Clinical diagnostics of the internal diseases of domestic animals

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CLINICAL DIAGNOSTICS

OF TAE

Internal Diseases of Domestic Animals

BY
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

Translated from the Fourth, 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
1924

COPYRIGHTED

WASHINGTON, D. C.

BY ALEX. EGER
1912

REPRINTED 1923

Authorized Translation

Translator’s Preface.

N 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 [ J.

Davip S. WHITE,
Paut FISCHER.

Author’s Preface to the Fourth Edition.

The present fourth edition has undergone in all depart-
ments a thorough revision. A few new cuts have been added,
some of which graphically demonstrate the respirations by
instructive curves. Throughout I have endeavored not only to
furnish the student an adequate guide but also to provide the
practitioner with a reliable adviser.

Notwithstanding the numerous additions, by increasing
the amount of printed matter on each page, the former handy
size of the book has been retained, MALKMUs.

Preface to First Edition

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 Kunstler,’ 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 publishing 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. MaLkMUus.

Table of Contents.

. ; PAGE
The Diagnosis of Diseases... 0 6... cece eee eee 11
Syl PlOims:. sven olga ey he ee caw eee ee 12
Determining the Diseased Organ ........... 14
The Recognition of the Disease ... ......... 15
I. Anamnesis .... ........ Yeeeatel, jade Serkan due ls Rakes 18
II. Determining the Status Praesens .......... seeped.
Method of Examination.
InSpectOli no sswe kei ead oe ae ee 21
Palpation snap: adv adi otek meted wets 23
Percussion ....... Sieg? cetudetealae Eyshioae ne eee 24
ATISCUIAHON: o..4 4S ves alts eo en ae er ree 29
A. General Part of Examination H
tf, Signalment:s «24 ac00nuhereebevascnse ee saa hee 31
O pa pitust s.centecitea yao AA Rohe het crete pedals 32
J. Attitude of the Patient ........... 38
TVs “GOndviiOwy sce see baa cin Sete 39
TEL: (Conformation 4s. acces. Serena hes 40
TV... Véiiperanient . ace acesse vere dees 40
Diseases which are character
ized particularly by change
Pat Seles, DASEAL Ge ssi ike acetone mare ase ae
@ The SKIN sx caciaveeac dees onaesn sree %
I. Condition of the Hair Coat........ +4
II. The Skin’s Moisture ............. 45
III. Swellings in, and immediately under,
the: Skiti-vseddiyeseaneee eKits 46
TV. Color of the Skin ......6... 0502055 49
V. Condition of the Skin ...........-. 50

Diseases of thie {S ktitvecsasyeace ets 50

VIII.

4. Examination of the Conjunctiva................
I. Discharge from the Eyelids.........

TN. SC@olOr 5239 5 es ate eee eo SA
TTT: SCS tas se ays sane Pade Saws oeiece acces

5. Bodily Temperature ................ 000: eeeee

I. The Normal Temperature.........
Il. Temperature of the Skin... 3 See

WE J ARCNGE: causa: scaupnc’eoclasaces Oadateusiend vise hee eet

IV. Subnormal Temperature .. .......
General Infectious Diseases....

Special Part of the Examination.

6. Circulatory Apparatus ................0. eee ee

Le? GRUNGE: eaten coe Ache des ee ees oieceaa
II. Examination of the Peripheral Blood
Wessels a.1oset de ccckee rant

TT alate SECA oct ihc eles oneeeats Seen:
Diseases of the Circulatory Ap-
Per BaeWS . 6 geysied wgaeayge ees low eee

7. Respiratory Apparatus ..................0.005

I. The Respiratory Movements.......
IM. “Eh6 BReathy oc: areeparae bade ree swe
Il. Nasal Discharge 29 x te.s-c ict a craaed araub ate ow
IV. The Nasal Cavities and Adjacent

DSIMUISESy oy oycncas cane Bard aiwlae irae

V. Examination of the Submaxillary
Lymph Glands ...........

Wil GOOG, tics thn gaeideutn koahe ane danas ots
WAT. GHG MiOIC Rs sob perma tneed Cinna eueaee

VIII. The Larynx and Trachea..
IX. Percussion of the Thorax...........
X. Auscultation of the Lungs..........
Diseases of the Respiratory Ap-
PaATAatiwiGass mkerderscndreecex ceades

8. Digestive Apparatus .................000 eee ee

L, Mog: att: RHR. oi aie gives nit dene een
I, “The Biiecal Cavity. «cxcscceacnwones
IIT. The Throat and Esophagus..........

IX.

LV... Rutnination: o¢iccs cous S355 See cues 150
Mis MOTIITEA GY Mh Neealind ancien aA Gai Boe 151
VI. The Abdomen .................... 153

VII. Intestinal Discharges or Evacuations. 163
Diseases of Digestive Appa-

PAUSE, ok ke Moraceae ogre mngde Paani e ealan 171.

9. Urinary Apparatus ...............0.-c cece eee 176
I. Manner of Voiding the Urine....... 177

II. Examination of the Urine.......- .. 479

A. Macroscopical Examination..... 179

B. Chemical Examination.......... 182

C. Microscopical Examination.. ... 193

A. Crystalline Constituents of Urine 194

B. Organized Elements of Urine... 196

III. Examination of the Urinary Organs.. 199
Diseases of the Urinary Ap-

Pid GETS sig seh aiaraaunne sees Ne ae ea Ae Ate thous 201
Diseases of Tissue Metabolism.............. 202
10. The Sexual Apparatus .................0e eee 202

I. Abnormally Increased Sexual Appe-
TILED edo dened nd ane ais clalen! again 202
Wey “Lhe VAIN 2 tec uaaoosea tesa cede 203
III. The Vaginal Mucous Membrane..... 204
IV... The Udder: .ccccteceyeaasaatwee 8 204

V. Diseases of the Male Sexual Organs.206
Diseases of the Sexual Organs.. 207

11. The Nervous System.................:00 ee eee 208
I. Psychic Functions ............. ... 210
il. “SQnsibility: «acs csteecto wens Gkeets 212
TU 2 MOtitty ses geenercetanletah waa kta eles 213
Diseases of the Nervous System. 218
C. Specific Examinations. 221
12, Body Movements ..........ccceee cere ce eeeees 221
J. Examination for Immobility......... 221
II. Examination for Heaves............ 224
III. Examination for Roaring...........- 226

IV. Examination for Epilepsy and Ver-
HPO! cyae becdake eed ta eon ee 228

V. Examination for Balkiness.......... 229

xX

18. Diagnostic Inoculation .................-2 0065 230
I. “BUB@TCHIOSIS: 22+ s:a ncndeergasuiad 231
We AG anders: ~ swiss ca rek vee seated 235

Il. Anthrax, Blackleg, Malignant Ed-
ema and \Wild-und Rinder-Seuche 240

Ms TRAD HES. cedeavadahavtee, -goduserdddees aise ede's 241
14. The Lymphatic Glands ...................... 243
aS. “THE BlOOd) waawvasc eign add dvanoadin di gulerece 245

Diseases of the Blo cxcsenaxs suis 249

The Diagnosis of Diseases.

The object of practical veterinary medicine is manifold,
but in the main it consists in the restoration of the destroyed
health of our domestic animals. For this purpose a knowledge
of the affected organ and of the character of the disease is
indispensable, because this knowledge offers the only safe basis
for a rational treatment and a correct prognosis.

Thus the art of making a correct diagnosis is not only the
foundation upon which practical veterinary medicine rests, but
it is pre-eminently that which elevates medicine to the dignity
of a science.

— Diagnosisistheart of determining in-
ternal changes of the body by the aid of
externally visible or otherwise apprecti-
able changes in the animal’s condition
or some of its organs. It also includes
the recognition and name of the disease.

Since disease is a deviation from normal conditions and
physiological processes, morbid changes cannot be recognized
without a knowledge of normal conditions.

In the classroom the student has no opportunity to study
the physical characteristics and the physiological functions of
organs in living animals; he must learn this from personal ob-
servation and investigation in the clinic. In the clinic he
must cultivate his senses and learn to hear, see, feel and smell
in order to be able to judge correctly.

In the course of his practice different species of animals
are presented to the veterinarian for clinical examination. This
gives rise to certain difficulties which, in the main, are based

12 CLINICAL DIAGNOSTICS.

on differences in anatomical structure and physiological func-
tion of the organs of different animals. The methods of ex-
amination are about the same for all species. One who has
thoroughly learned the fundamental principles underlying the
methods for the proper examination of a horse will have little
trouble in adapting them to other animals. However, import-
ant differences in this respect will receive due consideration.

A further considerable difficulty in diagnostics, for the
veterinarian, is his inability to determine the subjective feel-
ing of a patient. Still, this is of less importance than the
layman usually supposes. On the other hand, to compensate
for this, we are in a position, in all cases, to make a complete
objective examination of the patient in any direction. In this
respect we have an advantage over the physician who is fre-
quently denied this privilege and is, besides, liable to be misled
by the imagination, whim, shame or vanity of the patient.

A diagnosis consists in the determination of

1. The symptoms of the disease.

2 The diseased organ.

3. The character of the disease—its
name.

A Symptom is any observable deviation from the nor-
mal state or condition. Anatomy and physiology treat of the
normal conditions and functions; Symptomatology treats of
morbid conditions and of perverted functions.

The particular object of a clinical examination is the de-
termination of symptoms; it must therefore include the exter-
nal appearance and general behavior of the animal as well as a
careful inspection of every accessible organ. To avoid mistakes
or overlooking important factors we must conduct this exami-
nation according to a definite plan.

The best plan to follow is to take up the different func-
tional apparatus in their physiological order and complete the
examination of each in its turn. The beginner should memo-
rize the scheme and follow it faithfully. This is no difficult

DIAGNOSIS OF DISEASES. 13

task since the arrangement is a physiological and therefore
natural one.
We propose the following order of procedure:
I. Anamnesis (ascertaining previous history of case).
II. Determining the Status Praesens.
A. General examination.

1. Signalment of the patient.
2. Habitus.

3. Skin.

+. Conjunctiva.

5. Temperature.
B, Spécial ¢xaminations,
6. Circulatory apparatus.
7. Respiratory apparatus.
8. Digestive apparatus.
9. Urinary apparatus.
10. Sexual apparatus.
11. Central nervous system.

C. Specific examinations

12. Locomotion, exercise in harness or under saddle, ete.

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 symptems 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 condi-
tions 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.

The symptoms which appear in a disease have for the
determination of the affected organ a varied importance.
Local Symptoms emanate from the diseased organ and there-

DIAGNOSIS OF DISEASES. 15

fore are noted only when certain organs are suffering. For
this reason local symptoms are of great importance in diag-
nosis. Gencral symptoms originate from the sympathy of the
whole organism induced when varied organs are diseased.
General symptoms may arise from the primary disease and be
called (a) direct symptoms, or they may be due to complica-
tions or sequela when they are spoken of as (b) indirect o1
accidental symptoms.

To determine the affected organ all symptoms are care-
fully reconsidered in the order in which they were determined.
The healthy apparatus are for the time being disregarded,
the diseased apparatus are given special consideration.

A variation in the normal functional activity of an organ
does not i 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 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-

16 CLINICAL DIAGNOSTICS.

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.
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. @., 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).

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

DIAGNOSIS OF DISEASES. 1%

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. In the course of
one and the same disease the symptoms will change, depending
upon whether the onset, acme or latter stages are being ob-
served. The diagnostician 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.

Not infrequently, however, even the experienced prac-
titioner must content himself with limiting 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 par-
ticularly the case in the first outbreaks of infectious diseases
when localized changes are absent and in many chronic dis-
eases showing few symptoms.

We also distinguish between a definite, a probable, and
@ possible diagnosis.

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 cof
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.

1. How long has the animal been sick?
We may learn by this question whether the disease is an acute
or a chronic one, and perhaps also the stage of development

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.

*, What symptoms hasthe animal shown?
In the beginning? Later on? The objective observation of
the owner must be carefully sifted out from his subjective
interpretation of them.

a What, in your opinion, could be the
cause of the disease? We cannot search for the
causes until we know the symptoms.

Where and under what conditions did
the animal get sick? Feed, care, etc., 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, 1. 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.
A. Face.

4. 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.

CLINICAL DIAGNOSTICS.

5. Ocular region,
6. Masseteric region with maxillary articulation.

a

Soae

11,

12,

13.
14.

15;
16.

Intermaxillary space.

Fig. 1.

Forehead.

Frontal region.

Occipital region with forelock.

Temporal region with the temporal fossa, infra-
temporal groove and auricular region, [Ears].

Parotid region, which merges below into the laryn-
geal region.

Tracheal region with jugular groove, at the lower
end of which is the supra-clavical fossa.

Cervical region with crest and mane.

Lateral .cervical region, sides of neck.

Withers and dorsal region.
Lateral pectoral region [side of chest| with scap-

DETERMINING THE STATUS PRAESENS. 23

ular region, cardiac region, costal region.
17. Sternal region.
18. .Anterior pectoral region. [Breast].
IV. Abdomen.
19. Epigastric region with xiphoid spacc.
20. Mesogastric region with umbilical space, iliac

region (flank with “hollow of flank”) 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, ete.

—) 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 frm 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+. A part is Auctuating when it is soft, elastic and undu-
lates on pressure. Only fluids admit of such a rapid trans-
mission of pressure (pus, blood, lymph, serum). If the
tissue surrounding the fluid is not tense, waves are seen to
pass over the surface of the swelling (true or soft fluctuations).
Soft-elastic (fat) tissue or tissue impregnated with a quantity
of fluid may also show fluctuation; this undulating consistency
is spoken of as pseudo-fluctuation.

5. A part is emphysematous when it presents a puffy
swelling which crackles and shifts on palpation; it is due to
the presence of air or gas in the tissue (emphysenia).

3. Percussion.

By percussion we understand striking the surface of the
-animal body so that the parts thus set in vibration emit audi-
ble sounds. The “percussion-sound’ thus produced will differ
with the physical condition of the vibrating parts, and these
differences are so well marked that definite conclusions can be
drawn from them.

Methods of percussion. Percussion can be practiced without
the use of instruments [so-called anmediate percussion] on small ani-
mals or large animals thin in flesh. The index or middle finger of
the left hand i is held firmly against the part to be percussed and struck
with the middle finger of the right hand. The striking finger should
be held somewhat curved and stiff. The advantage of ‘immediate per-
cussion lies in the facility with which the finger may be placed
between the ribs and amid the long hair of some dogs and the wool
of sheep. By this method the sense of hearing is further greatly
assisted by that of feeling. For the larger animals the sounds ob-
tained from this finger-to-finger method of percussion are not definite
enough for practical use.

n the immediate method of percussion, however, the sound
can be augmented by employing the percussion hammer to strike
the finger which is applied to the part (finger-hammer percussion).

DETERMINING THE STATUS PRAESENS. 25

; The pleximeter and hammer (plexor) are most commonly used
in practice [so-called mediate percussion] as they permit not only
of gentle percussion but the part to be examined can be struck a
heavy blow which sets deep-lying parts into vibration. The plex-
imeter should be so held that its whole surface is in firm contact with
the part be percussed. In thin animals the pleximeter should never
be applied across two ribs, but should be made to occupy an inter-
costal space that the air between it and the body does not modify the
sound, The force with which we use the hammer depends upon the
thickness of the walls of the part percussed. [In fat animals it is
necessary to use more force than in lean ones.]

Usually two or three strokes, not too close together, suffice to
bring out clearly the character of the sound. For comparison it is
advisable to perctiss corresponding parts on each side of the body.

For a better conception of the percussion-sound it is advisable
to select a suitable place. A room with closed doors is the best; in
rooms filled with furniture, or out of doors the application of per-
cussion is never satisfactory.

As a rule large animals are percussed while standing, though
small ones may be placed in a recumbent position upon a table. Al-
though gentle animals may stand quietly during the operation, very
nervous horses or stubborn cows sometimes resist. They can gen-
erally be quieted by speaking to them in an assuring tone and by
omitting all rough usage of the instruments. ‘Dogs and cats may be
held by their owners or an attendant.

~+, The Qualities of Percussion-Sounds.

A body can only then produce a sound when it has lost
its equilibrium and vibrates by virtue of its elasticity. Two
principles form the basis of percussion:

1. Solid, airless parts of the body give forth a flat sound
of short duration and little intensity. Such a sound is called
dull, femoral or flat.

Fig. 3. Fig. 4.

26 CLINICAL DIAGNOSTICS.

2. If an air-containing organ is set in vibration it pro-
duces a sound of considerable intensity, duration and tone,
the so-called resonant sound.

The clearness of the sound depends upon the volume of
the air-containing organ which is vibrating.

a. The stronger the percussion the larger is the part
which vibrates and the fuller the sound (Fig. 2).

b. The thinner the over-lying tissue of the thoracic wall
the more lung tissue will vibrate and the fuller the sound
(Fig. 3).

c. If the volume of the air-containing organ is small in
itself then the sound is correspondingly less intensive (Fig. +).

This explains the varying intensity of the sound over dif-
ferent portions of the chest wall when the percussion blows
are applied with equal force. The resonant sound gradually
merges into the dull femoral as we approach the forward and
upper portions.

The resonant sound may be divided into:

1. The tympanitic sound which is emitted when the
vibrations of the tissue are uniform. It approaches a musical
sound and is, therefore, spoken of as a tympanitic tone.

2. The full sound which is emitted when the vibrations
of the tissue are not uniform. It lacks the musical quality of
the tympanitic tone and approaches a noise.

The tympanitic tone and the full sound merge into each
other gradually. The sound between is called “over-full’ or
“over-loud.”

The tympanitic tone and the full sound are resonant in
character. They may become modified as to clearness until
they are absolutely dull (flat). The intermediate stages are
dull vesonant and dull tympanitic.

DETERMINING THE STATUS PRAESENS. 27

~/ Occurrence of the Different Qualities of Percussion-
Sounds.

According to the above classification there are three kinds
of percussicn-sounds: The full (pulmonary resonant), the
ivmpanitic, and the flat.

1. The full sound is found over normal lung, the air in
the alveoh, and the lung tissue, and thoracic walls vibrating.
When the intestines are so distended with gas that when per-
cussed their walls vibrate with their contents, a full sound is
emitted.

2. The tyimpanitic percussion-sound has a varied origin.
It is heard:

a. Over cavities containing air which communicate with
the outside world, their walls being either firm or yielding:
trachea, caverns in the lung communicating with bronchi. The
pitch of the sound depends upon the size of the cavern and its
communicating opening.

b. Over enclosed air-containing cavities, hence over the
stomach and bowels.

c. When air-containing lung tissue is surrounded by
solidified portions as occurs in beginning hepatization, edema,
atelectasis and tumors of the lung.

3. The flat (femoral, dulf) sound is heard when percuss-
ing over solid tissues which do not contain air. As the most
forcible percussion does not produce vibrations at a point more
than 7 cm below the surface, dullness can be noted over the
normal lung when the chest walls are covered with heavy
muscles, fat, or edematous swellings.

An over-loud sound is emitted when the base of the
cecum in the horse or the paunch in the ox is percussed, these
organs being greatly distended with gas.

The sound is dulled when air-containing parts of limited
‘dimensions are percussed (borders of the lung, and under

28 CLINICAL DIAGNOSTICS

thick thoracic wall) or if small airless spaces lie amid those
containing air (nodular thickenings in the lung).

During the application of percussion we should note the
resistance the part offers to the hammer or striking finger.
[To understand what is meant by this the student should
strike with the plexor some solid object, as a brick wall, and
compare it with the feeling experienced when the human chest
is percussed.| By placing the index finger on the back of the
hammer the resistance can be better appreciated. From the
resistance the amount of vibration that can be induced in the
underlying parts may be determined, the greater the former
the less developed the latter. For this reason solid, airless
parts like muscle give a shallow percussion-sound and cause
the hammer to suffer a jar when they are struck.

Tactile Percussion.

The combination of palpation and percussion is called
tactile percussion. Through this method we endeavor to arrive
at the physical condition of deep-lying parts by stroking the
tissues covering them.

Method. The wrist and fingers should be held slightly flexed
and fixed. The parts to be examined should be pressed firmly
with the finger tips, exerting an interrupted stroke. After such a
stroke the fingers should be allowed to dwell for a moment to note
the recoil of the underlying tissue the consistency of which we
wish,to determine. In practicing this form of percussion bear in
Seager that the deeper rather than the shallower tissues are to
ve felt. :

Tactile percussion may also be practiced with the plexor
and pleximeter, the index finger being rested upon the back
of the hammer. It is usually better, however, to employ hammer-
to-finger or finger-to-finger percussion.

‘The thickness of the over-lying fat or muscular layers
does not seriously interfere in this» form of fercussion.
Through practice we. learn to select the factors of importance
to form an opinion. Deep-lying diseased conditions do not
present through tactile percussion specific symptoms, but we
may thus obtain valuable information in regard to the boun-

DETERMINING THE STATUS PRAESENS. 29

daries and consistency of otherwise unavailable organs or
parts. Tactile percussion simply supplements and completes
palpation and ordinary percussion.

Determining the Boundaries of an Organ from the
Percussion-Sound.

The boundary of an organ can be determined by percus-
sion only when the organ lies superficially and emits a percus-
sion-sound which differs from that of its neighborhood. For
this reason the boundary of the heart against the lung or the
lung against the bowels may be defined by percussion.

4. Auscultation.

By auscultation, applying the ear to a part, we seek to
obtain information, through the sense of hearing, as to the
physical state or condition of deep-lying organs. For this
reason auscultation is practiced upon the heart, lungs and
gastro-intestinal tract.

In human medicine auscultation is usually practiced with
the help of instruments (mediate auscultation), the so called
stethoscope, etc., being employed. [In veterinary medicine.
however, the use of such instruments is very limited, the

heavy hair coat materially interfering with and so modifying
the sounds that false conclusions may be drawn. To a limited

extent the phonendescope is useful in auscultating heart
sounds, but the hairs over the cardiac region should first be
thoroughly moistened or oiled.]

By simply applying the ear firmly to the part, better re-
sults can be obtained than by the use of instruments. In case
the skin is dirty, blistered, or the animal is lousy, a towel can
be placed between it and the ear. To guard against being
bitten or kicked an attendant should hold the patient by the

30 CLINICAL DIAGNOSTICS.

head. In large stables containing a good many animals the
noises they produce may interfere with auscultation; if it is
essential to diagnosis or prognosis, the patient should be
exainined in some quieter place.

A. The General Part of the Examination.

I. Signalment.

By the Signaliment is meant a description of the patient
for identification by peculiar marks or characteristics. For
forensic purposes and special cases the proper taking of the
signalment is of great importance. It is further of some value
in a diagnostic sense and is sometimes taken into consideration
therapeutically.

It includes:

I. Kind of animal. Many diseases are peculiar to cer-
tain genera while they do not occur in others. This is espe-
cially true of the infectious diseases as, for instance, the horse
suffers from strangles, and glanders: the ox from contagious
pleuropneumonia (lung plague), malignant head catarrh, and
swine from hog cholera and swine plague. There are also
special sporadic diseases which owe their origin to the pecu-
liar anatomical or physical make-up of a genus. As exam-
ples, may be mentioned traumatic pericarditis of the ox; rup-
tures of the stomach and roaring in the horse.

TI. Sex. Diseases of the sexual organs are not com-
mon in animals, but sex is of influence in the appearance of
some diseases. In stallions inguinal hernias which cause
symptoms simulating colic occur; mares during the period
of heat may act as if they were suffering from some brain
disease (act like dummies) or may balk or show obstinacy
when at work. In the ox urethral calculi are not uncommon.
The condition of pregnancy is as of great importance from
the diagnostic as from the therapeutical standpoint, because
this condition may induce physiological symptoms that would
be considered pathological in non-pregnant animals. In preg-

32 CLINICAL DIAGNOSTICS.
nant animals caution is demanded in the choice of drugs.

III. Color and white markings. For diagnosis the
color and markings are of less importance. White horses fre-
quently suffer from melanotic tumors that are either super-
ficial or located in internal organs. \White areas are more pre-
disposed to exanthemas, sunburn and “scratches.”

IV. Age. Alany diseases occur either exclusively or
generally in youth. Rachitis, diseases of the navel, strangles
in colts, scours in calves and distemper in puppies are exam-
ples. In old individuals diseases due to the animal’s use are
more frequent as are also chronic diseases of organs (dummies,
heaves).

The age is also of influence upon the prognosis in as much
as healing, ail things else being equal, is more to be hoped for
in the young individual than in the old one. In old animals
where the prognosis is a doubtful one all treatment is fre-
quently omitted on economic grounds.

V. Size. Size is of importance in posology only.

VI. Breed. In well bred animals the reaction against
the encroachment of disease is more energetic and the symp-
toms are more pronounced. Certain breeds are more able to
withstand infectious and sporadic diseases than others, this
must be considered in making a prognosis. Breed is also
taken into consideration in the treatment of diseases. Well
bred, fine skinned, sensitive horses vield to the action of cer-
tain drugs more readily than those of the opposite type. This
is especially true where outward applications (turpentine blis-
ters) are to be made.

2. Habitus.

By the term /rabitus we mean the general or external as-
pect or characteristic appearance of the patient, which is de-
termined by its physical attitude, condition, conformation and
temperament. It offers a convenient aid in ‘diagnosis, one
that can be readily observed and that, in many respects, is of

GENERAL PART OF EXAMINATION. 33

great importance. _Not infrequently a diagnostic conclusion
im a clinical case is reached largely through the impression
the patient makes upon us by its habitus.

Obvious physiological abnormalitiés are sometimes of
themselves an index to the character of the disease. How-
ever, one should guard against reaching hasty conclusions
from the first impressions of the patient, to the neglect of a
thorough examination.

—~_ 1. Attitude of the patient. Healthy horsés as a ‘rule
remain standing during the day, or if lying down they imme-
diately rise to their -feet at the approach of a stranger. They
will frequently lie flat on the side with feet extended, pro-
vided the halter strap is long enough and the stall of suffi-
cient width.

Healthy cattle lie down often during the day, especially
just after feeding, and they are not so prone to rise when
approached. They seldom lie flat on the side, but in sternal

decubitus the limbs folded under them.
Healthy sheep jump up when approached and usually

run away.
The attitude of sick av‘mals whether standing, walking

or lying down is often of value in diagnosis.

Standing attitudes assumed during disease. The head
is held stiffly and extended in pharyngitis, cerebro-spinal men-
ingitis, muscular rheumatism, malignant head catarrh of the
ox, and in acute encephalitis of sheep and goats.

Very sick animals usually hold the head down, and as-

sume a relaxed languid attitude, the ears drooping; horses
rest their feet alternately.

Cows suffering from severe vaginitis stand with arched
back, tail held high, and legs spread apart. They do not
“stand: over” readily in the stable, and if driven stop repeat-
edly to urinate.

a . .
A stiff, quiet attitude avoiding moving as much as possi-
ble, is characteristic of very painful affections in the chest or

34 CLINICAL DIAGNOSTICS.

abdominal walls (pleurodynia, pleuritis, peritonitis). Stal-
lions suffering from incarcerated inguinal hernia and oxen
with peritoneal hernia (gut tie) stand with the hind leg of
the affected side held backward and outward.

—.. Unphysiological attitudes. Animals afflicted with brain
troubles (acute or sub-acute encephalitis, dummies) very
often assume unnatural attitudes. Horses stand obliquely in
the stall, the head in a corner, resting against the wall or
sunk under the feed box. The limbs are drawn well up under
the abdomen, and not infrequently one leg is placed in a very
unphysiological position, perhaps crossing its fellow of the
opposite side. Dummies stand unusually quiet and seem
oblivious of their surroundings. They move without energy,
and are backed with the utmost difficulty. (See under “Cen-
tral Nervous System,” “Examination of Dummies’).

In acute brain diseases the horse does not continuously
assume these attitudes but only at times.

Continued standing is observed in:

a. Old, worn-out horses.

b. Pneumonia and Pleuritis. As a rule if the animals
lie down in these diseases it is on the diseased side, and for the
following reasons: because the slight pressure of the ground
against the body ameliorates the pain, and the pleuritic exudate
(the effusion in the chest) does not encroach so much upon
the heart and the still healthy lung. The respirations are
always more difficult when the animal is lying down. [In
peritonitis resulting from castration horses very commonly
remain standing; when forced to move they do so with hind
legs held in abduction, advancing very stiffly].

c. Severe Dyspnea. The head is held extended to allow
the air the easiest possible access to the lungs, thus facilitat-
ing inspiration.

d. Horses suffering from acute diseases of the brain.

e. Horses suffering from Tetanus. The stand with
legs braced like a saw horse, the head somewhat extended and
held high, the back held rigid. It is very difficult for them
to step sideways. The facial expression is anxious, the mem-

GENERAL PART OF EXAMINATION. 35

brana nictitans appearing plainly before the eve; the tail is
carried high and stiff, and the gait inflexible and laborious.

Restless Standing. Most commonly seen in horses suffer-
ing from colic and acute brain diseases. The former are rest-
less, lie down, roll, and get right up again. In many cases
it is only with difficulty that they can be kept on their feet;
when down it may be equally hard to drive them up. They
often look at the flanks, paw, strike the belly with the hind
feet, switch the tail, and stretch as if to urinate without void-
ing urine. At times they sit up like a dog.

Like symptoms but of shorter duration are observed in
the ox suffering from invagination of the intestines, torsion of
the uterus in cows and from urethral stones and peritoneal
hernia in steers.

Horses with acute brain disease show at times rabiform
symptoms, plunging, rearing and breaking loose. When not
tied they keep forging ahead or continue aimlessly walking
in a circle.

Restless, anxious moving about is seen in many cases of
severe dyspnea.

Gait. <A labored, slow, exhausted, wobbling gait is noted
in severe febrile diseases. It is especially marked in influ-
enza of the horse. In tetanus, muscular rheumatism and
purpura hemorrhagica the gait is stiff. Lameness of one or
more limbs is seen in foot and mouth disease and pyemia
(pyemic arthritis). The gait is unphysiological in acute and
chronic hydrocephalus. In the trotter disease of sheep the
patient does not walk but goes at a stiff trot. The crackling
of joints is heard especially in equine influenza.

_.. Lying postures assumed during Disease. Animals
found lying down and that can not be made to rise should be
examined very carefully. In them the examination is always
difficult. We should first try to drive them up by speaking
to them in a sharp tone of voice and assisting them by me-
chanical means. It is important to determine whether they

36 CLINICAL DIAGNOSTICS.

are really unable to rise or whether they are obstinate and
will not rise (malingerers).

If the animals have lain for a long time on one side, it is
advisable to turn them over before attempting to drive them up.
The same should be done when after a fruitless effort to get an
animal onto its feet, it falls back again to the ground and we make
a second attempt to make it stand.

Fig. 5—Horse with Azoturia.

To bring recumbent horses to their feet it is expedient, after
placing them on the sternum, to pass the end of a long halter rope
through a convenient ring in the wall, and keep it pulled taut; the
hind legs should be doubled under the body in a natural position
and the fore ones extended in front. By speaking to the animal,
striking it over the ears and nose, and lifting by the tail, we may
assist it to regain its feet. When this method fails, a sling should

GENERAL PART OF EXAMINATION. Bid

be placed under the body and the animal raised with block and
tackle.

The ox is often hard to induce to stand up after it has been
down for a time. It may be able to get up, but through obstinacy
will not do so. Whipping and beating in such cases is usually of
no avail; yelling in the animal’s ear, setting a dog on it or tieing
its nose shut may be tried. [By placing a rope around the body
so that it passes beneath the brisket in front and the ischii behind,
we have improvised a handle by which several persons can lift the
malingerer to its feet.]

Animals may be unable to arise:

a. In Tetanus. Horses suffering from tetanus, if down,
are as a rule unable to stand up without help, as the spasmodic
contractions of the extensors of the limbs prevent it. When re-

cumbent, the upper pair of legs do not come in contact with the
ground. The animals are very restless and bedewed with sweat.

Fig. 5a.

Horse with Tetanus.

b. In Azoturia. Horses suffering from acute azoturia
make vain efforts to stand. They are sometimes only partially
successful, the fore part of the body being raised and supported
by the front legs, but the hind limbs are unable to bear their
share of the weight, breaking down under it.

c. In Spinal paralysis from Fractures of Vertebrae.
The patients lose control of the hind parts which are no longer
sensible to pain [pin pricks]. Sometimes, however, reflex spinal
convulsions attend “broken back.” Dogs with paralyzed hind
parts usually sit sideways, the legs directed away from the body.

38 CLINICAL DIAGNOSTICS.

d. Ante- and Post-partum Paresis. Occurs in
cows before or after calving. The animals seem to be in com-
paratively good health, have a good appetite, but can not regain
their feet. There are no further symptoms of disease or injury.
They often lie stretched out on the side. [Prognosis is favorable. ]

e. Milk Fever (parturient paresis). The cow lies in a
comatose condition on the left side as if in profound sleep, the
head resting against the right chest. If the head be lifted

(
MG \
{7 BSS

Fig. 6.—Cow with Parturient Paresis.

it drops back again to its former position as soon as released. Sen-
sitiveness and temperature of the whole body are diminished.

f. Cramp of the Neck (cerebro-spinal meningitis). After
showing symptoms of stiff, wry neck, while standing, paralysis fol-
lows. The patients lie flat on the side with the head drawn back-
ward, the body convulsed with spasms.

Old, worn out horses are hard to get upon their feet once they
have lain or fallen down. When animals are suffering from severe
pain in the legs and feet (founder) or when lying on an injured
limb (fracture), they can as a rule rise only with the greatest diffi-
culty. Colic patients, when down, generally do not get up
promptly.

Inspection of Herds. In examining groups or entire
herds of animals, one should observe the behavior of each
individual. The inspection may be conducted in the stable
or better in the open, without undue excitement, and any ani-
mal showing symptoms carefully noted. Sick animals are rec-
ognized by their attitude, movements, depressed appearance,
lack of appetite, etc. .\fter such a preliminary survey of the
group or herd suspected individuals may be separately scru-
tinized.

GENERAL PART OF EXAMINATION. 39

_ IL. Condition. The condition of the animal is recognized
Principally by the rotundity and fullness of development of the body.
Cold blooded horses usually have well rounded forms because the
muscles are of large size and surrounded by well developed fat
deposits. The condition as to flesh is influenced by the quantity and
quality of the food and the use and purpose for which the animal
is intended and fed. Continued hard work reduces the fullness of
the body outline, causing the conformation to appear angular.

When the digestive tract is affected with disease whether local
or general, the condition of the animal becomes reduced. A gradual
but continual loss of condition, notwithstanding that the appetite
and food are good, always points to chronic disease, but not neces-
sarily to disease of the digestive tract. When the digestive tract
becomes diseased the appetite is impaired.

Depending upon the use and purpose of the animal we
distinguish the following kinds of condition: Prime, very
good, tolerably good, fair and bad. A gradual, progressive
general emaciation is called Cachexia. Rapid emaciation ap-
pears in purpura hemorrhagica and in severe infectious dis-
eases. Excessive corpulency (obesity) is common in bulls and
dogs.

If the patient’s condition as to flesh is of importance to
consider, it is well to note the things by which condition is de-
termined, such as the size of the muscles, thickness of the crest,
fat over the ribs, number of ribs visible, prominence of the
spines of the dorsal vertebrae, etc. The best way to deter-
mine whether the patient is gaining or losing in condition is
to weigh it, which should be done each morning, preferably
before feeding.

Of importance in diagnosis is the difference between
thinness and emaciation, Thinness is physiological and is
peculiar to certain breeds of animals. The thin (lean) animal
may feel well, show good appetite, smooth, lustrous hair coat,
and render efficient service (large milk flow). Emaciation,
on the other hand, is a condition due to disease, starvation or
old age. If for any reason the digestive tract can not per-
form its functions emaciation results. Rapid emaciation
occurs in purpura hemorrhagica and in all severe infectious
diseases. Emaciated animals show a dull, erect hair coat,

+40 CLINICAL DIAGNOSTICS.

leathery, dry skin, are languid and present varied disease
symptoms.

III. Conformation. It is advisable to classify horses
according to their use into heavy and light draft, carriage and
saddle horses. The classification is based upon the animal's
conformation. To judge of the conformation correctly we
should take into consideration the depth of the body, breadth,
depth of chest, curvature of the ribs, length of back, depth
of flank, breadth of pelvis, strength and angulation of the
joints, and the attitude of the limbs when standing natural!y.

Accordingly, we distinguish between a strong and weak,
heavy and light boned, well muscled and poorly muscled con-
formation.

Horses with flat, small chests possess poor staying quaii-
ties, the lungs correlatively being small. Horses with flat, not
well sprung ribs, tucked up abdomens and long legs, are as
a rule poor feeders. As such animals show continually poor
appetite tor food, the bowels are not kept well filled, hence
the body appears deficient in depth. Hearty horses, good
feeders, show on the other hand, better developed abdomens,
the bowels being distended by the large quantities of food
they contain. The more voluminous the food, the greater the
circumference of the belly. [The abdominal circumference is
further increased in pregnancy and in diseases causing exu-
dates to accumulate in the abdominal cavity, ascites].

Animals with curvature of the spine, abnormal bending
of the leg bones or diffuse enlargements of joints suffer or
have suffered from constitutional bone diseases in youth
(rachitis). Calves with broad, beefy hind parts and wide
loins suffer from pelvic distortion, grow slowly and should
not be used for breeding (‘“Doppellender’’).

IV. Temperament. By temperament we mean the
mental attitude the animal assumes toward impressions per-
ceived through the medium of the organs of sense. An ani-
mal’s knowledge of what is going on about it is obtained

GENERAL PART OF EXAMINATION. 41

through the instrumentality of the bodily senses of sight,
hearing, smell, and touch. We distinguish between a lively
and a phlegmatic temperament, comparing the power of quick
perception with its opposite slow comprehension. Too much

tendency in either direction will affect the usefulness of an
animal.

Animals of fiery disposition often show temper by being
stubborn, vicious, balky, or they are very nervous, anxious,
casily frightened, which reduces their economic value. Young
animals, especially horses, are often restless and like to play.

Animals of a very phlegmatic temperament may be so
slow to move as to impair their usefulness.

The sort of temperament possessed by an animal is shown
by its external appearance. The countenance, expression of
the eye, play of the ears, and quickness of movement form
sources from which the temperament and disposition may be
judged. The facial expression and eye give information as to
the mental condition.

Blind horses are often scary; they employ the sense of
hearing, moving the ears in a lively manner to take the place
of the lost sense of sight, at the same time holding the head
still. This may cause us at first sight to suspect that the
animal is suffering from a brain disease. Old horses are not
so sensitive to outside impressions as colts. Some colts, how-
ever, are little observing of their surroundings, appearing dull,
stupid and lazy, without suffering from disease. Great fatigue
produces temporary mental depression in individuals.

Febrile diseases affect the temperament, making the
animal affected sluggish in its movements. In animals of fiery
temperament this is not so noticeable.

In animals suffering from severe, serious diseases, the
temperament can become so changed that vices, such as crib-
bing, biting, kicking, etc., are no longer indulged in. The
countenance appears blank, expressionless, staring, eyes
sunken, locomotion slow and unsteady. A few hours before

42 CLINICAL DIAGNOSTICS.

the fatal termination of a disease, the normal tonus of the
tissues is lost, the muscles relax, especially those of the face,
forming the so-called Hippocratic countenance (facies Hip-
pocratica), one of the symptoms of approaching death.

Diseases Which Are Characterized Particularly by Change
in Habitus.
Tetanus. See pages 37 and 220.

Colic is a complex of symptoms in the horse characterized
by abdominal pain and suppressed peristalsis. It is due to some
affection of the stomach or bowels. For the symptoms in regard
to manner in which pain is shown, see page 35. Further symp-
toms are sweating, congested, “muddy” conjunctiva, accelerated
pulse, dyspnea, anorexia, suppressed peristalsis, obstipation. The
cause which lies at the bottom of these clinical phenomena can
be determined only by careful examination of the abdomen. (See
this.)

Azoturia is an acute auto-intoxication in the horse character-
ized principally by a peculiar severe parenchymatous inflammation
and paralysis of the muscles and complicated by hemoglobinemia
and acute nephritis. It appears suddenly under symptoms of par-
alysis of one or both hind limbs, inability to stand, restlessness
and sweating. Croup muscles tense, hemoglobinemia, hematuria.
No fever, mind clear, dyspnea, appetite retained. When standing
knuckle in joints of affected limb; make ineffectual efforts to re-
gain feet; hind limbs unable to support body.

Polyarthritis (articular rheumatism). Febrile infectious dis-
ease with inflammation of usually several joints. Without appa-
rent external cause there appear suddenly hot and painful swell-
ings of joints. Patients remain lying; high temperature, no appe-
tite, cease ruminating. Most common in ox; rare in horse.

Muscular rheumatism (myositis rheumatica). Peculiar in-
flammation of individual muscles or groups of muscles. Charac-
terized by wandering, periodical pains. Mostly confined to limbs
and back; head rarely affected. Temperature not high. Not in-
frequently complicates other diseases, especially those due to
refrigeration. Most common in horse, dog and swine.

Cerebro-spinal meningitis (cramp of the neck). Probably in-
fectious. Symptoms vary. Delirium, spasms of the muscles of

GENERAL PART OF EXAMINATION. 43

the head, neck and limbs. High fever; dysphagia. Patients re-
main lying with head drawn back (opisthotonus).

Parturient paresis (milk fever). See page 38.

Rachitis and osteomalacia. Both of these diseases are char-
acterized by the bones being deficient in lime salts. Such bones

Fig. 7.—Rachitic Dog.

possess little power of sustaining weight, hence they suffer change
in form when weight of the body must be borne by them.

a. Rachitis appears only in young animals, mostly in pigs
and puppies. Pathologically the disease may be considered to be
a remaining softness of the bones, the epiphyses becoming en-
larzed, the diaphyses bent. An upward curvature of the spine —™S

is called kyphosis, a downward “= lordosis, a lateral ) scoliosis.

Animals suffering from rachitis remain lying a great deal, find
trouble in regaining their feet, and locomotion is difficult.

b. Osteomalacia. Fragility of the bones is seen only in adult
animals (cattle). The animals lie down continually, are weak, eat
but little, and become thin in flesh. The bones of the extremities
become brittle; spontaneous fractures, decubitus, and death ensue.

38. The Skin.

The condition of the skin indicates the state of health.
The condition of the skin is affected not only in local diseases

44 CLINICAL DIAGNOSTICS.

of that organ, but in many maladies of a general nature,
involving internal viscera. An examination of the integument,
therefore, is of importance to diagnosis. The skin is examined
by inspection and palpation; in local diseases the microscope
is employed. An examination of the skin includes the fol-
lowing :

I. Condition of the hair coat. In horses and cattle in
good condition the hair is usually short, fine, glossy, and lies
smoothly. Horses running on pasture or kept in unsanitary
stables, show a long, lustericss, rough, bristling, hair coat.
If the condition of the hair coat is bad, notwithstanding good
care and shelter, it mav be assumed that the animal is suf-
fering from ill health. The appearance of the hair coat is
influenced mostly by chronic diseases. Temporarily the hairs
may become erect when the animal is carrying increased tem-
perature (chill) or from the effects of cold air or water.

In birds with fever the feathers appear ruffled, especially
those of the neck which stand erect.

In long haired animals the hair coat should lie closely
matted and the hairs have the same general direction. A
tufting of the wool of sheep is indicative of skin disease
(scabies).

Shedding of the hair. Inhorses and cattle a par-
tial shedding of the hair occurs normally each fall and spring.
In the fall the long, soft winter coat appears; this is shed the
following spring. [Animals kept blanketed in warm stables
retain a short hair coat throughout the winter.] Good care
and proper food hasten the shedding of the hair, contrary con-
ditions tend to postpone it. When the winter coat is retained
during the summer months, it indicates usually chronic disease
of nutrition.

When horses which have been poorly kept pass into good
hands and receive nourishing food and good attention, an
unusually early shedding of the winter coat follows.

GENERAL PART OF EXAMINATION. 45

Loss of Hair. A loss of hair over the whole or a large
part of the body (alopecia) sometimes quickly follows the re-
covery of an animal from a severe infectious disease (con-
tagious pleuropneumonia of the horse). A 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 fos is kept continually moist by
the secretions of the sweat glands. In healthy animals 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 tem-
peratures and nervous excitement. Sweating does not become visible
in swine, sheep, dogs, and cats.

In disease a more or less profuse outbreak of
sweat (hyperidrosis) appears :—

1. 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.

2. In painful maladies: founder, colic, enteritis.

3. In diseases painfully affecting the muscles: tetanus,
epilepsy, azoturia, cerebro-spinal meningitis.

4, In severe infectious diseases, septicemia, pyemia.

5. When an animal is much weakened from acute or
chronic disease.

Normally, perspiration is accompanied by a hyperemia
of the whole skin (“ot sweat”). 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 standpoint.

46 CLINICAL DIAGNOSTICS.

Local sweating (hyperidrosis localis), or sweat
appearing on only one side of the body (/entidrosis) is seen
at times to accompany diseases of the nervous system.

A decrease in sweat secretion (/yphidrosis)
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. 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 swellings 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

GENERAL PART OF EXAMINATION. 4”

troubles, chronic pleuritis, pericarditis, and traumatic peri-
carditis of the ox.

b. A watery condition of the blood (/ydremia) 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. Contrary
to edema due to venous congestion (stasis), the infiltrated
tissue is usually not reddened but pale, anemic. Dropsies due
to hydremia are noted under the jaws of sheep afflicted with
animal parasites, [the lung and stomach worms, Sfr.
contortus, Str. filaria; liver flukes, Dist. hepaticuim, being
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-

418 CLINICAL DIAGNOSTICS.

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 (empl. septicum). Spon-
taneous emphysema is pathognomonic of black leg, where it
appears upon the back, neck, and muscular portions of the
legs.

Emphysema occurs also from the aspiration of
air from without into the subcutis. The air may enter
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 cmphysema). 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-

GENERAL PART OF EXAMINATION. 49

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.

. IV. Color of the skin. The hair and pigment prevent us

om 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 aloss of pigment from the portions of the skin over which
they flow.

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.

A sharply defined, highly red or dark red discoloration of
the ears appears in chronic swine erysipelas (Rothlauf) and in
peracute hog cholera. In the latter the temperature may b-
normal or subnormal.

Yellow (icteric) discoloration and paleness of the
skin will be considered under “Examination of the Conjunc-
tiva.” See page F9.)

50 CLINICAL DIAGNOSTICS.

V. Condition of the skin. The skin of a healthy animal feels
pliable and elastic, and is movable upon its underlying 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 urinous odor, noted not infrequently from bladder
rupture, the contents of the organ being poured into the ab-
dominal cavity. This condition is noted following urethral
calculi in the ox.

Diseases of the Skin.

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.

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.

GENERAL PART OF EXAMINATION. 51

7 Seales (sqguamae) 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-parasitic Skin Diseases.

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 (hematidrosis) is the spontaneous appear-
ance of blood upon the apparently intact surface of the integument.
It is peculiar to Hungarian and Oriental 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.

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 and tail.

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 to 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.

52 CLINICAL DIAGNOSTICS.

Il. Skin Diseases Due to 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) Teas 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. ]

en

GENERAL PART OF EXAMINATION. 5

Fig. 8.
Fig. 9.

Hacmatopinus equi. Trichodectes equi.
Blood-sucking Louse. Scale-eating Louse.
x 12 x 20
Fig. 10 Fig. 11.

Psoroptes communis.
Ventral side. Ventral surface, Egg in Oviduct.
x 100 x 100

Symbiotes bovis.

54 CLINICAL DIAGNOSTICS.

Mange (scabics) 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.

Sarcoptes scabiei, Acarus
Ventral side. folliculorum.
x 100 x 150

GENERAL PART OF EXAMINATION. 55

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.
Sarcoptes 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.

Ill. Skin Diseases Due to Plant Parasites.

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
them. In mammals thick, depressed, yel-
lowish brown crusts appear.

Trichophyton tonsurans.

56 CLINICAL DIAGNOSTICS.

Trichorrhexis nodosa is a disease characterized by the forma-
tion of nodular enlargements along the shaft of the hair. The
hair breaks off at the nodule, leaving a brush-like stump behind.
Contagious.

IV. Avcuate Exist teenies:

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.

GENERAL PART OF EXAMINATION. 5v

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
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, ete. Course about 3
weeks. [Mortality 10 to 50%].

3. 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.

+. 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.

5. Pemphigus acuta. Noncontagious, benign exanthema char-
acterized by the formation of a limited number of large vesicles
(bullae) on different parts of the body.

V. GeneralDiseases which Affect the Skin.

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

wal

8 CLINICAL DIAGNOSTICS.

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%].

VI. Arcwhe Inteetious Diseases whitch Aite'et

theo oS kane

1. Black leg is an acute infectious disease 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, uxper portions of the extremities (never below 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 symptoms are high
fever, great depression, lameness, dyspnea. Mortality 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, j

3. Bovine pest (Wild- und Rinderseuche) 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 scpticemiae 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.

GENERAL PART OF EXAMINATION. 59

8
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
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 eve, that

60 CLINICAL DIAGNOSTICS.

organ must be free from local irritation. Severe ex-
ercise, and high atmospheric temperature cause a
healthy mucous membrane to appear very red from
physiological congestion; local inflammation also produces
congestions.

A careful comparison of both eyes will enable us to deter-
mine the presence of local inflammation. In healthy animals
the color of the conjunctiva is pale-roseate; in the ox paler
than in other animals. A few blood vessels are alwavs visible.
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 dis-
charges from the eyelids constantly present. The dis-
charge is either bilateral (from both sides) or wun-
ilateral (from one side only). Bilateral discharges are
seen in: malignant head catarrh (with keratitis), Rin-
derpest (no keratitis present), dog distemper, fowl
cholera, influenza. (Swelling shuts off the tear ducts,
strangles). Unilateral discharges occur: in continued
chronic nasal catarrh, a symptom of glanders, chronic nasal
or sinus catarrh. In all animals showing unilateral dis-
charge 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-
puscles.

1. 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:
Following great loss of blood, internal hemorrhages (liver,
heart, large blood vessels, etc).

GENERAL PART OF EXAMINATION, 61

_ In congestion of blood in the intestines (embolism of
intestinal arteries, displacement or torsions of the bowels).
Paleness appears as a clironi¢ condition:
In constitutional diseases of the blood-making organs
(leucemia, hydremia).

In all chronic diseases which lead to anemia or hydremia,
glanders, tuberculosis, distomatosis (liver flukes) and para-
sitic diseases of the stomach and lungs of sheep.

2. J caous engorgement does not always come from

plethora. It may be ramiforim, diffuse or punctiform, and
varies in color from a brick red to dark red (cyanotic).

a. Ramiform congestion from disease occurs:

In congestion of the head due to hyperemia of the brain,
encephalitis. The blood vessels are plainly marked in the dif-
fusely reddened conjunctiva.

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.

b. <A diffuse, faded bluish-red discoloration of the con-
junctiva 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).

c. Spotted or punctiform reddening is almost always
due to hemorrhage in the conjunctiva. The color is, there-
fore, bluish-red and the form round or streaked (petechia,
ecchymoses). Seen in purpura hemorrhagica, anthrax, severe
anemia and in pernicious anemia.

3. Yellow (icteric) discoloration (jaundice)

62 CLINICAL DIAGNOSTICS.

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.

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
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 (/iypercholia) 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 termination of the
ductus choledochus in the bowel. Hepatogenous icterus is
characterized by the appearance of bile pigments in the urine
while the feces, containing less than normal, are of too light
a color.

GENERAL PART OF EXAMINATION. 63

Hepatogenous icterus is seen 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
pleurcpneumonia of the horse, purpura hemorrhagica, ma-
lignant head catarrh of the ox, Rinderpest, anthrax, dog dis-
temper, chicken diphtheritis and strangles.

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 especial 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.

64 CLINICAL DINGNOSTIES,

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 considerable
moment. In all diseases affecting internal organs, the measur-
ing the temperature is imperative.

Method of examination. Thermometry. Formerly the tem-
perature was approximated by laying the hand upon different parts
of the body, namely the nose, ears, horns, extremities, or by inserting
the fingers into the mouth. Such methods require long practice before
a reliable estimate can be obtained, and they are always deceptive.
Only in exceptional cases are they now in vogue. The temperature
is most accurately measured with a thermometer, graduated in de-
grees and tenths of a degree. [Except in America, England and
perhaps one other country the Celsius (centigrade) thermometer is
in common use. It is graduated into 100 degrees, and these sub-
divided 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 traditional, 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 Cel-
sius scale may be converted into the Fahrenheit scale and vice versa:

Celsius = 5/9 (F—32),
Fahrenheit = 9/5 C+ 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 col-
umn of mercury should be shaken down. The use of water, saliva
or oil facilitates insertion. We should allow the instrument to re-
main in the rectum from three to five minutes.

In fowls the thermometer may be inserted in the rectum as in
other animals, or placed under the wing.

Taking the bodily temperature once daily is of great
value during the course of an internal disease; in important
cases the temperature should be rezistered 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

GENERAL PART OF EXAMINATION. 65

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,
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 ....38,0—39.5° “* [100.4—103.1° “J

Sheep ..39.0—40.5° “ [102.2—104.9° “ ]

Goat -..390—to5* * [102 2—1049° “]

Hog ...38.0—40.0° “ [100.4—104.0° “]

Des ..uwis—0" = | sos 088" = 3

Fowls ..41.5—42.5° “ [106.7—108.5° “J

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 to 1° C. [18° F-.].
In healthy but pregnant cows the temperature may vary

1.5° C. [2.7° F.]; a temperature elevation, therefore, of
40.5° C. [104° 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-

‘

66 CLINICAL DIAGNOSTICS.

son of the year, in cattle kept in stables the temperature may
rise 1.0° C., for a short time.
As a rule the bodily temperature is lowest in the morn-

ing and in the afternoon at about five o’clock highest.

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, as is also true of the comb and legs
of fowls.

The surface temperature is measured by laying our hands
on the patient, namely on the ears, horns, nose, muzzle and
legs. Deviations from the normal, especially in cattle, are
sometimes more appreciable by this method than by the use of
the thermometer.

A changing of the surface temperature of a given part
from hot to cold and vice versa is characteristic of fever.

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.

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.

GENERAL PART OF EXAMINATION. 67

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, Rinderpest, 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. re

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
normal one. The appearance of concomitant symptoms or
repeated recording of the temperature will generally decide

68 CLINICAL DIAGNOSTICS.

whether fever be present or not. In doubtful cases we speak
of high normal temperature.

The following temperatures may be safely assumed to
indicate fever :

In the horse a temperature of 39.0° [102.2° F.] and over.

In the ox : 40.0° [104.9° F.] i

In the dog es 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.
Zi) S16 J ee
41,0
v
40,0 =
vi
E
39.0 ¥
vi
re Ay
38,0 oe .
—
37,0
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. Afild fever 38.5°—39.5° C. [101.3°—103.1° F].
Moderate fever 39.5°—40,5° C. [103.1°—104,9° F.].
High fever 40.5°—41.5° C. [104.9° Ba? J.
Very mse 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°

He CO 0G

GENERAL PART OF EXAMINATION, 69

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.

Fig. 18.
A 2.| 3 Y c 6 & 9g 4O\ | 2) 13 | S¥ NAS) 16
41,0
rm A
RIN rt
\EREAR AAR
40,0 AN 7. T
PX Vir \
r iwi |
WAY i
38,0 TF ¥ 1
att ramet ral
t Ayo
UAE REA EEL
38,0 + + v
ia it
Ava ¥. 1
¥ ¥
37,0

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.
C182

2. Remuittent fever, daily variation over 1° C.

70 CLINICAL DIAGNOSTICS.

3. Intermittent fever, periodical temporary fall to nor-
mal temperature.

4. Atypical fever is one having no regular character.

Fig. 19.
213 4 5 7 9 |vol| ay | 1% | 75 | 76 /Y,
>
1
Ht
41,9 Tt
i Tt
40.0 rat
K A
aii ¥ al
mA i if
on E wi 2 A 1
38,0 a +
a y- { Pik ral “i 1 t 7 \ 7
87,0 t AV AG AN 2 vi
yi try 1 Vv
4 ave
tL}
Apyrexia. Relapse.

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.
3 4 5 | 4 9\\t ahs) i 7s] sol
41,0
40,0 aim Wd
f \ Fa a
39,0 Prt
7 a ix
i
3 4
38.0 ea , he
37,0
Initial Fever. Relapse. Fall
Abscess developing after opening
bscess.

Febris atypica—Strangles of the Horse.

GENERAL PART OF EXAMINATION. 71

1. Stage of increasing temperature (stadium incre-
menti).

2. deme, temperature at its highest (fastigium).
3. Stage of falling temperature (stadium decrementi).

A rapid fall of temperature (within 1-2 days) is called
crisis, a gradual decline, /ysis.

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-
ical. 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 def-
ecation takes place just before or during the insertion of
the instrument.

A subnormal temperature due to disease is uncommon.
It is seen to occur, but not constantly, in parturient paresis,

certain gastro-intentinal diseases of the dog, anemia, hemor-

rhage, icterus gravis. .\ subnormal temperature is most fre-
quent in fatal diseases just before death (temperature of col-
lapse).

General Infectious Diseases.

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.

72 CLINICAL DIAGNOSTICS.

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- at

ings of muscles, rap- iad or
id pulse, dyspnea, » on, a7, ne ‘ti hh. pfs Hh | ta i | a ik
"it gle | 2 man I nf hie hs i
ih og ci ia
it,

loss of milk, are

symptoms some- ee
times seen. In horse,
colic symptoms oc- 0
cur. Formation of

anthrax carbuncle in re
skin is not rare in ‘| |
the horse. In hog, ‘tl
symptoms of severe es
laryngo - pharyngitis eat

with swelling pre-

dominate. Diagnosis ‘ae Rahal y x
is positive only after Mo (ee. i i yl hi mt
finding bacilli under typ ae i id Wi a a thes
the microscope. An wie mH ‘i x ‘ " ne | Mh se ‘ rt
anthrax slide is made a oor a) Me fg

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%.

[Hog Cholera. Infectious disease of swine, caused by bacilli
which enter the bod: through the respiratory tract, or via respira:
tory tract or mouth—

GENERAL PART OF EXAMINATION. 73

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. Bowels 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 protozoén (Pyrosoma bigeminum) which enters and destroys
the red blood corpuscles. The disease is spread by the cattle tick,
Boophilus bovis, the younger generation of which carries the pro-
tozoon. 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%].

Chicken cholera. Attacks all kinds of fowls. Incubation
period one day. Birds sit languidly on the ground, feathers ruffled,
evelids closed and stuck with exudate. Temperature 42-43.2° C.
Respirations increased, jerky, and often noisy. Appetite lost. Thirst
increased. Feces watery, greenish, yellow or bloody, mixed with
mucus and fetid. Death in three days with sinking temperature.
Often apoplectic death.

Chicken pest is an acute, very transmissible infectious dis-
ease, generally distributed. Affects usually only chickens and clin-
ically and pathologically very like cholera. The patients never show
diarrhea, the course is slower and apoplectic death does not occur.
The virus, contrary to chicken cholera, is ultramicroscopic.

Hemorrhagic septicemia (Wild-und Rinderseuche) is an acute,
general infectious disease appearing in the exanthematous, pectoral
and intestinal form. High fever. In cattle a hard, inflammatory-
hemorrhagic edema of the head and swelling of the tongue occurs.
Dyspnea. : : é

Swine erysipelas (Rotlauf) is an acute, infectious disease,
usually fatal. “Incubation period 3-5 days. Sudden fever, great lan-
guor, weakness of the hind parts, stupor. Patients burrow in straw.
Vomiting. Skin between thighs, under belly, neck and chest diffusely
reddened. Dyspnea. Death in four days.

Braxy of Sheep. A peracute hemorrhagic inflammation of
the abomasum due to the bacillus gastromycosis ovis. In many
respects resembles anthrax.

G4 CLINICAL DIAGNOSTICS.

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,
animals 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:

1 Taking the pulse.

¢

u. Noting the condition of the peri-
pheral blood vessels.
mm. 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 be felt, hence the heart’s beat
is used.

To palpate the pulse place the first, second and third fingers
over the artery, pressing it slightly and rolling it somewhat under
the fingers. Before one can judge the pulse, several beats must
be felt, best counting them for a full minute.

From a clinical standpoint the 1. Frequency, 2. Rhythm,
and 3. Quality, are of importance to consider in examining

the pulse.

76 CLINICAL DIAGNOSTICS,

a. Frequency. By the frequency of the pulse
we mean the number of blood-waves (beats) felt in a
minute’s time. There is a great variation in the normal
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. Horses in general............... .. 28— 40.
Warm blooded stallions............. 28— 32.
Cold blooded stallions............... 28— 36.
Colts, two weeks old.............04. —100.

four weeks old.. ......... Pe — 70.
“six to twelve months old... .. 45— 60.
“two to three years old.. ...... +0— 50.

2. Asses and mules................00- 45— 50.

Gi: HROVINGES: -n95 22-4e Sees oe 8 Zhi Beha at 40— 89.

4, Slheepvaitd: @0ats ese ved eta augae 70— 90.

ee ieg SN LC asim oescreenline (a preyetlus oa sasler in te tag tt 60—100.

Os DOES i gewheiniwh toting Gein ee oe eee ies 60—120.

Yin CASAS tdi: She”, puter wrecatalan tung ten delta aes 110—130,

He TAG ONVIA. a Bcmei th abane eee auigd des she neues 120—160.

*NOTE. The numbers refer to the heart’s beat, as the pulse
can not be felt in swine and fowls.

SPECTAL CLINICAL EXAMINATION. 77

In regard to frequency we distinguish a slow pulse
(pulsus rarus) and a rapid pulse (pulsus frequens).

The slow pulse (pulsus rarus, bradycardia) is very un-
common. It most often accompanies brain diseases attended
by great depression (chronic and subacute hydrocephalus,
tumors in the brain), icterus gravis, and poisoning from alco-
hol or lead. 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.

ee ae

Slow, Sluggish Pulse of Horse.
Taken with Marey’s Sphygmograph—Art transversa faciei.

The fast pulse (pulsus frequens, tachycardia,) is very
common in disease. 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 unfavorable. Jn 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.

78 CLINICAL DIAGNOSTICS.

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
(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, i. e., arhythinic.

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 interiuttent, 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.

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-

SPECIAL CLINICAL EXAMINATION. i)

cence from infectious diseases which have occasioned high
pulse (contagious pleuropneumonia of the horse).

c. Quality. The pulse beats should be of equal vol-
ume. When this is true we speak of an equal pulse (pulsus
acqualis).

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 76.) In dogs often it is inequal.

The normal quality of the pulse can suffer change in
various ways.

1. According to whether a greater or smaller quantity
of blood is forced into the arterial system, we distinguish a
full (pulsus magnus) and anempty (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.

2, 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

80 CLINICAL DIAGNOSTICS.

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.

ey

3. 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 har]
pulse is the soft pulse (pulsus mollis).

5. As combinations of varied degrees of size, strength
and hardness of the pulse are noted, special but superfluous
kinds are spoken of: 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 associated 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.

6. The arch of the pulse wave may become changed in
cisease. If the wave is very abrupt, we speak of a hopping,
swift pulse (p. celer); if, on the contrary, the wave is much
nrolonged, it is spoken of as 4 “siuggish” pulse (p. tardus).

SPECIAL CLINICAL EXAMINATION. 81

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 fulland strong. Remarkably
in heart's weakness a pf. ccler is often present. However, here
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.

7. A pectuiar pu.se is the dicrotic pulse where two
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. 26.

Dicrotic_ Pulse—Horse.
Marey’s Sphygmograph.

II. Examination of the Peripheral Biood 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 pert-
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 aortal 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. «1 permanent distention of the veins is path-

82 CLINICAL DIAGNOSTICS.

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.

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.

+. From excessive intrathoracic pressure upon the heart
and large blood vessels: tympanitis, pleuritis, pericarditis
traumatica of the ox, tumors.

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,

SPECIAL CLINICAL EXAMINATION. 83

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
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 1s
coincident with the heart’s systole, and is produced by a de-
fective closing of the atrio-ventricular valves, the blood re-
gurgitating into the auricle. True venous pulse is
a characteristic symptom of tricuspid in-
sufficiency.

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.

III. The Heart.

The heart is examined by palpation, percussion
andauscultation.

Anatomical. In all domestic animals the heart lies in the ven-
tral portion of the thoracic cavity from 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 ob}ique one

s+ CLINICAL DIAGNOSTICS.

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 andsmall 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
ribs 1t comes in immediate contact with the thoracic wall. (See
Fig. 26.)

Dog. The heart is of rounder form and lies at an angle
of 40-45° with the sternum, touching the chest wall along a narrow
strip from the 4th to the 7th ribs. The apex is below the 6th
intercostal space. (See Fig. —.)

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 placed 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 at the 5th intercostal space, just above the union
of the ribs with their cartilages. 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.

In swine and fowls the heart is palpated to determine its
action, as the pulse in these animals can not be felt. In swine
the heart beats 60-100, and in fowls 120-160 times per minute.
Great variations are, however, noted due to the excitability of
these animals.

The force of the heart’s beat can be in-
creased 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.

SPECIAL CLINICAL EXAMINATION. 83

3. Where the lung between the heart and the chest wall
becomes thickened.
The heart’s beat is weakened:

1. When 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 emphysema or
tumors.

Percussion of the heart. Except in very thin animals
(horses) the percussion of the heart is of no great value in
the diagnosis of disease, the reason being that with the percus-
sion hammer we are unable to determine the boundaries of the
organ, the adjacent lung tissues 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.

Sheep and Goats. A slight dullness is noted over the fifth
rib.

Dog. A narrow horizontal line of dullness between the 4th
and 7th ribs can be determined on both sides by vigorous per-
cussion.

Due to unfavorable anatomical position, the percussion
of the heart is of diagnostic service only in a few instances.

The zone of cardiac dullness is in-
creased in hypertrophy of the heart and where fluids col-
lect in the pericardium; tumors and thickenings of the lungs
also induce it.

The zone of cardiac dullness is some-
times decreased from pulmonary emphysema because
the distended lung extends further over the heart.

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.

86 CLINICAL DIAGNOSTICS.
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 stethoscope 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 (systole),
and the second tone, which quickly follows the first, at the dila-
tion of the organ (diastole). The second tone follows so closely
the first one that it is difficult to differentiate between them, ex-
cept in animals which carry a pulse below 60. In animals which
have a 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.

[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 Jub-dub one can
mimic the sounds of the heart.

I II I II
- ~ & +4
lub dub lub dub

Change in Heart-Sounds Due to Disease.
Both sounds are increased in:
1. Hypertrophy of the heart, the valves remaining in-
tact. (idiopathic hypertrophy).
2. Anemias.

SPECIAL CLINICAL EXAMINATION. 87

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.
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 dul] in heart’s weakness and in myocar-
ditis, especially noticeable in acute infectious diseases.

A. splitting J~-|—~--| or doubling |~~-|—~-| 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.

Heart bruits)s Heart bruits are 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.

1. 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-

88 CLINICAL DIAGNOSTICS.

cal changes of the heart itself, they are called organic, other-
wise inorganic.

a. The organic or endocardial heart bruits are caused
either by a narrowing (stenosis) of the atrio-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 bruit occursatthe moment
the blood passes the contracted orifice, the
walls of which are set in vibration. If the stenosis involves
the atrio-ventricular opening the bruit occurs at diastole, if
in the arterial openings, at systole.

In insufficiency the bruit occursat the
momentat whichthe valves should close. 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
atrio-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-
cing, 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 Sccm of 50% alcohol and then diluted
with 20ccm of water.

SPECIAL CLINICAL EXAMINATION. 89

Insufficien c y
of an atrio-
ventricular
Systolic bruits|~.~|are characteristic of: valve.
Stenosis of
an arterial
opening.

Stenosis of
an atrio-
ventricular

Diastolic bruits|—~|are characteristic of: { opening.

Insufficien c y
of a semi-
lunar valve.

°

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 atrio-
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
again. Their origin is not well understood, They are nearly
always noted in anemic animals.

It is very important to distinguish between
organic and inorganic heart bruits, but in prac-

90 CLINICAL DIAGNOSTICS.

tice this is often very difficult. .\s a rule, soit, 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, further by a con-
gestion (stasis) in the pulmonary veins and accordingly an
increased pressure in the pulmonary artery, whereby the sec-
ond heart’s sound is loud and clapping.

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.

2. 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
Lecome 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-

RESPIRATORY APPARATUS, 91

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 peri-
cardium.

Diseases of the Circulatory Apparatus.

Palpitation of the heart (palpitatio cordis) is a nervous, transient,
greatly increased heart’s action not due to any anatomical lesion in
the organ. The loud thumping of the heart may shake the thorax and
be heard a distance from the bodv.

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 presert 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. Termination as in
chronic valvular disease. Most common heart disease of horse
and dog.

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, 1s compensatory.

Bicuspid (Mitral) insufficiency. Most common ferm
of heart disease in dogs and horses. Pulse small, irregular. Sys-

92 CLINICAL DIAGNOSTICS.

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
ox frequently primary. Systolic bruits, venous congestion, venous
pulse.

Stenosis of the tricuspid valves. Happens only
in the ox and is then combined with insuthciency. Diastolic bruits,
great venous congestion, dyspnea.

Insufficiency of the aortic semilunar 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, of all valvular diseases. In
chronic heart diseases the hypertrophy and dilatation of the ven-
tricle is followed by a relative insufficiency of the valves. Semi-
lunar defects lead to a relative insufficiency of bicuspids; bicuspid
defects to a relative insufficiency of the tricuspids. The special
diagnosis of the primary lesion is then very difficult. As sequela,
finally, the following symptoms appear: small, irregular pulse, sys-
tolic and diastolic bruits, congestion of veins, venous pulse,
edemas, dyspnea, albuminuria, dropsy, attacks of vertigo, emacia-
tion 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,
poneanie (frictional) bruits, which disappear when fluid exudate

ecomes 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

RESPIRATORY \PPARATUS. 93

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 auscultat’on 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.

The examination of the respiratory
tract is one of the most important re
sponsibilities of the veterinarian, first
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. The respiratory movements (res-
pirations).
Il. The breath.
Ill. The nasal discharge.
IV. The nasal cavities and adjacent
sinuses.
V. The submaxillary lymph glands.
VI. The cough.
VIL The voice.
VIIL The laryngeal region.

IX. The trachea.

xX. Phe percussion of the thorax.

XI. The auscultation of the thorax.

94 CLINICAL DIAGNOSTICS.

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 several times and take the average ob-
tained as the respiratory frequency.

In birds (fowls) the respirations may be counted while
tle patient stands or sits quietly and unmolested, by noting
the movements of the flanks and abdomen.

The smaller the animal the greater the number of res-
pirations. In one and the same animal the number of respira-
tions 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
respirations is a normal consequence. High atmospheric tem-

peratures, restlessness and anxiety, also make the breathin:
more hurried. In adult animals standing at perfect rest the

following number of respiratory movements per minute may
be taken as the average normal:

TOUS Ee? Bastard tate Suite in peda urand ae aR eee oth nce 8-16
Oper encttereianae Guid anmenl See nc « Pane a ee Cee 10-30
Sheepeand: Oates see seer Mave mua die 2 12-20
SWINE. 204 mot dius dead kes Gandeted 10-20
DDGSSs exigtcseaiahitee dere ed eh Go Os eons Jee. en 10-30
Cats siresaneuhantn csdiiehen eaves eee, Witla: 20-30
(SO OSCR ss ake accas ec Soca Cates e hora Gch att sa daoe Bul els 20-25
GIIGKEINA potash gitly eae ierh Glens pata ds 40-50

PASCO eixe eh eaentineae Gi eae Gtoneaed ted we. «60-70

RESPIRATORY APPARATUS. 95

Fig. 28a.

Normal Respiration Curve.

Fig. 28b.

Pure Inspiratory Dyspnea in Case of Bilateral Paralysis of Larynz.
The Breath Is Slowly Drawn In, Accompanied by a Strong Shak-
ing of the Thorax.

96 CLINICAL DIAGNOSTICS.

Fig. 28c.

Expiratory Dyspnea in Case of Emphysema Pulmonum.

Fig. 28d.

Inspiratory and Expiratory Dyspnea in Case of Inflammation of the
Lungs or Thoracic Wall.

RESPIRATORY APPARATUS. 97

A pathological increase in the number of respiratory
movements (polypnea) is spoken of as dyspnea (see this).

«lt decrease in the number of respiratory moveiments
(oligopnea) is rarely observed. It is seen in severe brain af-
fections (hemorrhage, hydrocephalus, tumors, poisonings, ac-
tion of septic substances as in pulmonary gangrene), also
where the anterior air passages are occluded (stenosis), which
is combined with a pronounced inspiratory tone. Oligopnea
associated with respiratory noise is always a sign of severe
illness,

b. Physiology of respiration. When an animal is at

perfect rest, the respirations are produced by the action of the
ce The contraction of the diaphragm produces a dila-
tion of the thorax. When the muscle contracts it flattens and is
drawn backwardly, the false ribs becoming elevated. Notwith-
standing that the diaphragm is str : teh
transversely between the thoracic ee
dominal cavities, its contraction d s
cause its points of insertion to appro
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 articulation of the
ribs with the dorsal vertebrae 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.

1. The normal rhythm of the respirations can be patho-
logically altered in that:

The inspiratory movement lasts too long,
the freé entrance of air, being prevented by stenosis of ‘the.
respiratory passages (inspiratory dyspnea).

2. The expiratory act lasts too long, the re-
laxation of the diaphragm not sufficing to a complete al
tory movement (expiratory dyspnea). 3

As the respirations are in a measure. controllable. by ihe
will, which depends upon the cerebrum, excitement or inflam-

98 CLINICAL DIAGNOSTICS.

matory conditions occasioning either irritation or depression
of this organ can bring about marked change in the rhythm
of respiration. The value of these changes to diagnostics is
limited.

A peculiar change in the rhythm and intensity of the respi-
rations, occurring in cycles, is noted in severe intoxications
and infections. It is known as Cheyne-Stokes respirations.
Following a pause in the respirations the breathing progres-
sively increases in frequency and intensity to dyspnea. It then
slowly subsides until another pause when the cycle is repeated.

2. 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 in-
tensity is increased by exercise; if it is augmented
and the animal at rest, it denotes disease. The 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 diminished when the pleura, chest wall
or diaphragm is diseased and painful.

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 uni-
lateral pneumonias or pleurites.

3. 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-abdominal.
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 of the costal type the respirations are slow.

RESPIRATORY APPARATUS. 99

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
corresponding to hiccoughs (singultus) in man. It is character-
ized by a rhythmic, spasmodic contraction of the diaphragm.

(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.
C. 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
every time the forefeet come in contact with the ground.

100 CLINICAL DIAGNOSTICS.

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 (stridores). When the respiratory
apparatus is diseased the following pathological
sounds may occur:

1, The wheesing or blowing sound which is stenotic in
its character, emanates from the nasal cavities. It is more
pronounced at inspiration, and results fromi a narrowing
of the nasal chambers due to the presence of tumors,
swelling of the alae of the nostrils, septum or chonchae, en-
largements 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. “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 ‘vith 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 sivnificance.

3. Sneesing 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.

4. 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
himen or the nasal cavities is contracted by swelling or thick-

RESPIRATORY APPARATUS. 101

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.

5. 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.

6. 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
by pronouncing the German “ch"]. If the lumen cf 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
increased 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 laryngeal
mucous membrane (phlegmonous laryngitis, strangles), tu-
mors in the larynx or its neighborhood which prevent the
free entrance of air.

7. Loud rattling noises [garglings] are heard when the
larynx or the trachea contains loose masses of mucus.

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

102 CLINICAL DIAGNOSTICS.

pressure of the distended abdominal organs upon the dia-
phragm, shortening the expiratory moment, which the animais
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 andkindof respiratory move-
ments, and the 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 dyspnea is recognized:

I. If the respirations are accelerated (altered in
number ), and the increased frequency is not attended with
change in the manner of breathing the dyspnea is simple.

In the horse, for instance, the number of respirations can
exceed 80-100 per minute and be superficial, onty the nostrils
becoming dilated.

If the dyspnea is severe, however, the intensity of the
respirations is increased.

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.

RESPIRATORY APPARATUS 103

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-
nea. 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.

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.
Notonlyisthediaphragmactivelyemployed,
butothermuscleswhicharenormallynot used
during inspiration are called into piay.
These muscles are: the serratus magnus, serratus anticus,
external intercostals, levatores, costarum, scalenus. The
following clinical symptoms character-
ize dyspnea:

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 retracted, 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.

104 CLINICAL DIAGNOSTICS.

Inspiratory dyspnea is observed:

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 occurrence 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-
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.

+. Where the principal respitatory muscle, the dia-
phragm, is inactive: rupture or inflammation, tympanitis.

Expiratoryv dyspnea appears when the exit
cf the air from the lung is made difficult. In this case
the expiration ensues not alone passively, but the accessory
expiratory muscles actively assist. 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
dyspnea is recognized by 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-

RESPIRATORY APPARATUS, 105

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
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 1s 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.

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 exhaled air is of diagnostic im-
portance in many morbid conditions. Normally the air is
emitted from the nostrils in two odorless currents of equal
size. The two deviations from the normal are: e:

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 toa narrowing of the nasal

106 CLINICAL DIAGNOSTICS.

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:

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 apparatus 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 decompesitioe has its seat in the nasal
cavity of that side, and usually Yt is accompanied by a unilat-
eral nasal discharge, bulging of the facial bones and swelling
of the submaxillary lymph glands.

RESPIRATORY APPARATUS. 107

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 De ascribed 16 pulmonary gan-
grene, for not infrequently a decomposi-
tion ofexudateinthe bronchi, (fetid bronchitis)
is present.

The presence of elastic fibres in the nasal discharge
speaks for pulmonary gangrene.

JII. 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, wate1 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

108 CLINICAL DIAGNOSTICS,

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.
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 superiormaxil-
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 colorless and clear discharge is noted in serous and
mucous catarrhs.

A gray discharge is due to the admixture of epithelial
cells; if leucocytes appear in it the color is greyish-white; if
red blood corpuscles are present a grevish-yellcw or even yellow
color is given to the discharge.

A green discharge is usually due to an admixture of the

RESPIRATORY APPARATUS. 109

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 (cpistaris) is observed only when
blood im 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 pentastomuim tenioides may lead to bloody nasal discharge,
and in sheep the larve of cestrus ovis.

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

110 CLINICAL DIAGNOSTICS.

the discharge assumes more of a cream-like consistency and
its color changes to grevish-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 massesofexudate 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.

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.

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).

RESPIRATORY APPARATUS. 1ii

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.

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
(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 solution (methylen blue 2, in 100 grammes of

a 25% sulphuric acid) is then applied and allowed to remain %
minute. Wash and examine.

Fig. 29.
‘a fA a # %s Pe ea Be
g ‘ i a as
oe x = & ‘
° .
f) os og Vy 16 f ao \
eu 4“ we @ ‘ 4 r
) vs 9 es
4 - t
? . ee « <4 . s
as 4 %% &
, ‘ Pa a’, Bi RA ? q
s “f° 4 : *
8 a 1?
Tubercle bacilli.

Beeddes the tubercle bacillus, other bacilli (acid-fast), which
stain by this method, are found in the feces of cattle and in butter.

112 CLINICAL DIAGNOSTICS.

IV. The Nasal Cavities and Adjacent Sinuses.

1. The external appearance of the facial bones will readily
betray any deformity. Circumscribed 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
pupura hemorragica. Tumors (atheromas) are frequent
in the false nostrils.

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
pigment. The white streaks thus formed speak for the
chronicity of the discharge.

2. 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.

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

RESPIRATORY APPARATUS. 13

and of round form (fetechiae, ecchymoses). When they
become confluent, the redness is diffuse or appears in irregu-
lar 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. Suffusions are
observed in septicemic diseases: anthrax, septicemia.

b. Swelling of the nasal mucous mem-
brane is characterized by the normal surface of the mucous

Fig. 30.

Examination of the Mucous Membrane.

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.

114 CLINICAL DIAGNOSTICS,

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.

e. Ulcers. Nexttonodules, ulcers form
the most important criterium in diag-
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
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 crosion 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.

g. A narrowing of the nasal passages and the presence
of tumors may be determined by the use of a hard rubber
sound such as is furnished with the Polansky-Schindelka lar-
yngoscope. [An ordinary urinary catheter serves the same
purpose.] The sound should be passed beyond the posterior
nares. In thorough-breds the nasal cavities are usually larger
than in coarsely bred horses. Wherever there is unilateral
nasal discharge and wheezing, blowing respirations present,
the nose should be sounded.

RESPIRATORY APPARATUS. 115

3. 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
flat. When the sinuses are only partially
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 property 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.

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 soon as an absorption of irritant or
infectious substances [bacteria] takes
place in the region drained by the lymph

116 CLINICAL DIAGNOSTICS.

yessels of the submaxillary glands, these
organs become secondarily diseased. The
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 glands enlarged? In acute
infectious catarrhs the glandular swelling is generally bilat-
eral; in glanders frequently wnilateral, 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, fense and firm in cellular infiltration
of the glands. Acute diffuse swellings (stran-
gles) often lead to suppuration (ab-
sces¢), 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-

RESPIRATORY APPARATUS, 117

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].

e. Movability of the glands. If the irrita-
tion is chronic and attended with the formation of new con-
nective tissue, the process involves the environing tissue, form-
ing adhesions with its neighborhood. In acute purulent in-
flammation of the glands there develops in the vicinity, name-
ly, directly beneath the skin, an inflampnatory 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.

Cough is a sudden expulsion of air
from the lungs, following a deep inspira-
tion. The glottis is forcibly opened dur-
ing the act, causing a sound to be emitted.
By coughing accumulations of mucus are removed from the
bronchi, trachea or larynx. In animals cough is a reflex
action which can to a certain extent be suppressed. Al-
though it can be induced by irritation to many peripheral
nerves, as a rule it emanates from branches of the vagus nerve
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

118 CLINICAL DIAGNOSTICS.

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 occurs:

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 nerve are no longer
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
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

RESPIRATORY APPARATUS. 119

it. Whether cough accompanies the disease or not can usually
be learned from the anamnesis, although we can not depena
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 pinching 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 foliow the manipulation, while in indolent indi-
viduals there is no reaction.

Healthy cattle can not be made to cough by simply pinch-
ing the trachea, and even those with diseased lungs may fail to
react. A better method is to close both nostrils for a minute,
which usually has the desired affect.

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 ke 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
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
elasticity 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

120 CLINICAL DIAGNOSTICS.

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.

Thelength of the cough 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 long—prolonged.

The depth and 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.

Thecough 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 cough is moist when easily movable masses of mucus
are collected below the larynx; it is dry when either no exu-
date is present or only small, viscid accumulations are ia the
air passages.

The ‘‘return sound’’ of the cotigh (Hus-
tenrueckstoss). 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.

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

RESPIRATORY APPARATUS. 121

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.

To obtain bronchial discharge in tubercular suspects it
has been recommended to insert a tracheotomy tube and pass
a swab of cotton on the end of a wire through the opening
wiping the inner wall of the wind pipe down to its bifurcation,
Ostertag causes the ox to cough by closing the nostrils for a
minute. He then introduces a long-handled, narrow spoon
between the left cheek teeth and the tongue as far back into
the throat as he can reach, turns the spoon up side down,
draws it back about 10 cm., then rights and withdraws it par-
tially filled with bronchial discharge. (See also Examination
for Tuberculosis.)

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.

12? CLINICAL DIAGNOSTICS,

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.

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.

RESPIRATORY APPARATUS. 123

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
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. \Vhen 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 (/aryigeal fremitus).

124 CLINICAL DIAGNOSTICS.

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
and assumes a wrtistling 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 ratiling 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
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 with cheir cartilages, far-
ther 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
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
hy the receding diaphragm is.immediately occupied by the sharp

RESPIRATORY APPARATUS. 125

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 conc-like dia-
phragm broadened.

Wig. 82:

Dorsal and ventral boundaries of the field of pulmonary percussion — - -
Costal attachment of diaphram. H. heart. d.c. dorsal colon. Lv. c. left ventral
colon.

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
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

126 CLINICAL DIAGNOSTICS.

posterior angle of the scapula to the external angle of the ilium.
Anteriorly the boundary is formed by the scapula and the
massive shoulder musctes.

By drawing the leg torward the field of percussion can be
somewhat enlarged. J’curra/ly the density of the sternum and
muscles overlying it render in this region the lungs unavail-
able to percussion.

Fig. 33.
— — 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.

The field of percussion is a right-angled tri-
angle the right angle of which lies at the
base of the scapula. In all animals the dorsal and
anterior boundaries of the field of percussion are the same, the
only variation being in the abdominal boundary.

RESPIRATORY APPARATUS. 127

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.

Fig. 34.
wm tee 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.

Dog. In the dog the shoulder lics well forward, which
gives a larger field of percussion. The abdominal boundary of
the field extends at the middle of the chest wall over the 9th
rib to the lower end of the 7th rib.

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.

128 CLINICAL DIAGNOSTICS.

The normal pulmonary percussion sound is due to the
sound of the blow, the vibration of the thoracic wall and of
the air contained in the lung. In large animals the sound is
generally quite dull (subdued), but clearer in the middle and
lower portions of the chest. In small animals the sound is
about the same over the whole field. The thinner the chest
wall, the clearer the sound. Toward the borders of the thoracic
cavity the intensity of the lung sound is diminished.

The pulmonary sound is heard over an area larger than
normal in vesicular emphysema, in the rarer interstitial em-
physema and in pneumothorax, because in these conditions
the diaphragm is forced backward. In vicarious emphysema
2 similar increase in area is sometimes noted.

The pulmonary percussion sound (pulmonary resonance)
is abnormally loud and clear (“‘over-loud’”), due to disease:

1. If the lung is greatly inflated (emphysema).

2. If the lung is abnormally distended with air as it
occurs, for instance, at the border of pleural exudate.

3. In pneumothorax.

The tympanitic percussion sound is noted over the
chest when the vibrating column of air, whether small or
large, is surrounded by a rigid wall and there is communica-
tion with the outside world. In small animals, therefore, the
pulmonary percussion sound is normally tvmpanitic. There is
no marked boundary of distinction between the tympanitic and
the full pulmonary percussion sound. A tympanitic tone is
heard:

1. When a portion of the lung containing air is more
or less surrounded by solidified tissue or exudate, whick
isolates it from its environment,

Therefore:

In the beginning and last stages of fibrinous pneumonia.

In catarrhal pneumonia.

In pulmonary edema and in pulmonary atelectasis.

RESPIRATORY APPARATUS. 120

In the presence of small or large tumors which surround
lung containing air.

2. If caverns containing air and large bronchiectasis are
present. The intensity and clearness of the sound depend
upon the size of the cavern and the momentary filling of the
same with air or exudate.

3. In pneumothorax.

4. In prolapse of the bowel into the thoracic cavity,
through a rent in the diaphragm.

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
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 communicating
bronchus, thus inducing this peculiar resonance.

The same sound may be heard, however, when a portion
of lung containing air is surrounded by a zone of hepatization.
The cracked-pot resonance, therefore,
does not always indicate the presence of a
cavern in the lung.

If the dull or flat percussion sound is heard where the
sound should be resonant, it always signifies disease. It oc-
curs:

i, Lf the Iting tissue becomes <eense,
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, therefore, on percussion,
a dull or flat sound. In catarrhal pneumonias the pulmonary

130 CLINICAL DIAGNOSTICS,

sound is not so flat, because the solidification of the lung is
not complete, the morbid process appearing in the form of
more or less isolated centers or foci which are not entirely
void of air. In hypostatic, metastatic, and ichorus pneumo-
nias, swine 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. Tf tumors or neoformations are pres-
ent in the lungs: glanders, tuberculosis, carcinoma, sarcoma,
echinococci, etc.

3. If an airless,solid medium comes be-
tween the lung and the pleximeter as in3

Inflammatory swelling of the thoracic wall (after mus-
tard applications) ; neoformations on the pleura; collections of
considerable fluid exudate or transudate in the chest; pleuro-
pneumonia of the horse, contagious pleuropneumonia 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.

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

RESPIRATORY APPARATUS. 131

may also be made more distinct by holding the nostrils shut
for a few moments causing the patient to become dyspneic.
The partial closing of the nostrils, however, 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
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.

2. 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. Ifa 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 the vesicles

132 CLINICAL DIAGNOSTICS

in consequence of great swelling or plugging of the larger
bronchi: severe bronchitis.

3. If the 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 [1. 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
confined to certain portion 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 and, if the patient is
dyspneic, at the root of the lung.

The occurrence of bronchial sounds in
the chest is always a sign of disease. Itis
audible only when the bronchi are free and the vesicles contain
no air.

Bronchial sounds displace the vesicular:

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 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

RESPIRATORY APPARATUS. 133

vesicles contain air at all a feeble vesicular murmur can still
be heard.

A special variety of bronchial respir-
ation is the amphoric respiration, which is a bruit 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 (pulmon-
ary gangrene), On percussion, in place of the
dulled sound which is usual when the
respiration is Dbronehial, = tympanitie
tone or a cracked-pot resonance is heard.

That bronchial respiration inay become audible in 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 bronchi
become free again.

c. The vague or indefinite respiratory sounds. Such
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,
thelarger will be the bubbles and the coarser the rales.
In the large bronchi 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. Faint rales are heard only at inspiration, increas-

134 CLINICAL DIAGNOSTICS.

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
respiration 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 adhering walls of the bronchi and vesicles.
They appear in bronchiolitis, pulmonary edema and in the
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 more or less
toughening of the mucous membrane, the projecting irregu-
larities of which vibrate and cause sounds during in- and
expiration. Dry rales are, therefore, of a sonorous, Jmmaning,
hissing, squeaky, whistling (sibilant) character. They most
commonly attend chronic diseases: chronic bronchitis, compres-
sion of the bronchi by nodules (tuberculosis, chronic pneu-
monia) and tumors (echinococci). In the echinococcus dis-
ease of the ox the rale has a peculiar (quurksend) character.

On account of their origin it is better to designate dry
rales as stenotic sounds.

| wheezing, crackling, whistling or piping, rale-like
sound is heard in interstitial emphysema of the lungs. It is
most pronounced during expiration.

DIGESTIVE .\PPARATUS. 135

e. Pleuritic friction sounds. Normally the pulmonary
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 plev-
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 noises.

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. In tuberculosis, as a rule, no fric-
tion sound is heard.

Pleuritic friction sounds are easily confused with rales.
Friction sounds are heard regularly at inspiration and
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 are commonly more pronounce |
at insviration than at expiration, are not jerking in character,
ard are removed or modified by cough.

Diseases of the Respiratory Apparatus.
a. Cavities of the Head.

Nasal Hemorrhage (Epistaxis.). Bleeding from the vessels
of the cavitics of the head. Generally unilateral. Blood appears
in drops or in a thin stream and is not foamy.

Acute ncsal catarrh. Rhinitis catarrhosa. Congestion of the
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 “glassy” in appearance; quan-

136 CLINICAL DIAGNOSTICS.

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 low-
ered discharge suddenly increases. Bulging of the diseased
sinuses; if filled with exudate flat sound on percussion.

Catarrh of the guttural pouches. Rare. Usually a secondary
condition. Generally unilateral, mucopurulent nasal discharge,
thickening of the posterior portion of the submaxillary lymph
glands, swelling of soft consistency in parotid region, which when
massaged causes nasal discharge to increase. In severe cases
dyspnea and dysphagia.

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.

b. Larynx and Bronchi.

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. 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,
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. Tever, 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.

DIGESTIVE APPARATUS. 137

Chronic bronchial catarrh. No fever. As a rule 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 micrurus in Ox
strongylus paradoxus in swine, and strongylus syngamus in towls.

ec. Lungs.

Pulmonary hemorrhage. Hemoptoae. Light red, foamy blood
from both nostrils, cough, rales heard over trachea and bronchi.

Pulmonary Congestion and Edema. Sudden, severe in- and
expiratory dyspnea, respirations may exceed 100, foamy serous
nasal discharge. Percussion normal; auscultation, exaggerated
vesicular sound, rales.

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
catarrnal 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-
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 superhcial 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.

138 CLINICAL DIAGNOSTICS.

d. 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.)
[According to Hutyra and Marek, the German ‘“‘Brustseuche” and
what is known in the United States sometimes as “contagious pneu-
monia” of the horse, is the pectoral (lung and pleural) form of in-
fluenza.] This is a contagious pneumonia affecting the parenchyma
of the various organs and is usually attended with secondary pieu-
ritis. 1. Stadium incrementi begins with high fever, yellow discol-
oration 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 small inflammatory centers which soon undergo degenera-
tion. The disease develops very slowly. Only advanced cases
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

DIGESTIVE APPARATUS. 139

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.

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 old horses
disease often limited to the pharynx.

Glanders, malleus is a contagious disease of solid ungulates
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
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,
croupous-interstitial pneumonia. An occult stage is distinguished
which is marked by a slight cough, fever and mild dyspnea. In
the acute stage there is distinct —41 C. and the symptoms of an
acute pleuropneumonia: great dyspnea, weak, short cough, slight
nasal discharge, flat sound on percussion, friction bruits, bronchial
sound, rales. Appetite, rumination and secretion of milk sus-
pended.

Malignant catarrhal fever, malignant head catarrh, is a specific
disease of the ox, takes a subacute course and affects chiefly the
mucous membrane of the respiratory and digestive tracts. The
brain is also involved. The disease is ushered in by chill; great
nervous depression, muscular trembling, stiffness, sometimes inabil-
ity to stand. Conjunctivitis and keratitis. Diphtheritic inflamma-
tion of the mucous membrane of the nose, sinuses of the head,
trachea and mouth; breathing wheezy and rattling. No appetite;
milk secretion suspended.

Swine plague, septicemia suum, is a contagious inflammation
of the chest organs of swine. The clinical phases vary with sever-

140 CLINICAL, DIAGNOSTICS.

ity of outbreak. The usual or pectoral form shows following
symptoms: Fever, languor, continued grunting, loss of appetite,
swelling and reddening of the conjunctiva; dyspnea, painful cough,
groaning, dullness over lungs on percussion; bronchial sounds;
death usually from asphyxia. The septicemic form shows severe
general symptoms and ends in death. The chronic form presents
symptoms of chromic bronchitis or catarrhal pneumonia, emacia-
tion, and stunted growth.

Dog distemper is a very contagious disease characterized
chiefly by a catarrhal inflammation of the mucous membranes.
Symptoms are quite varied. Catarrhal, nervous and exanthematous
forms are distinguished. The disease develops slowly. Languor,
conjunctivitis, keratitis, vomiting, anorexia, nasal discharge, cough,
dyspnea, tympanitic to flat sound on percussion; rales. Spasms
of the whole body or of muscle groups, general muscular weak-
ness, paralysis. Vesicular and pustulous exanthema.

Fowl] diphtheria is a contagious, croupous-diphtheritic inflam-
mation of all of the mucous membranes of the head, which some-
times attacks the comb, wattles and around the eyes, assuming the
form of an epithelioma. The patients are dyspneic, the respira-
tions noisy and performed with open beak. The course is chronic.

8. Digestive Apparatus.

Diseases of the digestive apparatus are common in do-
mestic 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 :

L Pood and Drink.
II. The Buccal Cavity
lil; The Pharryis and Esopharns,
IV. Rumination.
V. Vomiting.
VI. The Abdomen.
VII. The Intestinal Evacuations.

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

DIGESTIVE APPARATUS. 141

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 refused. Defective appetite alone is
neveranindicationofany particular dis-
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.

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 alkalics 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 caitle, and wool eating of sheep; in rabies the same is
observed.

142 CLINICAL DIAGNOSTICS.

Desire for water depends in the first place on
the amount of water containcd in the feed; dry feed requir-
ing more water than green feed; of course some water 1s

required in both cases. Under normal conditions horses
usually drink one or two large pailfuls of water per day. 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 re-
fuse ‘‘pure” water if of a different kind than that to which
they have been accustomed [e. 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-
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:

Animals with fever like small sips of fresh water
at frequent intervals.

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.

Diabetes insipidus of horses is attended with marked
increase of thirst; several pailfuls are taken at
a time.

Diabetes mellitus.

Gastric and intestinal catarrh [diarrhea] of dogs
—attended with frequent vomiting.

b. Manner of taking food. WHealthy horses grasp the
food with their lips and pass it 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.

DIGESTIVE APPARATUS. 143

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

144 CLINICAL DIAGNOSTICS.

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.”

Jastication 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. JJastication mav 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 mastica-
tion difficultand painful.

In dangerous diseases we often observe piece Bf 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.

DIGESTIVE APPARATUS. 145

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 disturbance of normal deglutition
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 a painfit? 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:

Paralysis of the pharynx in mycoses, parturient paresis
and rabies.

Spasm of the pharyngeal muscles in tetanus.

Tumors of the pharynx; actinomycoma, lymphoma, tu-
bercular lymph glands.

146 CLINICAL DIAGNOSTICS.

Besides the symptoms of difficult deglutition we observe
in addition: salivation, foaming -t 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.

DIGESTIVE APPARATUS. 147

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.

Anabnormal 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 ts
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

148 CLINICAL DIAGNOSTICS.

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.

Careful manualas wellasocular exam-
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 /oose. Carious incisors and molars occur in dogs
in the course of rachitis, distemper, anemia 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. ]

DIGESTIVE APPARATUS. 149

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. .\bnormal 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

150 CLINICAL DIAGNOSTICS.

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 recumbeut position. The
food is forced into the mouth by a contraction of the secona
stomach or reticulum into which it previously passes from the
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.

Considerabledeviations 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:

[All severe febrile and painful affections, surgical
diseases. |

Gastric and intestinal disturbances, especially over-
loading and paralysis of the paunch.

DIGESTIVE APP: RATUS. 151

Trautuatic inflamrnation of the stomach and dia-
phragm.
“ [All cachectic diseases. ]

[Many cerebral diseases. ]

Eructation or belching occurs normally ix 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. Sometiries
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 tlie 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

152 CLINICAL DIAGNOSTICS.

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 1s moderately filled with fluid contents, a rupiure 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 dis-
ease and occurs under the following conditions:

During the presence of foreign bodies in the larynx or
at the base of the tongue: pieces of bone, fish bones, needles,
feathers, ete., also when tough, stringy mucus collects in this
region in the course of pharyngitis and laryngitis.

Obstruction of esophagus.

Gastric affections, overloading of stomach, gastritis, and
in certain poisonings.

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, irritation of its
mucous membrane, an vomiting.

Chronic vomiting is observed in cattle and is always to
be regarded as an unfavorable symptom. It indicates esoph-
ageal stenoses, diverticula, enla-gement of the mediaestinal
glands, hernia of the diaphragm and constriction of the
pylorus.

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.

DIGESTIVE APPARATUS. 158

VI. The Abdomen.

Examination of the abdomen is conducted according to
the following general rules:

a. Inspection. The volume of circumference of the
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. A good plan is to inquire of the owner as to the
former or usual condition of the animal in this respect. Cir-
cumscribed enlargements are usually of interest from a sur-
gical point of view.

clbnormal distention of the abdomen may be due to:

1. Pregnancy; the form of the abdomen becomes barrel
shaped—increasing bilaterally.

2. Accumulation of abnormal quantities of food in the
digestive tract (in horses the cecum and colon, in ruminants
the paunch and other stomachs, in dogs the stomach). In
these cases the distention is due either to increased consump-
tion of food (overfeeding) or to accumulation of food taken
in normal quantities during inactivity of the bowels (constipa-
tion). In these cases the normal tympanitic tone is replaced
by a dull one. i

3. The accumulation of gases produced by fermenting
food. In this case the distention is in an upward direction,
the hollow of the flank is raised, and the abdominal walls be-
come distended (tympanitis, bloat). The rapid production of
gas may be due to the character of the food [legumes, cruci-
fera, etc.] or to suspended activity of the bowels.

4. Accumulation of fluid (transudate and exudate) in
the peritoneal cavity. This is occasionally seen in dogs, rarely

154 CLINICAL DIAGNOSTICS.

in horses. In this case the distention is in a downward direc-
tion, symmetrical and bilateral, fluctuation is observed and
percussion reveals a dull area bounded above by a horizontal
line. When a dog thus affected is raised to a vertical position
the dull area is shifted (ascites).

5. Tumors in the abdomen; liver (ecchinococci and car-
cinoma), spleen (leukemia), glands, etc.

6. Dropsy of foetal membranes.

7. Retention of urine in dogs.

Abnormal reduction in size of the abdomen may be due to:

1. Long continued starvation, or, if in spite of good care,
abundant food and sufficient rest an animal shows this symp-
tom, we may conclude that lack of appetite is at fault (digest-
ive disorders).

Fig. 36.

— — Dersal and Ventral limits of area of percussion. — - — Attachmentof diaphragm
toribs. N. Right kidney. L. Liver. H. Reticulum.
B. Manyplies. Labm. Stomach.

DIGESTIVE APPARATUS. 155

2. In serious subacute diseases; in such sases the ani-
mal’s general condition may still be good.

3. During or following severe diarrheas, or after colic
when strong purgatives were prescribed.

4. Fiolent contraction of the abdominal muscles in pain-
ful affections of the hind legs.

b. Palpation. The object of palpation is to ascertain
the consistency of the bowel contents and whether or not pain-
ful conditions exist. In ruminants the peristaltic motion of
the bowels per rectum is of especial value in large animals.

In horses the abdominal walls are thick and tense; this
and the fact that during an examination the animals frequent-
ly contract their abdominal muscles increases the difficulty of
arriving at accurate results in judging of the condition of
the abdominal organs, their contents, etc. In cattle the ab-
dominal walls are thinner, hence the results of palpation are
more accurate and satisfactory; in sheep this is true to a still
greater degree.

Dogs habitually contract the abdominal walls when these
are manipulated, but soon relax them again. In dogs both
sides are palpated simultaneously, and by exerting pressure
from both sides toward the median line the entire abdominal
cavity may be thoroughly examined.

Palpation serves in the first place to inform us as to the
degree of contraction (the tenseness of the abdominal walls
and the consistency of the bowel contents ; the latter should be
soft and easily compressible. If impressions are made by pres-
sure they should soon be effaced by the effects of peristalsis.
Large quantities of fluid bowel contents produce fluctuation.
Neoformations (tumors) are recognized by the extreme resist-
ance they offer to pressure. In dogs accumulated fecal masses
[and intussuscepted intestines] can readily be felt. Foreign
bodies in the stomach and intestines can also be detected by
palpation providing the normal bowel contents are previously,
evacuated [medicines or clysters].

156 CLINICAL DIAGNOSTICS.

Another object of palpation is to ascertain painful condi-
tions or abnormal sensitiveness. Even healthy horses are
often extremely sensitive to pressure exerted on the abdomen
and become restless when subjected to such an examination.
Care must therefore be observed not to mistake these symp-
toms for something more serious. In cattle it is different, be-
cause abnormal sensitiveness in these animals always points to
the existence of important lesions.

Sensitiveness to pressure between the 6th and 8th ribs
(opposite the reticulum) points to the possibility of an injury
to the diaphragm from a foreign body that penetrated the
reticulum. In acute affections of the true stomach cattle
evince symptoms of pain on palpation of the hypochondriac
region. Palpation of the right flank in cattle, when intussus-
ception of the small intestine exists, is also attended with
symptoms of pain. Foreign bodies in the intestines of dogs
produce symptoms of pain when pressure is exerted.

In cattle the peristaltic movements of the paunch are an
important consideration. Normally these can be felt in the
hollow of the left flank at the rate of about two per minute.
The food masses are moved from below upward and toward
the right side. Every contraction of the paunch is attended
by a slight rise in the hollow of the flank followed by a some-
what more sudden drop or depression. Imperfect or slowed
movements of the paunch point to the existence of some patho-
logical condition (overfeeding, tympanitis, paresis of the
paunch, peritonitis, adhesions of the paunch with the abdomi-
nal wall).

Palpation of the bowels per rectum. This is possible
only in the comparatively large rectum and roomy pelvis of the
horse and ox, but on the other hand the proportions are so
large here that only a part of the abdominal region can be thus
explored. In the region within our reach we can determine
position and contents of the abdominal organs, also the pres-
ence of foreign bodies and tumors.

DIGESTIVE APPARATUS. 157

Method of procedure. To make a thorough examination it
is often necessary to introduce the arm full length. A shirt with-
out a sleeve can be worn to advantage on such an occasion. [After
carefully paring the finger nails] the arm should be well covered
with oil, or soap (castor oil answers the purpese well) and then,
with the tips of the fingers forming a cone, the hand is carefully
introduced into the rectum. During the examination the animal’s
head (if a horse) is held up, and the forefoot on the side where
the operator stands is raised, by an assistant. Nervous or excit-
able horses can be secured with a twitch or the operator can pro-
tect himself against kicks by having the animal standing close to a
stable partition, the operator standing on the opposite side. The
left half of the abdominal cavity can be examined most satisfac-
torily with the right hand, the right half with the left hand. Since
perforations can be produced it is advisable to proceed with the
utmost care in making rectal examinations.

If accumulated food masses, contraction of the rectum, or the
presence of gases retard the easy introduction of the hand, simul-
taneous infusions of water should be given to facilitate the opera-
tion. It is always a good plan to insert the arm nearly its full
length before beginning our examination. In this way a long
piece of the rectum slips over the arm and there is less danger of

pulling or straining the mesentery. This danger decreases as the
length of the mesentery increases anteriorly.

Exploration per rectum is indicated in chronic colic and
in all cases of colic in stallions and cattle. Palpation may
serve to determine the following points:

I. Fullness and position of the bowels.
The separate regions of the intestines can be definitely recos-
nized only when they are filled with food. Mere distention
with gases does not always enable us to recognize with cer-
tainty the identity of parts. When the bowels are empty or only
partially filled with fluids or gases it may be impossible to dis-
tinguish between the large and the small intestine. The longi-
tudinal muscular bands of the large intestine of the horse are
the only means of differentiation, and these must be sought.
Manual exploration per rectum enables us to recognize food

158 CLINICAL DIAGNOSTICS.

accumulations or impactions in the following divisions of the
bowels:

a. Impaction of the floating colon. This is of frequent
occurrence in its posterior region and can then be easily rec-
ognized (rectal paralysis) ; constipation in the floating colon is
recognized by the nodular character of the surface and the sin-
uous course of the bowel. Its volume is appreciably less than
that of the colon or cecum.

b. Impaction of left colon. When well filled with im-
pacted food masses the pelvic flexure projects into the pelvic
cavity and frequently toward the right hand. This flexure is
recognized by its great volume, its curvature and the short
mesentery uniting the two superposed layers of the left colon.

c. IJmpaction of cecum. The base of the cecum is situ-
ated in the upper portion of the right flank and is attached to
the spinal column by means of a mesenteric fold and the pan-
creas. When distended with food-masses its great curvature,
which is smooth, projects almost to the right-hand border of
the pelvis. The small curvature can also be recognized and
serves to identify the organ. The longitudinal muscular bands
can also be felt.

d. Impaction of the ileum. This usually occurs near the
ileo cecal valve. The impacted intestine courses transversely
from the left to the right side of the flank. It can be recog-
nized by its sausage-like form which can be almost encircled
by the hand.

The following dislocations or displacements of the intes-
tine can be diagnosed:

a. Incarceration in inguinal canal; most frequently ob-
served in stallions. The intestine can be felt about two or
three inches in front of the pubic bone and four or five inches
to the right or left of the median line where it seems to be
firmly attached. A pull exerted at this point causes the ani-|
mal to evince signs of pain. Simultaneous examination of the
scrotum (external) clinches the diagnosis.

DIGESTIVE APPARATUS. 159

b. Peritoneal hernia or so-called gut tie of the or. A
loop or knuckle of intestine can be felt at the anterior margin
of the ileum, retained between the latter and the vestige of the
spermatic cord. The doughy, painful swelling, held in posi-
tion by the tense cord which is situated anteriorly, is charac-
teristic of this condition.

c. Invagination of the small intestine in cattle. This
condition is recognized by the presence of a firm but elastic
sausage-like mass in the lumen of the intestine, terminating
abruptly posteriorly but insensibly anteriorly where food
masses have accumulated. The length of this mass varies
with the extent of the invagination.

d. Torsion of the left layers of the colon in the horse.
In this condition the tense mesentery can be felt coursing
downward and to the left immediately in front of the entrance
to the pelvis and just below the 4th lumbar vertebra. A pull
exerted on the mesentery produces symptoms of pain. A sec-
ond tense strand can be felt in the umbilical region (a longi-
tudinal band of the inferior layer of the colon which courses
from left to right). The pelvic flexure has shifted from its
normal position.

Il. Enteroliths (stones and concretions in the in-
testines) can be detected only when the intestines are compara-
tively empty. The presence of large masses of food interferes
with their recognition. It is best, therefore, when these are
suspected; to free the intestines of their contents with a purge
before proceeding with the examination.

III. Tumors and tuberculous tumefactions of the
lymphatics can be recognized only when they have a certain
size, e. g., that of a hazelnut, and here too a purge must be
given to remove solid fecal masses before exploration begins,
otherwise mistakes are easily made.

c. Percussion of the abdomen. Topographical anatomy.
The position of the various portions of the intestinal tract
varies considerably according to their degree of fullness; we

160 CLINICAL DIAGNOSTICS.

can, therefore, not define the outlines of these organs with
any degree of exactness in the living animal. In a general
way, however, these outlines may be defined as follows:

The right portions of the colon and the cecum occupy the
right side of the abdominal cavity. We may be aided in de-
fining the position of the various portions of the intestinal
tract by drawing a line along the abdominal border of the
area ef percussion for the lung, and a second line along the
course of the last rib and extending over the cartilages of the
floating ribs; between these two draw a third (horizontal) line
at the middle of the body of the animal. This outlines three
areas on the right side of the abdomen. The anterior (lower)
area is occupied, in the main, by the right upper portion of the
colon, which occupies a position just behind the diaphragm.
The ventral portion of the colon lies opposite the cartilages of
the false ribs, in the region of the 8th to the 17th ribs, about
half of its volume being sitiated. above and the other half
below the cartilages.

The cecum occupies the ‘whole of the third or posterior
area as well as the upper anterior area as far as the 14th rib.
The small intestines and the floating colon occupy a position
behind the cecum beginning at a vertical line dropped from
the external angle of the ilium.

On the left side (Fig. 32, p. 125) (in the horse) the
small intestine and the floating colon occupy the region of
the upper two areas while the third, or lower, area is occupied
by the left portion of the colon, extending up to the ilium. The
lower portion of the colon occupies the greater area of the
abdominal wall, the upper portion being placed more toward
the median line of the abdomen, but approaching the abdominal
wall as it courses forward, touching it through the medium of
the diaphragm between the 7th and 11th ribs.

By careful observation of their topographical relationship,
and with the aid of percussion, we can readily determine the

DIGESTIVE APPARATUS. 161

character of the contents of the various sections of the intes-
tinal tract.

As a rule the stomach and intestines contain a moderate
quantity of gases which distend their walls only slightly;
hence percussion produces a tympanitic sound. In the paunch
of cattle and the large intestine of the horse where food
masses accumulate, the sound is at times dull tympanitic or
even dull. (Topography of bowels at left side in the horse;
see Fig. 32.)

Abnormal accumulations of food masses in the cecum
and colon give rise to a dull sound and a sensation of resist-
ance to the finger or pleximetric hammer at points on the ab-
dominal wall opposite them. If the accumulation of gases
causes the bowel ,walls to distend abnormally and become
tense, a clear sound is produced, a sound resembling that pro-
duced by the healthy lung, only clearer and louder because
large air chambers are present. (In the lungs the air cham-
bers are small).- |

Bilateral dtiliness, limited above by a horizontal line, is
observed when fluids collect in the abdomen (ascites). This is
most frequent in the dog; raising the animal to a vertical
position shifts the dull area accordingly.

d. Auscultation of the abdomen. The observation of
the various sounds produced by the moving along: of the intes-
tinal contents has for its object the determination of the char-
acter of the movements of the bowels. The sounds are pro-
duced by the onward movement of the solid, liquid and gaseous
contents of the bowels. The gases particularly produce dis-
tinctly audible sounds. In the absence of intestinal contents
sounds are not produced by peristaltic motion,

The character of the sounds is determined by the consist-
ency of the intestinal contents and by the quantity of gases
present. Hence: the sounds of the small intestine are those
of flowing liquid. gurgling, and splashing; the sounds of the
large intestine rumbling, cooing, and tumbling.

162 CLINICAL DIAGNOSTICS.

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

Fig. 37.
— — Dorsal and Ventral limits of area of percussion. — - — Attachment of diaphragm
toribs. Coec. Coecum. v.c. Ventral fold of the colon.
d. ec. 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:

In impaction, constipation and tympanitis, a paralytic

condition resulting from overdistention and overloading
(colic).

DIGESTIVE APPARATUS. 163

In spasmodic contraction of the small intestine in the
course of spasmodic and rheumatic colic.

In persistent diarrhea when the intestinal contents are
scanty.

In severe inflammatory conditions (because peristalsis
is then more or less suspended and the intestinal contents are
scanty) (enteritis, peritonitis).

Intestinal paralysis.

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

164 CLINICAL DIAGNOSTICS.

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 cvacuations 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 cavity (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

DIGESTIVE APPARATUS, 165

and is catised 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 + Ibs. at each
act, 20 to 30 Ibs. 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 moist balls, thick grucl-
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.

166 CLINICAL DIAGNOSTICS.

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-

DIGESTIVE APPARATUS. 167

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 in 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 food 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
(blood) are present under these conditions the odor is car-
rion-like (hemorrhagic enteritis, distemper of dogs).

168 CLINICAL DIAGNOSTICS.

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 whick

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

URINARY APPARATUS. 169

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,
Slood, pus, croupous membranes ; in chronic intestinal catarrh
o* 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 conr‘cum, 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,

170 CLINICAL DIAGNOSTICS.

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 trigonocephalus, 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 impossible and of no prac-
tical importance because diseases of these organs are rare.
As a rule, therefore, no examination is attempted.

The liver of dogs, cats and sheep will permit limited
palpation only, considerable hypertrophies, tumors (carino-
mata) may be recognized.

In cattle the liver, if much enlarged, may be palpated per
rectum and its character determined.

In tuberculosis we may recognize nodules, and in echin-
ococcus infection recognize fluctuating vesicles.

In a horse, Marek could palpate the hyperthrophied liver
at the last rib.

URINARY APPARATUS, 17]

In cattle the liver is always accessible to percussion since
it lies completely on the right side, extending from the upper
end of the last rib and forming a curve ending at the lower
third of the sixth intercostal space.

Since the border of the liver is thin, percussion sounds
are dulled only in the field of percussion of the lining begin-
ning at the next to the last rib and extending to the eighth
intercostal space in the form of a semicircle.

Slight deviations in size cannot be determined.

The spleen is accessible to palpation in the horse only,
in the upper posterior region, through the rectum.

It extends to the posterior border of the last rib.

Enlarged in leukemia, nodulated in tuberculosis,

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.

Actinomycosis. Multiple tumor at the lower maxilla, tongue,
pharynx or adjacent regions, caused by Streptotrix actinomyces.

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 otf
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.

172 CLINICAL DIAGNOSTICS.

Esophageal stenoses and diverticula usually develop slowly
and gradually. Symptoms: Sudden interruption in feeding, im-
paction of esophagus with food; regurgitation, choking. Dis-
charged masses are foamy but not sour.

Spasm or Cramp of the Esophagus. Esophogism. Periodically
spasmodic contraction of the esophagus, inability to swallow, sali-
vation, restlessness.

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
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 alternately,
containing mucus, appetite impaired. Mucous membranes muddy
red. Urine acid.

Gastro-enteritis.s 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.

URINARY APPARATUS. 173

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 bowel. 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 tie in the ox. Symp-
toms same as in invagination, in addition an abducted position of
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.

174 CLINICAL DIAGNOSTICS.

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 Diseases of the Peritoneum.

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 Inammation 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-
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 ae sixth and seventh ribs, painful. Milk secretion de-
creased.

f. Infectious Diseases with Localization
in the Digestive Tract.

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-

URINARY APPARATUS. 175

ored; secretion of milk suspended, great de i

weal ness of the body. Dave red ees oe pec ipe

ee Labate), bescre coated with grayish white layers, when the
Pp off and leave ulcerous erosions. Most animals die on

the fifth or sixth day.

_ Calf diphtheria. Diphtheria vitulorum is an acute infectious
disease characterized by compous-diptheritic accumulations on the
buccal mucous membrane and caused by the Bacillus necrophorus.

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 incubation 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, con-
junctivitis, now and then ulcers on the outer part (skin) of the
lips, forearm and body; healing requires 10 days to two weeks.

Hog cholera, an infectious septicemia produced by a filterable,
ultramicroscopic virus, readily transmissible. In its course multiple
hemorrhages appear in the mucous membranes and skin. In the latter.
superficial necrosis. At first a general febrile affection without local-
izations, aggravation of symptoms, conjunctivitis, red patches on the
skin, often vesicular eczema and diphtherioid lesions on the buccal
mucus membrane, especially that of the toncve. In the beginning
constipation and bloating of the abdomen followed by excessive diar-
rhea, stinking feces, drawing up and painfulness of abdomen. Sep-
ticemic, peracute cases also observed.

Swine typhus, typhus suis, a typical enteritis, not readily
transmitted, caused by Bacillus suipestifer. Febrile chronic affec-
tion with progressive emaciation. Often accompanying Hog
cholera and difficult to differentiate.

Dog plague (Stuttgart), typhus canum, a severe, acute, typical
contagious infectious disease, confined almost exclusively to the di-
gestive tract. Occurs in the form of a severe gastroenteritis and
ulcerous stomatitis. Vomiting, anorexia, exhaustion, laziness, coma-
tose condition. Never any elevation of temperature, often hypo-
thermia.

Diarrhea of calves. Dysenteria neonatorum. A neracute in-
fectious disease of new-born calves, resembling a septicemia. Char-
acterized by severe diarrhea, whitish stinking feces, general weak-
ness, and usually terminating in death within a few days.

Red Dysentery. Dysenteria coccidiosa bovum, a hemorrhage
enteritis caused by coccidia.

g. Intoxications.

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 depression.
Urine yellow, contains bile pigments and albumin.

176 CLINICAL DIAGNOSTICS.

[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-
sions when animal is excited, later on, general emaciation. Occurs
in western States.] *U. S. Report.

h. Diseases of the Liver.

Distomatosis, cachexia distomatosa, a disease of sheep (less
frequent in cattle or goats) caused by Distomum (Fasciola) hepati-
cum or lanceolatum. Course chronic. The first symptoms appear six
weeks, or later, after invasion of the host by the parasite. Anemia,
hydraemia, cachexia. Eggs of parasite in feces.

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
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 aisc
examine the urinary organs.

URINARY APPARATUS. 177

Accordingly we consider the following points and in the
order given:

I. Manner of VYoiding the Urine.
I. Examination of the Urimwe.
A. Macroscopical examination.
B. Chemical examination.
C. Microscopical examination.
Til. Examination of the Urinary Organs.

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.

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 favorite places are trees, the
corners of houses, etc.

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.

Horses (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-
tion, and per intest'nal tract; accordingly it varies very consider-
ably. Healthy horses ordinarily urinate 5-6 times a day.

1. Abnormally frequent urination in usual volumes is
a result of increased secretion (polyuria)

2. Diminished urination is not easily recognized in ani-
mals. In doubtful cases a clean cloth bandage may be tied
over the prepuce (in the ox) to determine whether the act
takes place at all. Urination is diminished or suppressed:

178 CLINICAL DIAGNOSTICS.

(a) When secretion is diminished, or when it ceases
entirely (anuria) in acute nephritis. Diminished secretion is
characterzed clinically by less frequent urination, continued
emptyness of the bladder, concentrated and dark colored
urine.

(b) When obstructions exist in the urethra (ischuria,
retentio urine) characterized by abnormal fulness of the
bladder, Concrements, swellings, strictures, tumors. Urine is
passed in drops or in a thin stream often accompanied by
pain.

When paralysis of the bladder exists, often accompanied
by paralysis of the rectum and of the tail (myelitis spinalis).
Urine is then often evacuated involuntarily during locomotion.

3. Urination is entirely suppressed in rupture of the
bladder following prolonged retention of urine. Most fre-
quent as a result of urethral calculi in wethers and steers.
The urine is evacuated into the abdominal cavity. Exhalations
from the body have a uriniferous odor.

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
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,

URINARY APPARATUS. 179

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:

1. In obstruction of the urethra (concre-
ments, swellings, strictures, tumors). In such cases the urine
is voided in drops or thin streams, and frequently with symp-
toms of pain.

2. In paralysis of the bladder; frequently
associated with paralysis of the rectum and of the tail.

e. Inability to retain urine, tncontinentia wrinae, 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. Macroscopical Examination.

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 4-1
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.

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 reabsorption of profuse exudates and in the criti-
cal stage of severe infectious diseases.

180 CLINICAL DIAGNOSTICS.

A decrease in the quantity of urine (Oliguria) is observed
in:

Profuse sweating and diarrhea.

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.

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. wrobilin
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
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

URINARY APPARATUS. 181

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 turhi-” 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.

Abnormal turbidity 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
of swelling and thus increase the consistency of the urine.
Acid horse urine is always less viscid than such as gives

182 CLINICAL DIAGNOSTICS.

an alkaline reaction because the epithelial cells swell more
in the former. .
All other domestic animals excrete a more watery urine.

e. The Odor of Urine. The freshly voided urine has
an odor peculiar to each species of animal. After medical
treatment with oil of turpentine the urine has.an odor of
violets. The odor of menthol, phenol and cresol, if given in
medicinal doses, can be detected in the urine.

If freshly voided urine has a pungent ammoniacal odor,
cystitis is indicated.

f. 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,
ox “ 1025—1045, “1030,
dog “ 1020—1060, “1040.

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.

B. Chemical Examination 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. Acidity increases with the nitrogen contents of the

food.
In herbivora the alkaline reaction is due to the
presence of acid bicarbonate of lime CO,H — Ca—CO,H.

URINARY APPARATUS. 183

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
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,.), +
2H,0 = CO, (NH,), = 2NH, + CO, + 4H,O.
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).

184+ CLINICAL DIAGNOSTICS.

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

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:

1. As a 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. In lowering of arterial 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.

URINARY APPARATUS. 185

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 whathas beenstated wecanreadily
see that the mere presence of albuminuria
does 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 % 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-
apheee 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
the nitric acid.

3. Acetic acid ferro-cyanide of
potash test. 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. A few crystais of salicylsuipuonic acid added to a few cubic
centimeters of urine will, if albumin is present, produce a cloudy
precipitate.

186 CLINICAL DIAGNOSTICS.

5. The addition of a few grains of trichlor-acetic acid added
to clear filtered urine produces a thick turbidity on the bottom of
the vessel near the reagent.

6. 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
‘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.

Albuminuria 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; leukemia, anemia.

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

URINARY APPARATUS, 187

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 5ce 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-
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

188 CLINICAL DIAGNOSTICS.

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).

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-
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 toxremic 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. Afyogente or rheumatic hemoglobinuria in azoturia.

c. Indican — indoxy] sulphate of potash C, H, N Kk
S O,, occurs in all urine in moderate amount. It is de-
rived from the indol C,11,N formed in the alimentary canal
during putrefaction of albumin; indol is oxydized into in-
doryl CJH,N O H and then combines with sulphate of
potash to form indowxyl 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-

URINARY APPARATUS. 189

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
s attended with much less indican formation.

Diarrhea is attended with diminished indican formation.

Test fo r Indican Mix equal parts of urine and
wun utric acid in a test tube, shake well; then add, drop by drop,
«lowed 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.

Quantitative Determination, according ta
Bauer. Take 20 cc of the urine, slightly acidulated with acetic
acid, precipitate with two, or if necessary, with four ce 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 hae
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 9
corresponding amount of indican. If the color corresponds in
shade to that given in plate I, the urine contains 50 mg of indigc
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, ete., 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 liva Bile

190 CLINICAL DIAGNOSTICS.

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 circu-
lation.

Of the bile pigments, bilirubin alone occurs in the
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 pigments 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-
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. Jilter 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.

URINARY APPARATUS. 191

Ehrlich’s test. Add one volume of 30% acetic acid to the
urine. Then, drop by drop, add Ehrlich’s reagent (1 gram acid sul-
fanil in aqueous solution, 15cc. HCl, and 0.1 gram Sodium Nitrite,
water sufficient to make 1,000 grams. If Bilirubin is present the
mass gets dark. If much glacial acetic acid is added or if boiled,
the fluid becomes intensely violet in color. Hydrochloric acid may

be substituted for the glacial acetic acid—producing a beautiful
violet red.

Schmidt’s test. Very valuable for dark colored urine or blood
serum. Add Sodium bicarbonate until reaction is alkaline. Add 10%
solution of Barium chloride until precipitates cease. If bilirubin is
present the precipitate is yellow, otherwise white. Centrifuge the
precipitate, wash with water, mix with alcohol containing 5%
hydrochloric acid by volume. If bilirubin is present, the super-
natant fluid, especially if heated, is bluish green. If the fluid be-
comes brown add a few drops of hydrogen peroxide to complete
oxydation whereupon the brown color becomes green.

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.

192 CLINICAL DIAGNOSTICS.

e. Grape sugar, Glycosuria, by means ordi-
narily employed can be detect-
edinurineindiseaseonly, viz.
in diabetes mellitus. In horses
this disease has been observed in a few
instances only, in dogs it is common. We
suspect the presence of sugar in polyuria
when the specific gravity of the urine is
high.

Chemical determination. If 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.

Thistest (Trommer’stest)
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, Hi2 O. = 2C, H; OH, + CO,
Grape sugar = alcohol+ carbondioxide.

This test can of course be relied upon only when we

URINARY APPARATUS. 193

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 13-24
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-
sis.

194 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. 44.

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. 19:

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 does 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 commonly 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,

196 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 sediment 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. 197

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
be able to feeOgnize the origin of the
cells by their form.

Renal epithelium is roundish or more or less
cubical and granulated with proportionately large granules
andis 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.

198 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: injuries, 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 frem 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.

URINARY APPARATUS. 199

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. 49.
red and white blood corpuscles
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- we
Epithelial 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. +, 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 in little groups.

III. Examination of the Urinary Organs.

Topography. In the horse and cow the left kid-
ney only is accessible for palpation from the
rec tum, the right kidney lies further forward and cannot be

0 Da

200 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.

Examination of the bladder, per rectum,
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. 201

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 1s 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.

Hermaturia 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

202 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.

Urolithiasis, stones, concretions and sediments (gravel) cause
catarrhal inflammation and periodical hemorrhages. Urethral con-
erements produce retention of urine.

Diseases of Tissue 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

BrePpe suealy 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. 203

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.

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.

Discharge from the inferior commis-
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.

Relaxation of the broad ligaments occurs not only imme-
diately before parturition but also in the course of ovarian dis-
eases (cysts) and diseases of the uterus and its neck.

204 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 neglected. In
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 cov-
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. 205

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 valve.
We can not rely upon negative results. This method is o&

206 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 possiblity 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 Guniea 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 existense of tuberculosis.

V. Diseases of the male sexual organs are usually
of a surgical nature. In vesicular eruption we find vesicles,
pustules and ulcers, or scars, on the penis. To examine
stallions or bulls they may be led up to a mare (or cow)
which usually results in a 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 tumors

SEXUAL APPARATUS. 207

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.

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
frequent 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.

Tuberculosis of the Uterus and the Vagina. Animals in
oestrum but no conception. Vulva asymmetrically enlarged or re-
tracted. Often muco-purulent discharge. Nodules or ulcers, size
of millet seed, on mucous membrane. Orificium uteri usually re-
laxed. Uterus enlarged, diffuse or nodular. Fallopian tubes tor-
tuous unyielding strands, nodulated.

Mastitis, inflammation of udder, garget.

1. Mastitis interstitialis. Fever and hot, rather
firm and painful swelling of udder. Quantity of milk decreased,
quality not affected.

2. 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. Asa 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.

208 CLINICAL DIAGNOSTICS.

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.

Infectious Catarrhal Vaginitis. A chronic catarrh of the
vaginal mucous membrane, frequently extending to the uterus.
Very contagious. Incubation period 2-3 days. General health not
affected. At first swelling and tenderness of the vulva, frequent
urination. Visible mucous membrane of vagina yellowish red,
covered with muco-purulent mass. One or two days later, numer-
ous milliform, dark red, firm nodules in the region of the clittoris.
Later these become pale and transparent. In bulls, simple ca-
tarrh without nodules. In cows vesicles, pustules or ulcers never

occur.
II. The Nervous System.

Diseases of the central nervous system can be recognized
only by the disturbed function 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

NERVOUS SYSTEM. 209

of the disturbed physiological processes and conditions. To
diagnose diseases of the central nervous system requires a
knowledge of the location of the principal
functions

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 motor and sensory paraly-
sis on the opposite side of the body.

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:

210 CLINICAL DIAGNOSTICS.

io Psseehae (Functions.
TW. Sensibility.
IL, oe titirts,

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
be ascribed to local causes only when
the possibility of a general cause is
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

NERVOUS SYSTEM. 211

a

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

Fig. 51.

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, complete insensibility.

A dulling of the psychic functions occurs in;

212 CLINICAL DIAGNOSTICS.

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
be taken inte account im testing res
sensibility. If dogs cry out during such an examination,
or test we may conclude that conscious feeling exists.

NERVOUS SYSTEM. 213

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, opts-
thotonus, spasms of the masseter muscles, trismus, spasms of

214 CLINICAL DIAGNOSTICS.

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 usual 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.

NERVOUS SYSTEM. 215

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 sometimes 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 thev 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 hemi-

216 CLINICAL DIAGNOSTICS.

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 (apoplexies), 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. Infectious diseases: dog distemper, rabies, rarely in
contagious pleuro-pneumonia of the horse.

Spinal paralyses also affect the veg-
etative branch 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

NERVOUS SYSTEM. 217

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 of the eyelids. The sensory 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
contraction of the orbicularis of the eyelids.

2. Sensitiveness to light on part of
the pupil. Stimulation of the optic nerve is trans-
mitted reflexly, to the oculomotorius, which, through con-
traction of the sphincter pupillae, cause contraction of the
pupil.

Increased reflex excitability occurs in
tetanus and in strychnine poisoning. Contracted pupil is ob-
served in morphine, eserine and pilocarpine poisoning.

Decreased reflex excitability in great
mental depression, excessive pain and in dyspnea 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).

218 CLINICAL DIAGNOSTICS.

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
(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
tendon 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 cerebral anemia. Disturbance of consciousness, un-
steady gait, staggering, leaning against objects for support, neigh-
ing, shaking of head, falling.

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

NERVOUS SYSTEM. 219

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.

Overheating (Hyperthermia) and Sunstroke (Insolatio). Ex-
haustion, dullness, unsteady gait; in the beginning, perspiration,
abating and followed by increased bodily temperature. Death
frequent, from cardiac paralysis.

Chorea. St. Vitus’ Dance. Continuous, usually incodrdinated,
rarely apparently codrdinated, involuntary, jerky movements of
limbs or portions of the body.

Epilepsy. “Falling sickness” is a chronic disease of the brain
characterized by paroxysms occuring at intervals and attended
by sudden loss of consciousness and disturbed sensibility.

Dizziness, vertigo. This is a primary disease, occurring at
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. Ist 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

220 CLINICAL DIAGNOSTICS.

paralysis of the hind parts and by progressive emaciation, invaria-
bly leads to death.

Infectious Diseases with Localization in
the Central Nervous System.

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 act,
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 in a
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
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.

Tuberculosis of the Brain. Irregular movements of the head
or unusual position. Jerky movements and spasms. Frequent and
continuous lateral decubitus. Inability to rise. Symptoms some-
times acute.

[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;

BODY MOVEMENTS. 221

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 all cases the specific examina-
tions are directed toward determining
definite diseases; and the characteris
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

222 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 animal begins to sweat it is taken toa
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

BODY MOVEMENTS. 223

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

Fig. 52.

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

224 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 al! 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 single symptom can never deter
mine a diagnosis, we must consider the
animal’s conditionasa 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. 225

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

226 CLINICAL DIAGNOSTICS.

when they return to the normal (the numbet 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 breathing, dyspnea (see p. 99). 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.

2

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 laryngitis
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. 227

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
bacl:, 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.

This kind of treatment can never pro-
duce roaring in a healthy horse.

In order to make a positive diagnosis of “roaring” it
is necessary to eliminate the possible presence of acute morbid

228 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.

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 normal.
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 observe an
attack we must base our diagnosis upon
unobjectionable statements ofwitnesses.

BODY MOVEMENTS. 229

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-
tory 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.
The examining veterinarian must be pres-
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

230 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 disease or to ob-
tain an early 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. 231:

imals on test or experimental an-
imals in order 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
animals.

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. [100.4° 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-
imals.

232 CLINICAL DIAGNOSTICS.

D.ose.* The tuberculin prepared as above described is
diluted with 9 volumes of water to which 14% of carbolic
acid has been added. Cattle and horses receive 5 cc of this
solution, yearlings 2.5 cc, calves 1 cc and dogs 0.5 —lIcc.

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 (reaction), 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-
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,

("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, 233

provided the difference between the highest pre- and post-
injunction 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.

In post-injection temperatures of cattle between 39.5° C.
[103.1° F.] and 40° C. [104.0° F.] the results are to be re-
garded 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 95% of the tuberculous ani-
mals give a positive reaction. Animals in advanced stage of
the disease 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
reacting animals is found to be free from tuberculosis, Nev -
ertheless, tuberculin is the best diag-
nosticum in our possession.

The Conjunctival or Ophthalmic Tuberculin Test. With a
camel’s hair brush or by means of a pipette introduce one-half
cubic centimeter of common tuberculin, tuberculin A, or Bovo-
Tuberculol D,. solutio I, into the conjunctival sac. To facilitate
the operation, secure the head of the animal, depress the lower
eyelid and drop the tuberculin into the pocket thus formed.

Tuberculosis is indicated if a pronounced mucopurulent
conjunctivitis develops in a few hours.

The technic is simple and may be carried out without se-
curing thé anirnals.

234 CLINICAL DIAGNOSTICS.

Results thus far have not been uniformly the same, but
are nearly as reliable as those obtained from the Subcutaneous
Method. The positive reactions are more trustworthy than the
negative.

The Intracutaneous Method.
On a smooth healthy portion of the side of the neck, lo-

cate two points separated by a distance of five centimeters.
These points should be marked for identification by clipping
the hair. Place the thumb and index finger of the left hand
on these points, draw the skin into a fold and ascertain the
thickness of the fold by means of a suitable instrument.
Clean the skin between the two points with alcohol, raise the
same into a longitudinal fold and then inject into the cutis
O. 1 cm. of a mixture of equal parts of tuberculin and normal
physiological salt solution. Use a graduated syringe and a
fine needle.

If the swelling of the skin increases 0.3 cm. or more in
the course of twenty-four hours, the animal is to be regarded
as tuberculous. Slight swellings or premature swellings are
of doubtful significance.

The cutaneous tuberculin test is not as reliable as either
of the foregoing.

These so-called local tests are recommended when the
temperature of the animal is abnormally high or when varia-
tions occur or are suspected. Sometimes the application of
several methods is of value. The local tests may be applied
simultaneously and then followed by the subcutaneous.

Inoculation of Experimental Animals. The milk of
tuberculous animals contains tubercle bacilli in all cases where
the udder is affected with tubercular processes; frequently
also in the apparent absence of such processes. The udder
should be thoroughly milked, massaged and then again milked.
The last drawing of milk is centrifuged, the cream and sedi-
ment mixed and used for intraperitoneal injection. If tuber-
cle bacilli are present, tubercular nodules will develop on the
peritoneum (omentum), spleen and liver in the course of two

DIAGNOSTIC INOCULATION. 235

weeks. Unless the innoculated animals die before, they should
be killed at the end of six weeks and examined for lesions of
tuberculosis.

According to Ostertag, the innoculations are best made
at the posterior inner surface of the thigh. This produces
results much sooner than the intraperitoneal method. Pseudo
tubercular processes are also avoided by this means. Experi-
mental animals may be killed for bacteriological examination
as soon as the lymph glands become conspicuous as painless
circumscribed tumors. This may occur in the course of ten
days, otherwise the animals should be killed for examination
by the end of the sixth week.

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 to an infection with gplanders
are subjected to a mallein test, with the
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.

236 CLINICAL DIAGNOSTICS.

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
6 P. M.

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° I*.] 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. A local typical infiltration of the tissues at the point
of inoculation is a positive indication of the existence of
glanders, even in cases where no thermal or general organic
reaction occurs.

6. All malleinized animals, whether they react or nct,.
must be subjected to the mallein test twice, at intervals of ten
to twenty days.

The results of the mallein test cannot be compared with
those of the tuberculin test; they are less reliable. There is
no doubt that the varying results obtained from the use of

DIAGNOSTIC INOCULATION. Pay

mallein are due to differences in the character of the mallein
used.
Serum Diagnosis by Means of Agglutination.

The term Agglutinate is used to designate the character-
istic of Blood Serum, which enables it to precipitate living
as well as dead bacteria in the form of clumps. The active
elements in this process are called Agglutinines. The normal
blood serum of the horse agglutinates glanders bacilli in a lim-
ited degree. However, if a horse is affected with glanders,
the agglutinines appear in larger masses.

In order to make an Agglutination Test for glanders, the
serum of the blood of the suspected horse is prepared in
various dilutions by means of the addition of a physiological
salt solution. In order to determine the agglutinating power,
equal quantities of emulsions of glanders bacilli which have
been destroyed by heating at 60°C. (test fluid) are added to
the serum solutions.

Horses, the blood serum of which will agglutinate gland-
ers bacilli in dilutions of 1:1000 or in greater dilutions, must
be regarded as affected with glanders. Agelutinating powers
ranging from 1:500 to 1000 are doubtful. Agglutinating pow-
ers in dilutions of 1:400 to 500 indicate the absence of gland-
ers. Exceptions occur in all of these cases. In case of doubt-
ful results, the test must be repeated after the lapse of a
certain period of time.

The real weakness of the agglutination test consists on the

one hand in the fact that horses that have chronic glanders
frequently have a very low agglutinating power and, on the
other hand, healthy horses sometimes possess an agglutinating
power as high as that usually found in glandered horses.
_- Since it is the degree of agglutination and not agglutina-
tion itself that determines whether or not infection is present,
the misinterpretations of results are unavoidable. Of course
we can use for comparison such results only as have been
produced by the same test fluid.

238 CLINICAL DIAGNOSTICS.

Inoculation of experimental animals. A male Guinea
pig is inoculated subcutaneously at the abdomen with nasal
secretion, pus, etc., from a suspicious subject. If the inocu-
lated material contains the bacilli of glanders a local abscess
will develop at the point of inoculation and a firm hot swelling
appear im the region of the thigh. After 2-4 weeks the
Guinea pig is killed with chloroform. The presence of the
characteristic nodules, etc., of glanders, in the region of the
point of inoculation and in the testicles confirms the diagnosis.

The method of Strauss, consisting of the intra-peri-
toneal inoculation of male Guinea pigs, is of more recent intro-
duction. With a cotton swab dip up somecof the suspicious
material from an ulcer or from nasal secretion, rinse in a few
cubic centimeters of sterilized water, and inject one or two
cubic centimeters of this fluid into the abdominal cavity of each
of several Guinea pigs. If the inoculated material contained
the bacilli of glanders, reddening and swelling of the scrotum
and adhesion of the testicles will occur in the course of two
or three days. More or less isolated pus centers develop on
the tunica vaginalis and cause an adhesion of the peritoneal
folds. Sometimes a single center at the point of inoculation,
constitutes the only lesion. The danger of a general septic
infection, from the impure material, may be obviated by keep-
ing the infected swabs in a refrigerator for a few days. Pota-
to cultures should always be made from the tesions of the
scrotum. The true glanders bacillus produces yellow colonies
resembling honey in color, while the pseudobacillus of glan-
ders (Kutscher) produces white colonies.

Cats, also, are suitable animals for inoculation. They are
inoculated at the back of the neck.

Serum Diagnosis by Means of Complement Fixation. In
glandered horses the toxin (antigen) of the glanders bacilli
causes the formation of antibodies. These antibodies can
develop only in the body of an animal affected with glanders.
Fresh Guinea pig serum contains free complements which,

DIAGNOSTIC INOCULATION. 239

with the aid of the glanders antibodies, have the power to fix
the antigen. This fixing power is increased by heating the
mixture at 37°C. in a thermostat. The diagnosis of glanders
by this method consists in the determination of the amount of
antibodies of glanders bacilli in the blood of a suspected horse.

The blood serum of a rabbit, when the latter has been
treated with red blood corpuscles of the sheep, contains an
antibody (hemolytic amboceptor) which will dissolve sheep
blood corpuscles if free complement is added.

If, therefore, we add free complement (fresh Guinea pig
serum) to the blood serum of a glandered horse and then
add rabbit serum containing hemolytic amboceptor, this mix-
ture, if added to the red blood corpuscles of the sheep, will
leave the latter intact, because the complement that was added
was already fixed to the antigen by means of the glanders
antibodies. Now, the blood serum of healthy horses does not
contain these antibodies and consequently the complement
added to it does not become fixed, but remains active. This
free complement, with the hemolytic antibody, dissolves the
corpuscles of the blood ia healthy horses.

The technique of serum diagnosis by means of comple-
ment fixation is as follows: To a measured quantity of blood
serum from a suspected glandered horse add glanders antigen
and fresh Guinea pig serum (this contains free complement),
then heat at 37°C. in a thermostat for a few hours. Then add
serum from a treated rabbit (as explained above) and also
some thoroughly washed red blood corpuscles from a sheep.
If the red corpuscles thus added are not dissolved the horse
is affected with glanders. If they are dissolved the horse in
question is free from the disease.

This method of diagnosis can be accurately conducted in
specially equipped laboratories only, and is therefore not
adapted for use by the regular practitioner. It is practicable,
however, for the latter to collect the blood of the suspected
horse and transmit it for examination.

240 CLINICAL DIAGNOSTICS.

III. Anthrax, Blackleg, Malignant Oedema and Wild-und
Rinder-seuche.

On account of their rapid course, the clinical diagnosis
of these diseases is often impossible; besides, the symptoms of
the different diseases are often much alike and hence a dif-
ferentiation impossible. Although a microscopical examination
of the blood (or exudate) of animals that died of one of these
diseases suffices to recognize their character by finding the
characteristic organisms, still there are cases where an inocu-
lation alone can decide the question. We use rabbits for this
purpose and inoculate them cutaneously (!) in the ear, with
blood or exudate from the animal or carcass in question. If
the rabbit dies the disease is either anthrax or Wildseuche
because blackleg and malignant oedema are not transmissible
by means of cutaneous inoculation. The differentiation
between anthrax,and Wildseuche is made by a bacterioscopic
examination of the dead rabbit. It is also worthy of note that
in Wildseuche there is always a severe tracheitis.

In case the rabbit does not die, it is
again inoculated; this time subcutaneously; if death
follows, it was a case of malignant oedema because rabbits are
immune against blackleg. The presence of blackleg can be
demonstrated by inoculating a Guinea pig with the suspected
material; death following in a few days after inoculation.

We can expedite matters by simultaneously inoculating
one rabbit cutaneously and another rabbit and a Guinea pig
subcutaneously. If all three animals die we had anthrax (or
Wildseuche) if only the two subcutaneously inoculated ani-
mals die it was a case of malignant oedema, and in case it was
blackleg only one animal, the Guinea pig, is sacrificed.

*If we desire additional proof by having the blood of a
suspected anthrax carcass examined by a second person we
may boil a potato, upon cooling cut it in halves with a steri-

* [This method is cammonly resorted to in Germany.]

DIAGNOSTIC INOCULATION. ‘241

lized (flamed) knife, apply some of the suspected material to
the surface of one half, replace the other half, pack carefully
and send it to the official bacteriologist. Blood sent in a flask,
is usually not adapted for microscopical examination.

IV. Rabies.

Suspected dogs are usually killed before they can be sub-
jected to examination by an expert. A post mortem examina-
tion will then hardly enable us to make a definite positive
diagnosis; we must resort to inoculation of a test animal.
The diagnostic inoculation of a rabbit
with the brain matter ofa suspecteddog
is the only absolutely safe method of
definitely determining the presence of
rabies.

Technique. The brain and cervical cord of the sus-
pected dog are carefully removed. The medulla oblongata is
severed from the brain by an incision, at the pons Varolii,
made with a “flamed” knife. A piece of the medulla (size of
a pea) is removed with sterilized scissors from the cut surface,
placed into a sterilized porcelain vessel and thoroughly tritu-
rated with a small quantity of distilled water. This emulsion
is used for inoculation.

1. The Intra-ocular method according to Johne. Two
rabbits are inoculated, each receiving a few drops of the emul-
sion into the anterior chamber of the eye; injected with a ster-
ilized hypodermic syringe. If the hypodermic needle is fine
and sharp and the rabbit’s eye has been previously dis-
infected and anesthetized the operation can be per-
formed with little difficulty. We insert the needle at the bor-
der of the cornea, directing it toward the median line. If the
operation was carefully conducted a slight turbidity of the
cornea, which soon disappears, is the only symptom that fol-

lows.

242 CLINICAL DIAGNOSTICS.

If rabies is present the first symptoms appear in from 2
weeks to 23 days; the animals are shy, crawl away, and show
loss of appetite. After 12 hours paralysis and difficult deglu-
tition is observed, the animals emaciate rapidly, grit their teeth
and emit a cry when touched on the head. The disease, thus
produced, terminates fatally within 48 hours.

2. Subdural Inoculation. Carefully trephine the
frontal bone of a rabbit, observing the necessary antiseptic
and anatomical precautions. By means of a sterilized glass
syringe having its nozzle bent at right angles, inject a few
drops of the emulsion under the duramater, stitch the wound
and protect with collodion, or absorbent cotton.

If the inoculation material is fresh and virulent, death
will follow in two or three weeks. Sometimes the animals
die as early as the 11th day, or may live until the 30th day.
[In some cases six weeks will elapse before the first symptoms
of the disease can be observed. |

8. Intra-muscular Inoculation. If the suspected nerve
tissue has begun to decompose, or if suspicion exists that it
may not be fresh, it should be immersed in a one-half per cent.
solution of carbolic acid and placed in the refrigerator for 24
hours. It is then removed and carefully triturated with
beef broth until a fine emulsion results. Rabbits receive from
three to five cubic centimeters of this emulsion injected into
the dorsal muscles in the region of the loins. As a rule septic
infection can be avoided in this way while the virulence of
the material is otherwise unaffected. Death follows after two
or three weeks or somewhat later.

The symptoms following subdural and intra-muscular in-
oculation are much the same. After ten or twelve days ema-
ciation sets in, followed by paralysis of the hind parts, and
death two or three days later.

4. Subconjunctival Inoculation. This is recom-
mended by Szpilman as easy of execution and certain in its
results.

THE LYMPHATIC GLANDS. 243

In the “Tollwuthabteilung of the Institut fuer Infections-
krankheiten,” in Berlin, the subdural and the intra-muscular
inoculations are used exclusively, sometimes both methods are
used at the same time. (Beck).

Differential diagnosis. Beck calls attention to the fact that
material obtained from dogs affected with the nervous form of dis-
temper will produce paralysis of the hind parts of rabbits that have
been inoculated. In these cases the paralysis is not confined to
the posterior extremities, but extends to the bladder and rectum.
Rabbits thus affected become soiled with feces and urine. This
affection cannot be transmitted to a second generation of rabbits.

14. The Lymphatic Glands.

The intermaxillary lymphatic glands of horses are always
subjected to an examination in aiseases of the respiratory ap-
paratus. Otherwise they are subjected to special exam-
inations only when infectious diseases, glanders and
tuberculosis. constitutional blood diseases (leuce-
mia) or the presence of malignant tumors (carcinoma
and sarcoma) are suspected. Examination consists in
palpation (conducted according to the rules given on p. 21).
The correct interpretation of these changes was discussed
under “intermaxillary lymphatic glands.”

When an examination is called for, the following lym-
phatic glands must be considered:

1. Intermaxillary lymphatic glands, lym-
pho glandula submaxillaris. In the ox these are of
the size of half a walnut and are situated on the median side of the
submaxilla, near its border and in the region of the point of in-
sertion of the musc. sterno-maxillaris.

2, Lymphatic glands of the parotid region,
lymphoglandula parotideae. These are between and
below the lobules of the parotid gland. In the ox they have the
shape of a flattened tongue and a length approaching 6cm.; this
gland projects from beneath the border of the parotid gland, below
the maxillary articulation.

3. The superior cervical glands lympho
glandula cervicales superiores, and retro-
pharyngeales are situated, as the name implies, on the pos-
terior wall of the pharynx. In the ox they consist of a closely
united packet, about 5cm. long, under the lateral processes of the
atlas, where they can be felt by placing the thumb on the lateral

244 CLINICAL DIAGNOSTICS.

process of the atlas (both sides simultaneously) and thus pressing
the finger tips behind the pharynx and then against the inferior
face of the lateral processes of the atlas.

4. In the ox a few large lymph follicles in the depression in
front of the shoulder (prescapular glands) and on the
chest in front of the elbow articulation (prepectoral
glands).

Fig. 63.

ee
>

NAS Sa
es MOORES

SAUNA
3 AS

Lymph glands of the ox accessible by external palpation.

5. The lymphatics of the shoulder (pre-
scapular glands) are covered by the mastoido-humeralis
muscle in front of the scapulo-humeral articulation.

6. The precrural glands lie at the anterior border
of the tensor fascia lata muscle; distinctly visible in cattle.

7. In the upper part of the flank of the ox
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 to do so.

THE BLOOD. 245

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
of the horse 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.

+ Weucemic 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, 1n
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

246 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
1s 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-
Fig. 55. ods. For those who care to take
G Q e oS up the study of blood examinations
@ in detail we recommend “Jacksch-

® So) Y Ag Klinische Diagnostik.”
Number of blood corpuscles.
@ The absolute number of blood cor-
cr (bp ° &_puscles in a given amount of blood
a @9 can only be determined with the
Abnormal Forms of Red aid of special blood-counting appa-
i aia 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 Corpuscles. White Corpuscles. Proportion.

Stallions 8.2 millions 10,500 1:780
Geldings 7.6 : 11,000 1:690
Mares 71 te 9,900 1:720
Colts 9.3. io 14,000 1:670
Bulls 6.5 os 7,800 1:820
Steers 6.97 9,400 1:720
Cows 5.5 ‘- 8,200 1:660
Calves 8.5 ge 15,700 1:550

Dogs 5.4 : 3,100-2,800

THE BLOOD. 247

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.
Gigantoblasts, still larger than the megaloblasts.
Microblasts, smaller than 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.

a0

248 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.
de bymiphOtytes aye poe taawiward cence 35-45... 2500-3500
2. Mononuclear Leucocytes .......... 1.5-3.5....150-300
3. Neutrophyle Polynuclear Leucocytes 50-70 ....4000-5000
4. Acidophyle Leucocytes ............ 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. 249

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. Mostly in young animals.

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 increases, small.
Heart tones, metallic sound. Enlargement of lymphatic glands usually
present. Sometimes ecchymotic hemorrhages in the mucous mem-
branes.

Infectious anemia of the horse. Transmissible, usually fatal
disease, coutse acute or chronic. Fever, 40.5° C. [104.9° F.] appears
after a period of incubation of 5-9 days, subsiding as the disease ad-
vances. Marked weakness, especially in hind quarters, dirty yellow-
ish red coniunctiva, some petecheae. Impaired appetite, emaciation,
swellings. Red corpuscles reduced in numbers.

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-

250 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 is a 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.

THE BLOOD. 251,

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.

Fig. 57.

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 above, 20 to 40 micra long, 1 to 2.5 micra in diameter, actively
motile,

Dourine. Maladie de coit. Lesions of the genital organs and
skin.

Trypanosoma equiperdum in the blood.

INDEX.

Abdomen 140, 153.

Abvormal sensitiveness 156.

Accumulation of food 153,
161.

Achorion Schoenleinii, see
Favus 55.

Acne contagiosa equor, see
Canadian horsepox 57.

Actinomycoma 149.

Actinomycosis 148.

Albuminuria 67, 184, 185.

Albumosuria 186.

Alkales, craving for 141.

Alopecia 45, 51,

Alveolar periostitis 144.

Anemia 47, 60, 249,

Anesthesia 213,

Anamnesis 18.

Anasarea 46.

Angina pharyngea 171.

Ante-and post-partum pare-
sis 38.

Anthrax 72, 240.

Anus 105,

Apoplexy 216, 219,

Appetite 141.

Arteries 81.

Ascites 40.

Asearides 63.

Atelectasis 27, 130.

Attitude 33.

Auscultation 29.

—of abdomen 161,

—of heart 86.

—of lungs 130.

Azoturia 37, 42.

Bacillus pyelonephritis 199.

Balkiness 229.

Bird lice 52.

Blackleg 58.

Bladder, diseases of 176.
—, examination of 200.
Blind staggers 219, 221.
Blood 245, 246.

Blood sweating, 51.
Blowing sound 100, 106.
Bodily temperature 63.
Bovine pest 58.

Broken back 37.
Bronchial eatarrh 136,
Bronchiectases 129.
Bronchitis 107, 137.
—yverminosa 137.
Bruits, anemic 90.

—, diastolic 87.

—, inorganic 88,

—, systolic, 87.

Cachexia 39.

Canadian horsepox 57.

Carbonate of lime 193.

Cardiac dullness 85.

Catarrh of maxillary sinuses
136.

—, of gutteral pouches 136.

Caverns in lunes 129.

Cerebral congestion 218.

—depression 210.

—hemorrhage 219.

Cerebrospinal meningitis 38,
42, 220,

Chills 67.

Choleurea 189,

Cireulatory apparatus 75.

Coital exanthema 208.

Colie 42, 164, 172.

Collapse, temperature of 71,

Colostral milk 205,

Colpivis 207.

Coma 211.

Condition 39.

Conformation 40.

Congestion, cerebral 218.

Conjunetiva 59.

Constipation 162, 164, 174.

Convulsions 213.

Cough 117.

—, return impulse of 120.

Cracked pot resonance 129,

Cramp of the neck 388, 42,
214.

Crisis 71.

Crusts 51.

Cystitis 201,

Defecation 163, 164, 218.

Degultition, difficulties of
145.

Diabetes 180.

—insipidus 202.

—mellitus 202.

Diaphragm, rupture of 129.

Diarrhea 155, 164.

Dicrotie pulse 81.

Differential diagnosis 16.

Digestive apparatus 140.

Dilatation of the heart 91.

Direct diagnosis 16.

Dislocation of bowel 129,
Li3;

Distemper of dogs 140, 213,
216.

—of horses 139.

253

Distoma, eggs of 169,

Diverticula of esophagus
150, 173.

Dizziness 212, 219,

Drowsiness 211.

Dropsy 46.

Dummies 31, 34, 219, 221.

Dyspepsia 172.

Dyspnea 34, 102.

Dysuria 178.

Eechymoses 113, 114, 147.

Echinococeus disease 187.

Eclampsia 219.

Eezema 51.

Edema 23, 47, 58.

—of glottis 136.

—collateral 47.

Emphysema 24, 48.

—, alveolar 131.

—, cutaneous 24, 48.

—, interstitial 137.

—, of skin 47.

—, septic 48.

Encephalitis 34.

Endocarditis, acute and
chronic 91.

Endometritis 207.

Enteritis, hemorrhavic 167.

Enteroliths 159.

Epilepsy 214, 219, 228, 229.

Epistaxis 135,

Eoithelial casts 199.

—eells 198.

Eructation 151.

Esbach’s albuminimeter 185.

Esophagus 149.

Excitability, abnormal 222.

Exhalations 105,

Expired air, odor of 106.

Facies hypocratica 42.

Facial nerve, paralysis of
216,

Fagopyrism 51.

Fainting 212.

Favus 55,

Feces 163, 165.

—, retention of 164.
—, voiding of 164.
—, volume of 165.
Fermentation test 192.
Fever 66, 68.

—, eatarrhal 139.
Fowl cholera 73.
—, diphtheria 140.
—, pest 73,

—curve 68.

—, types of 70.
Fluctuation 24,
Flagellosis 250.
Fleas 52.

Food, manner of taking 142.

Foot and mouth disease 56.

Foot eczema 51.

Foreign bodies in intestines
174.

—in esophagus 171.

Fowl cholera 73.

Friction bruits of pleura 135,

Garglings 101.

Garget 207.

Gastro-enteritis 172.

Gastro-intestinal eatarrh.
172.

Glanders 139.

—uleer 114.

—cicatrices 114.

254

Gmelin’s test 190.
Gram’s method 199,
Granular casts 199.
Granule casts 198.
Grape sugar 192.
Groaning 101.
Grunting 101.
Guttie of ox 34, 173,

Habitus 32.

Hematopinus 52,

Hair coat 44.

—-, shedding of 45.

Heart 83.

—hbeat 84.

—sounds 86, 87.

Heave line 104,

Heaves 224.

Hematuria 188, 261,

Hemidrosis 46, 51.

Hemiplegia 104.

Hemiplegia, laryngis sinis-
tra 136.

Hemoglobinuria 187, 188.
201, 249,

Hepatization 27, 129.

Herpes tonsurans 55.

Hippurie acid 195,

Hives 51.

Hog cholera 72.

Hyvaline casts 198.

Hydrocephalus 214, 218.

THypesthesia 213.

Hyperemia of kidneys, pass-
ive 201,

Hyperesthesia 213,

Hypertrophy of heart 91.

Hyperidrosis 46.

Hyperthermia 219.

‘Uypidrosis 46,

255

Icterus 61, 62, 212. Liver 170.
Immobility 221, Lockjaw 220, see tetanus.
Impaction of intestines 158. Loco weed poisoning 176.
—, rectum 216. Lordosis 48.
Inearceration®158. Louse flies 52.
Incontinentia urinae 201. Lumbago 37, 42, see azotu-
Indican 188. ria.
Influenza 72. Lungs, congestion of 187.
Inoculation 230, 234. —, gangrene of 187,
—for anthrax, etc., 240. —, edema of 137.
—for glanders 235. Lupinosis 175,
—for rabies 241. Lymphatic glands 248,
—for tuberculosis 231. Lysis 71.
Insufficiency 88.
—of mitral valves 91. Mast cells 248,
—of semi-lunar valves 88,91. Macula 50.
—of tricuspid valves 91. Mal de Cederas 250,
Intermaxillary lymph glands Mal du coit 208.

115. Malaria 250.
Intestinal catarrh 172. Malignant catarrhal fever
—evacuations 163. 139,
—gases 170. —carbuncle 47,
—noises or sounds 161. —edema 58.
—peristalsis 163. Malingerers 36.
Intoxication 19. Mallein inoculation 235.
Invagination 35, 159. Malleus 139.
Ischury 179. Mange 54,

—, acarus 55.

Kidneys, passive hyperemia —, psoroptic 54,

of 201. —, sarcoptie 54.
Kyphosis 48. —, sacoptie, of fowis 54

—, symbiotic 54,

Laryngeal catarrh 136. Mastiecation 141.
Laryngeal fremitus 123. Mastitis 207.
Laryngitis, croupous 136. Melanosarcoma 149.
Laryngoscopy 122. Microcytes 248.
Leucocytosis 248. Milk fever see parturient
Leucemia 249. paresis 38.
Lice 52. Mites 52.
Licking disease 178. Mold poisoning, see mycosis,

Lime easts 170. 147.

Monoplegia 216.

Morbus maculosus, see pur-
pura hemorrhagieca.

Motility 210, 213.

Mouth cavity 146.

Mouth speculum 148.

Mycosis 147.

Mydriasis 217.

Aucous click 100.

Muscular rheumatism 42,

Muscular sense 214,

Myocarditis, acute 91,

Nagana 251.

Nasal ecatarrh 135,
—discharge 93.
—mucous membrane 113.

—tone, see mucous click 100.

Nephritis 201.
Nettle rash 57.
Nervous system 218.

Nodules, see papules 50, 114.

Nymphomania 202.

Obesity 39.

Ocular vertigo 212.
Estrus ovis, larva of 109.
Opisthotonus 213.
Orthotonus 213.
Osteomalacea 43.
Overfeeding 153, 156.
Oxalate of lime 195.

Palpation 23.

—of bowels per rectum 156.
Panting 99.

Papules 50.

Paraplegia 104, 216.
Paralysis 215.

—of bladder 179.

—of facial nerve 219,

256

—of the larynx 136.

—of esophagus and pharynx
145, 171.

—of paunch 150.

—of recurrent nerve 226.

Parasites, intestinal 169.

—in cavities of head 135.

Paresis 215.

Parturient paresis 38, 71,
220.

Pathognomic symptoms 14,

Paunch, paresis of 156.

—, peristalsis of 156.

—, gases in 153.

Pentastonum tenioides 109,

Percussion 24.

Percussion, field of 126,

—of abdomen 159.

Pericarditis 85, 92.

—, traumatic, of ox 92,

Peritoneal hernia 159.

Peritonitis 34, 174.

Pernicious anemia 246.

Peruphigus acuta 57,

Petechia 113, 114, 147.

Pharyngitis 149, 171,

Pleuritis 34, 85, 138.

Pleurodynia 34, 137.

Pleuropneumonia of cattie
139.

—of the horse 138.

Pneumonia 123. ‘

—, catarrhal 137.

Pneumothorax 1381,

Poikilocytes 247.

Polyarthritis 42,

Priapism 202.

Proctitis 147.

Prurigo 219, 51.

Pseudo fluctuation 24.

Psychic functions 210,

Ptyalism 171,

Pulmonary, congestion and
edema 137,

—hemorrhage 137.

—gangrene 137.

—resonance 128.

Pulse 67, 73, 75.

Pumping of flanks 104.

Purpura hemorrhagica 57,
114,

Pustules 50.

Pyemia 71.

Pyelonephritis 201.

Pyrosoma bigeminum 250.

Pyrocatechin in horse urine
192.

Quality of percussion
sounds 27.
Quibbing 144.

Rabies 216, 220.

Rachitis 43.

Rales 133.

—, erepitant 134.

—, dry 134.

—, moist 134.

Reflex excitability 217.
Reflex spasms 214.
Regions of the body 21.
Regurgitation 127, 131.
Resistance in percussion 28
Respiration, types of 99.
—, amphorie 133.

—, bronchial 133.

—, vague or indefinite 133.
—, vesicular 131.

—, Gheyne-Stokes 98.
Respiratory apparatus 93.
Retentio urinae 201.
Return sound 120.

257

hiding school movements
214,

Rinderpest 174,

Rinderseuche 240.

Ringworm 55,

Risus sardonicus 214.

Roaring 98, 136, 226.

Rothlauf 212, 245,

Rumination 150.

Saliva, secretion of 147.
Satyriasis 202.
Saw-horse attitude 34, 214,
Seabs 51.

Scalma 138.

Sensibility 210, 212.
Septicemia 71, 73.
Serum diagnosis 237, 238.
Sexual apparatus 202.
—desire 202.

Sheep pox 57.

—, braxy 73.
Signalment 31.

Skin 43,

—, color of 49.

—, moisture of 45,

—, odors of 50.

—, reflexes of 217.

—, sclerosis of 50,
Skoliosis 43.

Sleepiness 211.

Sneezing 100.

Snoring 100.

Snorting 99.
Somnolency 211.

Sopor 211.

Spasms 213.

Spinal paralysis 37, 216.
Spinal meningitis 214.
—, reflexes 217.

Spine, fracture of 37, 216.

258

Spleen 171.

Stasis 46.

S.arvation 154.

S.enosis of air passages 226.

—of cardiae valves 88, 89.

—of esophagus 171.

Stenotice laryngeal tone 101.

Stethoscope 29.

Stomacace 147.

Stomatitis 171.

—pustulosa contagiosa 175.

Strangles 139, see distemper.

Stranguria 178.

Strongylus filaria 197.

Submaxilary lymph glands
93, 115.

Suffusions 113.

Sulphate of lime 196.

Summer surfeit 51.

Surra 251,

Sweating 45, 46.

Sweeny 48.

Swine erysipelas 73.

Swine plague 65, 72,

Symptoms 12.

Syncope 212.

Teeth 148.

—, caries of 106.

—, diseases of 172.

—. gnashing of the 144.
Temperament 40,
Tetanus 37, 219.

Texas fever 73, 245, 250.
Thirst, see ‘‘Desire for
water’’ p. 142.

Ticks 52.

Torsion of colon 159,
Torsio uteri 207.
Trembling 213.
Trichodectes 52.

Trichoerhexis nodosa 56.

Tricophyton tonsurans 55.

Triple phosphate 196.

Trismus 213.

Trommer’s test 192.

Tubercle bacilli 111.

Tubereculin test 231.

Tuberculosis 138, 203, 207.

—, of brain 220.

Tumors in cavities of head
1386.

Turnsick 212, 214, 219.

Tympanitis 173.

—acuta, 151, 173.

—chronica 151, 173.

Tzetse disease 251.

Udder 204, 206.

Uleers 147.

—catarrhal or erosion 114.
Upper air passages 112.
Uremia 212.

Urethral caleuli 200.
Urie acid 195.

Urinary apparatus 176.
casts 198.
Urination 176.

Urine, sediment in 194.
—, odor of 182.
Urolithiasis 202.

—, voiding of 177.
Urticaria 57,

Vaginal mucous membrane
204.

Vaginitis 207.

Valvular diseases 91,

Veins 81.

—, undulation of jugular 82.

Venous pulse 83.

Verminous bronchitis 137,

209

Vertigo 212, 228, 229. Water, desire for 142.
Vesicles 50. Whistling 102, 227.

' W 143.
Vesicular eruption 203, 208. ee Ye (ee.

Vesicular murmur 131, Wool in feces 169,

—respiration 132. Wheezing 100.

Voice, change in 121, Wild-uad Rinder-seuche 58,
: 240,

Vomiting 151,
—in horses 151. Yawn 100.

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