Q, (NHs)y = -2@NES> 4 COe a ae This ammoniacal fermentation can be recognized by its odor. A glass rod dipped in hydrochloric acid and held above the surface of the urine causes fumes to appear: NH,Cl = ammonium chloride. b. Albumin. Serumalbumin associated with serum- globulin is the usual form in which albumen occurs in urine. Albumoses, i. e., albuminous bodies not precipitated by boil- ing, may be found alone or in connection with the above, but are of rarer occurrence. (Pepton, propepton, hemialbumose). Occasionally hemoglobin and methemoglobin are found. These three groups are alone of practical importance. I. Albuminuria. Albumin never appears in normal urine in appreciable quantity; its presence must therefore always be looked upon as an indication of disease. As a rule the albumin is secreted with the urine, in the -- URINARY APPARATUS. | 175 kidneys (renal albuminuria), in rare cases its presence is due to admixture of blood or pathological products (acci- dental albuminuria). The fact that healthy urine contains no albumin in ap- preciable amount is explained by the impermeability of the renal epithelium to albumin and by the limited normal blood pressure. A change from the normal, such as may be brought about by pathological conditions of the blood or in- creased bodily temperature, may cause the appearance of albumin in the urine. Hence, renal albuminuria can occur: in Asea result of changes in. the renal-tis- sues due to inflammatory or degeneration processes; here we find not only albumin present, but the quantity of urine may be increased by the addition of albuminous exudate. 2 listo wertne.of artéerivgh pressure ; the lower the pressure the easier can a diffusion of albuminous substances take place. Pressure is lowered in weak heart or in venous congestion (organic heart disease, emphysema). Both conditions, after existing for some time, in addition produce changes in the renal epithelium. 3. In fever albuminuria is always present. Several factors are active here. The lowered pressure may alone account for it; the elevated temperature facilitates the pro- cess; continued fever produces changes in the renal epithe- lium. In case of severe infectious fevers a direct injury to the renal parenchyma probably occurs because in such cases the urine is very rich in albumin. 4. Mere changes in the normal composi- tion of the blood, in the absence of any change of blood pressure or change of structure of the kidneys, may bring about albuminuria (leucemia). From what has been stated wecanreadily See thatthe mere presence of albuminuria 176 CLINICAL DIAGNOSTICS. dees not necessarily indicate an affection of the kidneys. Accidental albuminuria is rare and of little importance. We assume that the albu- minuria is accidental when the filtrate contains large quantities of blood and pus corpuscles and epithelial cells and only a moderate quantity of albumin. In that case the proportionately small amount of albumin is supposed to result from par- tial solution of the cellular elements. Chemical determination of albuminuria. For this use freshly voided urine; if not clear, filter. 1. Koch’s test. Fill test tube to 4% its height with urine—if alkaline add a drop of acetic acid—boil and then add 1-10 its volume of dilute nitric acid (sp. gr. 1.18); a permanent precipitate indicates albumin. If a precipitate or turbidity produced by boiling dis- appears on addition of nitric acid it indicates phosphate of lime. 2. Heller’s test. The cold, filtered (and, if necessary, acidulated) urine is carefully poured on con- centrated nitric acid, so as to form a layer on the same. If albumin is present a white or cloudy ring is formed in the test tube where the urine comes in contact with Esba h's See : Albumini- the nitric acid. meter. a. A ce tic acid..ferro=¢y anaid-6 © a8 potash tést. To the filtered urine add a quan- tity of acetic acid and then a few drops of a 5% solu- tion of potassium ferrocyanide; the presence of albumin produces a white precipitate. If the addition, of acetic acid produces cloudiness mucin is present; in this case filter the urine. The mucin may also be pre- cipitated with acetate of lead before making the test. ; 4. In case only a limited quantity of urine is obtainable, the following method is recommended: Heat distilled water to boil- ing point in a test tube, add the urine drop by drop. If albumin. is present the drops _ become turbid in the water, and by continuing the addition of the urine, the water also becomes turbid. The methods here given suffice for the clinical demonstration of albumin. For a quantitative determination of the albumin preserve the tubes containing the precipitate and thus the sedi- ment, which consists of albumin, may be compared from day to day. For this purpose Esbach’s albuminimeter is both simple and practical. See fig. 40. [Similar tubes can be obtained in URINARY APPARATUS. trie g the United States.] It is used as follows: Fill the tube with urine to the mark U (urine), then add reagents sufficient to fill the tube up to the mark R (reagents) as follows: citric acid, 2.0 cc, picro-nitric acid 1.0 cc, distilled water 100.0 cc; put on a stopper, shake well, and let stand 24 hours. The sedi- ment which consists of albumin can then be read off in fractions of 1-10%. This instrument gives good results providing the amount of albumin present does not much exceed 0.2%; in that case dilute before testing the urine, say to 50% or 25%, by adding one or three volumes of water respectively; the result must then be multiplied by 2 or 4 according to the dilution. AIDUmintéria occurs: In all febrile diseases, especially in acute infectious dis- eases; contagious pleuro-pneumonia of the horse and in in- fluenza. : In acute and chronic affections of the kidneys. In venous congestion, hence in organic heart disease, emphysema and in the various. forms of heaves In blood diseases; leukaemia, anzemia. In nervous affections, epilepsy, eclampsia. II. Albumosuria. Examinations for albumoses have only recently become of importance, since simpler methods have been discovered. The occurrence of albumoses de- pends upon-entirely different conditions than those which produce albuminuria. Albumosuria is not caused by in- flammation of the kidneys, by disorders of circulation nor by anemia. Changes in the composition of the blood play the chief role here. Albumoses cannot be determined by boiling the fluid containing them, nor by the addition of acids. It is only in the absence of other albuminous sub- stances (albumin, globulin, mucin) and various other pig-- ments that their presence can be determined. Chemical determination of albumoses. Take 10 cc of unfil- tered urine and acidulate with a 20% solution of acetic acid. If the reaction of the urine is acid, two or three drops will suffice, if alkaline, it requires more. Add 5cc of a 20% solution of ace- tate of lead, boil and filter. Add to the filtrate a solution of caus- tic potash until precipitates no longer occur; it may require 15cc or more of the potash solution to bring about this result; it is im- 178 CLINICAL DIAGNOSTICS. portant to use sufficient potash solution as otherwise the reaction will not occur. The filtrate is now subjected to the biuret reac- tion: Add five or six drops of a solution of sodium hydrate, then add, carefully, one or two, or at the most, three, drops of a 10% solution of sulphate of copper. If albumoses are present a red- dish violet color is produced. This test is the simplest and most reliable for testing the urine of animals, since all substances that might otherwise have interfered with the test are removed. Schulz’s method is very simple and reliable. Filter the urine and add several volumnes of alcohol to precipitate all of the albuminous substances. Filter again and treat the residue (precipitate) with a stream of water; this dissolves the albumo- ses, if present, and then the biuret-reaction is applied to this solu- tion. Albumoses occur in the urine in the course of abscess formation in the internal organs of the body (Strangles), and as a result of the absorption of extensive exudates in the course of influenza of horses, peritonitis and pleuritis. The determination of albumoses is of clinical importance for the determination.of suspected abscess formation in inter- nal organs. . III. Hemaglobinuria. The fact that urine con- tains blood may often be recognized by its color alone; light red urine, resembling meat water, (oxyhemoglobin) is rare. As a rule it has a muddy brownish red color (methemo- globin). A diagnosis cannot be based upon the color alone, a chemical and microscopical examination is necessary. Chemical determination. Add caustic potash or soda until the urine is distinctly alkaline, then boil as in albumin test. This converts the hemoglobin into hematin, it is precipitated with the earthy salts and gives them a reddish brown color. The difference between oxyhemoglobin and methemoglobin must be determined with the spectroscope. Oxyhemoglobin gives two absorption bands between D and E, methemoglobin gives one between C and D. The presence of hemoglobin may be due to admixture of blood as such (hematuria) or to hemoglobin alone (hemo- globinuria). c Hematuria is recognized by microscopic examination of the sediment and the detection of blood corpuscles. The admixture of blood can occur in the kidney, the pelvis of the kidney, the bladder or the urethra. It occurs most fre- — URINARY APPARATUS. 179 quently in red water, acute nephritis, renal calculi, hemor- rhagic infarction of the kidney, pyelonephritis, acute cystitis, cystic calculi. Hemoglobinuria consists in the presence of hemoglobin (without the blood corpuscles) in the urine. The coloring matter is derived either from the blood or the muscles. Ac- cordingly we distinguish: a. Hematogenic or toxemic hemoglobinuria in red- water of cattle and in Texas fever, also in bad cases of pois- oning which cause decomposition of the red corpuscles, in extensive burns and in the course of severe infectious dis- eases. b. Myogenic or rheumatic hemoglobinuria in azoturia. c. Indican — indoxyl sulphate of potash C, H, N K S O,, occurs in all urine in moderate amount. It is de- rived from the indol C,H,N formed in the alimentary canal during putrefaction of albumin; indol is oxydized into in- doxyl C,H,N O H and then combines with sulphate of potash to form indoxyl sulphate of potash—indican. The urine of the horse contains on an average, 184 mg. per liter. If rapid putrefaction of albuminous substances takes place in the alimentary canal the amount of indican is in- creased; this is particularly the case in digestive disorders accompanied with diminished peristalsis, digestion and ab- sorption. Constipation of the ileum produces the largest amount of indican; impaction of the colon on the other hand, is attended with much less indican formation. Diarrhea is attended with diminished indican formation. Test for Indican. Mix equal parts of urine and pure nitric acid in a test tube, shake well; then add, drop by drop, followed by repeated shaking, a fresh solution of chloride of lime, this causes the formation and precipitation of indigo, recognized by its blue color. The addition of chloroform followed by thor- ough agitation, dissolves the indigo and the resultant blue solution settles at the bottom of the test tube. 180 CLINICAL DIAGNOSTICS. Quantitative Determination,. according to Bauer. Take 20 cc of the urine, slightly acidulated with acetic acid, precipitate with two, or if necessary, with four cc of a 20% solution of acetate of lead, filter through a dry filter paper; take 11 or 12 cc (enough to represent 10 cc of urine) of the filtrate and add an equal volume of Obermayer’s Reagent (solution of chloride of iron in fuming hydrochloric acid 2:1000). Upon the appearance of a dark coloration, always occurring in urine con- taining indican in any quantity, allow the solution to stand a few minutes, add 20 cc of chloroform and shake thoroughly for about fifteen seconds. After a short time, when the chloroform has settled to the bottom of the test tube as a clear blue solution, pour a portion of the chloroform into an absorption-test-vessel of 4mm depth, place the vessel upon a piece of paper adjacent to the colors. in the table, and by comparison determine which solution has a corresponding amount of indican. If the color corresponds in shade to that given in plate I, the urine contains 50 mg of indigo blue per liter, if it corresponds to the shade indicated in plate II, it contains 100 mg per liter, etc. If the shade is darker than indicated in plate VI, add an equal volume of distilled water, or, if necessary, several volumes; make comparisons as explained and multiply the result with two, three, etc., as the case may be. d. Bile Pigments. Choleurea. Under normal condi- tions bile pigments do not occur in the blood of animals. and are therefore also absent in the urine. Bile pigments. are always formed in the liver; if in the course of disease they are found in the blood (cholemia) .or in the urine (choluria) they must have originated in the liver. Bile passes into the blood as a result of the congestion of bile in the larger bile ducts from whence it passes through the lymphatics to the thoracic duct and the general circulation. Of the bile pigments, bilirubin alone occurs in the urine ; exposure to the air may convert this into biliverdin. Urine containing bile pigments is usually of a dark color, golden yellow, yellowish brown or greenish yellow, and the foam is yellow. The foam of urine free from admixture of bile pig- ments is white. Test for bile pigments. For the qualitative deter- mination of bile, we make use of Gmelin’s test. Into a test tube containing about three cc of concentrated nitric acid with an ad- URINARY APPARATUS. 181 mixture of fuming nitric acid (NO2) add a small quantity of the urine to be tested being careful that no mixing of the liquids occurs. (In case the urine has an alkaline reaction it should first be acidulated). If bile pigments are present, various colors will appear at the point of contact of the two liquids, of which the green color alone is characteristic. This antiquated test of Gmelin has been superseded by newer and better methods. The following are recommended: Rosenbach’s test. Filter the urine through a piece of white filter paper; to the paper thus saturated with the urine add a drop of nitric acid. If bile pigments are present, the characteristic color rings will appear encircling the drop. According to Dragendorf, this test is neatly performed by dropping some of the urine on a porous plate of earthenware and then adding the nitric acid as above. Salkowski’s test will sometimes give results when other tests fail. Add milk of lime or calcium chloride to the urine, collect the precipitate by filtration, wash with a stream of water, then dissolve the washed filtrate in hydrochloric acid and alcohol (5:100) and heat. Bilirubin, if present, is oxidized into biliverdin, producing a green color. Choleuria occurs: In retention of bile in the liver as a result of occlusion of the ductus choledochus in duodenal catarrh, presence of tumors, parasites, concrements. In lupinosis and phosphorus poisoning as a result of swelling of the liver and obstruction of the bile ducts. In all of these cases the feces are deficient in normal bile contents and as a result appear of a lighter color. When the bile secreted is of abnormal consistency (hypercholia), its flow ‘is interrupted and stagnation occurs. This results in the course of the destruction of large num- bers of red blood corpuscles; also in the course of haemo- globinaemia, lumbago, septicemia, pyemia, burns, internal hemorrhage, prolonged chloroform narcosis and _ similar poisonings. In addition to choleuria the feces also contain much bile. ‘ f { 182 CLINICAL DIAGNOSTICS. e. Grape sugar, Glycosuria, by means ordi- nartily employed can betetecr edin urine in:diseasée only, viz; in’ -diabet¢€s. ym ettatius. sin aotees this disease has been observed in a few suspect the presence of sugar in polyuria when the specific gravity of the urine is high. Chemical determination. [f albumin is present this must first be removed by adding acetic acid, boiling, and filtering. Then add to 10 cc urine 1 cc caustic potash solution; if this produces cloudiness, filter again. Then add about 3 drops of a 10% solution of sul- phate of copper. The appearance of a light blue color is in itself an indication of grape sugar; now heat the fluid, if grape sugar is present an orange yellow precipitate ‘which gradually extends downward is formed at the surface; this is an oxide of copper. Thus test ( Prosrments. tea) is by no means reliable for horse urine because the latter contains other bodies that have a reducing power: Pyrocatechin, etc. On the other hand, substances that prevent the reduction (or precipitation) of oxide of copper may be present. Pure grape sugar, when added to horse urine, can sometimes not be detected at all by means of Trommer’s test. In all cases of doubt we must therefore resort to the fermentationtest, as follows: Fermentation tube. Boil 20 cc of urine that has been freed from albumin, let cool and add a piece of baker’s yeast as large as a pea, shake thorough- ly, pour into a fermentation tube and close the latter with metallic mercury. Keep the tube at room temperature for 24-48 hours. If sugar is present fermentation will set in and the CO, thus pro- duced will collect in the top of the tube where the percentage is indicated by a graduated scale. C. Hi, O, = 2C, H; OH, 4+ € 0, Grape sugar = alcohol + carbondioxide. This test can of course be relied upon only when we instances only, in dogs it is common. We — =. URINARY APPARATUS. 183 are assured of the quality of the yeast and that it is free from traces of sugar. The phenylhydrazin test (C6H8N2) of V. Jacksch (Modifica- tion of Eschbaum) is very reliable for the urine of the dog (Regen- bogen). Mix 5 drops of phenylhydrazin, 20 drops of glacial acetic acid and 50 drops of urine in a test tube and boil gently for one minute; add 25 drops of officinal sodium hydrate solution and again raise to boiling point. Allow the mixture to settle for 12-24 hours and then make a microscopic examination of the sediment. If the urine contained sugar bunches of yellow, needle-like crystals of phenylglukosazone will be found. Fig. 42. Carbonate of Lime. Lactose occurs in the urine of cows advanced in preg- nancy, disappears after calving and reappears when the milk ducts become obstructed. C. Microscopical Examination oftheUrine. If the examination thus far conducted reveals any im- portant alterations, we complete the same with the micro- scope. Amicroscopicexaminationoftheurine in diseases of the urinary organs is of even greater importance than a chemical analy- SITS. 184 CLINICAL DIAGNOSTICS. Method. Pour some of the urine into a conical glass, previ- ously stirring the same with a glass rod to be sure to get an average sample. The urine is then set away to allow the solid particles to settle out; with horse urine this is a rather slow process. To prevent decomposition during the process of sedi- mentation, add a few drops of chloroform. Remove some of the sediment with a pipette and examine a drop on a slide, under the microscope. A. Crystalline Constituents of Urine. The reaction of the urine itself gives us a certain clue as to the character of the sediments. The normal alkaline urine of herbivora contains (see p. 151) carbonate of lime and small quantities of neutral phosphates Ca,(PO,).. -Such sediment does not dissolve when heat is applied, but the addition of hydrochloric acid produces solution, and develop- ment of CO,. The sediment which forms in the acid urine of carnivora consists of acid urates and acid phos- phates which dissolve on being heated. To determine accurately the nature of the crystalline sediment a microscopical examination must be made; the forms of the crystals indicate their nature. Amorphous salts can be recognized by micro-chemical tests only. a. Carbonate of lime crystallizes in globules with radi- ate markings, if the globules are large a concentric marking Fig. 43. Fig. 44. © By oe & ” Oxalate of Lime. Uric Acid. can also be observed. Carbonate of lime crystals also occur in form of breakfast rolls, dumb-bells, whetstones and crosses. Amorphous powder of carbonate of lime can be URINARY APPARATUS. 185 recognized by the fact that the addition of acetic acid causes an evolution of gas. b. Oxalate of lime crystallizes in square octahedra that have strong light-refracting power, other forms occur but are not characteristic. Acetic acid dces not affect oxalate of lime, hydrochloric acid dissolves it. It occurs in small quantities in alkaline urine, to a greater extent in acid urine, but is of no importance for diagnostic purposes. c. Uric acid and its salts are normal constituents of the urine of carnivora but traces of them also occur in the urine of herbivora. They commenly occur as an amorphous powder or in the form of crystals; whetstone, rhombic plates, pointed crys- Hippuric Acid. Triplephosphate Crystals. _tals, frequently occurring in the form of minute druses. A characteristic consists in the peculiarity that, on crystallizing, they attract the pigment of the urine which gives them a yellowish brown color. They dissolve in a solution of caus- tic potash, and they are precipitated in the form of rhombic prisms by the addition of hydrochloric acid. d. Hippuric acid and its salts form rhombic quadrilat- eral prisms and needles which dissolve in hydrochloric acid. Normal constituent of urine of horses. 186 CLINICAL DIAGNOSTICS. e. Triple phosphate of ammonia and magnesia PO, MgNH, crystallizes in coffin-lid forms, dissolves in acetic acid without giving off gas. Does not occur normally in freshly voided urine, but always forms when urine is exposed to the air for some time (fermentation). If found in fresh urine it indicates that ammoniacal fermentation has taken place in the bladder, cystitis, pyelitis. f. Sulphate of lime, gypsum, occurs occasionally and in small quantity in the form of columnar prisms or plates in acid urine. It is abundant after internal administration of sulphates (Glauber salts). Of no importance. B. Organized Elements of Urine. In the diagnosis of diseases of the urinary organs these are of the greatest importance. The addition of Lugol’s So- Sulphate of Lime. lution to the Semen is an aid in recognizing the cellular elements under the microscope. g. Epithelial cells in small number are found in normal urine, occasionally we find two or three pavement epithelial cells in one cover glass preparation. On the other hand the finding of epithelial cells from the uriniferous tub- URINARY APPARATUS. 187 ules (renal epithelia) is an exception under these conditions. Marked increase of epithelial cells is due to a pathological desquamation, hence is observed in catarrhs and inflammation of the membranes concerned. It is important to De duben to, Téecoonizé (the orieiny-of. the eelis: —by", their. form. Renal epithelium is roundish or more or less cubical and granulated with proportionately large granules and is much smaller than the pavement epithelium of the pelvis of the kidney, the urethra and the bladder. They occur singly or several united and not infrequently show signs of fatty degeneration. Their occurrence indicates a renal affection, but whether or not inflammation exists must be de- termined by further examination of the urine. Pavement epithelia from the pelvis of the kidney, the urethra and the bladder resemble each other and cannot be distinguished as to their particular source. They are large, flat, polygonal, transparent, nucleated pavement cells. Those coming from the surface layers of the mucous membrane are more roundish or polygonal, those from the deeper layers.are more oval, or cone shaped and may contain one or more protoplasmic projections that give ‘them a toothed appearance. If a considerable number of such cells are pres- ent a catarrhal condition of the corresponding mucous mem- branes is indicated. h. White blood corpuscles or pus cocci are spherical, granulated, nucleated cells that are cleared or become trans- parent when treated with acetic acid. They may have come from the kidneys or from the urinary tract; if from the kid- neys we also find casts, if they occur simultaneously with numerous pavement epithelia and crystals of triplephos- phate they come from the bladder. 188 CLINICAL DIAGNOSTICS. i. Red blood corpuscles, when found in the urine, have lost most of their coloring matter, are pale and swollen. Those coming from the upper portions of the urinary tract have undergone these changes to a greater extent than those coming from the lower portions. Thorough admixture of red corpuscles with the urine, thus retarding sedimentation of the former, points to renal hemorrhage; blood casts always point to renal hemorrhage. Large masses or clots of blood, not thor- oughly mixed with the urine, come from the bladder. An admixture of blood with the urine (hematuria) occurs in: 1. Diseases of the. kidneys * imjuries, hem orrhagic nephritis, embolic nephritis ; 2. Diseases of the urinary tract: pyelonephritis, cys- titis, red water of cattle, cystic calculi, cystic tumors, in- juries of the urethra. k. Urinary casts are cylindrical bodies that were molded in the lumen of the uriniferous tubules. In the urine of the horse we find similar structures under normal condi- tions; they consist of strings of mucus of variable thickness, sometimes macroscopically visible and granulated with de- posits of amorphous carbonate of lime. Addition of acetic acid causes the granules to disappear with the formation of CO,. In acid urine we find uric acid salts instead. These so called granule casts, lime casts, or cylinderoids have noth- ing whatever in common with true urinary casts. They are especially common in the transition stage from oliguria to polyuria. The true urinary casts are distinguished as follows: 1. Hyaline. casts, slender, transparent, homogeneous bodies of various sizes and not sharply defined contour. They are rare, occur in health as well as in disease, are of no diag- nostic importance and their origin is unknown. is wre » 2 URINARY APPARATUS. 189 2. Epithelial casts consist of renal epithelia agglutinated with exudates and forced out of the tubules by the pressure of the urine above them. Frequently Fig. red and white blood corpuscles eA are associated with them. Such cylinders, providing they occur in any appreciable numbers, al- ways indicate inflammation of the kidneys. These epithelial cells may also have undergone fatty degeneration. If they con- x pple tain no cells they are called Granular Casts. granular casts, and have the same significance as the epithelial cylinders. 3. Blood corpuscle casts are formed of agglutinated red corpuscles and are due to renal hemorrhage. If these casts contain many white corpuscles they indicate purulent inflam- mation (pus-casts). 1, Examination for micro-organisms is of value in case of fresh urine only, because urine that has been standing for some time will soon become filled with great masses of bacteria and mold fungi from the air. Large numbers of bacteria in fresh wrine occur in pyelonephritis bacteritica and in chronic cystitis. Bacillus pyelonephritis bovis will stain according to Gram’s method. A cover glass preparation is made from.the sediment of the urine, stained with gentian violet, rinsed with water, a few drops of Lugol’s solution (lod. 8, Pot. Iod. 4, Aqua 100) added, then decolorized in alcohol. All bacteria that stain according to Gram’s method have now assumed a deep blue color; while all the rest are decolorized. Bac. pyeloneph. appears as a rod with rounded ends, 2-3u long and 0.7u in diameter, evenly stained and usually occurring 1n little groups. ait bend So CeoX III. Examination of the Urinary Organs. Topography. In the horse and cow the left kid- ney only is accessible for palpation from the rectum, the right kidney lies further forward and cannot be 190 CLINICAL DIAGNOSTICS. reached by the hand. In the horse the left kidney extends back to about four inches behind the last rib and its inner border is separated from the median line by about the same distance. In the ox it is loosely suspended below the lateral processes of the first lumber vertebrae. Sometimes it may be shifted over to the right side. In the dog the kidneys lie in the lumbar region, the right somewhat more anterior than the left; hence the left kidney can be more easily felt from the outside than the right kidney. In palpating the kidneys follow the general rules for this method of examination (see p. 23). In pyelone- phritis of the ox the kidneys are enlarged and firm, the ureters distended and their walls thickened and firm. Bxamination “of the “bladder, per secu in the horse and ox, is quite practicable; in the dog the ex- amination must be made by external palpation. The extent to which the bladder is filled is of importance; if empty, in the horse and cow, it represents a soft pearshaped body lying on the floor of the pelvis. If well filled it can be felt as a dis- tended body projecting far beyond the anterior border of the pelvis. To feel it the hand need not be inserted much fur- ther than to the wrist. The contents of the bladder can be removed by a steady but moderate pressure applied with the hand, or by means of the catheter; this may be important to determine whether evacuation is possible. If the bladder is ruptured, which is most common in oxen with urethral calculi, it is permanently small and flabby. Cystic calculi and tumors in the bladder can be recog- nized with certainty only when this organ contains little or no fluid contents. ‘Examination of the .urethra | is of conse- quence in male animals, particularly in oxen, when the pres- ence of calculi may be suspected. As a rule these are lodged in the upper or lower portion of the S shaped curve. Pressure exerted at the point where the obstruction is located produces pain. As long as the bladder is not ruptured urine may drib- ble from the distended urethra. Unfortunately catheteriza- tion is impossible in the ox (sharp curves and narrow lumen URINARY APPARATUS. 191 of urethra) ; in the horse and dog this examination is easy and reliable. Diseases of the Urinary Apparatus. Passive hyperaemia of the kidneys occurs as a result of chronic heart and lung troubles. Urine is decreased, sp. gr. increased, albumin present. Symptoms more conspicuous after exertions. Acute diffuse nephritis. This is primary only in cases of poisoning with irritating substances, otherwise it is a symptom of severe infections. Dysuria, stranguria, pain in the region of the kidneys, stiff gait and crooked back. Considerable diminu- tion of renal secretion (anuria), thick and viscid, turbid, high sp. gr., acid, much albumin. Microscopic examination most important: granular casts, renal epithelia and blood corpuscles. Stupefaction, difficult breathing, oedematous swellings. Nephritis suppurativa. Secondary affection and usually of less importance than the primary disease. Intermittent fever, exhaus- tion, emaciation, urine contains albumin, pus corpuscles and micro- organisms. Chronic nephritis. No fever, develops very slowly. Anorexia, exhaustion, emaciation. Pulse strong and hard, heart hypertro- phied. Increased amount of urine, low sp. gr., amount of albumin slight, few epithelial cells and casts. Cystitis, inflammation of the bladder. Continuous efforts to urinate, hence small quantities or only a few drops are voided at a time. Urination painful, restlessness, groaning, animals remain for a long time in a “urinating attitude.” Urine cloudy, alkaline, slimy or purulent sediment, ammoniacal odor. Pus corpuscles, red blood corpuscles, numerous pavement epithelia, phosphate of ammonia and magnesia. Retentio urinae. Retention of urine. Complete (ischuria) or partial suppression of urination; in the latter case it is voided in drops and with symptoms of pain. Palpation of the bladder very important: distention, pain on pressure. Animals indisposed, in- active, do not lie down, appetite diminished, pulse increased, sweating. After rupture of bladder has occurred the pains disap- pear, animals feel more at ease, bladder is-empty. , Then come chills, high fever, urinous odor of transpired air. Incontinentia urinae. Paralysis of bladder. Involuntary flow of urine, especially during motion. : Hematuria is a chronic productive cystitis of the ox, with tendency to hemorrhage. Blood corpuscles and clots in the urine. Hemoglobinuria of the ox. Hemoglobinemia. Fever, par- tial loss of appetite, diarrhea. Urine light red to dark red, foams readily, urination painful, reaction at first acid, later on alkaline, contains hemoglobin, on boiling coagulates as gelatinous mass. Pyelonephritis bacteritica boum. This is a chronic purulent inflammation of the ureters and pelvis of the kidneys which spreads 192 CLINICAL DIAGNOSTICS. to the kidneys and is caused by a specific bacillus. Gradual ema-- ciation and general depression. Intermittent fever. Urine thick and slimy, cloudy, gray or grayish brown, white and red blood corpuscles, casts, numerous pavement epithelia, crystals of triple phosphate, and bacilli, Bacillus pyelonephritidis boum. Stain according to Gram, 2-3 micra long, 0.6-0.7 micra in diameter, non- motile, straight or slightly bent, rounded at the ends. Diseases of Tisste Metabolism. Diabetes insipidus, polyuria, pissing, is an independent disease in which large quantities of clear watery urine are passed continu- ously. Daily quantity of urine passed equaling as high as 30 liters. Urine as clear as water or slightly yellow, acid, sp. gr. 1001-1010, no albumin, little indican. Diminished appetite, desire for alkalies, [earth, etc.] emaciation. Diabetes mellitus, sugar in the urine, is very rare in horses, more common in dogs. Polyuria, ravenous appetite and thirst, rapid emaciation. Urine has high sp. gr., 1024-1045, and contains grape sugar. 10. The Sexual Apparatus. Most of the organs of the sexual apparatus may, for the greater part, be subjected to direct inspection and palpation; their examination should be conducted according to general rules, care being observed that no parts are overlooked. For evident reasons the female sexual organs are more frequently affected with diseases than those of the male. Most of these diseases belong to the field of obstetrics. I. Abnormally increased sexual desire manifests it- self not only by sexual excitement but also by psychic disturb- ances and altered sensibility, these often resembling diseases of the central nervous system. In females this condition is known as nymphomania, in males as satyriasis; continued erections of the penis is called priapism. Mares are usually very ticklish and easily excited, if touched with the hand or harness they squeak or cry out, switch their tail, back up against persons or against the wagon tongue, kick, urinate, and can be used for their regu- lar work only when special care is exercised. In rare cases they may act like dummies (general depression of the senso- rium) and show symptoms of hyperesthesia. SEXUAL APPARATUS. 193 Cows show symptoms of great restlessness, are very excitable, bellow frequently, attack strangers, etc. Milk se- cretion is reduced, the milk has a bad taste and sometimes curdles when boiled. In horses and bulls _ satyriasis manifests itself by restlessness and excitable, sometimes vicious, actions. In many cases the cause of these conditions cannot be as- certained; in cows tuberculosis of the ovaries, in horses cryp- torchism, is often the cause. Aone Mie Ler eon a tae Or o-g tis: II. The vulva. In bitches we observe swelling of the vulva and a bloody mucous discharge at the oestral period. In cows a tough glassy mucus is discharged just before parturition. This mucus comes from the neck of the uterus which it served to close. A slight swelling of the vulva occurs in vesicular eruption of this region; small vesicles the size of a millet seed, and swelling may also occur in the adjacent skin in this condition. In puerperal septicemia the vulva swells conspicuously. In torsion of the uterus the vulva is retracted and drawn into folds; however, exploration per vagina is necessary to definitely determine this condition. Dischatec “from the intertor commtis- sure of the vulva and soiling of the surrounding skin and tail are observed in: a. Catarrh of the vagina and uterus. In chronic catarrh (fluor albus) the discharge is of a thick slimy character and glassy; in acute catarrh the discharge is of a thin slimy character and discolored. . b. Retention of the afterbirth; an ill-smelling, discolored fluid mixed with fragments of the fetal membranes is dis- charged. c. Vesicular eruption; the discharge is slight, slimy or purulent, sometimes mixed with blood. d. Tuberculosis; slight, chronic, muco-purulent discharge containing tubercle bacilli. 194 CLINICAL DIAGNOSTICS. III. Vaginal mucous membrane. Whenever there is discharge from the vagina the vaginal mucous membrane should be examined. Method. Grasp the tail near its root, raise it well up, and let it rest on the back of the other hand, thus leaving the fingers of that hand free to open the lips of the vulva. In order to examine deeper-lying parts an assistant should hold the tail and the opera- tor can then insert his whole hand, which must be previously covered with oil. After thorough palpation in this manner the other hand may also be inserted, the vaginal walls spread apart, and their mucous membrane inspected; here artificial light may be of advantage. A vaginal speculum is not absolutely necessary for these examinations. By means of direct examinations like these, affections of the vagina can best be observed and their character deter- mined. In. vesicular eruption yellowish gray nod- ules, vesicles or ulcers, the size of-a millet seed, are found on the slightly and diffusely reddened mucous membrane. After healing, light specks that indicate the position of former vesi- cles and ulcers can be observed for some time. In torsion of the uterus the vagina is con- tracted, and the mucous membrane is drawn into twisted folds. The examination of the uterus and the explanation of changes in that organ belong to the field of obstetrics. IV. The udder. Inthe examination of cows the udder’ must never be neclected aie quire at least as to quantity and quality of the milk. Observe the color of the skin and note any changes that may have taken place. The teats of cows and sheep may be affected with pox, in foot and mouth disease the teats of cows may be covy- ered with blisters; we also find milk fistulae. Observe also the relative size of the different quarters of the udder and the condition of the surface; note the size, position, and direction of the teats. In palpation each quarter should be sep- arately felt, its size and consistency noted and sensi- tive or knot ted areas observed. The teats should be soft and the milk canal should not be felt; if thickenings or swellings exist, their location, extent, size and SEXUAL APPARATUS. 195 form should be determined. Finally, milk every teat in order to determine the ease with which the fluid can be drawn, no- tice the size of the stream and the character of the milk, whether it is clotted or bloody: A microscopical ex- amination of abnormal milk is not : necessary but may be of value in some cases. To determine wheth- er a cow is “fresh’’ a microscopical examination of the milk for the col- ostrum bodies or corpuscles must : be made. - Fig. 50. Colostral Milk. Harpooning the udder according to Ostertag. The operation may be performed on the standing animal, but bet- ter results can be obtained if the animal is cast and secured. Wash the field of operation with soap and water, rinse with 2 per cent. lysol solution, following this with 50 per cent. alcohol. With hooked forceps grasp the skin overlying the suspicious area in the udder and at the fold thus pro- duced incise the skin and underlying facia with scissors, grasp the tissues with the thumb and index finger of the left hand . and insert the harpoon with the right. When the suspected tissue has been reached give the harpoon a half turn and withdraw it quickly. The cutaneous wound is closed with artery forceps which are allowed to remain ten minutes, whereupon the wound is sealed with iodoformcollodion. Cows thus treated will give bloody milk for a few days, but if carefully performed the operation is not dangerous. Tubercles, if contained in tissue thus removed, can usual- ly be recognized with the aid of a simple lens. If the exam- ination gives negative results it is advisable to repeat the op- eration. Tubercle bacilli can always be demonstrated in the tubercles. In this method a positive diagnosis alone is of any value. We can not rely upon negative results. This method is of 196 CLINICAL DIAGNOSTICS. value in cases of suspected tuberculosis where we fail to get a tuberculin reaction, or when a suspected quarter is dry and the possibility of a direct examination of the milk is excluded. Bacteriological Diagnosis of Udder Tuberculosis according to Ostertag. The most reliable means of recognizing tuberculosis of the udder consists in the inoculation of Guinea pigs with a sample of milk from the suspected udder. To obtain reliable results the milk must be procured with proper precautions: Wash the udder with warm water until it is clean, follow this. with 50 per cent. alcohol and then dry with absorbent cotton. Discard the first ten CC of milk drawn. One CC of whole milk is used for the inoculation. Inject this into the muscles of the inner posterior region of the thigh. Upon the appearance of firm, hard, painless and well defined nodules the size of small peas or larger, representing the lymph glands near the point of inoculation, the animals may be killed. These nodules may appear as early as the tenth day after inoculation. If the nodules do not make their appear- ance, the Guinea pigs are killed at the end of six weeks. The presence of tubercle bacilli in the lymphatic glands-or in the internal organs demonstrates the existence of tuberculosis. Bu. Miia Fe Sect ad Ot 2 ase V. Diseases of the male sexual organs are usually of — a surgical nature. In vesicular eruption we find vesicles, pus-: tules and ulcers, or scars, on the penis. To examine stallions or bulls they may be led up to a mare (or cow) which usual-_ ly results in voluntary protrusion of the organ. In bulls manipulation with the hand may answer the same purpose. In glanders the testicles may reveal the presence of knots. Diseases of the Sexual Organs. Torsio uteri, torsion of the womb, of interest in internal medi- cine only when parturition or pregnancy is excluded. Animals are restless, kick belly with hind feet and have pains of labor. Exami- nation of vagina gives necessary information. SEXUAL APPARATUS. 197 Vaginitis (colpitis), inflammation of vagina. Symptoms vary much, according to degree and character of the affection. If in- flammation is severe, general health is affected. Animals make fre- quent attempts to urinate; small quantities of urine passed at a time; animals remain long in a “urinating attitude.” Examination of vagina gives necessary information. Endometritis, inflammation of the womb. Follows parturition; intensity of disease varies. General health more or less disturbed, fever, discharge from vagina which varies according to character of inflammation, is observed particularly when animals lie down. Soiled tail, examination of womb according to general rules of obstetrics is always indicated. Mastitis, inflammation of udder, garget. fe Mastitis interstitialis- -Fever and hot, rather firm and painful swelling of udder. Quantity of milk decreased, quality not affected. 29. Mastitis catarrhalis Udder evenly enlarged, soft and elastic, hot. ~Teats swollen, hot, sometimes reddened. Milk resembling whey. Fever, loss of appetite. Infectious catarrhal mastitis is a special form of catarrhal mastitis, infectious, milk yellowish. Usually all four quarters affected. 3. Mastitis parenchymatosa. As a rule only one quarter affected. Fever, appetite diminished, rumination inter- rupted, constipation. One-quarter of the udder enlarged, firm, hot, sensitive. The teat of the affected udder is usually free from inflammatory symptoms, the milk secretion is greatly decreased, yellowish, contains muco-purulent flakes which usually contain numerous streptococci. 4. Mastitis tuberculosa. A few nodular enlarge- ments, otherwise the udder is tough and flabby. Supra- mammary glands enlarged. Tubercle bacilli in milk. Vesicular eruption [coital exanthema] is an acute infectious vesicular exanthema of the mucous membrane of the vagina and the penis. Period of incubation 3-6 days. The vesicles develop into little ulcers. Mal du coit [seen in U. S. in imported stallions]. Period of incubation 8 days to 2 months. Swelling of the vulva and penis, formation of vesicles and ulcers. Frequent attempts to urinate, increased sexual desire, urticariform swellings of skin, paralysis of hind parts. II. The Nervous System. Diseases of the central nervous system can be recognized only by the disturbed functions of its parts, a physical exam- ination of the diseased parts is out of the question. We must therefore subject each function to a careful examination and draw conclusions as to the parts affected from the character 198 CLINICAL DIAGNOSTICS. of the disturbed physiological processes and conditions. To diagnose diseases of the central nervous system requires a knowledge ,. ofthe’ “Loication- of? thle’ “pra ner pam Lines tons. Preliminary remarks on anatomy and physiology. All efferent (motor) psychic (conscious and volitional) fibres originate in the cortex of the cerebrum, and all sensory fibres and fibres of special sense that conduct perceptible impulses terminate in the cortex of the cerebrum. The voluntary motor fibres (psycho- motor or cortico-muscular tracts, or simply pyramidal tracts) course from the cortex, through the pons Varolii to the anterior pyramids of the medulla oblongata. Here most of these fibres cross over to the opposite side (motor decussation) and go to the motor nerves of the extremities, through the lateral columns of the spinal cord. A few fibres that do not decussate as above described course along the anterior columns of the spinal cord and gradually pass over to the other side like the rest, but through the white commissure along the course of the cord. Hence destructive processes in one hem- isphere result in notonr anid. sensory patra eye sis on the opposite s iidies\ (ont, “the, Sb/od-y.- The cerebral hemispheres are also the seat of all psychical ac- tivities; they are the seat of thought, volition and sensation. Many motor centers are also found in the cerebral cortex and hence inflammatory conditions of this region may be attended with convulsive movements of the muscles. The midbrain (crura cerebri, corpora quadrigemini and optic thalami) is the seat of the entire mechanism, harmony and equilib- rium of all motions. Animals with both hemispheres removed, but with the midbrain intact can retain their equilibrium under the* most varied conditions. Inflammatory irritation of the midbrain produces involuntary movements. The cerebellum harmonizes or co-ordinates the movements of the body by regulating the succession of muscular contractions. The spinal cord, besides conducting impulses to and from the brain, contains reflex centers which, when stimulated by afferent impulses, cause certain kinds of important movements (defense, flight, etc). These movements are carried out independent of any action on part of the brain, as is easily proved on decapitated ani- mals or where the spinal cord has been cut through. The thus isolated cord is as prompt as ever in producing reflex actions. The lumbar cord is the special center for defecation and urination, which also depend on reflex activity. To be able to recognize normal conditions as well as to determine the presence and seat of pathological changes in the central nervous system, observe the following points : NERVOUS SYSTEM. 199 PL Psyehicoihunmetions. Loe ers ioe baat ys Hi Motility. I. Psychic Functions. Since the cerebrum and particularly its cortex is the seat of all psychic activities, disease of the same must interfere with normal thought, feeling, and volition; movements, sen- sations and perceptions of peripheral parts occur unconscious- ly. ._ The ‘general mechanism, harmony and equilibrium of muscular movements may be entirely intact in this condition. ~ Mental disturbances occur in a great many infectious dis- eases, in febrile diseases in general, in the course of intoxica- tions (poisonings) of varied kinds, and in local diseases of the brain itself. Therefore, mental disturbances can iP otaseribed toslocal causés. daly. w 1 Me the possibility~of a general cause i s eliminated. The disturbances in question consist of abnormal excitability or of abnormal depression. Mental excitement is the result of cerebral ir- ritation — as observed in acute cerebritis. Horses become restless, neigh, refuse to be led, try to tear loose from the halter, step to and fro, paw, climb up into the manger, are anxious and easily frightened. Cattle bellow, snort, shake their heads, jump around, and into the manger. Dogs mani- fest their restlessness by an aimless running about, barking, howling and even biting. Pigs squeal, crawl under the litter, run about, climb over obstacles and jump up against walls. Similar symptoms are also observed in rabies, acute tubercu- lar meningitis, malignant catarrhal fever of the ox and in anthrax. ; Symptoms of mental depression frequent- ly follow those of excitement. The animals droop the head, rest it on the crib or feeding rack, eyes half closed, take no 200 CLINICAL DIAGNOSTICS. interest in their surroundings, do not recognize familiar per- sons, run against obstacles, etc. In feeding they grab the food with the incisor teeth, chew slowly and “languidly,” stop without a motive when food is still in the mouth and between the lips. In drinking they plunge their mouth into the water and often “chew” it. It is hard to make them move,. they step around clumsily, won’t “get over” when commanded to Horse with chronic hydrocephalus. do so; they are hard to guide when driven, try to stay over on one side; if badly affected they cannot be used for serv- ice because they do not recognize commands. According to the degree of mental depression we recognize: Dullness ; Somnolency, sleepiness, drowsiness, from which the pa- tient is easily roused. Sopor, profound sleep, rousing difficult. Coma, profound insensibility. A dulling of the psychic functions occurs in; lll NERVOUS SYSTEM. 201 1. All acute infectious diseases; contagious pleuropneu- monia, influenza, Rinderpest, anthrax, horse, distemper, dog distemper, septicemia, Rothlauf of swine, etc. 2. All severe febrile diseases. 3. Chronic affections of the brain: blind staggers, turn- sick of sheep, second stage of acute cerebritis and cerebral hyperemia. , 4. Poisoning with narcotics. 5. Icterus, uraemia. 6. Chronic gastric and intestinal affections of the horse. Dizziness (vertigo) and syncope (fainting) are sud- denly occurring temporary disturbances of conscious- ness and loss of equilibrium. Animals suddenly become un- steady in gait or standing position, sway, reel, stagger and sometimes fall to the ground. The cause may consist of the presence of parasites in the brain, hemorrhages, tumors, ab- scesses, passive cerebral hyperemia (compression of jugulars by harness), aortic insufficiency or stenosis, also the action of ‘glaring light (“ocular vertigo”), irritations of the external auditory meatus, and of the nasal mucous membrane by para- sites, finally also of poisoning with certain plants. II. Sensibility. The sensibility is tested by artificial stimulation, sticking a finger into the ear, flipping the nose with the finger, stepping on the coronet, pin pricks. In testing the general sensibility observe that no inflammatory condition exists in the part “tested.” Peripheral irritation may give rise to spinal reflex actions, e. g. the hoof may be raised without any conscious- ness of the act on part of the animal either as to the act or stimulus producing it. For this reason the gen- eral behavior of the whole animal must ie ppaket ¢htolaccoaumt dn testing its sensibility. If dogs cry out during such an examination, or test we may conclude that conscious feeling exists. > 202 CLINICAL DIAGNOSTICS. Decreased sensibility is called hypesthesia, absence of sensibility is called anesthesia, abnormally increased sensibil- ity is called hyperesthesia. Sometimes sensibility is retarded ; this is indicated when the reaction occurs an unusually long time after the stimulus is applied. Hyperesthesia is most frequently seen in old ticklish mares, also in lumbar prurigo of sheep and in the first stages of cerebritis. Diminished sensibility is observed in chronic affections of the brain, immobility, tumors, second stage of acute cerebritis, parturient fever, second stage of cerebro-spinal meningitis, and in narcotic poisonings. III. Motility. In morbid conditions affecting the cerebral hemispheres only we observe no serious disturbances in motility because the mid brain and the cerebellum are the seat of co-ordinated movements. a. Spasms, or cramps, are involuntary muscular con- — tractions. Spasms of short duration, alternating with relaxa- tions, are called clonic spasms; if they are very slight, uni- form, rapid, and locally limited we call it trembling; if they affect large areas or extend over the whole body we call them convulsions. Clonic spasms are observed in partial and gen- eral epilepsy and in inflammatory affections of the brain and spinal cord (common after dog distemper). Tonic or tetanic spasms are muscular contractions that continue for some time without relaxation. They are characteristic for tetanus (lock- jaw) and strychnine poisoning, causing the body to assume a stiff position, especially the head, neck, ears, back, and tail. The mouth is closed as a result of contraction of masseter muscles, nostrils distended “trumpet like.’ Stiffness of the back without bending is called orthotonus, depression of spinal column and bending back of head toward withers, opis- thotonus, spasms of the masseter muscles, trismus, spasms of \e NERVOUS SYSTEM. 203: the extensors of the limb, sawhorse attitude, muscles of the eye, prolapsus of the membrana nictitans, cramps of facial muscles, risus sardonicus (canine laugh). Tonic spasms in connection with clonic spasms are also observed in cerebro- spinal meningitis (cramp of the neck). All spasms have their origin in the cortex of the cerebrum, the pyramidal tracts, or in the anterior cornua of the spinal cord. Spasms originating in the cerebrum are attended with mental disturbances (epilepsy), not so in case of spinal spasms. Reflex spasms are due to irritation of peripheral sensory nerve endings and are of spinal origin; they are observed when animal parasites occur in the intestines, during the pe- riod of shedding teeth, and in painful gastric and intestinal affections. b. Involuntary movements may be due to irritation of one of the cerebral hemispheres or to paralysis of the op- posite one, also to affections of the midbrain or of the cere- bellum. They always proceed from circumscribed lesions and are therefore known as “symptoms of local origin.” Some- times involuntary movements occur in the muscles of the body and extremities, or the asual voluntary movements assume an involuntary character. In such cases animals manifest a desire to “go ahead,” trot with head raised or lowered, run against obstacles; if they get into a corner they are at a loss. as to how to get out, frequently they fall down in such cases. Sometimes, but more rarely, they walk backwards. If the cerebral disturbances are unilateral the symptoms tend to be the same. The animals walk in a circle (Reitbahnbewegun- gen, riding school movements:) they lie down and roll, turn- ing on their long axis, or they fix their hind feet as a pivot, and walk around with their forefeet — move like the hands of a clock. Involuntary movements are most frequently ob- served in chronic and acute hydrocephalus, abscesses, hem- orrhages, tumors and parasites in the brain. Turn sickness, [gid], of sheep is thus characterized. 204 CLINICAL DIAGNOSTICS. * In so called riding school and clock hand move- ment the coenurus is usually‘located on the surface of that half of the cerebral hemisphere facing the center of the circle; *some- times on the optic thalamus of the opposite side. _ If affected sheep move forward with the head down and trot- ting motion of the forelimbs (trotters) the seat of the parasite is at the anterior end of the hemisphere or on one of the corpora striata. Staggering gait, reeling, dizziness (staggerers) indicate that the parasite is located in or on the cerebellum. When the coenurus is located at the base of the cerebellum it causes rolling movements of the animal. If the animals hold their heads up high or backwards and move forward rapidly, fall down (sailors), the coenurus is located in the posterior portion of the cerebrum. c. Disturbances of the muscular sense. The muscu- lar sense enables us to recognize the position of the limbs and the extent of passive and active movements. As long as equi- librium is not affected, an animal suffering from disease of the cerebrum can be made to assume unphysiologic positions without being conscious of it, in fact they do this themselves, they interrupt movements before they are completed or go to the opposite extreme and make more extensive move- ments than occur normally. In acute cerebritis and staggers horses Someeainee assume peculiar positions of the legs, cross them, set them close to- gether or one before the other ; one may be set unduly forward, the other unduly under the body. When such positions are produced passively the animals make no attempts to change them. In moving about they raise their legs unusually high, (groping, wading walk) or not high enough and thus stumble when they meet obstacles. d. Paralyses consist in partial or complete loss of power to bring about muscular contractions. Complete in- ability to move is called complete paralysis; if there is simply diminished _ power to produce movements we call it incomplete paralysis (paresis). According to the origin of the paralysis we distinguish cerebral, spinal, and peripheral paralyses. Paralysis of one side of the body is called hemu- NERVOUS SYSTEM. 205 plegia, of both sides (both hind legs) paraplegia; paralysis of a single organ or part is known as monoplegia. Hemiplegia has its origin in the brain, paraplegia in the spinal cord, monoplegia in the motor centers of the brain or, and as a rule, in peripheral nerves. In cerebral paralyses the cranial nerves are frequently also affected and psychic disturbances are present ; we observe cerebral paralysis in 1.. Brain diseases: acute cerebritis, cerebro-spinal menin- gitis, abscesses, hemorrhages (apoplexiés), tumors, parasites. 2. Infectious diseases: rabies, mal du coit (always), ex- ceptionally in horse distemper, and in contagious pleuro-pneu- monia of the horse. 3. In intoxication diseases: parturient fever, mycotic intoxications, brine poisoning. Spinal paralyses are usually cases of paraplegia which affect all nerves beyond the point of injury or dis- ease and are always attended with sensory paralysis. Psychic disturbances are wanting. They are caused by: 1. Spinal fractures ; 2. Diseases of the cord: inflammation, hemorrhage, tu- mors, parasites ; 3. Infectiotis diseases: dog distemper, rabies, rarely in contagious pleuro-pneumonia of the horse. Spinal paralyses also affect the veg- etativ.e Drameh-of the nervous system, since the lumbar cord is the center for the production of the contractions that produce defecation and urination. Hence paralysis of the rectum and bladder with the inevitable results (impaction of rectum and distention of bladder with urine) occurs. See pp. 137 and 148. Peripheral paralyses are for the most part of surgical interest. In internal medicine paralysis of the fa- cial nerve, because it interrupts normal feeding, and paralysis of the recurrent nerve, because it disturbs respiration, are of 206 CLINICAL DIAGNOSTICS. interest. These two morbid conditions have been considered more in detail elsewhere. e. Reflex excitability. Reflex movement is a tem- porary muscular contraction brought about by stimulating a peripheral (sensory) nerve ending. In order that reflex move- ment may occur the sensory and motor nerve fibres and the reflex center must be intact. Reflex movement is limited to one muscle or muscle group (simple reflex) or it may affect the whole body and in that case may be inco-ordinated (reflex spasm) or co-ordinated (motions of defense or flight). The following physiological reflexes are of clinical importance: a. Reflexes of the Brain. 1... Closing ofthe veyelrdsis | Uhessenaam fibres (trigeminus) of the cornea, conjunctiva and of the skin in the neighborhood of the eye conduct impulses to the medulla oblongata and from that point the facial nerve produces con- traction of the orbicularis of the eyelids. 2. s@nsitiveness. to, Ire ht on pate aoe the pupil:.lecreased reflex €x citabieuee occurs in tetanus and in strychnine poisoning. Contracted pupil is observed in morphine, eserine and pilocarpine poison- ing. 5 Decreased. reflex excitability ieee mental depression, excessive pain and in dyspnoea of high degree. Dilated pupil (mydriasis) occurs in paralysis of the optic nerve (black cataract) and in paralysis of the oculo’ motor nerve (atropin poisoning). b. Spinal Reflexes. 1. Skin reflexes consist of muscular contractions fol- lowing irritation of sensory peripheral nerves, e. g. manipu- lation or percussion of the walls of the chest or the flank. Touching the anus causes contraction of the sphincter ani NERVOUS SYSTEM. 207 (anal reflex) ; touching the skin at the perineum results in drawing up of the tail and depression of the croup. 2. Mucous membrane reflexes. Pressure upon the larynx or the upper rings of the trachea produces a cough (laryngeal reflex). 3. Tendon reflexes. Striking the flexor tendons of the carpus, the inferior patellar ligaments or the achilles ten- don causes the animal to raise its legs. 4. Normal defecation and urination. Spinal reflexes are diminished or absent in disturbances of the reflex arc, hence in peripheral paralyses and diseases of the spinal cord. Increased reflexes are observed in hyper- esthesia, strychnine poisoning and in diseases of the reflex inhibitory centers of the brain. Diseases of the Nervous System. Cerebral congestion. Hyperemia of short duration, fluctuat- ing in character and entirely curable. Begins with stage of ex- citement; animals are restless, try to force themselves forward or sideways, rear, kick, shake their heads, walk backwards, tear the halter strap, etc. After a few hours the stage of depression sets in: animals are stupefied, sad look of the eye, ‘head down, disregard familiar commands. Acute inflammation of the brain, acute hydrocephalus. Differs from congestion in itS more pronounced symptoms and its longer duration. In the second stage (that of depression) we observe abnormal attitudes and movements, staggering, sometimes falling down and inability to get up again; sometimes attacks of raving madness. Temperature frequently increased, but fever may be absent. Feeding always more or less interrupted, especially the manner of feeding. Blind staggers. Morosis equorum. Hydrocephalus chronicus. This is a chronic apyretic incurable affection of the cerebrum which manifests itself by mental disturbances, and by impaired locomo- tion and sensibility. Pulse strong and full, number of heart beats never increased, but frequently diminished—a very constant symp- tom. Appetite usually good but animal eats slowly. Ability to work present to a limited degree. Examination for staggers. See p. 180. _Epilepsy. “Falling sickness” is a chronic disease of the brain characterized by paroxysms occurring at intervals and attended by sudden loss of consciousness and disturbed sensibility. Dizziness, vertigo. This is a primary disease, occurring at 208 CLINICAL DIAGNOSTICS. intervals, characterized by interrupted equilibrium and due to cir- culatory disturbances in the brain. Cerebral hemorrhage. Apoplexy. Sudden dizziness, involun- tary movements, loss of consciousness, falling down, paralysis (hemiplegia and monoplegia). Eclampsia is an acute epilepsy, ending in recovery or in death. Turnsick is a disease of sheep caused by the presence of the larval form of ‘Tenia coenurus in the brain. 1st stage, cerebral excitement; 2nd stage, latent stage; 3rd stage is that of turnsick, characterized by symptoms of local brain affections. Paralysis of the facial nerve. In case of peripheral paralysis the cheeks, lips and nasal muscles are paralyzed, usually unilater- ally; if paralysis is bilateral we have dyspnea and difficulty in feeding. In case of central paralysis the upper eyelids droop, eyes cannot be closed and the auricular muscles are affected. Lumbar prurigo of sheep is a chronic, hereditary affection of the spinal cord characterized by hyperesthesia, weakness and paralysis of the hind parts and by progressive emaciation, invaria- bly leads to death. Intiectiows Diseases with Wd oc ali ata oneal thie (Cen ¢ cal UNie ry,01S, se yas hese Tetanus is an intoxication produced by the _ entrance of the products of the tetanus bacilli into the blood. Spasmodic condition of the entire skeletal muscles, animal is stiff, eyes re- tracted, membrana nictitans prolapsed, head and neck bent back, back depressed, tail erect. Sawhorse attitude of legs, hock turned out, producing bowleggedness. Spasm of masseter and pharyngeal muscles interfere with mastication and deglutition, spasm of the respiratory muscles affects respiration. Great excitability; thus aggravating the general muscular cramps. At first no fever, later on the fever is high. Pulse strong and full. Animals do not lie down, or when down they cannot get up. Mental condition is normal. Rabies is a strictly infectious disease characterized by disturb- ance of the central nervous system. 1. Initial stage. Dogs are restless, moody, easily frightened, want to be out of doors, depraved appetite. 2. Raving stage. Aimless running about, tendency to bite, sometimes break their own teeth in the ack, voice changed to a barking howl. 3. Paralytic stage. Emaciation, lower jaw paralyzed, tongue extended, hind quarters paralyzed. Horses show restlessness as in colic, neigh ina peculiar shrill or yelling manner, try to gnaw or bite the “point of infection, bite the manger and not infrequently fracture the lower jaw in the act. Paralysis and death follow within three days. Cattle bellow and run against objects with their horns, frequently fracturing them. Sheep and pigs also manifest a desire to bite. Infectious cerebro-spinal meningitis. Disease is frequently in- troduced with chills. Slight fever. Sensibility reduced, animals BODY MOVEMENTS. 2 209 are drowsy, stumble: and fall on slight provocation. Turning of eyes, jerking of muscles, later on paralysis. Tonic spasms of the cervical muscles; head drawn to one side. Intoxication Diseases. Parturient paresis, milk fever, is an acute auto-intoxication closely following the act of parturition, and characterized by cere- bral paralysis. Begins with slight, temporary, cerebral excitement; after a few hours symptoms of depression and paralysis set in. Animals lie immovably in a characteristic attitude, see p. 34. Eyes closed, paralysis of muscles of head, tongue extended, rattling breathing, distention of abdomen, constipation, paresis of paunch. Lowering of external and internal bodily temperature. C. Specific Examinations. We resort to the specific examinations only when definite results cannot be obtained with the foregoing methods, espe- cially in cases of differential diagnosis between similar dis- eases. In al cases the specific examina- tioms are’directed toward determining deiinite diseases: and the cHatacteri's» tics of these are specially considered. 12. Body Movements. Many diseases are not observed until the animal is in harness or under the saddle, others become more conspicuous in their symptoms under these conditions. The rule. is to examine animals while engaged in their accustomed occupa- tion (blind staggers, balkiness). Draft horses should be ex- amined when hitched to the wagon, riding horses under their rider. Unaccustomed work fatigues animals unduly and ex- cites them. Sometimes fatigue and excitement make certain symptoms more conspicuous (roaring) ; in such cases we make an exception of the rule just given. In all cases we must ob- serve that the animal is properly harnessed. I. Examination for Immobility. (Examination of So-called Dummies). Blind Staggers. Blind staggers may be defined as an incurable disease of the brain accompanied by cerebral depression. It may develop 210 CLINICAL DIAGNOSTICS. gradually or follow an attack of acute hydrocephalus. Ac- cordingly, blind staggers is characterized by disturbances of consciousness. These symptoms may be observed while the animal is at rest, but frequently they are not sufficiently pro- nounced so that a diagnosis can be based upon them. Sub- jecting a suspicious animal to exercise is a valuable aid in making a diagnosis, it furnishes a better opportunity for test- ing the psychic functions and the resulting increased blood pressure intensifies the existing symptoms. It is of diagnostic importance that horses affected with immobility can be used for work, though in a limited degree, and that horses suffering with acute cerebral affections re- fuse to work or, if worked, symptoms of cerebral excitement follow. Again, horses with blind stag- gers always have a low pulse, eat slowly but nevertheless eat a full feed. On the other hand, horses with acute cerebral affections have poor appetite and a high, or change- able, pulse. In examining for blind staggers the horses must be test- ed while performing accustomed duties, and care must be ob- served not to excite them; in no case must they be subjected to unaccustomed work. It is advisable to drive or ride the animal oneself; notice the facility with which the animal is guided, effect of whip and spurs, tendency to go over to one side, ease with which animal moves forward or backward. As soon as the animai begins to sweat. it is taken to a quiet place and rested, here we repeat a careful examination of the cerebral functions, (the animal's ‘psychical condition) ; observe the expression of the eye, effect of sur- roundings, general attitude of the body, movements of the head, use of eyes and ears. To determine the degree of sen- sibility we resort to mechanical irritation: gently inserting a finger into the animal’s ear, flipping the finger against the nose, stepping on the coronet, kicking against the cannon bone. Finally the animal’s motility is tested to determine whether it —s BODY MOVEMENTS. 211 voluntarily assumes unnatural positions (setting a foot ab- normally forward or back) whether it advances or backs read- ily, follows its leader or not, halts without a command when the attendant leading it stops, etc. An important test is to Examination of a horse for Blind Staggers. attempt to cross the forelegs; horses with blind staggers can usually be made to assume this position and throw their weight on their feet when thus crossed.. To make this test the operator stands on one side of the animal, his legs spread so % 4 212 CLINICAL DIAGNOSTICS. that one is in front, and the other behind the front leg of the horse, then grasps the foot of the opposite side (at the meta- carpus and from behind), forces the horse back a little to relieve the foot in question, pulls it over and crosses it in front of its opposite. Quiet and gentle animals will sometimes remain standing in this position and even permit other insults, but from their general attitude it is plain that the reason for all this is not an abnormal mental state but rather extreme good naturedness. Animals greatly fatigued may show symptoms of a depressed sensorium, but they are always of short duration. A gingele -synm.ptom “can, tiey er de tee mine a.diagrvosis, we must comsider (ie animal’s condition as a whole. II. Examination for Heaves. Heaves may be defined as a chronic, incurable disease of the lungs or of the heart, characterized by difficult and la- borious respiration. This definition is forensic in its sense, and includes a number of chronic incurable diseases of the lungs and of the heart that are attended with difficult respiration. As a rule chronic bronchitis, alveolar emphysema of the lungs, chronic interstitial pneumonia or heart disease constitute the anatom- ical lesion at the bottom of heaves. Although it is frequently possible to determine the exact nature of the anatomical le- sion, it is customary, in Germany at least, to apply the term “heaves” to all of these conditions, because “heaves” is con- sidered as one of those diseases the presence of which is a legal ground for the setting aside of a contract of sale and is referred to under this name in all laws concerning it. The term “difficult and laborious respiration” is com- parative in its sense, and in applying it we must always con- BODY MOVEMENTS. 213 sider the nature of the exercise leading to it as well as the constitution and anatomical make-up of the animal. On the other hand, whether the pathological condition in any way affects the use of the animal for some particular purpose or not, does not come under consideration. To make a positive diagnosis of “heaves” it is necessary only to recognize the existence of a difficulty of respiration which is due to a chronic and incurable disease of the lungs or of the heart. For this purpose a careful examination of the circula- tory apparatus and of the respiratory apparatus is indispens- able. It is also necessary to determine positive symptoms of the disorder under consideration in order to be fortified against the possible assertion that the disease is due to other causes than chronic and incurable affections of the lungs or of the heart. Furthermore, we must exclude, by careful exam- ination of all functional apparatus, any acute affections that may produce increased respiration. External painful condi- tions must also be taken into consideration. “If it is impossible to differentiate between the effects of dis- turbances of this nature and existing symptoms of heaves, it would be well, in all cases where legal complications are possible, to inform both buyer and seller of the existing conditions and_ of the necessity of withholding the expression of a final opinion until the animal has recovered from the existing acute disease. - If, at such a time, the previously observed symptoms of “heaves” are still present, the existence of the disease at the time of pur- chase must be conceded. The examination of a suspected “heavey”’ horse is con- ducted not only while the animal is at rest, but also during and after exercise. Animals are worked in an accustomed manner and made to exert themselves to a moderate degree, at the same time we note the character and frequency of respira- tion. The horse should be driven or ridden in a quiet trot; a draft horse made to pull a moderately heavy load. Count the respirations every 5 minutes and let the animal work until it sweats, but not longer than 15 minutes. Then put the animal ~ in a stable, count the respirations every 5 minutes and note™ 214 CLINICAL DIAGNOSTICS. when they return to the normal (the number counted before exercising). In healthy horses _ the number of respirations runs as high as 50 or 70 per minute, sometimes even higher. Respiration occurs without exertion, the animals may now and then give a voluntary snort and take a few deep inspirations. In the course of at most 15 to 18 minutes after cessation of the exercise, the number of respirations should be reduced to that observed at rest. “Heavey’” horses, on the other hand, show increased or difficult brething, dyspnea, (see p. 84). Inspiration and expiration may be so difficult that the number is not increased, but the character of the respiratory movements enables us to recognize the dyspnea. But as a rule the number of res- pirations, when animals are exercised as above described, runs up to 80 to 120 per minute and goes back to the normal very gradually. Not infrequently this requires 30 to 60 minutes. In chronic bronchitis a white foamy nasal discharge is ob- served. III. Examination for Roaring. ‘ The term “roaring” is applied to a form of breathing attended with the production of an audible sound and due to a chronic, incurable disease of the larynx or trachea. | As arule, roaring is caused by a paralysis of the left recurrent nerve and the resulting inactivity and degener- ation of the muscles which it supplies (Hemiplegia laryngis. sinistra). ; In rare cases a paralysis of the right recurrent nerve or a bilateral paralysis may exist; sometimes thickening of the mucous membrane or the presence of tumors may be the cause. An exact diagnosis of the cause of such a stenosis can be defi- nitely determined only with the aid of the laryngoscope; but in 99 per cent. of all cases a left handed paralysis is the cause. Except in rare cases, laryngeal roaring is no- BODY MOVEMENTS. 215 ticed only in forcible or increased respiration, and is then characterized by ..a harsh sharp inspiratory noise or tone (wheezing, whistling, blowing, hum- ming, roaring, snoring.) The respiratory noise is caused by the fact that deep and rapid inspiration causes the air current to force the paralyzed arytenoid cartilage and vocal cord into the lumen of the larynx and thus obstructs its free passage. Decreasing the volume of the ingoing current of air by com- pressing the nostrils causes the noise to cease. Pressure on the paralyzed arytenoid cartilage increases the noise. Pres- sure on the right (unaffected) cartilage increases dyspnoea to such an extent that inspiration is almost impossible, it ceases entirely or continues with a sharp wheezing sound, because the lumen of the larynx is now obstructed by both arytenoid cartilages. In examining for roaring the horse must be placed under conditions that force it to make rapid and energetic respira- tory movements, it must be “worked hard,” pull heavy loads over soft ground, or gallop. Exercising or riding are especially adapted for this purpose because we can control the position of the head, and thus influence respiration. Whether or not the animal is accustomed to this sort of exercise has no effect on the general result. If the head and neck of the animal are well checked up and back, the points of insertion of the dorsal muscles are approxi- mated and the action of the latter on the spinal column is reduced: now, in order to fix the spinal column the longissimus dorsi, the inspiratory and the abdominal muscles must be contracted with unusual force; this can be done only at the moment of inspiration. In expiration these muscles are relaxed and the animal loses, more or less, the control over its spinal column. It therefore makes an effort to reduce the expiratory period by rapidly and energetic- ally following with the inspiratory movement. If only one aryte- noid cartilage projects over the lumen of the larynx the inspiratory current forces it in, produces a stenosis and causes the respiratory sound. By turning the head toward the right the in-streaming current of air is directed on the left arytenoid cartilage, and if the paralysis is only an incomplete one the characteristic sound is pro- duced just the same. : Dieter Oil tt ed tmemorean never _pro- ioe. oar neon a healthy horse. In order to make a positive diagnosis of “roaring” it is necessary to eliminate the possible presence of acute morbid 216 CLINICAL DIAGNOSTICS. conditions of the upper air passages as well as stenoses of the nasal: cavities since these conditions will also produce audible breathing. Contractions or other deformities of the nasal cavities can frequently be recognized upon superficial exami- nation, or by the wheezing noise they produce. If the trouble is unilateral, the peculiar noise will cease upon closing the af- fected side, or become more pronounced upon obstruction of the healthy nostril. If existing lameness or the presence of acute affections of the respiratory apparatus or other organs make this method of examination impossible, the laryngoscope may do valuable service. « (see p. LOL.) IV. Examination for Epilepsy and Vertigo. Epilepsy isa chronic cerebral disease that is char- acterized by paroxysms occurring at intervals and attended with interruption or loss of consciousness and sensibility. Vertigo (dizziness) is a similar affection; it is an inde- pendent disease occurring in the form of periodical attacks, disturbed equilibrium and consciousness. The difference be- tween epilepsy and vertigo is that spasms are absent in the latter. The diagnosis of these two diseases is not diffi- cult if one has an opportunity to observe an attack. In the intervals horses act perfectly» n.0% ae Sometimes certain known conditions bring about an attack; when making an examination .of suspected animals we can often make use of this knowledge to bring on an attack. Horses may be hitched up and driven as on former occasions when an attack was observed, etc.. The fit of the harness should be carefully inspected. Sometimes frightening or ex- citing the animal, or driving with the face turned toward the setting sun, or along streets sprinkled with alternating shade of trees and the glaring light of the sun, will produce an at- tack. If-we cannot personally, observerae attack we must base our diagnosis upon unobjectionable statements ofwitnesses. BODY MOVEMENTS. 217 Epilepsy. Characteristic epileptic spasms occur either only at the head and neck (partial epilepsy) or the whole body is affected (general epilepsy). Animals stop suddenly, distort their eyes, blink, spasmodically contract the muscles of the lips and face, raise their heads high and jerk them to one side, sometimes they step to and fro, or backward and forward, restlessly. In general epilepsy the spasms rapidly extend over the whole body; mastica- tery movements are spasmodic, the saliva is churned into foam, the animals grate their teeth, spasmodically distort their neck side- ways, the muscles generally undergo spasmodic contractions, the animals stagger and fall and then the spasms may continue for some minutes. An attack may last from %4 to 15 minutes, the horses then get up and become quieted. The intervals between attacks are very irregular. The above described idiopathic epilepsy must be distinguished from acute cerebral affections and from epileptiform spasms due to peripheral irritations (reflex epilepsy). Vertigo. Attacks usually occur while animals are at work; they suddenly walk slower, nod and shake their heads, snort, raise their heads up and sideways, stagger, spread their legs and not infrequently fall down. Here they lie quietly, sometimes kick, a little and then get up again. During the attack there is a loss of consciousness and sensibility, sometimes increased respiration and profuse sweating. Attacks of dizziness due to congestion of the brain (compres- sion of the jugulars) and to cerebral anemia (stenosis of aortic valves) do not belong under the head of idiopathic vertigo. V. Examination for Balkiness. Balkiness is refractoriness manifested in common and accustomed work. Hence a horse must be tested while at accustomed work, and we must proceed with utmost caution and quiet and avoid everything that might excite the animal. Loeerexaminine veterinarian must be: press ent during. all-manipulations and see ;to. it that rough or improper treatment is avoided. : We first examine those parts of the body that bear the weight and pressure of the harness and see that no morbid or painful conditions exist; the animal is then properly harnessed. In case the harness does not fit, it should be made so by short- . ening or lengthening parts that may require it, or by using a new set of harness. Then the animal is tested in the capacity for which it is intended, single or double, as coach or draft horse, or under the rider, as the case may be. Active 218 CLINICAL DIAGNOSTICS. or passive refractoriness to reasonable demands is regarded as balkiness. Young animals, such as are not yet sufficiently accus- tomed to work, also evince a certain degree of refractoriness, but, as a rule, if properly handled they will soon yield and obey willingly, especially if they are hitched with older and quiet horses. 13. Diagnostic Inoculation. Diagnostic inoculations consist in the introduction of cer- tain substances into the bodies of animals for the purpose of determining either the character of the substance or the con- dition of the animal’s health. We base our judgment on the character of the result. For the clinician diagnostic inocula- tions serve merely to recognize a few infectious diseases ; cer- tain of these diseases have so rapid a course that the clinical symptoms cannot be relied upon to determine either their kind or character with any degree of certainty. Others which ter- minate much less rapidly do not show sufficient symptoms for a definite diagnosis. In these cases nothing save a correctly performed inoculation will serve-to recognize the adisease ofr togee tain an.carly diagnosis. Diagnostic inoculations are always made with respect to certain well known infectious diseases which our examination leads us to suspect. In performing the inoculation, therefore, we must consider the peculiarities of these diseases, we choose certain tissues, fluids or other substances for our inoculating material, we follow a certain method of inoculation and make use of particular animals. For inoculation we use 1. Material of known composition (tu- berculin, mallein) in order to determine the condi- tion of the animals from the resulting reaction. 2. Tissue and other material from diseased an- DIAGNOSTIC INOCULATION. 219 imals on test or experimental an- 1mals_ inorder to determine the pathogenic char- acter of the inoculated material. Diagnostic inoculations are of particular value in the infectious diseases which follow. I. Tuberculosis. Tuberculosis can be recognized in only a small per cent. of affected animals by the use of ordinary clinical methods. On the one hand only a few symptoms can be determined, on the other hand these symptoms are not characteristic be- cause they also occur in other diseases. The discovery of the tubercle bacillus as the cause of tuberculosis is hardly of any value in the clinical diagnosis of the disease in animals. Mor- bid products from an affected organ (lung of cow) for micro- scopical examination, are difficult to obtain; the quantity is small and besides is swallowed by the animal as soon as it reaches the pharynx. But, an opportunity to examine patho- logical nasal secretions, ejections, vaginal discharges or patho- logically altered milk must never be neglected. (See p. 94.) Under these circumstances the experimental de- termination of this disease is of great impor- tance. For this purpose we resort to the tuberculin test and to the inoculation of small experimental a una LS. The tuberculin test. Tuberculin is the toxin of the tubercle bacilli, obtained from artificial cultures of the same. The tubercle bacilli are cultivated for six weeks in 5% glycer- ine beef bouillon at 38° C. [1004° F.] The culture is then sterilized at 110°C. [230° F.] and filtered through unglazed porcelain tubes. The filtrate is evaporated to one-tenth its volume and thus constitutes tuberculin. After these manipu- lations the tuberculin is absolutely free from germs and there- fore it could never produce tuberculosis. Furthermore, it has no permanent injurious influence on either sick or healthy an- 220 CLINICAL DIAGNOSTICS. imals; during the tuberculin test the quality of the milk is in no way affected, but the quantity may suffer to the extent of a reduction of 10% or less, for a few days. In cattle with very advanced tuberculosis the disease has been ob- served to have become aggravated — according to reports. Dose.* The tuberculin prepared as above described is. diluted with 9 volumes of water to which 4% of carbolic acid has been added. Cattle and horses receive 5 cc of this. solution, yearlings 2.5 cc, calves 1cc and dogs 0.5 —Icc. Technique. The tuberculin is injected subcutane- ously at the neck or in front of the shoulder. Before and after using, the hypodermic syringe should be disinfected with a 2% solution of carbolic acid. Before inserting the hypo- dermic needle smooth down the hair at the point of injection. Disinfection of the injected area is not necessary if care is exercised otherwise. The best time for injection is in the evening between 9 and 10 o’clock. The bodily temperature of the animal to be injected should have been ascertained at noon of the day of injection and also just before injection. Eight or nine hours after injection of the tuberculin, hence at 6 A. M., next day, the temperature of each animal should again be taken, and thereafter every two hours until the 18th hour after injection. Perhaps it is unnecessary to state that the temperatures should be recorded. Interpretation of Results. In tuberculous animals the injection of tuberculin produces fever od ato healthy an- imals are not affected. a. Cattle with pre-injection temperatures not exceeding 39.5° C. [103.1° F.] and post-injection temperatures exceed- ing 39.5° C. [103.1° F.], providing the difference between the highest pre-injection temperature and the highest post-in- a [*This applies, of course, to the German tuberculin. In America the article is man- ufactured by a number of reliable firms. It should always be used as fresh as possible: and the dose regulated according to the strength of the material. This is always indi- cated in the “directions for use.’ DIAGNOSTIC INOCULATION. 221 jection temperature is at least 1° C. [1.8° F.] are regarded as tuberculous. b. In calves under 6 months of age a rise of temperature exceeding 40° C. (104° F.) after injection of the tuberculin, provided the difference between the highest pre- and_ post- injuction temperatures is at least 1° C. (1.8° F.) indicates the existence of tuberculosis. The International Veterinary Congress of Budapest has accepted the following interpretation of the results of a tuber- culin test: 1. A post-injection temperature exceeding 40° C. [104° F.], provided the temperature at the time of injection did not exceed 39.5° C. (103.1° F.), is to be regarded as a positive reaction. If the pre-injection temperatures of cattle exceed 39.5° C. C. [103.1° F.] and 40° C. [104.0°F.] the results are to be regarded as doubtful and to be considered upon their own merits. If the pre-injection temperatures of cattle exceed 39 :5° C. [103.1° F.], or if those of calves less than six months of age exceed 40° C. [104.0° F.], the tuberculin test should be made at a later date. Reliability. The tuberculin test cannot be regarded as absolutely infallible. About 90% of the tuberculous ani- mals give a reaction. Animals in advanced stages of the dis- ease frequently do not react. As a rule, however, a physical examination of such animals reveals symptoms which, when considered alone, would at least awaken suspicion as to the existence of the disease. Only a small per cent. of the react- ing animals is found to be free from tuberculosis. Never - fieless, tubercw@lin.is the best diagnos- ftLeti Aw Our possession. Inoculation of experimental animals. The milk of tuberculous cows contains tubercle bacilli when the udder is affected with tubercular processes, and also in some cases 222 CLINICAL DIAGNOSTICS. where tubercular processes in this organ seem to be absent. Microscopical examination of milk for tubercle bacilli is very difficult and the results unreliable, therefore we resort to intraperitoneal inoculation of Guinea pigs with the fresh milk of a suspected animal. If tubercle bacilli are contained in the milk tubercular nodules will develop on the peritoneum (omentum), spleen and liver in the course of two weeks. If the Guinea pigs do not die before, they are killed at the end of six weeks and carefully examined for tuberculosis. II. Glanders. In view of the great infectiousness and incurability of glanders, the object of the veterinarian is to determine the presence or absence of this disease at the earliest possible date. However, horses affected with glanders show no symp- toms or at least no characteristic symptoms in the early stages of the disease; for this reason horses that have been exposed ta an tatection “watt h’ @ ) am dieu are. subjected to 4a mallein’ test swe object of thus enabling us to recognize the disease. If the animals show symptoms of the disease we endeavor to obtain some of the pathological products or secretions and with them inoculate experimental animals which are known from experi- ence to be susceptible to the disease and develop it in a char- acteristic form. Mallein inoculation. Mallein is the toxin of the bacilli of glanders and is obtained from their cultures in a manner analogous to that ‘employed for obtaining tuberculin. The crude preparation is a fluid, obtainable from the manufacturer and injected in doses designated. It may also be obtained in the dry or powdered form and is thus injected in doses of 0.02 —0.1 G. according to the weight of the animal. It is best to have the solution of the dry tuberculin prepared by the manufacturer. DIAGNOSTIC INOCULATION. 223 Technique. This is the same as for tuberculin inocu- lation. Taking temperature of animal to be tested, two or three times at definite intervals before inoculation; inoculation between 10-12 P. M., and taking temperatures again on next day beginning at 5 A. M., and repeating every two hours until Ga VE; Interpretation of Results. The International Veterin- ary Congress has accepted the following principles for guid- ance in interpreting the results of a mallein test: 1. A positive reaction to mallein confirms the diagno- sis of glanders only when it possesses a typical character. 2. A typical reaction consists of an elevation of temper- ature.of at least two degrees centigrade [3.8° F.] and must exceed 40° C. [104° F.] The temperature curve usually re- mains at an elevation for some time or it may make a slight drop and rise again on the same day. On the second, and sometimes on the third day, there will be more or less eleva- tion of temperature. A local as well as a general or con- stitutional reaction is also observed. 3. Elevations of temperature less than 40° C. [104° F-.], as well as greater elevations of an atypical character require re-testing of the animal. 4. Gradually attained high temperatures of considerable duration, even if not typical, indicate the existence of glanders. 5. ~ AAU ® at Lymph glands of the ox accessible by external palpation. 5 The. .lymphatacs- of the -showlder, Gparess scapular glands) are covered by the mastoido-humeralis muscle in front of the scapulo-humeral articulation. 6. The precruraJ glands lie at the anterior border of the tensor fascia lata muscle; distinctly visible in cattle. % In the upper part. of thie, flank chee four or five follicles as large as a lentil can frequently be felt sub- cutaneously. 8 The deep inguinal glands lie’ in the crural canal covering the crural vessels. [The superficial inguinal glands in the male animal at the neck of the scrotum on each side of the penis in the sheath. In the female as follows:] 9. The retromammary glands (glands of the udder) are especially well developed in the cow and are situated behind and above the udder. 10. The mesenteric, lumbar and sacral glands of the horse and cow can be examined per rectum. In the former the bowel should be evacuated by means of a cathartic; for the lat- ter it is at least advisable* ito do so. THE BLOOD. . 231 In the healthy horse we can distinctly feel the intermax- illary glands, in the healthy ox the precrural glands, and no others; if any-of the other glands are distinctly palpa- ble we assume that they are enlarged. The intermaxillary lymphatic glands tiStieaorse are Sometimes extirpated in order to subject them to a special macroscopical, or microscop- ical and bacteriological examination. For diagnostic purposes we resort to it in glanders only. We operate on the standing animal and anesthetize according to Schleich’s method. 15. The Blood. The examination of the blood is of importance in a few rare cases only. A microscopical examination to determine Fig. 54. Leucemic Blood. the presence of certain infectious diseases is of value only in anthrax and Rothlauf in pigs, and even in these diseases the circulating blood contains only few organisms. However, in Texas fever it is of diagnostic importance, and in con- stitutional blood diseases it is equally invaluable. The best way to obtain the necessary blood is to make a slight incision into the lip, with the point of a knife, observing 232 CLINICAL DIAGNOSTICS. care not to stretch the skin during the operation. If a larger quantity of blood is desired a hypodermic needle, inserted into the jugular vein, answers the purpose better. [As far as an- noyance of the animal is concerned, tapping the jugular vein is preferable in all cases.| In practice we may limit our- selves to the microscopical examination; for this purpose a single drop of blood, placed directly on the glass slip or cover, will serve the purpose. From this drop we can make a few cover glass preparations, allow them to dry, take them home, fix, stain and examine them at leisure; or we may add a 0.3% solution of sodium chloride and examine the blood in its fluid condition. Exact blood examinations are difficult and must be carried out with such care and minuteness that the practitioner is obliged to get along with the results of the simplest meth- Fie. 55. ods. For those who care to take @ Q a >) up the study of blood examinations | @ in detail we recommend “Jacksch- ® co Y Ay Klinische Diagnostik.” @ Number of blood corpuscles. The absolute number of blood cor- can only be determined with the Whiornial Waseem Teas aid of special blood-counting appa- ee ratus (Thoma-Zeiss). According to the investigations of Storch, the number and proportion of red and white corpuscles per cubic millimeter are as follows: Red Corpuseles. White Corpuscles. Proportion. 0 &__puscles in a given amount of blood & Oo -@d Stallions 8.2 millions 10,500 1:780 Geldings 7.6 . 11,000 1:690 Mares — 7.1 e 9,900 1:720 Colts fee iy 14,000 1:670 Bulls G5 oy 7,800 1 :820 Steers 6.7 se 9,400 1:720 Cows Ban Ninf 8,200 1:660 Calves 8.5 se 15,700 1:550 Dogs Rano 3,100-2,800 THE BLOOD. 233 Since the results of these investigations show that con- siderable variations occur under normal conditions, extreme variations alone can be regarded as being of importance. An increase in the number of red corpuscles has been observed in serious general diseases with fatal termination: pulmonary gangrene, angina, pleuro-pneumonia. A decrease in the number of erythrocytes occurs in essen- tial anemia, hydremia, leukemia, and particularly in per- nicious anemia. Shape of the red blood corpuscles. We usually group them as follows: 1. Normal red corpuscles, without nucleus. 2. Nucleated erythrocytes. a. Normoblasts of normal size. b. Megaloblasts, two or three times the size of nor- mal red corpuscles. c. Gigantoblasts, still larger than the megaloblasts. d. Microblasts, smaller fan the normoblasts. When the normal blood corpuscles deviate from their usual biconcave form they are called poikilocytes. Similarly altered nucleated red corpuscles are called poikiloblasts. The red corpuscles frequently undergo considerable change in form in the course of preparation for microscopic examination. This must always be borne in mind when dif- ferentiating between the different groups. Varieties of the white corpuscles. According to Ehr- lich and his pupils the white corpuscles are classified as fol- lows: 1. Lymphocytes. These are from 6 to 9 micra in diam- eter, with a single, large, well-defined nucleus containing an abundance of chromatin. They stain with basic aniline dyes, the protoplasm absorbing more of the stain than the nucleus. 2. Large Mononuclear Leucocytes. These are 12 to 15 micra in diameter, contain a large, not well-defined sin- gle nucleus with little chromatin, and homogeneous, baso- phile protoplasm. \ 234 CLINICAL DIAGNOSTICS. Transition forms occupy a position between the large mononuclear leucocytes and the polynuclear leucocytes, their nucleus being divided into two or three sections. They resem- ble the mononuclears in their affinity for stains, 3. Polynuclear Leucocytes. These are 10 to 12 micra in diameter, are provided with a slender but broken and irregular nucleus containing an abundance of chromatin and a finely granular, opaque, neutrophile protoplasm. 4. Eosinophile Leucocytes. These are 12 to 15 micra in diameter, the body of the cell is filled with large roundish granules which have an exceptional affinity for eosin and other acid stains. They have one or two nuclei which are packed in between the granules. The nuclei contain an abundance of chromatin. 5. Mast Cells. These vary in size up to that of the eosin- ophyles, they have clumsy nuclei of various forms containing little chromatin, and basophyle, coarsely granular protoplasm. According to Wiendick the varieties of leucocytes occur in the following proportions in the blood of the horse: Actual No. per cubic Percentage. centimeter. 1s. Lymphocptese st. 255%. sos es ee 35-45 ... .2500-3500 2..* Mononuclear Leucocytes” 7A eee 1.5-3.5....150-300 3. Neutrophyle Polynuclear Leucocytes 50-70 ... .4000-5000 4. ~Actdophyle, Vencocytess is. aoa dens 1.5-5.0... .200-350 5. Mast Cells (Basophyle leucocytes) . .0.2-0.7....20-60 It is not unusual to observe even greater variations than those shown in the table. A temporary increase in the actual number of leucocytes (hyperleucocytosis) may occur after feeding and in animals in advanced pregnancy. Such an increase is also observed in the course of all infectious inflammatory processes, especially during the formation of abscesses in the course of strangles. The actual number of leucocytes is reduced (hypoleucocy- tosis) permanently in the course of pernicious anemia. In THE BLOOD. 235 this disease the relative proportion of red corpuscles is less than normal. The normal color of blood serum is a light golden yellow (straw color). After the destruction or breaking down of a large number of red corpuscles their coloring matter is dissolved in the plasma of the blood and is partially converted into methemoglobin. This causes a reddening of the serum (Hemoglobinemia). The presence of the coloring matter of the muscles may produce a similar result. Diseases of the Blood. Essential (idiopathic) anemia. Bloodlessness. Consists in a diminishment of the quantity of blood without a determinable cause. Blood pale and coagulates poorly. Mucous membranes pale and low temperature. Pulse small, heart tones metallic sound. Appetite poor. Tendency to dropsical swellings. General weakness. Mostiy in young animals. Pernicious anemia. Primary anemia of adult animals with fatal termination. Fever not constant. Mucous membranes pale and somewhat yellowish. Pulse gradually becoming more rapid, appetite less and less. Increased weakness terminating in death. Blood watery, changes in red corpuscles characteristic: usually large ones with nuclei, and small irregular forms, seem aan angular or toothed, club or pear shaped. Leucemia. Chronic alterations of the blood and increase in number of white corpuscles. Animals are languid, lazy, sweat easily, pale mucous membranes. Appetite grows less, pulse in- creases, small. Heart tones, metallic sound. Enlargement of lym- phatic glands usually present. Sometimes ecchymotic hemor- rhages in the mucous membranes. Hemoglobinuria of cattle. An acute non-contagious infec- tious disease of cattle caused by the presence of the protozoon Pyroplasma bigeminum in the blood, and characterized by hemo- globinuria. About 12 days after the animals have been on an in- fected pasture, the first symptoms appear—fever, loss of appetite, diarrhea. Urine light to dark red, very foamy, urination painful. Urine contains hemoglobin and coagulates into a gelatinous mass when boiled. Gait stiff and clumsy, often attended with pain. Also anemia, icterus, general debility, continuous. lying down, edematous swelling of head and neck. The cause of the disease is found in the blood in the form of ‘a protozoon called Pyroplasma bigeminum. The latter has a roundish form which may become very irregular as a result of ameboid movement. When fully developed they are found in the red corpuscles in the form of two pear shaped bodies with the narrow ends ap- 236 CLINICAL DIAGNOSTICS. proaching each other, or in actual contact. They are 2.5-4 micra long and 1.5 to 2 micra wide. Two per cent. of the red corpuscles in the circulating blood are infected, while 50% of the red corpus- cles of the capillaries of the organs contain the parasites. The presence of the parasites is easily demonstrated by fixing smear preparations in absolute alcohol and staining with alkaline methylene blue. Texas Fever. Is an infectious disease of cattle caused by Pyrosoma bigeminum [indirectly by the presence of Texas fever ticks, Boophilus bovis]. Period of incubation 10-15 days. High and continuous fever, rapidly progressing anemia, red corpuscles reduced in number from six million to one million per cc. Hema- globinuria. Fatal termination the rule. Pyrosoma bigeminum isa minute pale protozoon of a roundish form found in the red corpuscles. It possesses ame- boid movement and can therefore assume irregular shapes. When fully developed the parasites occur as two pear-shaped bodies with Fig. 56. OOO® Different stages of development of Pyrosoma bigeminum in red blood corpuscles. their pointed ends, converging. They are 2.5 to 4 micra long and 1.5 to 2 micra wide. In the circulating blood 1 to 2% of the blood corpuscles are infected, in the capillaries of the various organs more than half of them contain the parasites. Malaria A non-contagious infectious disease caused by Plas- modium malariae. Remittent fever, pronounced icterus, petechiae, cerebral depression, small rapid pulse. Loss of appetite, increased thirst, dark-colored urine staining white hair yellow. The malaria parasites which occur in the blood constitute a special group of protozoons. They differ from the Pyrosoma in being pigmented. They may be stained with methylene blue. They are bright roundish bodies with distinct outline, occurring singly in the red blood corpuscles. Flagellosis of horses. Mal de Caderas. Gradually rising re- current fever rarely exceeding 40° C. (104° F.) Rapid emaciation in spite of good appetite. Paralysis of the hind quarters, bladder and rectum. Edema, hemoglobinuria, continuous lying down, coma, death. The specific cause of the disease, Trypanosoma equina (Flagellata) is found in the blood as an actively motile parasite. Smear preparations may be stained in 15-20 minutes with carbol-fuchsin to which has been added one-third volume of glycerine. Magenta red, however, is a better stain. The parasite has the form of a whip lash and is three or four times the length [Malkmus regards this disease and hemoglobinuria of cattle (Europe) as very proba- bly identical. ]—Translators. ry THE BLOOD. 237 of the diameter of a red blood corpuscle. The convex border of the body contains a delicate membrane which extends to the end of the body, forming.a tail. The body of the parasite contains bright round granules which do not take the stain. Very destruc- tive in South America. Nagana, Tsetse Disease, Surra. Occurs in cattle, solidungula, camels, dogs and cats. This is a pernicious anemia caused by Trypanosoma Evansi (introduced into the tissues through the me- dium of the tsetse fly). Fever, muscular weakness, edema, affec- tion of the eyes, pronounced anemia. A flaggellate parasite, like the spare 20 to 40 micra long, 1 to 2.5 micra in diameter, actively motile. INDEX. Abdomen, 133, 145. Abnormal sensitiveness 149. Accumulation of food 146, 154. Achorion Schoenleinii, see Favus 54. Acne contagiosa equor, see Canadian horsepox 56. Actinomycoma 142. Actinomycosis 136. Albuminuria 66, 174, 176. Albumosuria 177. Alkalies, craving for 135. Alopecia 44, 50. Alveolar periostitis 137. Anemia 48, 59, 235. —, pernicious 235. Anesthesia 202. Anamnesis 18. Anasarca 47, Angina pharyngea 164. Ante-and post-partum pare- sis 37. Anthrax 71, 226; Anus 99, Apoplexy 205, 208. Appetite 134. Arteries 79. Ascites 40. Ascarides 61. Atelectasis 27, 122. Attitude 33. Auscultation 29. —of abdomen 154, —of heart 83. —of lungs 124. Azoturia 37, 41. Bacillus pyelonephritis 189. Balkiness 183. Bird lice 51. Blackleg 57. Bladder, diseases of 167. —, examination of 190. Blind staggers 207, 209. Blood 231, 232. Blood sweating, 50. Blowing sound 94, 100. Bodily temperature 62. Bovine pest 57. Broken back 37. Bronchial catarrh 130. Bronchiectases 107, 123. Bronchitis 102, 180. —verminosa 180. Bruits, anemic 87. —, diastolic 85. —, inorganic 85. —, systolic 85. Cachexia 39. Canadian horsepox 56. Carbonate of lime 183. Cardiac dullness 83. Catarrh_of maxillary sinuses 129. Caverns in lungs 123. Cerebral congestion 207. _—depression 200. —hemorrhage 208. Cerebrospinal meningitis 38, 42, 208. Chills 66. Choleurea 180. Circulatory apparatus 73. 239 Coital exanthema 197. Colic 41, 157, 165. Collapse, temperature of 70. Colostral milk 195, Colpitis 197. Coma 200. Condition 38. Conformation 39. Congestion, cerebral 207. Conjunctiva 57, Constipation 155, 157, 166. Convulsions 202. Cough 111. —, return impulse of 114. Cracked pot resonance 123. Cramp of the neck 38, 42, 203. Crisis 70. Crusts 50. Cystitis 191. Defecation 156, 157, 207. Deglutition, difficulties of 138. Diabetes 171. —insipidus 192. —mellitus 192. Diapnragm, rupture of 124. Diarrhea 147, 157. Dicrotic pulse 79. Differential diagnosis 16. Digestive apparatus 133. Dilatation of the heart 88. Direct diagnosis 16. — Dislocation of bowel 124, 165. Distemper of dogs 133, 202, 205. —of horses 132. Distoma, eggs of 162. Diverticula of esophagus 143, 164. Dizziness 201, 207. Drowsiness 200. Dropsy 47. Dummies 31, 34, 207, 209. Dyspepsia 164 Dyspnea 34, 96. Dysuria 170. Ecchymoses 107, 108, 140. Echinococcus disease 181. Eclampsia *208. Eczema 50. Edema 23, 47, 57. —of glottis 129. —collateral 48. Emphysema 24, 49. —, alveolar 180. —, cutaneous 24, 48, —, interstitial 131. —, of skin 48. —, septic 48. Encephalitis 34. Endocarditis, acute and chronic 88. Endometritis 197. Enteritis, hemorrhagic 160, Enteroliths 152. Epilepsy 203, 207, 216, 217. Epithelial casts 189. —cells 187. Eructation 144. Esbach’s albuminimeter 176. Esophagus 146. Excitability, abnormal 210. Exhalations 100. Expired air, odor of 100. Facies hypocratica 41. Facial nerve, paralysis of 134. Fagopyrism 50. 240 Fainting 201. Favus 54. Feces 156, 158. —, retention of 157. —, voiding of 157. —, volume of 158. Fermentation test 182. Fever 65, 67. curve 67; —, types of 69. Fluctuation 24. Flagellosis 236. Fleas 51. Food, manner of taking 135. Foot and mouth iiopace 55. Foot eczema 91. Foreign bodies in intestines 166. —in esophagus 164. Fowl cholera 72. Friction bruits of pleura 128. Garglings 96. Garget 197. Gastro-enteritis 165. Gastro-intestinal catarrh 165. Glanders 132. —ulcer 94. —cicatrices 95. Gmelin’s test 180. Gram’s method 189. Granular casts 189. Granule casts 188. Grape sugar 182. Groaning 96. Grunting 96. Guttie of ox 34, 165, Habitus 32. Hematopinus 52. Hair coat 43. —, shedding of 44. Heart- 81. —beat 82. —sounds 84, 85. Heave line 99. Heaves 212. Hematuria 178, 191. Hemidrosis 45, 50. Hemiplegia 98. Hemiplegia, laryngis sinis- ita, B22) Hemoglobinuria 178, 179, 191, 235. Hepatization 27, 122. Herpes tonsurans 54, Hippuric acid 185. Hives 50. Hog cholera 71. Hyaline casts 188. Hydrocephalus 119, 203, 207. Hypesthesia 202. Hyperemia of dirs pass- ive 191. Hyperesthesia 202. Hyperidrosis 45. Hypertrophy of heart 88. Hypidrosis 45. Icterus 60, 61, 201. Immobility 209. Impaction of intestines 151. —, rectum 205. Incarceration 151. Incontinentia urinae 191. Indican 179. Influenza 71. Inoculation 218. —for anthrax, etc. 226. —for glanders 222. —for rabies 227. . —for tuberculosis 219. — 241 Insufficiency 86. —of mitral valves 89. —of semi-lunar valves 86, 89. —of tricuspid valves 89. Intermaxillary lymph glands 105. Intestinal catarrh 166. —evacuations 156. —gases 163. —noises or sounds 154, peristalsis 156. Intoxication 19. Invagination 35, 152. Ischury 170. Kidneys, passive hyperemia of 191. Kyphosis 43. Laryngeal catarrh 129. Laryngeal fremitus 117. Laryngitis, croupous 129. Laryngoscopy 116. Leucocytosis 234. Leucemia 235. ice or. Licking disease 166. Lime casts 163. Liver 163. Lockjaw 208, see tetanus. Loco weed poisoning 167. Lordosis 43. Louse flies 51. Lumbago 37, 41, see azotu- ria. Lungs, congestion of 130. —, gangrene of 130. —, edema of 130. Lupinosis 167. Lymphatic glands 229. Lysis 70. ‘ Mast cells 234. Macula 49. Mal de Cederas 236. Mal du coit 197. Malaria 236. Malignant catarrhal fever 133. —carbuncle 48. —edema 57. Malingerers 36. Mallein inoculation 222. Malleus 132. Mange 53. —, acarus 54, —, psoroptic 53. —, sarcoptic 53. —, sarcoptic, of fowls 58. —, symbiotic 53. Mastication 134. Mastitis 197. Melanosarcoma 142. Microcytes 234. Milk fever, see parturient paresis 37, Mites 51. Mold poisoning, see mycosis. Monoplegia 205. Morbus maculosus, see pur- pura hemorrhagica. Motility 199, 202. Mouth cavity 139. Mouth speculum 141. Mycosis 140. Mydriasis 206. Mucous click 95. Muscular rheumatism 42. Muscular sense 204. Myocarditis, acute 88. | Nagana 237. 242 Nasal catarrh 129. —discharge 90. —mucous membrane 107. —tone, see mucous click 95. Nephritis 191. Nettle rash 56. Nervous system 197. Nodules, see papules 50, 108. Nymphomania 192. Obesity 39. Ocular vertigo 201. Estrus ovis, larva of 103. Opisthotonus 202. OrthHotonus 202. Osteomalacea 43. Overfeeding 146, 149. Oxalate of lime 184. Palpation 23. —of bowels per rectum 149. Panting 94. Papules 50. Paraplegia 98, 205. Paralysis 204. —of bladder 170. —of facial nerve 208. —of the larynx 130. —of esophagus and pharynx 138, 164. —of paunch 143. —of recurrent nerve 214. Parasites, intestinal 162. —in cavities of head 129. Paresis 204. ; Parturient paresis 37, 70, 209. Pathognomic symptoms 14. Paunch, paresis of 149. —, peristalsis of 149. —, gases in 146. Pentastonum tenioides 103. Percussion 24. Percussion, field of 120. —-of abdomen 152. Pericarditis 82, 89. —, traumatic, of ox 9. Peritoneal hernia 152. Peritonitis 34, 166. Pernicous anemia 235. Petechia 107, 108, 140. Pharyngitis 142, 164. Pleuritis 34, 82, 131. Pleurodynia 34, 180. Pleuropneumonia of the ox 133. —of the horse 181. Pneumonia 123, —, catarrhal 1380. Pneumothorax 181. - Poikilocytes 233. Polyarthritis 42. Priapism 192. Proctitis 140. Prurigo 208, 50. Pseudo fluctuation 24. Psychic functions 199. Ptyalism 163. Pulmonary, congestion and edema 180. —gangrene 101, 126, 130. —resonance 122. Pulse 66, 73. Pumping of flanks 99. Purpura hemorrhagica 56, 109. Pustules 50, Pyemia 70. Pyelonephritis 191. Pyrosoma bigeminum 236. Pyrocatechin in horse urine 182; 243 Quality of percussion sounds 26. Quibbing 137. Rabies 205, 208. Rachitis 42, 43. Rales 127. —, crepitant 127. =, dry, 128. —, moist 127. Reflex excitability 206. Reflex spasms 203. Regions of the body 21. Regurgitation 120, 125. Resistance in percussion 28. Respiration, types of 94. —, amphoric 126 —, bronchial 126. —, vague or indefinite 126. —, vesicular 124. ‘Respiratory apparatus 90. Retentio uranae 191. Return impulse 114. Riding school movements 203. : Rinderpest 167. Rinderseuche 226. Ringworm 54. Risus sardonicus 203. Roaring 98, 129, 214. Rothlauf 201, 231. Rumination 143. Saliva, secretion of 140. Satyriasis 192. Saw-horse attitude 34, 203. Scabs 50. Scalma 181. Sensibility 199, 201. Septicemia 70. Sexual apparatus 192. —desire 192. << Sheep pox 55. Signalment 31. Skin 43. —, color of 45. —, exhalations of the 46. —, moisture of 44, —, odors of 46, —, reflexes of 206. —, sclerosis of 46. koliosis 43. Sleepiness 200. Sneezing 96. Snoring 95. Snorting 94. Somnolency 200. Sopor 200. Spasms 202. Spinal paralysis 37, 205. Spinal meningitis 203. —, reflexes 206. Spine, fracture of 37, 205. Spleen 163. Stasis 47. Starvation 147. Stenosis of air passages 214. —of cardiac valves 86. —of esophagus 164. Stenotic laryngeal tone 95. Stethoscope 29. Stomacace 140. Stomatitis 1638. —pustulosa contagiosa 167. Strangles 132, see distemper. Stranguria 169. Strongylus filaria 130. Submaxillary lymph glands 90, 109. Suffusions 108. Sulphate of lime 186. Summer surfeit 50. Surra 237. Sweating 44, 45. “ ~ ~~ 244 Sweeny 49. Swine erysipelas 46. Swine plague 64, 71. Symptoms 12. Syncope 201. Teeth 140. —, caries of 101. —, diseases of 164. —, gnashing of the 137. Temperament 40. Tetanus 37, 208. ‘Texas fever 72, 231, 236. Thirst, see ‘‘Desire for water p. 134. Tieks 51 Torsion of colon 152. Torsio uteri 196. Trembling 202. Trichodectes 52. Tricophyton tonsurans 54, Triple phosphate 186. Trismus 202. Trommer’s test 182. Tubercle bacilli 105, 106. Tuberculin test 219. Tuberculosis 131, 193. Tumors in cavities of head 129. Turnsick 201, 203, 208. Tympanitis 165. —acita 144, 165. —chronica 144, 165. Tzetse disease 237. Udder .194, 196. Ulcers 140. —catarrhal or erosion 108. Upper air passages 106. Uremia 201. eUrethral calculi 190. Uric acid 185. Urinary apparatus 167. —casts 188. Urination 167. Urine, sediment in 184. —, voiding of 167. Urticaria 56. Vaginal mucous membrane 194, Vaginitis 197. Valvular diseases 88. Veins 80. —, undulation of jugular 80. Venous pulse 81. Verminous bronchitis 130. Vertigo, 201, 216, 217. Vesicles 50. Vesicular eruption 193, 197. Vesicular murmur 124. —respiration 125. Voice, change in 115. Vomiting 144. —in horses 144. Water, desire for 134, Whistling 96, 215. , Woody tongue 136. Wool eating 151. Wool in feces 162. Wheezing 94. Wild-und Rinder-seuche 5%, 226. 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